Clinical Assessment Program Review of the Atlanta VA Medical Center, Decatur, Georgia for Thursday, 8 June 2017 - Veterans Affairs Office of Inspector General (OIG) in Washington, D.C., United States

Clinical Assessment Program Review of the Atlanta VA Medical Center, Decatur, Georgia for Thursday, 8 June 2017 - Veterans Affairs Office of Inspector General (OIG) in Washington, D.C., United States

Clinical Assessment Program Review of the Atlanta VA Medical Center, Decatur, Georgia The VA Office of Inspector General (OIG) conducted an evaluation of the quality of care provided at the Atlanta VA Medical Center. This included reviews of various aspects of key clinical and administrative processes that affect patient care outcomes—Quality, Safety, and Value; Environment of Care; Medication Management; Coordination of Care; Diagnostic Care; Moderate Sedation; Community Nursing Home Oversight; Management of Disruptive/Violent Behavior; and Mental Health Residential Rehabilitation Treatment Program. OIG also followed up on recommendations from the previous Combined Assessment Program and Community Based Outpatient Clinic and Primary Care Clinic reviews and provided crime awareness briefings to 344 employees. As a result of the findings, OIG could not gain reasonable assurance that: (1) Clinical managers effectively monitor the professional competency of providers, peer reviewers assess important aspects of care, and physician advisors’ input is considered when making utilization management decisions; (2) Facility leaders address environmental deficiencies and maintain a clean and safe environment in patient care areas; (3) The facility has a comprehensive anticoagulation therapy management program; (4) Clinicians always safely transfer patients from the facility; (5) Glucometers are always clean; (6) The facility has an effective program to prevent and manage disruptive/violent behavior; (7) Facility leadership implemented and maintained processes to ensure care for patients with pressure ulcers and positive alcohol screens. OIG made recommendations for improvement in the following six review areas: (1) Quality, Safety, and Value; (2) Environment of Care; (3) Medication Management: Anticoagulation Therapy; (4) Coordination of Care: Inter-Facility Transfers; (5) Diagnostic Care: Point-of-Care Testing; and (6) Management of Disruptive/Violent Behavior. OIG made a repeat recommendation in Pressure Ulcer Prevention and Management and in Alcohol Use Disorder. Veterans Affairs Office of Inspector General (OIG). Veterans Affairs Office of Inspector General (OIG) · 801 I St NW · Washington, DC 20536 · 800-827-1000

-------

Men’s vitality, good health habits formed in uniform go together - Military Health System

Men’s vitality, good health habits formed in uniform go together Retired Army Maj. Bill Gleason’s active lifestyle in Savannah, Georgia, includes cycling and sharing full-time day care duties with his wife for three grandchildren ages 8, 6, and 4. (Courtesy photo) Navy veteran John Weidman has been out of uniform for 19 years, but he still follows health and fitness routines he developed during 16 years as a flight officer. The former lieutenant commander gets physical exams every year around his birthday. He exercises regularly and has started running again after being sidelined by surgery for a torn meniscus, the C-shaped cartilage that protects the knee from everyday stresses. And he’s talking with his longtime physician about the pros and cons of taking a statin to reduce his high cholesterol, which is hereditary. “A lot of guys are afraid to go to the doctor for an injury or even a checkup,” said Weidman, 57, who lives outside of Dallas. “But I’m not. Being in the military got me in the habit, and I recognize how valuable it is.” Regular physician appointments and fitness routines are easier for men on active duty because good health is a job requirement. “You get up in the morning and do PT [physical training] because that’s just the way it is,” said retired Army Maj. Bill Gleason, 63, of Savannah, Georgia. “You line up for your flu shot every year and have an annual physical whether you want to or not. You get into good habits, and they’re habits I still follow.” Many men, however, slack off after retiring or separating from the service. The Centers for Disease Control and Prevention’s most recent National Health Interview Survey found men were more than twice as likely as women to report they hadn’t seen a health care professional in two years, and three times as likely to say they hadn’t seen one in more than five years. “The older we are, the busier we get, and the less time we think we have to focus on health and wellness activities,” said Dr. Don Shell, director of disease prevention, disease management, and population health policy and oversight in the Office of the Assistant Secretary of Defense for Health Affairs, Health Policy Oversight. “A lot of guys develop the attitude that they don’t really need to be in contact with a health professional unless something goes wrong,” Shell said, noting that of course regular contact is important. “But it’s the choices men make every day that really influence how healthy or unhealthy they are over time.” Those choices include avoiding tobacco, limiting alcohol intake, participating in some type of physical activity, and eating healthful foods. “It’s very difficult to maintain your health if you’re not physically active,” Shell said. He noted that the Army’s Performance Triad recommends 150 minutes of moderate activity plus 75 minutes of vigorous activity weekly for active-duty service members. Men who aren’t in uniform can focus on achieving the 150-minute weekly exercise target, he said. Sufficient physical activity results in fewer worries about weight gain. “As most people get older, they lose muscle mass and gain fat,” Shell said. “Exercise stimulates muscle growth and helps maintain strength and vitality.” Shell said limiting unhealthy fats and sugars while eating fruits, vegetables, fish, and whole grains will help aging bodies remain lean. Regular exercise enables men to “enjoy a few treats and snacks once in awhile, as long as they’re burning those extra calories.” Excess weight leads to acute and chronic health issues including high blood pressure, diabetes, and heart disease. It also can lead to injuries to the musculoskeletal system -- the bones, muscles, cartilage, tendons, ligaments, joints, and other connective tissue providing the body’s form, support, stability, and movement. “At 18, you think you’re always going to have unlimited energy, and that you’re never going to get sick,” said Gleason, adding that maintaining good health habits is like saving for retirement. “People don’t do that, either, because they can’t envision that day coming.” “But your body is going to change,” he said. “It’s hard to even conceive of that until you’ve walked that road.”   Read More ... Military telepain clinics in D.C. area help patients manage pain Dr. Christopher Spevak, director of the opioid safety program for the National Capital Region in and around Washington, D.C., uses the telehealth equipment at Walter Reed National Military Medical Center, Bethesda, Maryland. (DoD photo by Kalila Fleming) Some military treatment facilities in the Washington, D.C., area offer virtual appointments for patients being treated for chronic pain. Providers at Walter Reed National Military Medical Center in Bethesda, Maryland, can now video conference with patients who are in hospitals and clinics at Marine Corps Base Quantico, Virginia; Fort Belvoir, Virginia; Joint Base Andrews, Maryland; and the Pentagon. Dr. Christopher Spevak, director of the opioid safety program for the National Capital Region in and around Washington, D.C., said telehealth is especially important for patients who are using opioids to manage chronic pain because it gives them easier access to doctors who specialize in pain management and can offer alternative modalities. “Virtual health care has really a unique opportunity to help with pain care and decreasing our opioid burden, not only in the military but in civilian sectors,” said Spevak. Sometimes, remote hospitals and clinics don’t have the capacity Walter Reed has to offer substitutes for opioids. “That’s the unique advantage of this program.” Spevak explained this telehealth option is currently offered to those clinics in the D.C. area because providers must also be credentialed in the facilities where the patient is sitting for video consultation, in addition to the hospital where the doctor is located. All military hospitals and clinics provide the highest level of security for patient information in these video discussions. “This isn’t a visit that occurs over your cellphone or Skype or any other commercial type of service,” said Spevak. “It’s a military-grade standard with a secure connection, that is compliant with all federal and state privacy regulations.” Retired Army Lt. Col. Bruce Moler has firsthand experience using this telepain option. The former infantryman has a chronic pain condition for a back problem that started 20 years ago, just a couple of years before his retirement in 1999. At first it was an issue with his back that cropped up after “overdoing it.” But the problem got progressively worse as he aged, and he had to increase pain meds and eventually give up things he loved, such as running and refereeing lacrosse matches. Moler lives near Quantico and has been going there for telemedicine appointments for almost two years, just after the service began at the base. “It’s been great,” said Moler. “I have no problem getting an appointment. It’s been a blessing.” Moler praised the people at Quantico who help set up the appointments on his end, and Spevak and physician assistant Jasmine Anthony, who see Moler through a computer screen at their offices at Walter Reed. “They’ve been excellent. I’m upright. I’m walking. They’ve done very well,” said the 63-year-old Moler, adding that Anthony is doing everything possible to keep him off the operating table for his deteriorating back condition. “The first time I talked with Dr. Spevak and Anthony, they told me their job was to keep me away from the surgeon’s knife as long as possible. And that’s what they have done.” Moler admitted it took a little getting used to having his care provider “seeing” him through a video screen, although there are technicians in person at the Quantico clinic who could take care of anything that required direct contact. He recommends the service to others in the D.C. area, if it’s available in their location. “It works just as well as having the doctor right there in the room with you,” said Moler. “I’m a happy customer.”  Read More ...

---

Questions for MHS? Contact Us

STAY CONNECTED:

---

Military Health System · The Pentagon · Washington, DC 20301

-------

Review of Alleged Inappropriate Contract Actions Related to VA’s Lease of a Digital Imaging Network-Picture Archival Communication System - Veterans Affairs Office of Inspector General (OIG)

Review of Alleged Inappropriate Contract Actions Related to VA’s Lease of a Digital Imaging Network-Picture Archival Communication System In June 2015, the Office of Inspector General received an allegation regarding the procurement strategy used by VA under the Department of Defense (DoD) Digital Imaging Network-Picture Archival Communication (DIN-PACS) contract. The complainant alleged that VA did not perform a proper business case analysis of its procurement strategy of leasing versus purchasing DIN-PACS. The complainant further alleged technical evaluations were manipulated, excessive amounts of equipment were purchased, and an award was made at a cost 30 percent higher than recommended by the contracting officer. We reviewed the Veterans Integrated Service Network 1 DIN-PACS lease and found that VA did not adequately evaluate the advantages or disadvantages of leasing versus purchasing DIN-PACS. Furthermore, VA did not comply with the Federal Acquisition Regulation (FAR) and DoD contract, as required by the contract terms, and determine that prices were fair and reasonable once it elected to use the DoD contract to lease the DIN-PACS. This occurred because VA’s contracting officer misinterpreted an internal directive and did not fully comply with FAR Part 7.4, which requires a lease versus purchase analysis. The contracting officer did not ensure the acquisition team fully complied with FAR to conduct this analysis even after receiving advice from VA’s General Counsel In addition, VA lacked documented evidence of a formal contract oversight review as required by VA’s Integrated Oversight Process. As a result, VA’s contracting officer’s decision to lease DIN-PAC systems at an estimated value of $9 million could lead to the wasteful spending of taxpayer dollars. We did not substantiate that VA manipulated technical evaluations, purchased excessive amounts of equipment, or made an award 30 percent higher than recommended. We recommended the Deputy Assistant Secretary for Acquisition and Logistics develop procedures to ensure the acquisition team complies with the fundamental requirements of FAR and contracting officers comply with DoD contract terms. The Principal Executive Director concurred with our recommendations. We consider their corrective action plans acceptable and will follow up on the implementation. Veterans Affairs Office of Inspector General (OIG). Veterans Affairs Office of Inspector General (OIG) · 801 I St NW · Washington, DC 20536 · 800-827-1000

-------

Find out if you qualify for VA disability compensation - U.S. Department of Veterans Affairs

Did you know VA offers monthly tax-free disability compensation to Veterans who qualify? If you have a disability as a result of an injury or disease that occurred or got worse during active military service, you may be eligible to receive VA disability compensation. Do you have a physical or mental disability? Did your injury or disease occur while in service? Is there a connection between your current disability and military service? If you answered “yes” to these questions, you may be eligible. Learn more about disability compensation and how to apply at Explore.VA.gov.   Learn More   Live life after service to the fullest with benefits you may have earned. Your first step starts with Explore.VA.gov.   U.S. Department of Veterans Affairs | 810 Vermont Ave. NW, Washington, DC 20420                                                                 Keep updated & let us know how we're doing.   Explore VA benefits at explore.va.gov   US Department of Veterans Affairs 810 Vermont Avenue, NW · Washington, DC 20420

-------
Veterans Affairs YouTube Update - U.S. Department of Veterans Affairs

Veterans AFFAIRS         VA YouTube   The American Veteran - Episode #1102 06/06/2017 10:14 AM EDT     Keep updated & let us know how we're doing.     Explore VA benefits at explore.va.gov.   US Department of Veterans Affairs 810 Vermont Avenue, NW · Washington, DC 20420

Attachments area

Preview YouTube video The American Veteran - Episode #1102

The American Veteran - Episode #1102

-------

D-Day through the eyes of a combat medic, 73 years later -Military Health System

06/07/2017 D-Day through the eyes of a combat medic, 73 years later Edwin “Doc” Pepping, left, and Albert “Al” Mampre, right, both served as combat medics attached to Easy Company during World War II. (Photo courtesy of Matthew Pepping) They trained with infantry soldiers, carrying first aid kits instead of weapons. They dodged bullets to tend to wounded soldiers, sometimes with whatever supplies they could find. And even in the midst of thick combat, they remained steadily focused on their mission of saving lives. They were the combat medics of World War II. No amount of training or planning could have prepared them for the casualties inflicted during the largest amphibious assault in history: the Allied invasion of Europe, commonly known as D-Day. “Boy Scouts was the closest thing to medical training I had before that,” said Private First Class Edwin Pepping, who was just 21 years old at the time. “But you didn’t have a chance to be nervous.” In preparation for ground combat after Pearl Harbor, the United States Army hurried to create a ready force. Medical units made up of individuals of both military and civilian background were gathered and trained. Their duties included treating minor injuries, applying splints and tourniquets, and bandaging wounds. Known as “band-aid bandits” to their comrades, Pepping and Staff Sgt. Albert Mampre were attached to Easy Company, 2nd Battalion of the 506th Infantry Regiment, 101st Airborne Division also known as the “Band of Brothers.” Seventy-three years ago today, the U.S. took part in the invasion of Normandy, which would ultimately be the turning point of the war in Europe. More than 13,000 aircraft and 5,000 ships were used in the D-Day landing, which was part of Operation Overlord. In the early morning hours of June 6, 1944, Pepping boarded a C-47 transport for the big jump. But as often happens in combat, the plan didn’t go as expected. “We were supposed to be dropped at 700 feet at 95 miles per hour, which was enough to get our parachute to open and get our equipment down safely, but they dropped us at 300 feet at 165 miles per hour, which is almost impossible to survive,” said Pepping, who turns 95 in July. As Pepping jumped, he was hit by a high speed gust of air that ripped 125 pounds worth of supplies off of him. His parachute opened at the same time, causing him to violently spin before falling to the ground. He hit the ground so hard that his own strapped helmet flew back and knocked him in the neck, leading to a concussion and three cracked vertebrae. After landing near the town of Angoville-au-Plain behind Utah Beach, Pepping spent the next several hours helping another medic, Willard Moore, bring severely combat-wounded soldiers to a makeshift aid station in a nearby church. Moore drove the jeep while Pepping loaded his wounded and nursed them until they got back to the church, he said. “There were so many catastrophic wounds that a lot of the time it was beyond us to do anything except to see if we could get a doctor to help,” said Pepping. Two other medics treated patients at the aid station. They used whatever medical supplies they could find after losing most of theirs in the jump, and they treated whomever they found – American, French, and German alike. Together, they saved more than 80 lives that day. “When we flew into Normandy, we met some very, very serious cases and a lot of the time we didn’t know exactly how to handle them,” said Pepping, adding that it taught him perseverance. Today, the church serves as a memorial. The blood stains where the wounded were laid remain on the pews. “A sense of humor is really what saved us,” said Pepping, who said the biggest lesson he learned as a medic was to duck. “You couldn’t make it through the war without it.” Although medics were unarmed, they were identified by the Red Cross symbol on their helmets and arm bands. Even so, they weren’t always spared as a target. Mampre, who had to miss the jump on D-Day after coming down with a severe infection just a few days before, went on to receive the Purple Heart for action in Holland. After spotting a wounded lieutenant in a field, he was told the soldier was dead and best left alone. Mampre ran out to him through heavy gunfire and found him alive. Despite being shot through the leg, he and the lieutenant made it to safety and survived. “I’d do it all over again,” said Mampre about being a combat medic. “But if they need me again at 95 years old, boy we’re in trouble.”  Read More ...

---

Questions for MHS? Contact Us

STAY CONNECTED:

---

Military Health System · The Pentagon · Washington, DC 20301

-------

Updates from the VA Office of Health Equity -VHA Office of Health Equity

NASEM Workshop; June Focus on Health Equity & Action (FHEA); Office of Health Equity-QUERI Partnered Evaluation Center

Announcements June 6, 2017 Learn How VA is an Example of Where Health Care and Social Determinants Meet in the Newly Released Workshop Proceedings from the NASEM The National Academies of Science, Engineering, and Medicine (NASEM) held a public workshop December, 2016 that explored the importance of affordable and accessible community-based housing especially for vulnerable adults. Dr. Uchenna S. Uchendu, Chief Officer of the VA Office of Health Equity and member of the NASEM Roundtable on the Promotion of Health Equity and the Elimination of Health Disparities, served on the planning committee and on the reactor panel that addressed policy implications and research needs discussed during the workshop. Dr. Uchendu highlighted partnerships with Veteran service organizations and stakeholders to collect data on military service, partnering with the VA, and the incorporation of social determinants of health in the electronic health record. These steps further ensure that community-housing programs are serving all Veterans especially vulnerable Veterans. According to the new report, “The VA is a good model of where health care and social determinants such as housing intersect, Uchendu said. Veterans’ benefits administered by the VA include education through the G.I. Bill, housing via VA loan guarantees, and housing the homeless through its partnership with HUD and other stakeholders." [Read More] The new report, Developing Affordable and Accessible Community-Based Housing for Vulnerable Adults: Proceedings of a Workshop, was released May 17, 2017 and can be downloaded for free. Source: National Academies of Sciences, Engineering, and Medicine. 2017. Developing affordable and accessible community-based housing for vulnerable adults: Proceedings of a workshop. Washington, DC: The National Academies Press. https://doi.org/10.17226/24787. READ FULL REPORT Newly Released Paper from the OHE-QUERI Partnered Evaluation Center Finds Racial/Ethnic Disparities Persist in VHA Patient-Centered Medical Home Photo Caption: Members of the Office of Health Equity and the Office of Health Equity-QUERI Partnered Evaluation Center at Face-to-Face Brainstorming Session in DC A new peer-reviewed manuscript from Dr. Donna L. Washington, MD, MH, Principal Investigator of the Office of Health Equity-QUERI Partnered Evaluation Center and co-authors was released today. The new manuscript, Racial And Ethnic Disparities Persist At Veterans Health Administration Patient-Centered Medical Homes, explores the implementation of the VHA patient-centered medical home and racial and ethnic disparities in hypertension and diabetes outcome data. The manuscript is published in the June 2017 issue of Health Affairs journal themed, “Pursuing Health Equity.” Dr. Washington, along with a panel of experts and other authors, participated in a high- level conversation about contributing factors to health and health care disparities today at the National Press Club in Washington, DC. Dr. Washington will also present the findings from this new manuscript at the June 2017 Focus on Health Equity and Action Cyberseminar on Thursday, June 29th, 2017. Details and registration information about the session are available further below.   Racial and Ethnic Disparities Persist At Veterans Health Administration Patient-Centered Medical Homes Abstract:  Patient-centered medical homes are widely promoted as a primary care delivery model that achieves better patient outcomes. It is unknown if their benefits extend equally to all racial/ethnic groups. In 2010 the Veterans Health Administration, part of the Department of Veterans Affairs (VA), began implementing patient-centered medical homes nationwide. In 2009 significant disparities in hypertension or diabetes control were present for most racial/ethnic groups, compared with white veterans. In 2014 hypertension disparities were similar for blacks, had become smaller but remained significant for Hispanics, and were no longer significant for multiracial individuals, whereas disparities were now significant for American Indian/Alaska Natives and Native Hawaiians/other Pacific Islanders. By contrast, in 2014 diabetes disparities were similar for American Indian/Alaska Natives, Blacks, and Hispanics, and were no longer significant for Native Hawaiians/other Pacific Islanders. We found that the modest benefits of the VA’s implementation of patient-centered medical homes were offset by competing multifactorial external, health system, provider, and patient factors, such as increased patient volume. To promote health equity, health care innovations such as patient-centered medical homes should incorporate tailored strategies that account for determinants of racial/ethnic variations. Evaluations of patient-centered medical homes should monitor outcomes for racial/ethnic groups.    Source: Washington DL, Steers WN, Huynh AK, Frayne SM, Uchendu US, Riopelle D, Yano EM, Saechao FS, Hoggatt KJ. (2017) Racial And Ethnic Disparities Persist At Veterans Health Administration Patient-Centered Medical Homes. Health Affairs, 36(6):1086-1094. June Focus on Health Equity and Action Cyberseminar Focuses on New Research on Disparities in Obesity and Hypertension and Diabetes Disparities in the VHA Patient-Centered Medical Home Please join the Office of Health Equity for the June 2017 Focus on Health Equity and Action Cyberseminar titled, “Chronic Health Conditions among Vulnerable Veterans: Current Research and Action.” Event description and registration information is below. Chronic Health Conditions among Vulnerable Veterans: Current Research and Action Thursday, June 29th, 2017 3:00 – 4:00 PM (EST) REGISTER Event Description June’s Focus on Health Equity and Action Cyberseminar session spotlights recent publications on chronic health conditions and disparities among vulnerable Veteran patient groups: The Obesity Epidemic in the Veterans Health Administration: Prevalence Among Key Populations of Women and Men Veterans (April 2017) Racial and Ethnic Disparities Persist At Veterans Health Administration Patient-Centered Medical Homes (June 2017) Panelist will discuss the following: 1) demographic variability in the prevalence of chronic health conditions and disparities among Veterans using primary care in VHA; 2) recent efforts in using VA data to systematically characterize health and healthcare disparities in VA for vulnerable Veteran groups; 3) the potential for the patient-centered medical home to identify and reduce disparities; and 4) operational and research partnerships executed by the Office of Health Equity to advance the goals of the VA Health Equity Action Plan. Confirmed Speakers Jessica Y. Breland, PhDVA Palo Alto Healthcare System, Palo Alto, CA  Donna L. Washington, MD, MPHVA Greater Los Angeles Healthcare System, Los Angeles, CA   Uchenna S. Uchendu, MDChief Officer, Office of Health Equity, Washington, DC Background Resources  Breland, J.Y., Phibbs, C.S., Hoggatt, K.J., Washington, D.L., Lee, J., Haskell, S., Uchendu, U.S., Saechao, F.S., Zephyrin, L.C. & Frayne, S.M. (2017). The obesity epidemic in the Veterans Health Administration: Prevalence among key populations of women and men Veterans. Journal of General Internal Medicine, 32(1):11-17. Washington DL, Steers WN, Huynh AK, Frayne SM, Uchendu US, Riopelle D, Yano EM, Saechao FS, Hoggatt KJ. (2017) Racial And Ethnic Disparities Persist At Veterans Health Administration Patient-Centered Medical Homes. Health Affairs, 36(6):1086-1094. REGISTER Visit the Office of Health Equity website at https://www.va.gov/healthequity/ for more details about Veteran health equity issues, VA’s strategic plan to achieve health equity for Veterans (Health Equity Action Plan), and to learn more about the Focus on Health Equity and Action Cyberseminar series. Using VA Data to Characterize Health and Healthcare Disparities in VA with the Office of Health Equity-QUERI Partnered Evaluation Center Despite some progress in eliminating or reducing health disparities in the VA healthcare system, health and healthcare disparities unfortunately exist for some vulnerable Veterans. The Office of Health Equity-QUERI Partnered Evaluation Center, led by Dr. Donna L. Washington, Principal Investigator, was established to support the VA Office of Health Equity’s efforts to better understand the extent of these disparities and engender appropriate actions. Join Dr. Washington this month as she discusses the work of the Office of Health Equity-QUERI Partnered Evaluation Center. Using VA Data to Characterize Health and Healthcare Disparities in VA Tuesday, June 20th, 2017 12:00 – 1:00 PM (EST)  REGISTER Event Description The Office of Health Equity-QUERI Partnered Evaluation Center uses VA data to systematically characterize the health and healthcare disparities in the VA for vulnerable Veteran groups. This presentation will describe the challenges and strategies for using VA data to measure characteristics of vulnerable populations, such as race/ethnicity and socio-economic status. The cyberseminar will also present findings on health and healthcare disparities in the VA. Objectives Describe the data sources and data decisions used to construct vulnerable population characteristics, such as race/ethnicity and measures of socio-economic status. Describe variations in patient experiences of VA care and in VA care quality by vulnerable population characteristics. REGISTER Additional Resource Focus on Health Equity and Action Cyberseminar - 03/24/2016 Using Data to Characterize Vulnerable Veteran PopulationsSusan Frayne, MD, MPH; Uchenna S. Uchendu, MD U.S. Department of Veterans Affairs810 Vermont Avenue, NW Washington DC 20420

US Department of Veteran Affairs, Veterans Health Administration, Office of Health Equity, 810 Vermont Avenue, NW · Washington, DC 20420

-------

A Veteran's Final Hours at a VA Hospital - Veterans Health

Veterans Health Administration Update     Veterans Health Administration Update         Inside Veterans Health   A Veteran's Final Hours at a VA Hospital Carol Graves, wife of Army Veteran ‘C.A.’ Graves, said her 76-year-old husband received the utmost respect and kindness during the last few days of his life at the VA hospital in Shreveport, La. Read the full story     Keep updated & let us know how we're doing. US Department of Veterans Affairs Veterans Health Administration · 810 Vermont Avenue, NW · Washington, DC 20420 · 877-222-VETS (877-222-8387)

-------

Veterans Affairs YouTube Update - U.S. Department of Veterans Affairs

Veterans AFFAIRS         VA YouTube   Press Briefing with VA Secretary David J. Shulkin, MD 06/06/2017 08:57 AM EDT     Keep updated & let us know how we're doing.     Explore VA benefits at explore.va.gov.   US Department of Veterans Affairs 810 Vermont Avenue, NW · Washington, DC

-------

Army veterinarian reflects on unconventional journey to colonel - Military Health System

06/06/2017 Army veterinarian reflects on unconventional journey to colonel Just out of high school and unsure of what to do with his life, a young Ohio man went to a bus depot, handed a ticket agent almost everything in his pocket and said with a smile, “I’ll go wherever this takes me.” So begins James “Nick” Koterski’s unconventional journey to Army colonel. (Courtesy photo) Just out of high school and unsure of what to do with his life, a young Ohio man went to a bus depot, handed a ticket agent almost everything in his pocket and said with a smile, “I’ll go wherever this takes me.”  So begins James “Nick” Koterski’s unconventional journey to Army colonel. Landing in New Orleans, he emptied his pocket on a good meal. Shucking oysters nights and weekends to earn money, he worked toward an undergraduate degree from the University of New Orleans, and eventually, completed his doctorate of veterinarian medicine in 1989 from Louisiana State University. Koterski worked in a regular clinical practice for a few years. “It wasn’t for me,” he said, so he found a food inspector position with the U.S. Department of Agriculture.  A couple of years later, a colleague in the Army Reserve suggested that his adventurous nature would make him a good fit for the Army. His first assignment sent him to Fort Monmouth, New Jersey, where he primarily conducted food inspections for the commissary and exchange.  However, he said, what made the assignment really satisfying was providing for the medical needs of all the working dogs for the Port Authority of New York and the Coast Guard. He continued his food inspection role for all DoD installations and vendors at the southern tip of Korea, stationed at Camp Hialeah. Koterski returned to New Jersey and earned a doctorate in microbiology from Rutgers University. These credentials led him to join an exclusive group of medical research scientists, who account for about six percent of the 400 Army veterinarians.  Koterski joined DoD’s lead lab for medical biological defense research, the U.S. Army Medical Research Institute for Infectious Diseases, Fort Detrick, Maryland.  The institute’s core mission is to protect service members from biological threats, but it also investigates disease outbreaks and threats to public health, especially those that can be used as weapons. One of his first expeditions involved working with local public health researchers at various Native American reservations in the “four corners” area (Arizona, New Mexico, Colorado, and Utah). He worked on a new test for plague, which naturally occurs in prairie dogs and other rodents in the area. He had another memorable assignment with Inuit natives in Canada’s Northwest Territory on the Great Slave Lake, sampling tissues of wildlife to find bacterium similar to anthrax, but not as highly lethal. Koterski returned to Fort Detrick in 2005, this time with the U.S. Army Medical Material and Development Activity, to develop new drugs for biological defense threats not common enough for drug companies to invest in. Koterski said one of his most challenging assignments was the year he spent in the Democratic Republic of Congo, where he helped collect blood samples from patients, and charted the natural course of a rare disease called monkey pox, similar to smallpox. In 2012, Koterski deployed to Kandahar, Afghanistan, as part of a Forward Assist Science and Technology team investigating products to enhance combat safety and medical efficiency. “It was interesting and rewarding,” he said. He gathered direct input on a noise-cancelling stethoscope intended for use on medivac helicopters. “We also spent a lot of time talking to infantrymen finding out what did and didn’t work in pursuit of new items like ballistic and blast-resistant undergarments.” Since May 2015, Koterski has been the medical countermeasures director in the Office of the Assistant Secretary for Health Affairs in the Department of Defense. He works closely with the Departments of State, Health and Human Services, and Homeland Security ensuring the national stockpile of countermeasure vaccines and drug treatments is maintained. Koterski, who is retiring in the fall after 22 years of service, said no single role or assignment stands out as his favorite. “You know, it really isn’t about what I did or where,” he said, “it’s about appreciating each and every person I’ve had the great fortune to spend time with on the journey.” Read about the 101st anniversary of the Army Veterinary Corps.   Read More ... Physical therapy helps keep pain away Aviation Electrician's Mate Airman Melanie Hess performs physical therapy aboard the amphibious assault ship USS Bataan. Three months into Bataan’s deployment the physical therapy area in the medical ward continues to see dozens of patients a week. (U.S. Navy photo by Mass Communication Specialist 2nd Class Magen F. Reed) FIFTH FLEET AREA OF OPERATIONS — Navy medicine strives to provide comprehensive care to Sailors and Marines all over the world. For a long time physical therapy has been a part of that at hospitals on shore and aboard aircraft carriers at sea. According to Navy Lt. Joseph Neil, a physical therapist attached to Fleet Surgical Team 6, it is now made available for the first time to a greater portion of the Navy with the amphibious assault ship USS Bataan. “We’ve been demonstrating since the early 2000s that physical therapy was a valued asset aboard aircraft carriers,” said Neil. “Recently it was proposed that we could be helpful on the smaller amphibious assault ships. This study right now is to try and demonstrate the value of it by helping reduce the days that are lost to injury and trying to improve the overall health of the crew.” A deployed naval vessel has a lot of moving parts. Those aboard are working almost nonstop every day they are underway. Bataan is 844 feet long from bow to stern and inside is a honeycomb of passages that each crew member must traverse to complete their daily tasks. “Life on a ship can be very stressful on your body,” said Hospitalman Drew Aligsao, who is training with Neil as a physical therapy technician. “Just walking around the ship with the high impact surfaces and steep ladderwells can cause problems for your body.” With that in mind, Neil wasn’t surprised at the demand for services when he started working aboard Bataan. “The first few weeks we were here we were inundated with patients,” he said. “Sometimes all they will need is a manipulation of their back or maybe a few exercises they can perform on their own. Then there are other cases where we’ll try to have the patient come in a few times a week to get more skilled, hands-on guidance from us.” According to Neil, physical therapists in the Navy are autonomous, independent care providers. What that means for the average crew member is they don’t have to go through a referral process to be seen. A quick trip to see the physical therapist to set up an evaluation is all that’s needed. After the initial introduction comes an evaluation of the problem. Lack of mobility, loss of muscle strength, and any number of other conditions are brought into consideration. Then the physical therapist creates a plan of care that is carried out by himself with the assistance of the physical therapy technician. Three months into Bataan’s deployment the physical therapy area in the medical ward continues to see dozens of patients a week. Their patient count indicates the value of their presence aboard the ship. “Navy medicine’s priority is ensuring the health of Sailors and Marines,” said Neil. “We do that by operating our forces where our Sailors and Marines operate themselves. We’re at shore in large hospitals or smaller clinics, we’re on ships and downrange with them. There are very few places where physical therapy does not reach out to.” Disclaimer: Re-published content may have been edited for length and clarity. Read original post.  Read More ...

---

Questions for MHS? Contact Us

STAY CONNECTED:

	|

---

Military Health System · The Pentagon · Washington, DC 20301

-------

Review of Alleged Overpayments for Non-VA Care Made by Florida VA Facilities - Veterans Affairs Office of Inspector General (OIG)

Veterans Affairs Office of Inspector General (OIG). Review of Alleged Overpayments for Non-VA Care Made by Florida VA Facilities The OIG Hotline received an allegation in October 2014 that VA was paying full price for physician services to a non-VA care provider rather than paying lower contract rates, resulting in overpayments of provider claims for non-VA care. We substantiated the allegation that, contrary to Government regulations, Veterans Health Administration’s (VHA) Florida claims processing centers did not reimburse a non-VA care provider based on the applicable Medicare rates, when appropriate. We determined that VHA payments exceeded Medicare rates in 52 of the 55 examples provided by the complainant, of which 44 (with a value of $27,010) were related to specific physician administered drugs. The associated overpayments totaled $28,295. Based on these results, we expanded our review to all payments made by Florida VA facilities from October 1, 2012 through March 31, 2016 for these types of services. Our review of 73,124 payments to non-VA care providers for physician-administered drugs from October 1, 2012 through March 31, 2016 identified 26,178 overpayments (35.8 percent), totaling approximately $17.2 million, ranging from $.01 to $47,943.40. Of this $17.2 million, VHA overpaid approximately $6.9 million (40.2 percent) to the provider identified in the allegation. These overpayments occurred because VHA did not use Medicare rates for physician administered drugs, as published by the Centers for Medicare & Medicaid Services. These funds could have been more effectively spent on veteran care. We recommended the Under Secretary for Health ensure that all payments for non-VA physician-administered drugs are made in accordance with the Code of Federal Regulations for all Veterans Integrated Service Networks. We also recommended the Under Secretary develop a plan for uploading Medicare rates into the Fee Basis Claims System (to enable the proper payment of physician-administered drug claims) and issue Bills of Collection for overpayments to non-VA care providers. VHA concurred with our recommendations and provided an action plan to address those recommendations. VHA also stated that they would provide the OIG with documentation to support completion of the action plans. Veterans Affairs Office of Inspector General (OIG). Veterans Affairs Office of Inspector General (OIG) · 801 I St NW · Washington, DC 20536 · 800-827-1000

-------

Snoqualmie Washington Man Sentenced to Three Years in Prison for Defrauding Government Programs of More than $646,000 - Veterans Affairs Office of Inspector General (OIG)

Press Releases for Veterans Affairs Office of Inspector General (OIG). Snoqualmie Washington Man Sentenced to Three Years in Prison for Defrauding Government Programs of More than $646,000 Veteran sentenced to prison for lying about injuries received during military service to defraud the VA and other agencies of benefits. Veterans Affairs Office of Inspector General (OIG). Veterans Affairs Office of Inspector General (OIG) · 801 I St NW · Washington, DC 20536 · 800-827-1000

-------

Review of Alleged Mismanagement of VA’s Personal Identity Verification Processes - Veterans Affairs Office of Inspector General (OIG)

Oversight Reports for Veterans Affairs Office of Inspector General (OIG). Review of Alleged Mismanagement of VA’s Personal Identity Verification Processes The Office of Inspector General (OIG) conducted this review to determine the merits of allegations involving the mismanagement of the Personal Identity Verification (PIV) Program and related systems. In June 2015, we received a Hotline complaint alleging that VA’s Security and Investigations Center (SIC) was inappropriately permitting the issuance of PIV cards and VA network system access to individuals who did not have completed background investigations or adjudicated fingerprinting. SIC personnel process and adjudicate the background investigations for all moderate and high risk public trust and national security positions for Federal employees within VA. They also process all levels of investigation for contractors performing jobs and functions for VA. We determined that SIC personnel appropriately authorized the issuance of PIV cards in accordance with VA policies and procedures. More specifically, we did not find any instances where VA’s SIC was inappropriately authorizing the issuance of PIV cards and allowing VA network system access to individuals who did not have completed a Special Agreement Check (SAC) and a scheduled background investigation as required by VA policy. We reviewed VA local policies and procedures as they related to PIV card authorizations. To evaluate business processes and compliance with VA policies, we judgmentally selected 32 cases to sample from VA’s Security Manager system of record. The 32 cases included 25 individuals chosen randomly, six personnel who were SIC management, and one individual who was named in the complaint as having received a PIV card without meeting VA policy requirements. We observed SIC personnel accessing each of these cases in the system of record and reviewing the electronic records, SAC, background investigation dates, and any relevant comments associated with each case. We found that each case we reviewed met VA policy requirements for PIV card authorization. As a result, we concluded that SIC personnel appropriately authorized the issuance of PIV cards in accordance with VA policy. We did not substantiate the allegations of SIC’s mismanagement of the PIV Program and related systems. Additionally, we did not find any instances of improper processing of selected cases. Accordingly, we have no recommendations for improvement. Management concurred with our report and did not provide any comments. Veterans Affairs Office of Inspector General (OIG). Veterans Affairs Office of Inspector General (OIG) · 801 I St NW · Washington, DC 20536 · 800-827-1000

-------

DoD Vaccine Research Saves Military, Civilian Lives - Military Health System

DoD Vaccine Research Saves Military, Civilian Lives Mosquitoes lie in a petri dish for testing. Personnel at the Walter Reed Army Institute of Research, a Defense Department biomedical facility in Silver Spring, Maryland, are researching and developing vaccines that can save military and civilian lives. (U.S. Air Force photo) SILVER SPRING, Md. — Americans rely on the U.S. military to keep them safe from humans who would do them harm. What they might not know is that some service members work around the clock to protect them from microscopic bad guys, as well – i.e., deadly viruses and bacteria. Personnel at the Walter Reed Army Institute of Research, a Defense Department biomedical facility in Silver Spring, Maryland, are researching and developing vaccines that can save military and civilian lives. Disease Prevention Army Col. Paul Keiser, director of Walter Reed Army Institute of Research’s Viral Diseases branch, holds one of the insectary’s mosquito habitats at WRAIR. Around 250 adult mosquitos live in each bucket. (DoD photo by Rick Docksai) The military has a personal interest in disease prevention. U.S. service members deploy to areas rife with malaria, Zika and other dangerous pathogens. Troop infections happen, and when they do they require costly, time-consuming medical leave and hospitalizations. Effective new vaccines can consequently be the key to healthier troops and better-operating units. But civilians get these treatments, too. Glaxo-Smith-Kline and Sanaria are both close to rolling out new vaccines for malaria, a disease responsible for 300,000 deaths worldwide every year. And WRAIR was a research partner for both. WRAIR was additionally a research partner in the development of every existing malaria medication on the market today, according to Kevin Modjarrad, WRAIR’s associate director for emerging infectious diseases. “Every single licensed therapy for malaria has somehow made its way through Walter Reed Army Institute of Research at some point in its development: It was tested, validated and developed within our institution,” Modjarrad said. Important Vaccines Walter Reed Army Institute of Research’s “insectary” breeds and houses tens of thousands of mosquitos for use in malaria vaccine trials. (DoD photo by Rick Docksai) WRAIR developed the first effective licensed vaccine against meningitis in the 1970s. And in recent years, according to Modjarrad, WRAIR has tested several vaccines against Ebola. One of them went into use in Nigerian communities during the West African Ebola outbreak of 2014 with highly positive results. “It did save lives,” Modjarrad said. “Wherever we tested it, those people did not get Ebola.” Modjarrad is co-leading a WRAIR program to develop a Zika vaccine. The program has made rapid progress, moving from an initial experimental vaccine in early 2016 to a preliminary human trial last November that is still screening new volunteers. Modjarrad attributed the fast turnaround time to earlier work WRAIR researchers had done on vaccines for dengue and encephalitis, which are in the same family of viruses as Zika. “We were able to use the knowledge we had gained from that platform and make a Zika vaccine with the same methods and the same general platform,” Modjarrad said. Military-Civilian Partnership WRAIR is also finishing trials of a vaccine for Middle East Respiratory Syndrome, or MERS, and is planning another malaria vaccine trial that will start in fall of this year. And it is partnering with Themis-GmbH, an Austrian-based pharmaceutical company, to test a vaccine for chikungunya, a mosquito-borne disease that has appeared in countries in Africa, Asia, Europe, the Indian and Pacific Oceans and islands in the Caribbean. Although rarely fatal, it can leave infected persons with long-lasting joint pain. And its vast geographic spread causes military leaders significant concern for their troops. “When you take a whole bunch of personnel and put them in an area where there’s ongoing disease transmission, a lot of them will get sick at the same time. And then you can’t carry out your missions, because too many of your soldiers are having joint pain and can’t march,” said Paul Keiser, director of WRAIR’s viral diseases branch. “Not only do you have short-term mission compromise, but you have long-term disability.” Themis-GmbH CEO Erich Tauber praised WRAIR’s expertise at vaccine testing, which he said greatly accelerated the chikungunya research. Tauber forecasts that the vaccine could be ready in less than five years, thanks to WRAIR. “The test that we used was very well established at WRAIR, and they have done this testing for us with exceptional expertise. WRAIR’s involvement has greatly helped us to advance the project,” Tauber said. PaxVax, a U.S.-based pharmaceutical company, is working on its own chikungunya vaccine but will work with WRAIR to carry out its next human clinical trial, according to John Smith, chief scientific officer at PaxVax. Smith credited WRAIR with providing “significant funding to further this vaccine effort.” Networks of Support WRAIR is DoD’s largest disease-research center. But it doesn’t work alone. Fort Detrick, Maryland, hosts the U.S. Army Medical Research Acquisition Activity, which also researches new pharmaceuticals and is aiding WRAIR and PaxVax’s vaccine-development efforts. “It takes all of these activities working in concert to efficiently develop new vaccines,” Smith said. “PaxVax very much appreciates the expertise that has been made available from each of these activities, and has a high level of confidence that effective vaccines will result from the close interaction that has been possible in this partnership.” Developing vaccines is expensive, and private-sector pharmaceutical companies are not always in a position to pursue them on their own. Private investment is often sparse, Keiser noted, since the profit margin for a vaccine, which a patient takes only once, is typically lower than that of a maintenance drug that a patient takes repeatedly. WRAIR mitigates this problem, he added, by providing resources and support to jumpstart a vaccine research program and get it far enough advanced that large private companies will be interested in acquiring them. “By us funding further studies of these vaccine candidates, we can generate more data on how safe and effective they are. And that will make it more likely that a drug company may pick them up,” he said. As long as infectious diseases threaten us, WRAIR will continue to support the rollout of effective safeguards against diseases, both for U.S. troops and for the civilians those troops protect. “What we do is meant to be directly relevant for the warfighter. But our work doesn’t stop there. It's very much integrated into global health. The products that we develop are broadly relevant not just to our service members, but the communities they’re serving in, as well,” Modjarrad said. Disclaimer: Re-published content may have been edited for length and clarity. Read original post. Read More ...

---

Questions for MHS? Contact Us

STAY CONNECTED:

---

Military Health System · The Pentagon · Washington, DC 20301

-------