Cooperating for better care.

Department of Veterans Affairs

Tag Archives

VA wants to expand role of advanced nurses


The Department of Veterans Affairs (VA) has formally proposed to let its advanced practice registered nurses (APRNs) work independently without physician supervision in its  healthcare network, the largest in the nation.

The VA said that expanding the APRN scope of practice in such a way would increase veterans’ access to care and shorten their notoriously long wait times for appointments.

Not surprisingly, the American Medical Association opposes the plan because it runs counter to physician-led, team-based care, which it called the best approach to improving quality.  Many physicians also worry that such change could reduce the influence and income of physicians.

Read more here.


Group wants to privatize the VA


Book given to U.S. veterans in 1919 to help them readjust to civilian life after World War I.

Nearly two years after a scandal  erupted about poor care at some Department of Veterans Affairs (VA) hospitals, a panel is considering a proposal to privatize veterans’ care.   But some healthcare experts have asserted that the VA system is actually better than many private-sector hospitals but is being unfairly denounced by right-wing ideologues and those who want to make lots of money off a for-profit veterans health system.

Seven members of the 15-person VA Commission on Care floated a 34-page preliminary “strawman document” recommending granting all VA beneficiaries immediate access to private-sector medical services while gradually closing all VA facilities, beginning with those that are obsolete or little-used,  reported the Military Times. The department  would eventually become  solely a Medicare-like payer entity.

Numerous veterans’ groups, however, have denounced the proposal as lacking   transparency, being rife with conflicts of interest and showing an “utter lack of consideration that veterans would want to improve and expand the VA healthcare system.”

In any event, the  department continues to struggle to  discipline employees  found to have made serious mistakes and still employs people accused of serious misconduct, including even crimes.




Increasing the number of physicians who know veterans’ issues



“Memorial Day, Boston,” by Henry Sandham.


For Kaiser Health News

Most former servicemen and women (and their families) get their healthcare at civilian facilities, where only rarely do health professionals ask patients if they or close relatives have a military background. But not only do veterans suffer from a disproportionate share of ailments such as post-traumatic stress disorder and brain injury, many who were in combat zones may also have been exposed to hazards such as the defoliant Agent Orange in Vietnam, or huge burn pits in Iraq and Afghanistan that produced toxic fumes.

Recognizing the potential for missing important health issues, a small group of medical professionals banded together to ensure that in the future doctors will at least be aware of the possible medical problems of former military members, who now number about 14 million. Going forward, the exam every medical student and new physician must take to get a license will include questions about military medicine. That, in turn will force medical schools to teach it.

Brian Baird, a former Democratic member of Congress from Washington and a licensed clinical psychologist, has helped spearhead the change, which is being publicized as the country prepares for Veterans Day this Wednesday. He said he was inspired by some of his own patients who returned from duty in need of help.

“We don’t even ask, ‘Have you or a loved one been deployed overseas,’” he said in an interview. “And I thought, what a terrible oversight.”

Baird set out to talk to every medical organization he could find. Several responded, or were working on a similar project at the same time, including the White House’s “Joining Forces” initiative.

Baird found an eager partner in Steven Haist, a physician and vice president at the National Board of Medical Examiners, which develops and runs the U.S. Medical Licensing Exam.

Haist has spent nearly four years organizing the effort and bringing in specialists from the Department of Veterans Affairs and every branch of the military to develop and write the questions. Military medicine will be included in all three of the exam’s “steps,” which students take at different points in medical school and after they complete the early phases of post-graduate training.

“In some respects, I think it could have been done a lot sooner,” said Haist, given many of the well-recognized issues affecting returning troops from Vietnam and the first Gulf War. But he said he hopes that ensuring that physicians know about potential problems “will improve the health care that is received by returning deployed servicemen and women and their families.”

Karen Sanders, M.D., who helps oversee academic training for the VA, and who got the project funded, says she’s confident the change will make things happen. “If you change the exams, schools and curricula will follow,” she said. “We hope this will drive schools to offer courses” in medical conditions experienced by members of the military. A surveyconducted by the Association of American Medical Colleges found that as of 2012, only about half the schools had such courses.

Other medical organizations have also acted to better integrate the health problems stemming from military duty into non-military health care. Both the American Medical Association and American Academy of Nursing are actively encouraging providers to ask patients about their or a family member’s military service.

But encouraging is not enough, say Howard and Jean Somers. Their son, Daniel, committed suicide in 2013 after being unable to receive treatment for mental-health issues upon returning from Iraq. They have been working to improve the care at the VA and bring more attention to returning troops’ health problems ever since.

“How do you make it a requirement without making it part of the licensing or re-licensing,” said Howard Somers, a retired urologist.

They called putting questions on the licensing exam “fantastic,” but stressed that something similar needs to be done to educate doctors who have completed their training and initial licensing.

In order to maintain his medical license, said Howard Somers, “I had to take an online course in pain management. That would be another way to address this, to get medical societies to make this a requirement.”

Former Congressman Baird agrees. “I’ve asked a lot of physicians about it, and many of them said, ‘You know I’ve had courses in things I will never see in my practice. But there’s a pretty darn good chance I’m going to see somebody who’s been deployed.’”

But getting military service training to be a required part of continuing education for doctors is a daunting task. “You’d have to deal (separately) with every state medical board,” says the VA’s Sanders.

There is also a parallel effort to put questions about military service not just on intake forms that patients fill out but also in the electronic medical records that are filled in by health care providers.

Epic, a spokeswoman for Epic, the dominant software developer in the market, said that the company’s standard record does include questions about military service, but they don’t show up unless the customer  — a hospital or doctor’s office – requests that.  “Pediatrics, for example, will not turn it on,” she said.

But Baird insists that the question should be included on every single electronic medical record, including those for children: “The classic case would be a child struggling in school, who can’t sleep.” A doctor might prescribe medication, he said, “but never stops to ask if anybody in the (child’s) family has been deployed.”

Baird recognizes that while the adoption of the test questions marks a milestone, there is still a long way to go. “My goal is nothing less than making this a permanent  aspect of our medical education and our health care system,” he said. “It’s rather shocking that it hasn’t been done actually.”

Healthcare spending increasing again



Healthcare spending is rising again, growing 5,5 percent in 2014 from 2013 and projected to climb 5.3 percent this year.  From 2015 to 2020 spending growth is expected to average 5.8 percent, peaking at 6.3 percent in 2o2o, reports Health Affairs.

The general rate of U.S. inflation has averaged less than 3 percent in the last few years, brought down by stagnant wages.

What this means, among other things, is increased pressure on providers to curb costs to stem tax and insurance-premium increases. And drug makers, responsible for much of the increase, will come under increased public- and private-sector pressure to reduce their  very wide profit margins.

While the GOP-run Congress opposes giving Medicare the power to negotiate prices with pharmaceutical companies — a power that the Department of Veterans Affairs has — we can see public anger about drug prices  swelling enough in the next few years for Medicare to win that authority.


Most want negotiated Medicare drug prices

A survey says that vast majority of Americans want  Medicare to be able to negotiate with drug companies to set lower medication prices, a practice currently prohibited by law.

The poll,  by the Kaiser Family Foundation, found that 87 percent of people surveyed want Medicare to have the authority to press drugmakers for greater discounts, as the Department of Veterans Affairs  does for vets.

The soaring prices for crucial medicines have hit both health insurers and consumers, who are being asked to cover a higher proportion of their medications’ cost though bigger co-pays. While the Republican Congress is unlikely to allow such negotiations, political pressure and insurance-industry lobbying may make it happen within a few years.

“People don’t understand why these drugs cost so much, and they don’t understand why, in America, you can’t negotiate for a better price,” Mollyann Brodie, executive director of public opinion and survey research at Kaiser Family Foundation, told Reuters.

Efforts to allow Medicare to negotiate drug prices have not been successful because, of course, of pharmaceutical industry opposition and because of ideological opposition to government interference in the marketplace despite the seeming contradiction seen in the government’s right to negotiate drug prices for vets.

Drug makers say their prices reflect the billions of dollars they spend in research and development,  for approved treatments and the new drugs  that fail. But critics charge that too much of the money is spent on marketing.


America’s Health Insurance Plans, an industry lobby group, may bring increase pressure on drugmakers now that AHIP has named Marilyn Tavenner, the former head of the Centers for Medicare and Medicaid Services, as chief executive.



It’s now easier to sue Feds for malpractice


The U.S. Supreme Court has made it easier to sue the federal government for negligence, including medical malpractice at Department of Veterans Affairs hospitals, in a case involving deadlines for filing lawsuits.

The 5-4 majority  held that such deadlines could be extended for plaintiffs who had either done their best to comply with them or had failed to obtain critical information before them, MedScape reported.

In one brief, the Paralyzed Veterans of America and other groups argued that, as an Associated Press story put it, “veterans unwittingly miss their deadlines for filing claims because the Department of Veterans Affairs has created a confusing process.”

Contact Info

(617) 230-4965

Wellesley, Mass