Monday, January 15, 2018

VAMC NORTHPORT - WEEKLY NEWS DUMP

IT ONLY GETS BETTER FROM HERE...
I am still having trouble with people who write articles about our Nation's Veterans and refuse to capitalize the “V". It seems references to Program and Initiatives receive a capital “V”, but when it comes to the men and women who risk their lives for this Country, the default spelling drops down to a lower-case “v”. This, folks, is the ultimate insult to those who keep our Nation free and democratic.

In The News:


VETERANS AFFAIRS

Senate Passes VA Telehealth Expansion Bill

January 5, 2018

The Senate recently passed the Veterans E-Health & Telemedicine Support (VETS) Act to expand access to tele-health services for VA patients.

The Senate voted unanimously for the bill, which was sponsored by Senators Ernst (R-Iowa) and Mazie Hirono (D-Hawaii).

“All of our veterans must have access to quality and timely care, including life-saving mental health treatment, regardless of where they live,” Sen Ernst said in a press release. “The VETS Act would allow Iowa’s rural or disabled veterans to receive care from their own home by increasing tele-health and telemedicine services provided by the VA. With more than 200,000 veterans across Iowa, I am thrilled to see our bipartisan effort advance through the US Senate so we can continue working to ensure better care for those who have sacrificed so much.”

The bill reforms VA tele-health licensure by allowing providers to connect with and serve patients anywhere in the country, despite the provider’s location.

According to Sen Ernst, the VETS Act will expand access to mental health services for VA patients. By removing the barrier of state lines, providers will be able to service patients in states and areas of the country that lack tele-health services for mental health. Sen Hirono said that this bill will be especially helpful for veterans living in Hawaii.

“The VETS Act will help Hawaii veterans access high quality VA care and health services when they need it, where they need it,” she said. “I urge the swift enactment of the bill and will continue to fight to ensure Hawaii veterans can access the care they need from a strong, well-resourced VA system.”

The bill will move to committee where the Senate and House must reconcile the language discrepancies between their two bills before passing it onto the President and into law. The House passed its own version of the bill in November.
I guess we’re just going to have this rammed down our throats by VA & Congress. Obviously, no one consulted with the end-users of this anti-Veteran program.

VA is looking for medical center directors to honor America’s Veterans in these locations




Posted on Tuesday, January 9, 2018 6:03 pm Posted in VA Careers by VA Careers 80 views

Update: New locations seeking medical center directors – see list below.

The recent “Department of Veterans Affairs Accountability and Whistleblower Protection Act of 2017,” dramatically speeds up hiring of Medical Center and Network Director positions. Thanks to the new law, VA now has the flexibility to hire qualified health care executives expeditiously to lead its key health care organizations without going through a previously cumbersome and time-consuming hiring process.

“Being able quickly to hire skilled executives to lead our medical centers and networks is a powerful tool to ensuring the best possible leadership being put in place,” said VA Secretary Dr. David J. Shulkin. “Leaders establish the vision for our thousands of employees who are doing their best to serve our nation’s Veterans. They also ensure accountability for those employees who do not deliver the care our Veterans deserve.”

The Medical Center Director has the full delegated authority and responsibility for executive level management of the VA Medical Center (VAMC). The Director has overall responsibility for planning, organizing, coordinating, controlling, reviewing, evaluating, and improving the medical, administrative and support operations of the facility.

Some locations currently available for Medical Center Director openings:
• Bedford, MA
• Buffalo, NY
• Dublin, GA
• Saginaw, MI
• Danville, IL
• Fayetteville, AR
• Walla Walla, WA
• San Juan, PR
VA encourages qualified candidates for medical center or network director positions to apply immediately by contacting the VHA Virtual Recruitment Center at 844-456-5208, or by submitting a résumé for consideration to VACareers@va.gov.
They could add every VA facility to this list and the system would still be all “f##ked" up! Screw a bunch of directors. Our little slice of Heaven could use a top-to-bottom replacement of all middle and upper management.

VA to Begin Paying Up to 800,000 Non-VA Emergency Claims
Tom Philpott 11 Jan 2018

Military Update: The Department of Veterans Affairs published a revised rule Jan. 9 that allows payment of hundreds of thousands pending claims for private sector emergency care that veterans' other health insurance covered in part but not in full.

Some pending claims for non-VA emergency care were filed as far as back as 2010 and were kept alive by appeal. In some cases, individual reimbursements owed will total tens of thousands of dollars, for example for emergency heart surgery or other complex procedures not covered well by alternative health plans.

Also:       

Oh, Mary, Joseph, & Jesus.....Watch them screw the pooch on this effort, once again. You simply can’t fix STUPID!

AND, NOW FOR THE LOCAL NEWS:

“Wee” Willy Sainbert, chief O’Human Resources has been forced into retiring; effective February 30th. Steve “The Snake" Snyder has jumped in with both feet and is now the acting Chief O’Human Resources. 
Is he going to get to order his door plaque soon? Gotta keep up with “Chatty” Cathy Cruise, you know.

It’s official: Sterling “Pewter” Alexander is out - forced to resign - finally! Maybe there are a few more doctors who can be had by hospital management and forced out on trumped up charges. It seems that false charges of sexual harassment is the one sure fire way to show someone the door. Who’s next?


VA still billing private insurances of Veterans with 100% disability. This is against the Law. Check all
private insurance statements. United Health Care is starting to wise up to this fraud, and they are refusing to pay. This decision by UHC is based on the Veteran’s 100% disability-rating rule and the lack of any coding, diagnosis, documentation, etc. If you are 100% disabled, VA is not supposed to billing any outside insurance you may have. This is getting duly reported to the Inspector General, Shulkin’s office, the Government Accountability Office, and the Joint Commission. I am sure I will hear the results and let you know!


The saga of our little toxic waste dump here in Northport continues. Bldg. #11, which housed the Beacon House homeless domiciliary and HUD/VASH, has been padlocked. Homeless residents have been scattered around Long Island at other Beacon House Residents. HUD/VASH will most likely end up in Bldg. #63, if they can find the room. A small problem occurred during the last deep freeze. The heat gave out; pipes burst; water service had to be shut down; and, there was remarkable water damage leeching the black mold out of walls ceilings and floors. Watch for the “Company Line”: “Bldg. #11 temporarily closed due to major remodeling project.”

Is this the beginning of the end? When do the bulldozers arrive? The buildings that have incurred major mechanical and environments issues include, but are not limited to: Bldg. #1, Bldg. #2, Bldg. #5, Bldg. #7, Bldg. #11, Bldg. #63 (partial), Bldg. #65, Bldg. #(87??)(Pool), Connector Tunnels, Bldg. #200 (Cooling Towers, 4th Floor Bathrooms, Basement [multiple areas]). That’s 9 out of 17 Bldg.’s seriously compromised (over 50%). Those are only the ones we know about. What’s behind all those locked doors in the basements and attics of all 17 Bldg.’s? Wouldn’t OSHA love to know? How’s that maintenance tunnel between Bldg.’s #12 & #1? Oh it’s going to be a busy year for the boys and girls in the executive suite!
I wonder if Scotty “Lock The Door” qualifies for these savings


$89.........


Chimney Sweep and Safety Inspection, (31.01% Savings), Reserve Now for $31.15
I say.....go for it, Scotty!

How about that report on the Research Study on Liver Fluke; conducted a year ago by our crack Research Department ( Hussein “The Horrible” Foda, Large-and-in-Charge)?

Title of Study: Testing for Clonorchis Sinensis Exposure in Vietnam Veterans and Risk for Cholangiocarcinoma

Sponsor: Research Corporation of Long island

Principal Investigator: George Psevdos, MD VAMC: NORTHPORT

VA FORM Revised March 12, 2015

JAN 199010-1086

Seems a little pressure from Congress has bumped up the release date from 2019 to February 2018. Nonetheless, FOIA requests are in for the third time. The first two were given the old VA whitewash, double talk, and typical denial. We are holding their collective feet to the fire on this one!

WHAT WE’RE WATCHING...

1) I still can’t drive my brand new Maserati Sport Coupe into the VAMC Northport; not enough ground clearance to navigate all the bomb craters in the roads.

2) We know OSHA and the Joint Commission and Congress is on its way to our lovely Shangri-La. Keep an eye out. It might be sooner than you think, and they probably won’t announce they’re coming - sneak attack!

3) As buildings are padlocked, the management will have to toss all the residential programs out on the street to make way for Staff offices that will be moved. What a wonderful way to treat and honor VA Employees and Veterans!

4) Watch out for some blockbuster financial fraud and embezzlement issues. Keep an eye on the folks from DAV and our crack Financial Department. Can you say “Voodoo accounting”? What could possibly go wrong when you have cash business transactions with little, or no, accountability?

5) We are waiting, with baited breath, the return of Hussein “The Horrible” Foda from the cotton and rice fields of Egypt. We expect a full report on how our resident Plantation owner fared this past year, and what the prognosis is for the coming year in international agriculture.

6) I hope everyone keeps an eye on the heat and hot water situation at our little hospital on the hill. Seems we have been heating the great outdoors, now, for a few months with the underground steam leak across from Bldg. #61. The typical VA answer is just to throw a chain-link fence around it and hope it all goes away. Meanwhile, how’s the heat and hot water situation over on Bldg. #17 for the live-in Residents and Interns?

7) Forget the “betting pool” for the Super Bowl. We need to start selling boxes for the departure date of Scotty “Lock The Door” Guermonprez. Word is trickling down that Scotty wants to get out of Dodge before he really lands in a bucket of poop.

8) And, last but not least, we are watching the game of “musical chairs/beds” being played by all our VA swingers in the crowd! It’s just our little slice of Heaven on earth.





               And, just because I can't resist:


HEY, VA

MY LITTLE GIRL

DOESN’T LIKE

YOU VERY MUCH

Sunday, January 7, 2018

VAMC NORTHPORT - WEEKLY NEWS DUMP

OUR LITTLE HOSPITAL ON THE HILL






The New Year brought us nothing but good news from our local “rag”, Newsday. Someone’s Editor must have a love affair going on with our wonderful VA Medical Center. Nothing but “feel good” stories are all the news that’s fit to print. Looks like our news sources don’t use “spel check” anymore.

There is also a consistent amount of “dirt” posted on military.com. and elsewhere.
Please note:

The use of Capitol & Lower Case letters - VA, VFW, Veterans Medical Center, VA Clinics, House Committee on Veterans Affairs, & “veterans”. The references to actual human Veterans only deserve a lower case “v”; everything else deserves a capitol “V”. That alone tells what the general public and the majority of the Press think about our Nation’s actual “First Responders”! This article serves to hi-light the fact that Veterans in this Country, and particularly on Long Island, are treated as third-class citizens. It’s so heartening to know that, after being sent to fight our Nation’s Wars, we are held in such high esteem.
https://www.newsday.com/long-island/va-veterans-northport-1.15674791
For new head of VA on LI, telemedicine is high on to-do list

Scott Guermonprez, a retired Air Force colonel who was born in Huntington, took over in June at the VA Medical Center in Northport.

Scott Guermonprez has since June served as the executive director of the VA Medical Center at Northport. Photo Credit: U.S. Department of Veterans Affairs


Updated January 1, 2018 8:22 AM
The job of ushering Long Island’s veterans health system into the future falls upon Huntington-born Scott Guermonprez, a retired Air Force colonel who learned the medical-administration business halfway around the world in Okinawa.

Guermonprez, born at Huntington Hospital, joined the Air Force after graduating from high school in Georgia. He took over in late June as the new head of the Department of Veterans Medical Center in Northport.

Interviewed last month at the medical center, he identified a key initiative — using video and data technology to provide remote care at VA clinics on the Island.

Doing so, he said, could eventually spare as many as 40 percent of the medical system’s patients the need to drive to Northport to interact with its doctors for medical or psychiatric care. Patients and doctors would instead interact through telemedicine monitors from any of the five satellite VA clinics, or perhaps even video equipment located in their homes.

“The goals for the medical center and the entire VA is to expand telemedicine,” he said. “What we’d like to do is make sure we make strategic investments in extending access to care to our veterans closer to home.”

Veterans have long complained that it can be difficult to reach Long Island’s only veterans hospital, located on a narrow road 10 miles from the Long Island Expressway.

Northport’s location was considered a plus in the 1920s, when the facility was first built to quarantine tuberculosis patients. But for East End veterans who must drive an hour and a half or more to get there, it’s now mostly a nuisance.

Guermonprez said telemedicine could also help Northport address shortages in certain medical specialties, by allowing patients to interact with caregivers at VA facilities anywhere in the country. And telemedicine has the potential to reduce the number canceled appointments by patients too frail or otherwise unable to travel.

Top of Form

“If you are an elderly veteran and have difficulty traveling just five minutes to the grocery store to get a bottle of milk, it may be difficult for you to be asked to go 30 minutes or an hour to the main medical center for care,” Guermonprez said.

The medical industry is increasingly leveraging remote communications, a trend driven in part by falling prices for improved cameras, cellphone technology and increased internet speeds.

Clinicians using high-definition video monitors can examine wounds, review prescriptions, answer questions, and even hold psychotherapy sessions — all without requiring the patient to be physically present.

Last year, the VA spent more than $1.2 billion nationwide to provide telemedicine services to more than 700,000 patients, according to the House Committee on Veterans Affairs.

Nationally, the VA is still in the early stages of developing a portfolio of telemedicine practices; Northport is part of the effort.

“We’ve already placed an order for 297 more webcams,” Guermonprez said.

Ken Wiseman, a legislative liaison for the national Veterans of Foreign Wars, said the veterans advocacy group is generally supportive of the move toward telemedicine.

Still, he worried that tens of thousands of veterans with no internet access could be left behind if the shift toward telemedicine deprives brick-and-mortar VA health facilities of resources, he said.

And Wiseman said it is important that the technologies and methods that the VA develops are user-friendly, especially for older veterans who came of age before the era of laptop computers, text messages and Skype-style conversations.

“It needs to be easy,” Wiseman said. “I’m only 34 and can have trouble with my iPhone.”

A start on Long Island

Guermonprez lived in Lake Grove until, at 13, his family moved, first to Phoenix and then to Savannah.

An enlistee at 17, Guermonprez took on finance administration as his military specialty so he could honor his mother’s wish that he attend college while in uniform.

His introduction to running medical facilities was made on tropical Okinawa.

Sent to Japan in 1987, Guermonprez studied Japanese language and culture while working on a 1990 bachelor’s degree in computer studies through a remote campus program of the University of Maryland. He met his Okinawan wife there, and sometimes held staff meetings in Japanese.

His 30-year Air Force career frequently involved him in medical logistics — the process of ensuring that military hospitals are kept supplied with therapeutic drugs, surgical equipment and other supplies needed to keep running.

Guermonprez, who served with the Medical Services Corps, directed the VA medical center in Albany until June.

Guermonprez, who also holds a master’s degree in management from Alabama’s Troy State University, acknowledges he faces several other challenges at Northport.

With leaking roofs, failing ventilation systems, crumbling sidewalks and other maladies, much of the facility’s infrastructure is in such bad disrepair that the hospital was forced to cancel surgeries for several months in 2016. He said one of his earliest decisions involved directing the maintenance staff to build a drainage trench to divert rainwater that regularly flooded the facility’s auditorium building, leaving it smelling moldy.

In less than six months, Guermonprez has presided over dramatic management changes at Northport, replacing among others the facility’s medical chief of staff, its chief of engineering, its nursing director and its chief financial officer.

He said he has drawn on his military background to try to motivate a staff he said perhaps had become comfortable in waiting for things to happen.

“It’s holding folks accountable and getting people to see that they can be pushed beyond what they think is possible,” he said. “The expectation is, you get it done someway, somehow.”

Northport VA Medical Center

·                  Opened: 1928

·                  Average number of patients per day: 1,450

·                  Number of unique patients per year: 32,000

·                  Largest clinical patient load: mental health

·                  Clinics located in Riverhead, Patchogue, Bay Shore, East Meadow and       Valley Stream

HOLY CRAP, BATMAN...

I WILL LET THIS LITTLE GEM STAND ON ITS OWN



And, this from Military.com. These idiots at VA couldn’t punch their way out of a wet paper bag. First, they don’t pay these outside providers, then they claim they ran out of money because no one could add at a first-grade level. As a result, many of the original outside providers have fled the scene and are refusing to participate due to lack of payment from the VA. Now they are going for strike three on this program, and throwing their “Tele-Medicine” on top of it. What could possibly go wrong?




VA to Take Immediate Actions on Timely Payments to Community Providers


Office of Public and Intergovernmental Affairs

January 3, 2018, 03:58:00 PM

WASHINGTON — Today the U.S. Department of Veterans Affairs (VA) announced a series of immediate actions to improve the timeliness of payments to community providers. 

The actions will address the issue of delayed payments head-on and produce sustainable fixes that solve ongoing payment issues that affect Veterans, community providers and other VA partners. 

“It is vital to the health of our network of providers that we provide payment in a timely and consistent fashion,” said VA Secretary Dr. David J. Shulkin. “Our outside providers are an essential part of our network and we need to improve our system of payments for their services.” 

VA will immediately take the following short and long-term actions to improve payments to community providers. Short-term actions include: 

Publish a list identifying providers with high dollar value of unpaid claims, to be published the week of Jan. 8 at the following website: https://www.va.gov/COMMUNITYCARE/providers/.

Create rapid response teams to work on the ground with these providers to reach financial settlement within 90 days.

Increase the number of claims processed by vendors by 300 percent in January 2018 and by 600 percent in April 2018 with a goal of 90 percent clean claims processed in less than 30 days.

Establish multiple entry points for providers to check the status of their claim, including a dedicated customer service team and VA’s Vendor Inquiry System (VIS) located at https://www.vis.fsc.va.gov

In addition, long-term actions include: 

Deploy multiple IT improvements within the first six months of 2018 that streamline the claims submission and payment process to reduce time for payments significantly.

Align on concurrent performance improvement goals with VA’s existing Third Party Administrators to improve multiple aspects of their performance rapidly to ensure Veterans have continued uninterrupted access to care.

Award four new contracts in 2018 for implementation in 2019 to establish the new Community Care Network that includes elements designed to ensure prompt payment of claims.

Work with Congress to consolidate and simplify all VA community care programs, including provisions for prompt payment of claims.

Ensure transparency with VA’s claims processing performance by publishing VA’s claims processing timeliness on a monthly basis.

VA’s current Third Party Administrators, Health Net Federal Services and TriWest Healthcare Alliance are committed to working with VA to improve the timeliness of payments to community providers. Health Net and TriWest manage VA’s community care networks and process payments to community providers.

 “It is an honor and responsibility to serve the Veteran community,” said Billy Maynard, CEO of Health Net. “We remain committed to partnering with VA to improve the claims payment process.” 

David McIntyre, president and CEO of TriWest said, “We could not be more pleased at the aggressive focus on this critical topic. We look forward to continuing to reach the industry- leading performance level we all desire and expect.” 

Improving timeliness of payments to community providers is a critical element in VA’s goal of building a community care program that is easy to understand, simple to administer and meets the needs of Veterans and their families, community providers and VA staff. 

Here are resources for community care providers:


Learn about the new community care network in this video:




The following was a result of the VA’s first attempt at “Telemedicine”. It was attempted here in Northport, and fell on its face almost immediately. Especially for Mental Health, this program has proven itself totally worthless on numerous occasions. all over the Country.

Veteran Suicide Linked To Deficient VA Telemedicine



March 24, 2016


The veteran who set himself on fire outside the Atlantic County CBOC was reportedly being treated there by the new VA telemedicine psychiatric platform. That veteran died on Saturday, according to Northfield Police. News of his death was not reported until Tuesday.

Many veterans have complained about the apparent media blackout concerning the limited coverage of the event. Insiders now report that VA leadership from Wilmington VA is pressuring VA employees at its Northfield clinic to not speak to reporters.

The blackout campaign has been so successful that Wilmington VA leadership is reportedly bragging about the lack of coverage.

How shameless can these federal bureaucrats be in the face of such an awful travesty? Apparently, the answer is “very shameless” when it comes to shutting down media inquiries.

VA TELEMEDICINE FACILITY IN NORTHFIELD, NJ

The Northfield, New Jersey location is new as of 2011. At the time, VA moved the outpatient clinic to help improve access to services with upgraded technology and better care using the VA telemedicine platform. The facility was apparently created to utilize the cheaper but more technology dependent telemedicine model.

However, reports are circulating that VA has not adequately staffed the clinic. Veterans seeking access to mental health care are reportedly not receiving the timely services the community was promised when the facility opened.

ATLANTIC COUNTY CBOC WAIT LIST SCANDAL

Instead, this CBOC in Northfield, NJ was recently linked to the wait list scandal and discussed briefly within a March 1, 2016 VA OIG report covering Wilmington VAMC and its CBOC clinics. A Northfield VA whistleblower reported:

·                  Reminder delinquencies were not handled properly

·                  Appointment scheduling procedures were improper

·                  Manipulative techniques showed wait times as being “zero” days when they were not

So what was really going on at Northfield that led up to the veteran’s suicide? Wasn’t VA telemedicine supposed to reduce wait times and increase access to care?

VETERANS SPEAK OUT AGAINST VA TELEMEDICINE

Following publication about the self-immolation on Monday, veterans have expressed concern about the services being provided at Northfield.

One veteran commented:

After checking out more on the VA clinic in Northfield where this happened. It appears it’s main function includes a Psychiatry clinic that uses Telemedicine with a Doctor in charge named Dr. Jane Mary Chamberlain.

When checking her info found something unusual. Although she is listed as certified it shows that she is not current with completing her Maintenance of Certificate (MOC).

The board list it as “MOC Status: Not Meeting MOC Requirements and Is Not Required To Do So”.

Some kind of very special arrangement there given they are required to meet MOC every ten years.

So this is looking like another VA Programed Suicide via prescription with a new twist. Telemedicine.

Another veteran commented:

VA Telemedicine and Psychiatry…what could possibly go wrong? Or, as Melvin coyly implied, it sounds like Telemedicine and Psychiatry could easily take a page from one of my favorites, “The Manchurian Candidate”.

Not stating that’s what is going on but of ALL things, why have Psych Care Telemedicine and The VA be in the same room with these parasites simply furthering their freaky research…as Dr. Candy Man has shown, and the VA let it go on…and that was also Psych…person to person.

Will the VA’s usual knee-jerk reaction be to have every one of us Vets wearing a Hannibal Lector Mask when on federal grounds? VA will then need another $3 Billion for Disney to market and manufacture said masks? Yeah, a bit flippant there, but that’s the level of “ridiculousness” we have arrived at.

Still another veteran commented:

Thank you for rejecting telemedicine!!!

There are instances where telemedicine, Skype or other remote methods of treating patients is acceptable and even helpful for the patient, which should be the focus, and other instances where it is lunacy to think telemedicine is appropriate.

In the last years I was reviewing veterans medical research for funding, there were more and more research projects being pitched to determine the effectiveness of using telemedicine, and the bottom line reason was to cut costs. Quality of care for veterans didn’t seem to be much of a concern.

I am sure I am not alone in my opinion that telemedicine in some instances shows the doctor just does not care enough about the patient to bother with a face to face visit.

Why not just tell them to search out a few YouTube videos.

Meanwhile, VA and the major news networks are not reporting on the suicide with any degree of detail you would see with most suicide stories.

So what is so unique about this particular suicide that the media has gone largely dark? Could the linkage between reduced psychiatric care quality, availability and telemedicine have something to do with the lack of coverage?


Is this what we’re going to be left with in the future as the VAMC Northport tries to become the “Center Of Excellence” for an already failed program? Can you say:




TELEMEDICINE
TELEMDEICINE  OR  A GLOCK  OR   SELF-IMMOLATION?


Yup! This is how they do it. This is how our little Shangri-La in Northport gets a 4-Star rating. Total bullshit!

At Veterans Hospital in Oregon, a Push for Better Ratings Puts Patients at Risk, Doctors Say

By DAVE PHILIPPS JAN. 1, 2018



Walter Savage, 81, an Air Force veteran, at a medical center in Roseburg, Ore. Mr. Savage was turned away from the veterans hospital there even though two doctors said he should have been admitted.

Credit Ruth Fremson/The New York Times

ROSEBURG, Ore. — An 81-year-old veteran hobbled into the emergency room at the rural Veterans Affairs hospital here in December, malnourished and dehydrated, his skin flecked with ulcers and his ribs broken from a fall at home.

A doctor examining the veteran — a 20-year Air Force mechanic named Walter Savage who had been living alone — decided he was in no shape to care for himself and should be admitted to the hospital. A second doctor running the inpatient ward agreed.

But the hospital administration said no.

Though there were plenty of empty beds, records show that a nurse in charge of enforcing administration restrictions said Mr. Savage was not sick enough to qualify for admission to the hospital. He waited nine hours in the emergency room until, finally, he was sent home.

“The doctors were mad; the nurses were mad,” said Mr. Savage’s son-in-law, Mark Ridimann. “And my dad, he was mad, too. He kept saying, ‘I’ve laid my life on the line, two years in Vietnam, and this is what I get?’”

The denial appeared to be part of an attempt by members of the Roseburg Veterans Administration Medical Center to limit the number of patients it admitted to the hospital in an effort to lift its quality-of-care ratings.

Fewer patients meant fewer chances of bad outcomes and better scores for a ranking system that grades all veterans hospitals on a scale of one to five stars. In 2016, administrators began cherry-picking cases against the advice of doctors — turning away complicated patients and admitting only the lowest-risk ones in order to improve metrics, according to multiple interviews with doctors and nurses at the hospital and a review of documents.

Those metrics helped determine both the Roseburg hospital’s rating and the leadership’s bonus checks. By denying veterans care, the ratings climbed rapidly from one star to two in 2016 and the director earned a bonus of $8,120.

Current and former staff members say the practice may reach well beyond Roseburg. Recent government reports also challenge the reliability of the department’s metrics, casting doubt on a key tool that it says it relies on for reforming its beleaguered health care system.

The hospital’s director, Doug Paxton, acknowledged that being more selective had improved ratings, but denied that the hospital was turning patients away to improve scores. Tightening admissions, he said, benefited patients, not metrics, because Roseburg’s hospital lacks the resources for acute patients, so many need to be sent to larger hospitals in the community.

“The numbers are indicators of the quality of care for the veterans, so, sure, we’re worried about the numbers,” he said. “But if you improve the care to veterans, in turn your numbers are going to improve. That’s the bottom line.”

But five emergency room doctors strongly disagreed. In a letter in response to questions from The New York Times, they said they had warned about the arrangement at Roseburg, where physicians are repeatedly overruled by administrators. “When we voice concern that a process is dangerous and not good for patient care,” they wrote, “we are met with the response that ‘this is what the director wants.’”

“We cannot express strongly enough how detrimental this process has been for patient care and how unacceptable it would be anywhere else,” the letter noted.

The day after Mr. Savage was turned away, he showed up again asking for help. Again, he was denied. He waited for hours in the emergency room until a doctor finally admitted him against the wishes of the administration, his son-in-law said. The administration, ever mindful of metrics, moved him to a nursing home in less than 24 hours.

The Department of Veterans Affairs began grading hospitals about four years ago based on 110 performance indicators such as wait times, infection rates and nurse turnover at its 1,200 hospitals and clinics.









The V.A. hospital in Roseburg, Ore.

Credit Ruth Fremson/The New York Times




“It’s a numbers game,” Dr. Steven Blum, a doctor at the veterans hospital in Roseburg, said of the medical center’s approach. “The leadership has figured out the hospital can actually do better by seeing less patients.”

Credit Ruth Fremson/The New York Times

Another penalty is assessed for deaths in the hospital or within 30 days of discharge. To avoid counting these, doctors and nurses say, the administration regularly persuades veterans to be admitted only as hospice patients, signaling they are terminal and don’t want treatment. Often neither is true. Doctors said some veterans were switched to hospice without their knowledge.

“It’s extremely unethical, extremely,” Dr. Blum said. “I was asked to do it and so were the emergency department doctors. And we refused, so the administration just did it.”

The focus on improving scores overshadowed deep-seated problems, staff said, including crippling turnover in primary care doctors.

In 2015, 17 of 23 primary care doctors left, according to Laura Follett, who oversaw scheduling for Roseburg’s primary care clinic.

“Teams would have no doctors, and we’d have to just cancel appointments,” Ms. Follett said. She resigned in 2016.

Dangerous gaps appeared when doctors ordering critical tests were no longer around to review the results and alert patients. Several nurses said they saw positive cancer screening alerts and other critical lab results languish for weeks or even months.

“Alerts go into Neverland,” said Treva Moss, a nurse who works in the medical center’s specialty clinic in Eugene, Ore.

 


Laura Follett, who oversaw scheduling for Roseburg’s primary care clinic, at home in Springfield, Ore., this month. She resigned in 2016.

Credit Ruth Fremson/The New York Times

This fall, a number of employees complained to their congressman, Peter DeFazio, who blasted the hospital management on the floor of the House of Representatives as “dysfunctional.” At his request, the department is conducting an investigation.

Roseburg’s decision to cloak deficiencies by manipulating metrics is part of a persistent problem that reaches beyond one rural hospital, said Dr. Michael Mann, a professor of surgery at the University of California, San Francisco who led the thoracic surgery program at the San Francisco veterans hospital for eight years.

Attempts to track performance in the veterans health care system have repeatedly created perverse outcomes, he said. He pointed out that the 2014 scandal exposing hidden wait times for veterans arose only after the department began tracking whether medical appointments were scheduled within 14 days, and veterans hospitals across the country that could not meet the goal began keeping off-the-books lists to hide actual wait times.

During Dr. Mann’s tenure, the veterans department began ranking hospitals on surgical complications. Remarkably, complications across the nationwide system dropped steadily, decreasing 47 percent between 1997 and 2007.

“Of course quality had not really improved by that much,” Dr. Mann said. “People had just learned to make it appear that it had.”

Many hospitals simply stopped performing surgeries on high-risk patients, or cut high-risk procedures all together, Dr. Mann said. “I’m very ashamed. I colluded. I was told not to operate and pulled back, and at least one of my patients died because of it.”

The vast health care system has little choice but to rely on metrics, said David J. Shulkin, the veterans affairs secretary.









Mr. Savage outside the Rose Haven Nursing Center in Roseburg, where he was transferred by the veterans hospital. Credit Ruth Fremson/The New York Times

“Without it we’re like an airport with no air traffic control,” he said in an interview. “We don’t know where our hospitals are, we don’t know where they are headed. All we can do is respond to the crashes. I’d rather be able to look ahead and prevent them.”

The department regularly audits hospitals, he said. But the Government Accountability Office raised doubts in a report this fall noting in many cases the data seems inaccurate but the central office “has not determined the extent to which these problems exist.”

In 2014, when Mr. Paxton took over Roseburg, he vowed to turn around a hospital that had long ranked one of the worst in the system. He added staff, tried to cut inefficiencies, and tapped his new chief of mental health, a social worker by training named Paul Beiring, to figure out how to improve metrics.

In an interview, Mr. Beiring said focusing on hospital admissions was strategic because it accounted for a big slice of the rating.

“It is weighted really high, so we knew we had to optimize that measure,” he said.

The medical center created an “exclusion list” of conditions deemed too severe for Roseburg and put in place a “utilization management team” of administrators to approve hospital admissions using a risk analysis score.

Doctors were required to call an off-site nurse to ask permission to admit a patient. Patients who had a high risk of death — usually because of advanced age — were routinely transferred to other hospitals or sent home. Even low-risk patients that Roseburg could easily have cared for, such as people with pneumonia, were denied, doctors said.

In a statement, the Department of Veterans Affairs said Roseburg was not manipulating data, adding: “All admission decisions are based on the hospital’s ability to provide the care patients require and are made by clinicians, including the facility chief of staff and her clinical chiefs of service — nonclinical administrators have nothing to do with these decisions.”

The hospital has no plans to change its admitting practices. In November, Roseburg was demoted to one star, because of what Mr. Beiring called “a death or two” but he said it was a temporary setback and the hospital had already “deployed counter measures” that would soon send its ratings up again.

One of those measures, doctors said, appears to be that admissions have become ever more strict.





If you have TRICARE as your default medical insurance plan, please pay attention to all the changes that are coming down the pike in 2018. We have heard the lame excuses of streamlining and reorganization for efficiency. All that really means is that your benefits under this plan are being stripped away. Major changes have already been effected in the past six months.



AND, NOW FOR OUR LITTLE SLICE OF HEAVEN IN THE BUCOLIC ROLLING HILLS OF NORTHPORT, NY:

 

1) WORD ON THE STREET is indicating that the DAV is up to some funny business with its finances on the hospital grounds. Sounds as if some “laundering” is going on with the Golf Course funds (all cash), and possibly something with the DAV Transport program. Someone has alleged that little Joey “The Klepto” Kozlowski made off with about $80,000.00 in DAV cash. “Richie” Rich Kitson apparently covered for him and saved him some serious jail time. The missing funds were said to be never recovered. Stay tuned for further developments...

And, who can forget that DAV funds were used to pay for Philly “The Fat Mans’” and “Richie” Rich’s stripper, Sasha the Fire Gypsy! ($1.2k or so)
AND, IT WAS AT A PARTY WITH CHILDREN PRESENT, AS SHE EROTICLLY PASSED FIRE BATONS BTWEEN HER LEGS.


Is Scotty “Lock The Door” next?   




                                             

   
2) SOUNDS AS IF more Doctors are scaling back their presence to a “part time”
level while holding “full time” jobs out in the community at other hospitals and practices. One problem with that is they are still drawing “full time” salaries from the VA. Keep your eyes open and you may see who’s leaving their post early to scoot off to another job.


3) DID YOU KNOW? We have “Hospitalists” who are raking in about $190k per year. The grapevine is reporting that they are “full-time” at the VAMC Northport and have “full-time” gigs at Huntington Hospital and Good/Bad Samaritan Hospital. It is being reported that our “Hospitalists” have a Patient Panel of ten that keeps them on the VA payroll. I do hope we’re not overworking these folks!

4) DID YOU KNOW? Those nice soft luxury sheets on your bed; do you know where the cotton comes from? It mostly comes from Egypt. Yes, they have huge cotton plantations in Egypt. Guess who inherited one of the bigger plantations from his daddy; The Foda Family Farm? That’s right; Hussein “The Horrible” Foda. Not only that, but he religiously drops all his duties at our little hospital to make his annual pilgrimage to the plantation every January. So, if you don’t see him this month wandering the halls the entire month, chances are he’s in Egypt singing;
“You gotta jump down, spin around...pick a bale o’cotton. You gotta jump down, spin around...pick a bale o’hay.”
Umm...plantation owner, sole proprietor at the Research Corp. of Long Island, Chief O’Department at the VAMC Northport, head of the Ethics Committee....his office door is filling up fast with “Chief O’” plaques. He’s starting to rival “Chatty” Cathy Cruise’s office door.

NEWS FLASH: Egypt just dropped its farm subsidies. Hussein “The Horrible” may be in big trouble here. Word is that he’s added rice farming to his agricultural empire.

 5) I KNOW Joan “Of Arc” McInerney likes to put “Dr.” in front of her name, but come on. I know the Medical School she went to in the Caribbean (a friend of mine went there, too). It doesn’t have the greatest of reputation with the AMA. Word has it that she was fired about ten years ago from Nassau University Medical Center. She was Chief O’Emergency Medicine. And, that qualifies her to be the Director of a VA Regional office???  

WTF, VA

Reference: (from last week’s blog)

VA Health Leaders Failed to Protect Patients from Inept Doctors


HOW ABOUT A LITTLE “FREAKY FRIDAY”?

A.   Confirmed: A seventy (plus) year old EMS worker, loved by many, was summarily axed for “sexual harassment”. Heh as cancer and requested time off for treatments. That appears to be the kiss of death for any employee, now! (except, the “chosen” ones)

B.   “sexual harassment” charges are piling up. A Section Chief in Pharmacy was axed for harassing a subordinate.

C.   The Assistant Chief of HR is preceding her boss, “Wee” Willie Sainbert, out the door. She is being “reassigned” to another hospital pending termination. Apparently “passing the buck” is the order of the day here in Northport.


WHAT WE’RE WATCHING:

     I.         
                    Team Thomesen (Charlene “The Charlatan” & “Little” Dickie): what will the New Year bring? (hints: “You’ve been served!”, “Are you being served?”) Oh, our little hospital on the hill is just one happy family!



  II.          The rate of refusal on FOIA requests is through the roof at VA. Even if you follow the instructions to a “T”, the VA has figured out ways to derail your request at every turn. Transparency is not what they’re doing even though they have the public hoodwinked into thinking this is their direction. Our little hospital on the hill is at the head of the class on this, and Scotty “Lock The Door”, “Chatty” Cathy, et al are putting this effort to cover their tracks on steroids!

III.          How much longer can Scotty “Lock The Door’s” GAG order on employees last. It seems this boat is springing some serious leaks! Maybe, Joan “Of Arc” McInerney should think about grabbing a life vest; the ship is sinking, darlings!


IV.          Why Scotty “Lock The Door” decided to just clean the HVAC vents & ducts in Bldg. #65 instead of replacing them, as per Louie “The Lip” Errichiello. Here they go again
trying to save a dollar on the backs of their employees and Patients.





So far, the crack maintenance team has done a really bang-up job on cleaning up after the duct work left debris all over everything.
.................NOT!...........
Once again, the place is a pig sty!

HEY, VA...
MY LITTLE GIRL DOESN’T

LIKE YOU VAERY MUCH!