Health Care Happenings

This past Friday, I had the opportunity to attend the official dedication and opening of the National Intrepid Center of Excellence (NICoE) on the campus of the current National Naval Medical Center in Bethesda MD.
And what a truly fantastic facility this is!

This new facility is now the nation’s foremost facility for research, diagnosis and treatment of traumatic brain injury (TBI) and post traumatic stress (PTS), conditions which afflict thousands of our nation’s military personnel and veterans. This center joins the existing Center for the Intrepid, which is also a world class state-of-the-art center located at Brooke Army Medical Center in San Antonio Texas.

The NICoE is a model of public-private partnership and was completed on time (actually a bit early..) and on-budget. It cost nearly $60 million to design, build and equip and every cent came from gifts from the general public. It’s progress and development was overseen by the Board of Trustee’s of the Intrepid Fallen Heroes Fund.

This center is architecturally unique and promotes a wellness and healing environment due to its use of windows which incorporates an indoor-outdoor atmosphere. Most importantly, NICoE has been specifically designed to meet the needs of our injured heroes. Its rooms, labs and open spaces are warm and inviting. The diagnosis and treatment equipment represents the latest advances in care, and the progress made in this Center will lead to further improvements in diagnosis and treatment. In addition, NICoE will incorporate families into the treatment process, which is key to the care that will be provided.

The location of the Center plays an important role. The proximity of it will foster partnerships with the National Institues of Health, the Uniformed Services University of the Health Sciences and the Department of Veterans Affairs. Employing a “center of centers” concept, NICoE will further leverage the distinguished expertise of four established centers within the Department of Defense: the Defense Veterans Brain Injury Center; the Center for the Study of Traumatic Stress; the Deployment Health Clinical Center; and the Center for Deployment Psychology.

We at MOAA look forward to the progress and the outcomes research which will be generated by this outstanding Center ~ The National Intrepid Center of Excellence for Psychological Health and Traumatic Brain Injury, which will address the needs of the men and women who have recieved these injuries serving our nation.

The doc’s are weighing in heavily on the impending 21% cut in Medicare payments. Many of us have experienced the message effects of the American Medical Association’s (AMA) multi-million dollar advertising campaign featured in full page adds in most of the major newspapers in this country, as well as on television and radio. The message is abundently clear in its criticism of the Senate for adjourning for its Memorial Day recess without acting to cancel the reimbursement cut.

As of the time of this blog writing, the Senate is not expected to hold any votes until next week. Even then it is unclear what action the Senate will ultimately take on this particurlar issue. It will prove extremely difficult to pass a payment fix over a year in length as there is no way to pay for it now. Thus, we may very well be in for a series of month to month fixes.

What does this mean for many of our doctors in practice and also for many of us – the patients who recieve our care from these doctors? – Remember, TRICARE reimbursement is tied to Medicare’s rate of doctor reimbursement for services, so many of our military families and retiree’s are at risk as well as our age 65 and over members.

The AMA just released a survey of over 9,000 doctors who take care of Medicare patients. Based on this they confirm that beneficiaries are being hurt by Congress’s failure to fix the physician payment system.

The survey found that 17% of doctors said they have been forced to limit the number of Medicare patients in their practice. Nearly one-third of primary care physicians have been forced to take that action, the survey found.

“The top two reasons physicians gave for these actions were the ongoing threat of future cuts and the fact that Medicare payment rates were already too low,” again according to the AMA.

This becomes more than concerning when you view many physicians practices as a “small business”. Which is really what they are and it becomes quite simply an issue of cash-flow. This reimbursement problem creates payment instability and is forcing some doctors to cut their staffs, take out loans, and defer payments on equipment. It also makes it very difficult for them to purchase the equipment for health reform’s requirement’s in the area of health technology. Think electronic medical records.

We at MOAA continue to watch these developments closely. We ask you to let us know if you experience access problems with your doctor as a result of this reimbursement issue.

Older veterans who suffer from posttraumatic stress disorder (PTSD) are almost twice as likely to develop Alzheimer’s disease and other age-related dementias as veterans without PTSD…”

…So says a study funded by the Department of Defense and the National Institute on Aging—the first ever to link combat related PTSD to dementia in older veterans.

It’s not clear from the study findings if having PTSD increases the risk of dementia later in life or whether recurring PTSD is an early symptom of the condition in older veterans.

The study can’t say specifically that PTSD causes dementia as one of the researchers points out…

                …….       But if it does, one theory is that stress is to blame, states the  WebMD Health News article entitled,

Study Shows Veterans With PTSD More Likely to Develop Alzheimer’s Later In Life.”

There is evidence however that chronic stress can cause damage to the brain where critical memory and learning takes place.

Here are the basic facts from the study:

• Followed 180,000 older veterans, mostly male, over a 7-year period
  53,000 were diagnosed with PTSD
• None had dementia in late 2000, but by 2007, 17% had been diagnosed with degenerative memory and thinking disorder
• Veterans with PTSD had about an 11% risk of developing dementia during the 7-year period, unlike those without the stress disorder

The findings seem pretty interesting and a lot scary to me.

Would love to hear your reactions to the article.

…………………What’s your take? ……………………..

The big fear about the looming 21% cut in Medicare and TRICARE payments to doctors is that doctors will stop seeing patients using those programs.

Many already are running into access problems, and the fear is that any significant payment cut could make that situation much worse.

So far, the vast majority of MOAA members haven’t experienced access problems.  Our surveys have indicated that 85% or more report no problems.

But that’s no help to the 15% who say they’ve had trouble finding a doctor to see them.

According to Medicare, the number of doctors who take Medicare patients actually rose last year — to 97.1%, vs 96% last year.  But that doesn’t mean they’re all accepting new Medicare patients, just that they’re seeing at least some.

According to the Medicare Payment Advisory Commission, people under 65 report greater access problems than those 65 and over.  Some claim that doctors can’t afford to stop seeing Medicare patients, because they comprise such a large share of their caseload (and income).

On the other hand, the AMA says its surveys show that 17% of providers already are limiting the number of Medicare patients they see because of low payment rates and worries over further cuts.

Does MOAA believe Congress will actually let a 21% payment cut go permanently into effect?  Not a chance.

But the realities of health care and budget politics will probably keep us all on the hook for a while…maybe until after the November election.

In the meantime, there’s not much that will upset people more than a persistent threat that their health care could be disrupted — regardless of patients’ present experience. 

Congress will do well to pay attention to the public’s growing worries on that topic.

Here We Go…Yet Again!

A New York Times Article reads, “Pentagon Told to Save Billions For Use in War.”

Sound familiar? Like a rerun to a bad movie?

Let’s see. The country, not to mention our military, veterans and their families are still reeling from the fallout of national health care reform.

And, we’ve just come off Memorial Day weekend where our defense leaders thanked our military and veterans for their service and sacrifices, many giving the ultimate sacrifice in order to protect our country and our freedoms.

Now this—the top civilian leader in the Pentagon, Defense Secretary Robert M. Gates has ordered his military and civilian staff to find $7 billion dollars in spending cuts and efficiencies in the 2012 budget, and for those cuts to grow to $37 billion annually by the year 2016 to pay for war-fighting operations.

Cuts will target 3 areas, the first is no surprise—management and personnel, overhead, logistics and base operation and support accounts.

The second, war-fighting accounts and the third, is the Secretary’s staff and agencies.

Seems there’s not a week goes by we don’t hear the Pentagon saying, ‘that health care costs are eating the Defense Department alive,” as is article cited in the article.

When I hear statements like this one or about the need to cut budgets I can’t help wonder:

-  What’s the plan or strategy in all of this decision-making?
-  Is anyone taking a longer-view—who’s really looking at the consequences of, or more importantly, the unintended consequences of these short-term, reactionary policy and budget decisions?
-  And, at the end of the day, will budget cuts really result in the Pentagon running more effectively and efficiently?

Rest assured though, the military community and beneficiaries will be impacted by these budget cuts. We’ll see benefits and services reduced, replaced, deleted, and/or, we’ll be forced to absorb the costs of inefficient or ineffective government programs and decision-making policies.

Can see the writing on the wall, increased TRICARE premiums and fees?

… All for the sake of saving money! …

So what’s a person to do?

Some might say, well that’s life—the government giveth, and the government taketh away!

We at MOAA don’t plan to let our leaders and elected officials off the hook.

Each of us individually is one person—collectively, we are a POWERFUL CHANGE-AGENT.

Please share this information with others to MAKE SURE MILITARY PEOPLE AND THEIR FAMILIES CONTINUE TO BE A “TOP PRIORITY!”

Pentagon briefing on the subject is available on the Pentagon Channel.