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Tuesday, December 06, 2016

The VA may be on the brink of wearing a new and unfamiliar hat: policy trailblazer.

The department is considering "scope of practice" reforms that would allow VA nurses to work outside the direct supervision of doctors. If the agency follows through, it could become a leader in the occupational licensing arena and spur state governments to follow suit.

Occupational licensing has garnered increased attention as it has become clear that requiring individuals to obtain government licenses in order to work in certain fields hurts both would-be workers and consumers. State and local governments require licenses for a whole host of jobs, from florists to dental hygienists to hair braiders.

While licenses can make sense in some industries, in general they block lower-income individuals from entering the workforce while also increasing the prices consumers pay for goods and services. read more

Monday, December 05, 2016

President-elect Donald Trump is leaning on a once-obscure group backed by conservative billionaires Charles and David Koch as he seeks to make good on a campaign promise to overhaul veterans' care programs he has denounced as a tragic failure. Concerned Veterans for America (CVA), founded just four years ago, has little connective tissue with other veterans groups, whose membership-heavy organizations have long dominated policy discussions in Washington. The leading candidates to run the sprawling Department of Veterans Affairs, the second-largest federal agency, have close ties to the group. Traditional veterans advocates are alarmed by CVA's rising profile in Trump's orbit and in Congress. They reject its highest-profile proposal, to allow veterans to see doctors of their choosing outside VA medical system. read more

"Victory Lane," a new book by Cathy Lueers of Hampton, borrows its title from the VA Pittsburgh Healthcare System's hospice unit in O'Hara. Lueers' dad -- Korean War veteran Ron Bleiler -- died in the unit on Thanksgiving Day 2015 at age 82.

"He went out in victory with the care of wonderful nurses and chaplains," Lueers said. "There were so many miracles along the way."

With gratitude for her father's care, Lueers, 52, subsequently wrote and self-published "Victory Lane" to honor him.

Lueers, a mother of four, also wrote the book to aid loved ones of others seeking health care through the U.S. Department of Veterans Affairs. read more

The US Veterans Affairs Administration is the largest provider of hepatitis C care in the United States. Approximately 174,000 veterans who receive care through its clinics had been diagnosed with chronic hepatitis C virus (HCV) infection by 2013 and a further 45,000 were estimated to be undiagnosed.

As part of a larger analysis of treatment patterns within the VA system, George Ioannou and colleagues examined the annual uptake of treatment. They found that 57,445 people have been cured of HCV in the VA system since 1999.

Almost half of these patients – 28,084 – were cured in 2015, and almost half of all people cured in the VA system in 2015 began treatment in August and September of that year. read more

Saturday, December 03, 2016

According to the campaign talk of President-elect Donald Trump, it's just a matter of time before Obamacare, as the ACA is more commonly known, is repealed and replaced.

Perhaps the biggest issue with Trumpcare is that there's nothing stated in his plan about how he'd deal with the roughly 21 million people currently receiving federal assistance via Obamacare's Advanced Premium Tax Credit, cost-sharing reductions, or Medicaid expansion.

It's possible that these estimated 21 million people could lose their health coverage if Trump's healthcare plan becomes law.

That's terrible news for insurers like Anthem, which specifically angled their business to court Medicaid expansion enrollees, and hospitals like HCA Holdings, which have benefited from setting aside less money for doubtful revenue collection thanks to lower uninsured rates. If uninsured rates rise, uncollected revenue is likely to rise for hospitals, too. read more


The VA is in a position to negotiate a fair price for this life saving cure. Were they able to?


I believe so ...

JAMA - VA Extends New Hepatitis C Drugs to All Veterans in Its Health System

Aided by new funds from Congress, the Department of Veterans Affairs (VA) is extending new antiviral treatments to all veterans with hepatitis C treated within its sprawling health care system -- regardless of the stage of their illness and whether they contracted these infections during military service.

The move puts the VA at the forefront of combatting the nation's deadliest infectious disease, which kills more people in the United States than HIV, tuberculosis, pneumoccocal disease, and dozens of other infectious conditions combined, according to the Centers for Disease Control and Prevention (CDC) (www.cdc.gov).

If a veteran is connected with the VA, he or she pays the following in copay prescription drug prices ...


Right like how Kanrei had to fight to get screening for cancer because of studies like this that show "over testing"? Great way for insurance companies to deny testing.

Glad you weren't his doctor.


The reason I strongly advocate VA healthcare is that it's heavy on screening and preventive medicine, as opposed to aggressive and invasive medicine.


How does the VA measure up against other U.S. health care providers? To address this question, RAND researchers compared the medical records of VA patients with a national sample and evaluated how effectively health care is delivered to each group. Their findings:

- VA patients received about two-thirds of the care recommended by national standards, compared with about half in the national sample.

- Among chronic care patients, VA patients received about 70 percent of recommended care, compared with about 60 percent in the national sample.

- For preventive care, the difference was greater: VA patients received about 65 percent of recommended care, while patients in the national sample received 20 percent less.

- VA patients received consistently better care across the board, including screening, diagnosis, treatment, and follow-up.

- Quality of care for acute conditions -- a performance area the VA did not measure -- was similar for the two populations.

- The greatest differences between the VA and the national sample were for indicators where the VA was actively measuring performance and for indicators related to those on which performance was measured.

Kanrei was a victim of private healthcare where there's little financial incentive for private doctors and private hospitals to prescribe screenings and preventive medicine, as the above RAND Study shows. The table from the RAND Study link does an even better job in explaining this situation.

Right like how Kanrei had to fight to get screening for cancer because of studies like this that show "over testing"? Great way for insurance companies to deny testing.

Glad you weren't his doctor.


I would rather have over testing than under testing. Common sense dictates you can't be too careful.


More tests and treatments often leads to more chances of being harmed as a patient.

Harms of overtreatment

Published on Oct 3, 2012
Reporter Jeanne Lenzer investigates overtreatment at the heart of healthcare.

Overly aggressive treatment is estimated to cause 30 000 deaths among Medicare recipients alone each year. Overall, unnecessary interventions are estimated to account for 10-30% of spending on healthcare in the US, or $250bn-800bn (£154bn-490bn; €190bn-610bn) annually.

Read more about the problems of overtreatment in Jeanne Lenzer's feature article Unnecessary care: are doctors in denial and is profit driven healthcare to blame?


Most people think more is better, and it's not. I've tried to say in these healthcare conversations that it's hugely complicated and almost always counter-intuitive -- like more medicine is better.

What patients need to demand is the "right amount" of testing and treatments. And that is predicated on a doctor knowing what they're doing per the science and evidence, and most doctors don't know...


Most of us are confident that the quality of our healthcare is the finest, the most technologically sophisticated and the most scientifically advanced in the world.

But there is a wrinkle in our confidence. We believe that the vast majority of what physicians do is backed by solid science. Their diagnostic and treatment decisions must reflect the latest and best research. Their clinical judgment must certainly be well beyond any reasonable doubt. To seriously question these assumptions would seem jaundiced and cynical.

But we must question them because these beliefs are based more on faith than on facts ...

Only a fraction of what physicians do is based on solid evidence from Grade-A randomized, controlled trials; the rest is based instead on weak or no evidence and on subjective judgment. When scientific consensus exists on which clinical practices work effectively, physicians only sporadically follow that evidence correctly.

Medical decision-making itself is fraught with inherent subjectivity, some of it necessary and beneficial to patients, and some of it flawed and potentially dangerous. For these reasons, millions of Americans receive medications and treatments that have no proven clinical benefit, and millions fail to get care that is proven to be effective. Quality and safety suffer, and waste flourishes.

When it comes to medicine, a test or treatment is either indicated (do it) or contraindicated (don't do it) and it's up to the physician or primary care provider to correctly assess the patient and prescribe the appropriate patient care. But as you can see, physicians mostly don't follow the science and the evidence. In Kanrei's case, he unfortunately got stuck with physicians and/or protocols that caused him harm.

Sorry to bum you guys out, but I'm just trying to arm you with the truth.

You don't seem to understand that vets want the choice.


Veterans do not want privatization.


APRIL 12, 2016
By Garry J. Augustine

When it comes to how to strengthen the Department of Veterans Affairs, candidates, Congressmen and pundits need to stop talking and start listening -- specifically, listening to veterans. Privatized health care is not what veterans want, yet just last week a congressionally-authorized Commission was discussing whether to shut down the entire VA health care system over the next twenty years.

In a recent survey of America's 22 million veterans conducted by global research firm GfK for the DAV (Disabled American Veterans), 87 percent of veterans said the federal government should provide a health system dedicated to the needs of ill and injured veterans.

The same message came from veterans surveyed by the well-respected and bipartisan survey team of Lake Research and Chesapeake Beach Consulting.

Their survey found that regardless of political party, branch of service or geography, America's veterans strongly oppose privatizing VA health care. Eighty percent oppose turning VA health care into a system of private sector vouchers...

Looking at how privatization proposals would radically change veterans health care shows why so many strongly oppose this idea. For example, moving all veterans out of the federally-run VA health care system and into private sector hospitals or insurance programs would result in a shift from veteran-centric health care to financially-driven medical care.

In all likelihood, the same economic pressures forcing private doctors to see more patients per hour by shortening appointment times will negatively affect veterans health care.

Corporate imperatives to increase profit margins could become as important as clinical considerations about how to treat PTSD, TBI and other complex medical conditions.

And millions of veterans might have to choose whether they can afford to get all the care they require if they have to pay more out-of-pocket in copayments and deductibles for private care.

Again, this is why all the big time veterans groups say that full choice is a non-starter that they will "furiously oppose".

I have, and every one would like having the choice. The nearest VA hospital to me is 65 miles away.
The VA clinic is for checking blood work and "first echelon" care.
I want the choice.


Veterans do not want privatization. The problem with "choice" depends on who's defining the word. Veteran advocates like all the aforementioned veteran groups are okay with veterans getting care where there's shortfalls so long as the VA approves and coordinates it. Why? Because of the reason I keep reminding everyone: private healthcare is more expensive, lower quality, and more unsafe -- plus because of who is also defining what "choice" means ...

The Kochs and their lackeys in the CVA want full choice so veterans can go anywhere at anytime for their care, no questions asked. Now why would the Vietnam Veterans of America, The American Legion, Paralyzed Veterans of America, and all the rest of the big time veterans groups be against this? See below ...


Carl Blake, associate executive director of government relations for Paralyzed Veterans of America, said PVA supports better integration of VA health care and private-sector providers. But the idea of allowing veterans to choose primary care physicians from either VA clinics and hospitals or pools of private-sector doctors triggers alarms.

No group is as interested as PVA in preserving the VA system of care for spinal cord injuries, Blake said. There's no program like it in American medicine. That's also probably true, he said, for other VA specialty care of amputees, blinded vets, poly-trauma cases, traumatic brain injury, post-traumatic stress and other mental health care.

"So what happens to those services if more and more veterans leave the VA system and go into the community to access care," Blake asked. Assurances from the commission that VA specialty care programs will be spared any belt-tightening are "predicated on the idea that those services would operate in a vacuum.

But they don't," Blake said. "So if you encourage more veterans to leave the system, then you risk undermining those services which are the bedrocks of VA health care."

Louis Celli, director of veterans' affairs and rehabilitation for The American Legion, said it "firmly believes based on our research that any attempts to outsource or take services away from the campuses of VA will be financially unsustainable for the Treasury and will ultimately start to transfer the cost obligation on to the veteran with service-connected disabilities."

Something similar occurred over decades for military retirees, Celli said. They were promised free care from base hospitals and so for decades retirees opted to live nearby. Then CHAMPUS and the follow-on Tricare program began offering low-cost insurance to be able to use private-sector care.

Now Tricare beneficiary co-pays are rising, Celli said.

The above is why all the major VSOs call BS on any privatization effort. You want choice? In the words of Rick Weidman, legislative director of the Vietnam Veterans of America, that coordination "should be VA. Let VA be VA.".

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