VA Secretary Nominee James Peake Vows To Move Swiftly To Improve Health Care Services For Veterans
Main Category: Public HealthArticle Date: 03 Dec 2007 - 6:00 PDT
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Retired Army Lt. Gen. James Peake, President Bush's nominee for Department of Veterans Affairs secretary, has promised to quickly repair problems in the VA health system if confirmed, according to a 28-page questionnaire submitted to the Senate Veterans' Affairs Committee that was obtained Thursday by the Associated Press, the AP/Houston Chronicle reports. Peake stated that he would work to improve accountability, streamline the VA and Department of Defense health systems and make treating veterans with post-traumatic stress disorder "a very high priority." In addition, Peake said he wants to reduce delays in disability claims decisions from the current average of 180 days to 125 days. Peake said that he would make efforts to improve and streamline medical record-keeping. He wrote, "Timely is yesterday!" adding, "So my answer is that we need to move as quickly as possible with initiatives that do share digital data and records."
Also in the disclosure, Peake denied having "firsthand" knowledge during his tenure as U.S. Army surgeon general from 2000 to 2004 about substandard care that some veterans were receiving at Walter Reed Army Medical Center. Peake also said that if confirmed, he would leave his post as chief medical officer of QTC Management, which has held millions of dollars in contracts with the VA. Peake, who took an unpaid leave of absence from the company after his nomination, wrote, "If confirmed, I will terminate any connection with QTC, will have no ongoing or residual financial interest in QTC and will recuse myself in any matters related to QTC."
He also promised upon confirmation to divest stock holdings in more than 57 companies, including many pharmaceutical companies that either currently or might do business with the VA, according to a Senate staffer who requested anonymity. The committee on Wednesday is scheduled to consider Peake's nomination (Yen, AP/Houston Chronicle, 11/29).
Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
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Salisbury Veterans Affairs
posted by jason edwards on 5 Oct 2008 at 6:40 amLadies and Gentlemen,
I am a concerned decorated Veteran, US taxpayer and loyal United States Citizen. I am concerned and bewildered of the recent administrative decisions concerning the Salisbury Veterans Affairs Medical Center. On September 19, 2008, the Director of the Medical Center made the announcement to close Emergency Room, Inpatient Medical and Surgical Unit, Inpatient Surgery Services, and the Intensive Care Unit. The administration’s goal is to progress to a long-term and mental-health Center of Excellence.
The United States Economy is already in shambles. Proceeding with the plans to close the Salisbury VAMC Emergency and Inpatient Services may create a windfall of needless additional spending on services that the Salisbury VAMC can provide themselves if adequately staffed to support the current available services. According to the Salisbury VAMC Website, “Primary and secondary inpatient health care are available to more than 287,000 veterans living in a 23-county area of the Central Piedmont Region of North Carolina. This includes the Charlotte area with over 100,000 veterans, and the Winston-Salem area with 65,000 Veterans. The Salisbury VAMC has been authorized 159 Hospital Beds for Inpatient services that include acute medicine, cardiology, surgery, psychiatry and physical medicine and rehabilitation, as well as sub-acute and extended care. It also was authorized 270 Nursing Home Beds, 55 Psychosocial Residential Treatment Program/Substance Abuse Residential Rehabilitation Program Beds. It has been designated a General Medical and Surgical Hospital with supporting specialty programs that include Ambulatory Care, Psychiatric Intensive Care, Mental Health Clinic, Nuclear Medicine, Psychiatric Emergency Service, Pulmonary Function Laboratory Geropsychiatric Unit, Psychiatric Community Team, Nursing Home Care Unit, MRI, Interventional Radiology, PTSD Program, Homeless Veterans Treatment Program, Sustained Treatment and Rehabilitation Unit, Women’s Health Care, Advanced Low Vision Clinic, Care Coordination Home TeleHealth.”
It is a disappointment and embarrassment that the leadership has not equipped the hospital with the resources needed to fulfill its great potential. Medical, Surgical, and Interventional Services are routinely outsourced to local contractors. Fee Basis is a common practice for services the Salisbury VA can provide if adequately equipped. The census on the Medical, Surgical and Intensive Care Units has been significantly reduced over the past year to enable the staff to provide safe and efficient patient care versus recruiting additional staff to alleviate the workload. All of this costs the taxpayer hunders of thousands of dollars each month. Meanwhile, a select few are rewarded with substantial bonuses while undercutting services. Statistics are manipulated, appointments cancelled, consults cancelled, procedures outsourced, primary care Providers encouraged to schedule a follow-up appointment with patients with chronic illness only twice a year, and recently the clinics have been instructed not to schedule future appointments outside the 30 day Performance Marker. Instead, a letter is sent to the Veteran to “call for an appointment in six months.” These current administrative practices can be attributed to VA Performance Measures goals. Meeting Performance Goals equates to thousands of dollars in bonuses to certain individuals. The implementation of Performance Goals is to improve quality, but the way this administration carries this out interferes with quality patient care.
I have been reviewing the cost comparisons of implementing the closure of these essential units and contracting these services to local facilities. The average cost comparison of Common Diagnosis-Related Groups (DRGS) between the Salisbury Veterans Affairs Medical Center (VAMC) and local facilities does not appear to be cost effective care. According to the North Carolina Hospital Association figures (see below), the average Common DRGs that can be treated at the Salisbury VAMC would cost an average of $15,000 each at local facilities. The Salisbury VAMC treated approximately 2,500 Inpatients last year. If one would multiply these 2,500 patients by $15,000 for each patient, it would equal an additional cost to the taxpayer $37,500,000 per year (since the Salisbury plans on no reduction in force). The current plan to eliminate Veteran’s Services would cost tens of millions of dollars more as compared with the current staffing at the Salisbury VAMC Emergency Room and Inpatient Units. In addition, the NCAH explains that, “the average charge shown for each procedure reflects the average charge by the hospital during the 2006 fiscal year. Physicians' professional fees are typically billed separately by the physicians and are not reflected in the charges shown on the data below. Charges for a procedure vary from hospital to hospital. Charges may also differ for patients at the same hospital based on the nature of the patient's treatment and care.” These hidden charges would add significantly to the average $15,000 DRG at a local facility. This is only the tip of the iceberg. According to Mrs. Carolyn Adams during her meeting with Veterans September 29, 2008, “only 2,000 out of 21,000 VA Emergency Room Visits were real emergencies.” This is roughly 10% emergent cases out of the total encounters, but this compares with most national Emergency Room encounters at 10-15% emergent cases actually seen. Closing the Salisbury VAMC Emergency Room will also significantly add an astronomical cost for outsourcing these 21,000 Veterans to local facilities.
In summary, since 1953, VAMC Salisbury has been improving the health of the men and women who have so proudly served our nation. The Salisbury VAMC’s Mission is to provide high quality, patient focused, cost-effective health care to Veterans. Unfortunately, the current plan to eliminate Emergency Care and Inpatient Medical and Surgical Services does not support this philosophy, nor is it in the best interest of its Veterans. Unfortunately, it has the potential to foster more unnecessary spending and multiply the complexities of our already fragmented health care system. Veterans have sacrificed lives, health, family, friends and well-being for their service to our country. Veterans and the taxpayer will suffer because of this waste, fraud, and abuse of government administrators. This plan to close Veterans Affairs Services will add millions of dollars to the Government’s current 700 Billion Dollar Bailout and leaving the taxpayer and Veterans with the bill.
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