Health Care Happenings

This past Wednesday I had the opportunity to sit in and observe the Senate Armed Services Personnel Subcommittee’s hearing to consider the Defense Health Program (DHP) and the Administration’s proposed FY-2011 Defense budget. The Subcommittee was chaired by Senator Jim Webb (D) Virginia and the ranking minority member Senator Lindsey Graham (R) South Carolina. Testifying for the Defense Health Program was acting OSD/ Health Affairs, Dr. Charles Rice MD, RADM Chris Hunter for the TRICARE Management Activity, each of the service Surgeons Generals, and the Medical Officer of the Marine Corps.

Senator Webb opened the meeting expressing tremendous support for military medicine and noted that “..we have been at this war now for 9 years and we are now in unchartered territory”. This was in reference to the challenges our troops face with multiple deployments, rotational cycles and generalized stress on the force. He continues to maintain his focus on the deployed forces and in this respect he expressed great concern on the reported increased use of precription drugs by both active and the deployed forces. An alarming statistic he quoted was 1 in 6 of our active forces are on psychiatric type drugs such as anti-depressents, sleep aids and pain killers. Understanding this problem is imperative.

Echoing this concern, we also heard testimony from Senator Ben Cardin (D) Maryland. Noting that this is an extremely sensitive issue, and this may be a reflection of how the troops are dealing with deployment. He noted that in 2005 the use of prescription drugs was about 1% and in 2007 the use of prescription drugs of this nature was up to 5%. He expressed concerns with respect to the proper medical monitoring of the effects of these drugs especially during the first 6 weeks of prescribing. He also stated that DOD must drill into this further to gain understanding and develop policy. Also, there is a need to understand this in relation to the increase in suicides.

Bottom line is that Congress is highly concerned and has charged the Defense Health leaders to provide the very best data on the issue of psychiatric prescriptive drug use and to provide clarity of the magnitude. You can bet on a required report out on this!

Even though the DHP is fully funded for this year (2011) in the budget, concerns were noted that the cost of the program continues to go up and is putting strain on the total defense budget. Senator Graham was interested to know if the department was doing everything it could to control costs and asked if they were employing all the strategies they could. He explicitly stated that before any notion of a premium increase would be entertained he wanted to ensure the department was aggressively pursuing system efficiency measures.

The department’s testimony noted that it is under mounting financial pressure. The DHP has more than doubled since 2001 – from $19 billion to $50.7 billion in 2010. The majority of DoD health spending supports healthcare benefits for military retirees and their dependents. The department projects that up to 65% of DoD healthcare spending will be going toward retirees in FY 2011, this is up 45% from FY 2001. As civilian employers’ health costs are shifted to their military retiree employees, TRICARE is seen as a better, less costly option and they are likely to drop their employer’s insurance. These costs are expected to grow from 6 % of the Department’s total budget in FY 2001 to more than 10% by 2015. Since 2008 the number of enrollee’s has increased by 370,000.

The Department discussed the many initiatives and ways that they are addressing costs. Some of these include identifying and understanding variations in clinical practices across geographic areas and the many efforts they are undertaking in the area of patient safety and quality. In addition, when the electronic health record becomes fully utilized, this will provide a great deal of efficiency and medical management. In addition initiatives to encourage patient utilization of appropriate venues of care with a focus of decreasing inappropriate emergency room usage.

Also of the many issues touched on, lastley Senator Webb questioned the current disability evaluation (DES) pilot program which is underway. Noting that there remain system challenges he suggests a concept of a joint VA/DoD disability board. Something needs to happen to improve these two systems which at times are antiquated and adversial!
Well said.