Health Care Happenings

Coffee or no coffee?

     Is it good for you or bad for you?

What’s a person to believe???????????????????

Well, drum roll please…………a new study may be encouraging for those of us who love our coffee and can’t image life without it!

“Older adults who drank coffee–caffeinated or decaffeinated–had a lower risk of death overall than others who did not drink coffee, according to a study by researchers from the National Cancer Institute, part of the National Institutes of Health, and AARP.”

GREAT, RIGHT!

The study showed individuals who drank 3 or more cups of coffee per day were 10% less likely to die from heart disease, respiratory disease, stroke, injuries and accidents, diabetes, and infections.

BUT, the study could not make the linkage to cancer…AND, the researchers caution that the study represented a single point in time–participants, 400,000 men and women in the U.S., ages 50-71 in the mid-1990′s through their death or until December  2008, whichever came first, self-reported and may not be representive of longer term coffee consumption.

Guess like everything, moderation and consumer education is key.

Read more about the study at “NIH study finds that coffee drinkers have lower risk of death” and then, YOU DECIDE!

Today, MOAA President VADM Norb Ryan defended military people at a three-person debate on military pay and benefits at the Center for American Progress (CAP) in Washington, DC.  He sparred with Maj. Gen. Arnold L. Punaro (USMCR-Ret.), a member of the Defense Business Board and Michael J. Bayer, former Chairman of the Defense Business Board, whose 2011 report recommended major cutbacks in military retirement.  The panel was moderated by Lawrence Korb (USNR), Senior Fellow for CAP and former Assistant Secretary of Defense for Manpower, Reserve Affairs, Installations and Logistics.

The debate was over a new CAP study that recommends cutting back on military pay raises, converting military retirement to a contributory 401(k)-style system, and dramatically increasing TRICARE fees for military retirees, among other things.

Bayer said, “Until personnel costs are wrestled down to manageable levels, there won’t be enough to fund other defense needs.”  He advocated a radical overhaul of what he asserted is “an archaic system of [military] pay and benefits”, noting that 83% of military people leave service without any benefit.

Punaro said he agrees with MOAA that we don’t want to return to the “erosion of benefits” era of the late 1970s, but argued for significant benefit cuts for future entrants.  He noted that military retirees’ life expectancy will continue to rise another 6 to 8 years, “creating another huge financial burden for the country.”

VADM Ryan countered that Defense leaders are “missing the forest for the trees” on these issues, and that the real focus should be on sustaining needed incentives for the 17% to stay rather than whacking their benefits to help the 83% who choose to leave.  “There’s a reason only 17% stay for a career,” he said, citing the huge sacrifices inherent in a military career.  “The 83% don’t leave with nothing,” he said.  “Congress approved a GI Bill worth upwards of $80,000 per person, to help them with that transition.”  He noted a 20-year NCO earns retired pay of only $23,000, and that proposing big pay, retirement, and healthcare cutbacks “dishonor their service.”

Fresh from the Annual Pharmacy Outcomes Conference sponsored by the Department of Defense’s pharmacy contractor, Express Scripts, we were briefed on some concerning health information.  This has to do with the incidence of the top three chronic health conditions experienced in our country.

Chronic conditions affect all of us directly or indirectly.  Treating chronic diseases accounts for about 75% of the healthcare dollars spent in the U.S., with two-thirds of the increase in healthcare spending since the late 1980′s due to increases in the incidence and costs of chronic conditions.  At the top of the list of these conditions are diabetes, high blood cholesterol and high blood pressure/heart disease.  Diabetes is poised to become the largest driver of pharmacy costs in the next few years.

Already fairly common in the U.S., diabetes is becoming more common every day, with 8.3% of the population estimated to have the condition.  Because age and obesity are risk factors for developing this, the incidence of diabetes will continue to rise as the population ages and obesity becomes more prevalent.

High blood cholesterol, which held the number-one spot in pharmacy expenditure for a decade, affects one in every six American adults (16.3%).  Individuals with high blood cholesterol have twice the risk of heart disease – a major cause of death in the U.S. and a major overall driver of healthcare costs.

High blood pressure is among the most common chronic conditions.  Approximately one-third of U.S. adults – 76.4 million – have elevated blood pressure.  More than half of those diagnosed with high blood pressure fail to reach adequate levels of control.

These top three conditions have things in common.  First they are are co-morbid conditions, in that they often occur in the same individual together.  About one in eight Americans (13%) have two of the three conditions, and almost 3% live with all three.

Additionally, all three of these conditions share a common key risk factor:  excess body weight.  Today adults of normal weight are in the minority:  only 35% of the adult population is of normal weight.  or even greater concern, the obesity rate for children in the U.S. has tripled since the mid-1970′s.  Consequently, these three conditions are now increasingly being discovered in younger adults and children.

These three conditions have significant behavorial components.  The World Health Organization reports that by eliminating just three behavioral risk factors – being overweight or obese, getting insufficient exercise and smoking- would prevent 80% of heart disease, stroke and diabetes and 40% of cancer cases.  Once an individual is diagnosed however, prescription drug therapy is often a major component of care.

This brings us to the issue of individual compliance with their prescribed medications.  Medications to control these three chronic conditions can help reduce healthcare costs when taken as prescribed.  Adherence to prescribed drug therapy is one of the most important self-care behaviors for maintaining or improving health and preventing disease progression for individuals with chronic conditions.  But despite the benefits of taking medications as prescribed, adherence rates are far from ideal – behavior that is both costly and dangerous.  There are research estimates that the national cost of nonadherence for these three conditions alone exceeds $105.8 billion per year!

Developing effective solutions to address the issue of nonadherence to prescribed medications is a major focus of for all of us interested in decreasing the costs of healthcare in our country.

“We have heard frequently about how long it takes for veterans to get into treatment, and I am glad that the Department of Veterans Affairs (VA) Inspector General (IG) has brought those concerns to light…the IG has an entirely different, and more useful way of understanding access to care.  This model would give more reliable data, and reduce the rampant gaming of the system that we have seen thus far.” 

Chairman Patty Murray (D-WA), Senate Veterans’ Affairs Committee

 Hearing on VA Mental Health Care, April 25, 2012

This statement came after two previous hearings in 2011 where VA told members about all they were doing to make mental health care services accessible to veterans.

But, at each hearing Committee members heard conflicting information from veterans and VA employees that told a very different story as to the actual conditions on the ground.

VA reported that 95% of veterans received mental health evaluations within 14 days…

Reality…IG found it was only about 50%!

VA data stated that after the evaluation was completed, 95% of veterans received an appointment for treatment within 14 days…

  Reality…IG found it was only 64%!

 ” …of the 12% of veterans that were scheduled beyond the 14 day follow-up appointment window, providers told the IG that they were delaying follow-up appointments for months, not because of the veteran’s needs, but because their schedules were too full…

VA is failing to meet its own mandates for timeliness, and instead is finding ways to make the data look like they are complying,” said Murray.

A number of other revelations surfaced during the hearing that were equally troubling. Clearly the IG report indicates that major actions must be taken to right the system and change the culture, immediately–that is, to change the system’s focus from quantity [number of veterans seen] to making quality [of medical care] a priority!

• The IG witness spoke to the need for VA to focus on the integrity of data, an issue the agency has continuously reported as a problem over the last 7 years.  VA needs to change its culture and hold facility directors accountable–there has been little focus on how schedulers are capturing data which ultimately drives demand and other system outcomes stated the witness.
• From 2007-2011, VA hired 8,000 mental health providers, but currently has 1,500 vacancies.
• VA announced this week it plans to hire 1,600 additional mental health providers and 300 support staff = 1,900 positions, for a total of 3,400 positions that must be filled.
• VA has no reliable staffing model to determine where these new hires would be needed.
• National shortages in mental health providers, salaries and hiring practices present recruiting challenges for the VA.

MOAA is encouraged by the Committee’s oversight and monitoring of these very important issues.

To some veterans, VA care may be their only hope and can mean the difference between life or death.

Veterans who have made the hard choice to reach out to the VA deserve a hand back from the VA…one that welcomes them and understands their needs.

Got any old, outdated prescription drugs you want to get rid of safely? Don’t flush them or throw them in the trash. That can have a significant negative effect in the environment we all share. Instead, take advantage of Take-Back Day.

The Drug Enforcement Administration (DEA) has scheduled another National Prescription Drug Take-Back Day which will take place on Saturday, April 28, 2012, from 10:00 a.m. to 2:00 p.m. (local time). This is a great opportunity for those who missed previous Take-Back events or who have subsequently accumulated unwanted, unused prescription drugs, to safely dispose of those medications.

“These three events have dramatically reduced the risk of prescription drug diversion and abuse, and increased awareness of this critical public health issue, said a DEA spokesperson”. November 2011′s Take-Back event collected over 188 tons of unused or expired medications for proper disposal.

On Saturday, April 28, 2012, from 10:00 a.m. to 2:00 p.m. (local time), collection sites will be available across the nation at designated police departments, military installations, fire departments and schools. To find the collection site that’s closest to you, please use one of the following:

a. “Links for MIL\RET\VETS” web site at http://www.hostmtb.org. Click on the “4th NATIONAL PRESCRIPTION DRUG TAKE BACK DAY- Saturday, April 28, 2012 10:00 am – 2:00 pm” link (middle of web page), and then click on “Collection Site Locator”

Or

b. “DEA” web site at http://www.deadiversion.usdoj.gov/drug_disposal/takeback/index.html. Click on “Collection Site Locator”

If you do not find a collection site near you, please check back frequently, new sites are added every day.

Take-Back Day pamphlets, posters, banners, etc., in English and Spanish, are available at http://www.justice.gov/dea/take-back/takeback-day_2012.html

If you are unable to connect to the above web sites or if you have questions about the “National Prescription Drug Take-Back Day,” collection sites, etc., please contact Take-Back officials at Toll-Free 1-800-882-9539.

All living creatures in the environment thank you.

In these challenging days of economic uncertainty and rising costs of food, gas, taxes, healthcare………….and the list goes on………….what are we suppose to do?

If you believe in Maslow’s Hierachi of Needs, then the first two levels are critical to achieving the ultimate level of ‘self actualization’–at the very basic level of human needs is psychological needs, that is, air, water, food, and sleep!

….Next level is security needs which includes steady employment, health insurance, safe neighborhoods, and shelter.

But alas, many Americans are being economically squeezed from all directions, forcing them to make some really tough choices, including what they can afford in the way of medicine and health care–tough choices that, in some cases could greatly impact their health.

An NPR blog, Drug Spending Levels Off, But Not for The Usual Reasons, got me thinking about the difficult health care choices Americans are being forced to make today.

….And, we aren’t exempt in the military health system as we’ve seen in recent years of proposals pushing more and more of the Defense Department’s health care costs on the backs of beneficiaries, placing them in the same category as other Americans, rather than recognizing their service and sacrifice that earned them this very important benefit that they value.

 The blog post had some very interesting, and surprising points cited from an annual IMS Health report about the decline in prescription drug spending in 2011:

• Usually a slow down in drug spending is  due to the drug industry not producing new medicines, but….this was not the case last year–the industry saw “the most new medicines in a decade!”
• Some of the decline in drug spending can be associated with more people using generic medications…“80% of dispensed prescriptions were generics and generic spending grew by $5.6 billion!”

BUT, the biggest reason for the decline in drug spending? 

“…was the actual use of prescription drugs, particularly by seniors!”  

That’s right.  Seniors traditionally are the largest consumers of prescription drugs, but they cut back their use during the year–blood pressure medications saw the biggest drop in use…And, along with the drop in dispensing of medications, doctor visits and non-emergency room hospital admissions also declined.

The report points to a trend that goes back a few years when the economic crisis began.

Very troubling.  I can’t help wondering what choices my 87 year old mother-in-law and her sister who is 77 would make if they didn’t have us to take care of them.

Then, I can’t help wondering what hard choices our military beneficiaries will have to make about their health care, in light of the looming budget problems in the Pentagon and in our country?