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Review of Alleged Patient Deaths, Patient Wait Times, and Scheduling Practices at the Phoenix VA Health Care System

August 26, 2014 Comments off

Review of Alleged Patient Deaths, Patient Wait Times, and Scheduling Practices at the Phoenix VA Health Care System (PDF)
Source: U.S. Department of Veterans Affairs, Office of Inspector General

This is the final report addressing allegations of gross mismanagement of VA resources, criminal misconduct by senior leadership, systemic patient safety issues, and possible wrongful deaths at the Phoenix VA Health Care System. The OIG found patients at the Phoenix VA Health Care System experienced access barriers that adversely affected the quality of primary and specialty care provided for them. Patients frequently encountered obstacles when patients or their providers attempted to establish care, when they needed outpatient appointments after hospitalizations or emergency department visits, and when seeking care while traveling or temporarily living in Phoenix.

In February 2014, a whistleblower alleged that 40 veterans died waiting for an appointment but the whistleblower did not provide us with a list of 40 patient names. However, we conducted a broader review of 3,409 veteran patients identified from multiple sources, including the electronic wait list, various paper wait lists, the OIG Hotline, the U.S. House Veterans Affairs Committee and other congressional sources, and media reports. We were unable to assert that the absence of timely quality care caused the deaths of these veterans.

This report includes case reviews of 45 patients who experienced unacceptable and troubling lapses in follow-up, coordination, quality, and continuity of care. The patients discussed reflect both patients who were negatively impacted by care delays (28 patients including 6 deaths), as well as patients whose care deviated from the expected standard independent of delays (17 patients including 14 deaths). In addition to 1,400 veterans waiting to receive a scheduled primary care appointment who were appropriately included on the Phoenix VA Health Care System Electronic Wait List, we identified over 3,500 additional veterans. Many of the 3,500 veterans were on what we determined to be unofficial wait lists and were at risk of never obtaining their requested or necessary appointments.

Since the Phoenix VA Health Care System story first appeared in the national media, the OIG received approximately 225 allegations regarding health care at Phoenix and approximately 445 allegations regarding manipulated wait times at other VA medical facilities. The VA OIG Office of Investigations opened investigations at 93 sites of care in response to allegations of wait time manipulations. We are coordinating our investigations with the Department of Justice and the Federal Bureau of Investigation.

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DoD and VA Take New Steps to Support the Mental Health Needs of Service Members and Veterans

August 26, 2014 Comments off

DoD and VA Take New Steps to Support the Mental Health Needs of Service Members and Veterans (PDF)
Source: U.S. Department of Defense/U.S. Department of Veterans Affairs

Today, President Obama will announce 19 new executive actions that the Departments of Veterans Affairs (VA) and Defense (DoD) are taking to improve the mental health of service members, veterans and their families. Today’s announcement builds on the actions the Departments have taken in response to the President’s 2012 Executive Order on service members, veterans and their families’ mental health. In response to the Executive Order, VA has increased its mental health staffing, expanded the capacity of the Veterans Crisis Line, and enhanced its partnerships with community mental health providers. DoD is reviewing its mental health outreach programs to prioritize those with the greatest impact; DoD and VA worked to increase suicide prevention awareness and, DoD, VA and the National Institutes of Health jointly developed the National Research Action Plan on military and veteran’s mental health to better coordinate federal research efforts. These efforts and actions represent the latest in DoD and the VA’s continued commitment to ensure that this Administration is working to fulfill our promise s to service members, veterans and their families, and we will continue to look for additional ways to do so in this space, both thorough our work and work with the private sector.

Military Service and Alcohol Use in the United States

August 19, 2014 Comments off

Military Service and Alcohol Use in the United States
Source: Armed Forces & Society

It is well known that enlistees and veterans in the United States are more likely to use alcohol than civilians. However, most of this research is potentially biased in that it often does not employ control variables (other than age) and is based on cross-sectional data. Much of this research also fails to consider the relationship between military service and alcohol use among women. Using longitudinal data taken from the 1997 National Longitudinal Study of Youth, we investigate the relationship between military service and alcohol consumption employing a fixed-effects approach. We find that military service appears to encourage young men to consume alcohol. It is also the case that the effect of military service is not limited to the time that men spend in the military given that male veterans are also more likely to consume alcohol than are comparable nonveterans. We find, however, that women who serve, both enlistees and veterans, are less likely to drink than their civilian counterparts.

CRS — The Post-9/11 Veterans Educational Assistance Act of 2008 (Post-9/11 GI Bill): Primer and Issues (July 28, 2014)

August 15, 2014 Comments off

The Post-9/11 Veterans Educational Assistance Act of 2008 (Post-9/11 GI Bill): Primer and Issues (PDF)
Source: Congressional Research Service (via Federation of American Scientists)

The Post-9/11 Veterans Educational Assistance Act of 2008 (Post-9/11 GI Bill®)—enacted as Title V of the Supplemental Appropriations Act, 2008 (P.L. 110-252) on June 30, 2008—is the newest GI Bill and went into effect on August 1, 2009. There were four main drivers for the Post-9/11 GI Bill: (1) providing parity of benefits for reservists and members of the regular Armed Forces, (2) ensuring comprehensive educational benefits, (3) meeting military recruiting goals, and (4) improving military retention through transferability of benefits. By FY2010, the program had the largest numbers of participants and the highest total obligations compared to the other GI Bills.

The Post-9/11 GI Bill provides benefits to veterans and servicemembers who serve on active duty after September 10, 2001. Participants may be eligible for payments to cover tuition and fees, housing, books and supplies, tutorial and relocation assistance, and testing and certification fees. Individuals who serve on active duty for 36 months after September 10, 2001, may receive a tuition and fees benefit of up to the amount of in-state tuition and fees charged when enrolled in public institutions of higher learning (IHLs), or up to $19,198.31 when enrolled in private IHLs in academic year 2013-2014. Benefit payments vary depending on the participant’s active duty status, length of qualifying active duty, rate of pursuit, and program of education.

Combined Assessment Program Summary Report: Evaluation of Hospice and Palliative Care in Veterans Health Administration Facilities

August 12, 2014 Comments off

Combined Assessment Program Summary Report: Evaluation of Hospice and Palliative Care in Veterans Health Administration Facilities (PDF)
Source: U.S. Department of Veterans Affairs, Office of Inspector General

The VA Office of Inspector General Office of Healthcare Inspections completed an evaluation of hospice and palliative care in Veterans Health Administration facilities. The purposes of the evaluation were to determine whether VHA facilities performed active hospice and palliative care case finding, provided end-of-life care training to staff, and met selected documentation standards and to assess selected Palliative Care Consult Team processes, documentation, and staffing.

Inspectors evaluated hospice and palliative care at 54 facilities during Combined Assessment Program reviews conducted from October 1, 2012, through September 30, 2013.

Although we observed many positive practices, we identified two opportunities for Veterans Health Administration facilities to improve. We recommended that the Under Secretary for Health, in conjunction with Veterans Integrated Service Network and facility leaders, ensures that:

+ Facilities provide at least the minimum required Palliative Care Consult Team staffing.

+ Facilities provide end-of-life care training to staff who work in areas where they are likely to encounter patients at the end of their lives.

CBO — Veterans’ Disability Compensation: Trends and Policy Options

August 11, 2014 Comments off

Veterans’ Disability Compensation: Trends and Policy Options
Source: Congressional Budget Office

The Department of Veterans Affairs (VA) oversees a disability program that makes payments through the Veterans Benefits Administration (VBA) to compensate U.S. veterans for medical conditions or injuries that are incurred or aggravated during active duty in the military, although not necessarily during the performance of military duties. Compensable service-connected disabilities range widely in severity and type, including the loss of one or more limbs, migraines, scars, and hypertension. Payments are meant to offset the average earnings lost as a result of those conditions, whether or not a particular veteran’s condition has reduced his or her earnings or interfered with his or her daily functioning. Disability compensation is not means-tested; veterans who work are eligible for benefits, and, in fact, most working-age veterans who receive disability benefits are employed. Payments are in the form of monthly annuities and typically continue until death.

Adjusted for inflation to 2014 dollars, VA disability compensation to veterans amounted to $54 billion in 2013, or about 70 percent of VBA’s total mandatory spending, according to analysis by the Congressional Budget Office (CBO). The remainder of the department’s mandatory spending that year was for programs that provide veterans with housing assistance, education, vocational training, and other assistance. In 2013, about 3.5 million of the nation’s 22 million veterans received disability compensation benefits. (Those benefits are distinct from the health benefits provided through the Veterans Health Administration [VHA].)

CBO Releases Updated and Complete Cost Estimate for H.R. 3230, the Veterans Access to Care Act of 2014, as Passed by the House

July 29, 2014 Comments off

CBO Releases Updated and Complete Cost Estimate for H.R. 3230, the Veterans Access to Care Act of 2014, as Passed by the House
Source: Congressional Budget Office

Today, as part of its ongoing work to assist the conference committee that is working on H.R. 3230, the Veterans Access to Care Act of 2014, CBO issued an updated and complete estimate of the version of the bill that was passed by the House of Representatives on June 18, 2014. That version of H.R. 3230 would authorize the appropriation of whatever sums are necessary for the Department of Veterans Affairs (VA) to expand, for two years, its use of non-VA health care providers to provide medical services to veterans.

Initially, CBO had issued preliminary estimates for the major provisions of the House-passed and Senate-passed bills. Since then, it has obtained additional information, refined its analysis, and completed estimates of other provisions of those bills. An updated and complete estimate of the Senate version of the bill was issued on July 10. Today, CBO issued an updated and complete estimate of the House version of the bill. Those updated estimates provide a basis for CBO’s analysis of proposals that would modify the earlier versions of the legislation.

Assuming appropriation of the necessary amounts, CBO estimates that implementing the House-passed bill would lead to a net increase of $41 billion in VA’s discretionary spending over the 2014-2017 period, reflecting the expectation that veterans’ utilization of contracted care under this act would ramp up over time. We also estimate that enacting the House version of the bill would reduce direct spending by $80 million during that period. Finally, if the amounts estimated were appropriated, CBO estimates that implementing the bill would lead to savings totaling $7 billion in the Medicare and Medicaid programs and to additional revenues of $2.5 billion over the 2015-2017 period.

The Senate-passed version of H.R. 3230 would authorize and appropriate such sums as may be necessary to carry out a similar expansion of health care services. CBO estimates that enacting the Senate version of H.R. 3230 would increase direct spending by $35 billion and increase revenues by $2.5 billion over the 2014-2024 period, and lead to additional appropriations totaling about $2 billion over the 2014-2019 period.

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