Recent emails:1) TUNNEL RATS
July 3, 2018
“There are cockroach and/or rat killing pellets in the tunnels by police station and building 65. It’s gross. I am worried a service dog could eat them and get sick.”
2) July 3, 2018
“There are cockroach and/or rat killing pellets in the tunnels by police station and building 65. It’s gross. I am worried a service dog could eat them and get sick.”
2) July 3, 2018
Veteran Could Get Stuck with $30,000 VA Choice Bill
Soldiers Bob Hart, left, and Ron Ridgen, right, stand for a photo on the shore of the South China Sea. Hart, drafted at age 19, was a radio operator during the Vietnam War, where he was exposed to the chemical herbicide Agent Orange. (Photo courtesy of Bob Hart via Stars and Stripes
Stars and Stripes 4 Jul 2018 By Nikki Wentling
Bob Hart, a 73-year-old farmer in central Illinois, always pays his bills. But that changed when the Vietnam War veteran was informed he owed $30,000 for medical treatment he thought the Department of Veterans Affairs covered.
"I got a call from my hospital saying I owed them, or they'd take the money out of my bank account," Hart said. "I just thought, 'You've got to be kidding me.'"
Hart uses the VA Choice program to get treatment at his local hospital in Jacksonville, Ill., where he receives biweekly injections of anti-inflammatory medication for a condition linked to exposure to the chemical herbicide Agent Orange.
The Choice program allows veterans who can't get a VA appointment or who live in rural areas -- such as Hart -- to get treatment at private medical providers paid for by the VA. Hart has used the program to go to Passavant Area Hospital for nearly two years -- but administrators there told him the VA hasn't paid them for his treatment since December.
Since he was informed of the bill several weeks ago, Hart has continued to go to the hospital for his injections feeling concerned about whether he will receive treatment.
Hart got his injection July 3 with no troubles. His next is scheduled for July 17.
"I don't know where I stand on this," he said. "If I don't get the shots, I'm in trouble. But I can't lose everything I've got."
Passavant is part of the Memorial Health System. A communications official there was reached by phone last week but did not respond to questions about Hart's bill or about troubles with the hospital getting paid by the VA.
VA Press Secretary Curt Cashour said Tuesday the agency was looking into Hart's situation. He also said Hart would encounter no interruptions in treatment and his credit wouldn't be affected. Cashour said the VA contacted TriWest, the third-party administrator that the government uses to pay private providers through the Choice program, to inquire about payments for Hart's care.
"We have contacted TriWest in order to resolve this as soon as possible," Cashour said. "In the meantime, VA will be reaching out to the veteran directly to ensure he is getting the care he needs."
Years of problems
Hart's situation isn't unique. The slow reimbursement of private-sector hospitals has been a chief complaint about the Choice program, which is often criticized as complex and bureaucratic.
"We're very aware that this is a problem for some veterans who've used the Choice program and community care," said Kayda Keleher, an associate director at the Veterans of Foreign Wars. "It's something we've worked hard with the House and Senate on. The VA should be paying the bill."
Since the Choice program was created in 2014, some private medical facilities have experienced delays getting paid by the VA. When payments are stalled, veterans' medical bills can be sent to debt collectors and their credit reports damaged.
The VA established a toll-free number, 877-881-7618, for veterans to call when facing billing issues through the Choice program. According to a letter sent last year by 40 lawmakers to the VA about the issue, the agency received more than 57,000 calls between the program's launch in late 2014 and May 2017 from veterans facing adverse credit reports.
Elected officials have previously tried to step in. The House Financial Services Committee advanced a bill three months ago that would protect veterans' credit scores when the VA is slow to reimburse private-sector doctors for their medical care. The bill has not yet been scheduled for a vote on the House floor.
In 2015, Sen. John Boozman, R-Ark., arranged meetings between VA officials and hospital administrators who said they were collectively owed millions of dollars for treating veterans.
Working on a fix
A massive VA reform bill passed last month by Congress aims to finally fix the problem.
The VA Mission Act overhauls Choice and instructs the VA to implement a new program for private-sector care by next summer.
The new law will require the VA to pay private-sector medical providers within a certain time, or possibly incur interest. The time is 30 days for electronic claims and 45 for paper ones.
The law also requires the VA to submit an annual report to Congress that lists the number of late claims, how many days that they were overdue and how much interest the agency had to pay out.
Rep. Bruce Poliquin, R-Maine, said the VA is behind on paying some hospitals in his state that can't afford to wait for reimbursement. In March, Poliquin and Rep. Collin Peterson, D-Minn., founded the Congressional Rural Hospitals Caucus, which promises to ensure private hospitals receive timely and accurate payment from the VA.
"This is a problem when you've got a small hospital that might not have bills paid for one to two years," Poliquin said when speaking in May on behalf of the Mission Act. "We need to make sure all of our rural hospitals get paid, and this bill says if they are not paid within 30 days, then interest starts accruing on that."
The new law also permits the VA to contract with an outside company that could take on the duties of paying private-sector providers. That decision will likely be made in the next year as the VA goes through the rulemaking process to implement the Mission Act.
"This tells the VA they need to figure out how to handle this internally and do this efficiently, or allow them to contract out to a non-government entity," Keleher said.
It's unclear what happened in Hart's situation. The VA confirmed Hart has approval from them to receive treatment at his local hospital through June 2019.
On Tuesday, Hart visited the billing department at Passavant hospital, attempting to understand the mix-up. He said it appeared there was a communication breakdown between the hospital, the VA and TriWest about whether his doctor was an authorized provider through the Choice program.
"This is a mess," Hart said. "I just don't understand it."
Oh.....but wait a minute! They passed a Bill. Didn’t they??
More VA stuff
In 2014, the Veterans Access, Choice and Accountability Act – effectively called the “Choice Act” – was signed into public law for the purpose of providing Veterans the ability to seek medical care at facilities other than Veteran Administration Medical Facilities due to prolonged waiting times for care, distance from a VA facility properly equipped to handle specific care needs, and/or even geographical burdens in attempting to get to a VA facility. While the new law was intended to help and aid Veterans to get the care they rightfully needed and deserved, the VA to date has effectively refused to allow Veterans to take advantage of the new law by purposely restricting Veterans’ ability to use the program. The United States Department of Veterans Affairs (VA or DVA) is a government-run military Veteran benefit system with Cabinet-level status in the federal government and an annual operating budget authorized by Congress of over $150 billion USD as of 2014. The sole mission for the VA? To take care of Veterans… So one would have to ask then, why exactly would the VA refuse to allow Veterans to use a program passed by Congress that actually helps them receive the medical care they need? To answer that, we need to start by looking at a little bit of history as to why the Choice Act was enacted in the first place.
The Choice Act was created due to response from years of massive VA corruption at nearly all levels. The Veterans Administration for decades refused to acknowledge evidence of Agent Orange Toxicity connection with Veterans’ illnesses and deaths caused by exposure. The VA for decades refused to compensate and treat Veterans who claimed service connected medical disabilities caused by health issues directly related to Agent Orange Exposure. The VA for decades refused to acknowledge the existence of Gulf War Syndrome in Veterans cause by exposure to Sarin Nerve Gas. Both the VA and other departments within the government for decades refused to acknowledge evidence that Sarin Nerve Gas exposure actually occurred and was directly linked to Gulf War Syndrome. The VA for decades refused to compensate and treat Veterans who claimed service connected medical disabilities caused by health issues directly related to Gulf War Syndrome induced Sarin Nerve Gas exposure… The VA to this day refuses to acknowledge Veteran and Veteran Family medical issues directly related to illegal chemical storage, storage failures, substance destruction, and dumping that contaminated water supplies, wells, rivers, soil, and the air throughout the entire area at Ft. McClellan. To this day, the VA refuses to acknowledge medical disabilities caused as a direct result of exposure to toxic chemicals by all – Veteran and Family Member alike – who even stepped foot on the base. To this day, the VA refuses to compensate or treat those with medical issues caused as a direct result of exposure to toxic chemicals, or even acknowledge the deaths of those who suffered from medical issues caused by exposure while at the base – Veteran and Family Member alike… These are the major cases, and there are hundreds upon hundreds of minor cases little or less known. However, the last few years have shown the nation that the VA has yet to end corruption within its own offices.
Recently, evidence came out from whistle blowers across the nation as VA facilities refused to comply with federal level requirements for care provision within appropriate times. While in only a few locations it has been documented that appointment wait times were a systemic problem caused by limited staff, ill-equipped facilities, and simply not enough space, there are other locations that had no such excuses. Further, instead of openly admitting the problems, multiple VA facilities across the nation chose instead the hide the evidence. The corruption – which extended all the way to the VA’s highest levels – involved placing new appointment requests onto secret waiting lists, kept separate from each locations actual appointment list, in order to create the false image that those facilities were in compliance with federal requirements. Shocking still is the fact that the VA has been caught lying to congress countless times, stonewalling the investigation, and whistleblowers have alleged insider cover-ups of the evidence by altering patient records. To date, investigative reports have proven that hundreds of Veterans – and perhaps thousands more yet to be accounted for – have died as a direct result of waiting for appointments to receive the care they needed, but that never came.
This is the history of the Nation’s Veteran Care System’s corruption, and the very reason why Congress passed legislation to overhaul Veterans’ access to care last year by creating the Choice Act. Naturally, giving Veterans the ability to choose not to use a VA facility and go to a civilian doctor of their choice in their local area, while still being covered for medical care, would be beneficial for everyone. It would decrease the stress on a VA system trying take care of more patients than any one facility can effectively care for, it would remove the iron grip of VA care restricted solely to VA facilities and allow care provision to Veterans in quicker times, and it would even remove many – though not all – of the factors that have contributed to VA abuses in the first place by giving Veterans the freedom to see a doctor of their choice, at a local facility of their choosing, while still remaining fully covered.
The Veterans Choice Act came sweeping into law with a House vote of 265-160, a Senate vote of 93-3, and was signed into law on the 7 of August 2014. The bill was estimated to cost nearly $2 billion USD, of which, approximately $500 million USD is to be used for the hiring of more doctors and nurses to work in VA facilities, and the program is designed to last for 3 years or until funds for the program have been exhausted. Finally, the program would allow Veterans who fit the criteria for seeking outside care the ability to see health care providers who maintain the same or similar credentials and licenses as VA providers, and to whom agree to provide both proof their credential and license currency annually, as well as provide the VA with electronic copies of any and all medical records related to care and services provided to Veterans under the program.
In order to assess the feasibility of the program within budgeting constraints, the Congressional Budgeting Office (CBO) prepared the analysis of the Choice Act, and estimated that the act itself would create an increase in direct spending by roughly $35 billion USD across a 10-year period from 2014 through 2024, and the reason for this is simple… a very large number of Veterans today who are eligible for VA care do not trust the VA, and as such, have never signed up for VA services. The VA’s current health care enrollment figures sit around 8.4 million, meaning that the nations remaining 13 million Veterans are not involved with the VA. Out of that remaining 13 million figure, the CBO estimates that 8 million more Veterans are eligible for VA health care enrollment and services, but to this day, have refused to enroll in the VA system. The logic here is that these additional 8 million might choose to enroll if they could receive care by a private doctor outside of the VA while still receiving coverage by the VA system, and this is where the cost increase over time would come from. The VA currently spends about $44 billion USD of its $150 billion USD annual budget on providing health care services to those enrolled, and of course, that number is only representative of short-term costs. It does not include long-term care programs, paying for care providers, or even programs designed to end Veteran homelessness, so it’s understandable that the drafting of the law required extensive research into assessing how the budget would be affected over the long-term. Yet, despite this careful analysis, there seems to be one thing that Congress clearly forgot to consider, and that is who would be the right person to take charge of implementation of the program itself.
Congress mistakenly gave the VA control over implementing the very policy enacted because of the VA’s track record of corruption. Of course, the first thing the VA did was draft internal policy based on its own narrow interpretations of the law that restricted actual use of the program by any Veteran who attempted to take advantage of it. The VA chose to ignore the aspect of what actually constitutes correct levels of care, or the provision of care specific to individual needs, effectively allowing the VA to by-pass entire sections of the law that authorizes Veterans to use the program. They did this by defining any VA facility within the 40-mile radius of a Veterans listed home of address as constituting the presence of VA care within acceptable distance of the Veteran – regardless of whether or not that facility was equipped to provide the actual care required.
“Veterans are being told they cannot use their Choice Cards because they live within 40 miles of a VA facility, even though that facility does not offer the care they require. The VA is denying the access the law was intended to provide and forcing veterans to choose between traveling hours to a VA medical facility, paying out-of-pocket or going without care altogether.”, stated Senator Moran (KS), “Veterans simply want what they were promised in the Choice Act: the choice to access the care they deserve in their community. In my hometown of Hays, Kansas, a veteran is forced to drive 200 miles several times a month for routine cortisone shots because the VA outpatient clinic just 25 miles from his home does not offer the shots he needs. One would think this veteran could use his Choice Card to visit a local physician or local hospital to get the shots he needs – but the VA is denying access to this care. Thousands of veterans across the country are facing this same frustration.”
As if that isn’t bad enough, now the VA is looking to end the program with Obama’s help. Not less than 6 months after the act became law, and only 3 months after Veterans started receiving their Choice Cards, now the VA is collaborating with Obama in trying to use the Presidential Office to force relocation of the program’s budget. The VA drafted a report based on the programs budgeting figures alone and presented it as evidence that the funding was not being used. The VA’s single sided evidence came with a statement that Veterans are not interested in seeking medical care from local physicians, that Veterans are not interested in seeking care outside of the VA, and that the proof was in the numbers. But this is nothing more than yet another VA lie. “I was proud to sponsor the Veterans Access, Choice and Accountability Act of 2014 (the Choice Act), and deliver good news to veterans: They would have a choice when it comes to accessing health care they deserve, and many would have the option of seeing their local physician.”, Stated Sen. Moran, “Now, the VA is trying to take that choice away.” The Senators words bring up a very important question that must now be considered… why would the VA do this?
Of course there is zero doubt as to the ethical violations present at this point. The VA is an organization tasked with taking care of the nations Veterans through the provision of health care, earned benefits, and a large array of other programs, yet the largest source of income for the VA itself rests in health care alone. If more Veterans stop using VA facilities and start using other medical service providers, the VA itself may not maintain the numbers it requires to justify the same level (or greater) of funding in the future, and to the VA, that is a threat. With that argument in mind, it seems that the VA purposely designed restrictions into implementation of the Choice Program in such a way so as to make it near completely impossible to use, and for any who jumped through all the hoops just to actually use the program, the experience was so painful that the hope was the Veteran might simply just give up and return to using a VA facility. The issue is that, if the card and the program really were purposely designed to force Veterans back to VA facilities by denying them access to use the program, the ethical violation present is that the VA is – once again – violating public trust and seeking out methods to create gains for itself, while at the same time, actually causing direct harm to Veterans (the one group of people the department exists to serve), and falsely creating an intentionally worthless program for the sake of trying to look good to oversight. Furthermore, since the program is already funded, one only has to ask… just what does the VA intend to use that $169 billion USD – that was intended for this program – for anyway?
What should have happened from the very beginning was the removal of the VA from the system entirely. The VA should have never been allowed to even have a say in the Choice Program, and there do exist several other alternative agencies who very well could have handled the program’s implementation in a responsible and effective manner. To provide just one example, the military’s health insurance agency owned by the Department of Defense and operated by the Defense Military Health System, Tricare – which is used by all active duty service members, their families, national guard and reserve members while on-duty, and to which is even extended to military retirees – could very well have been extended to both cover all those who qualified for VA care but chose this program instead. At the very least, that would have been both a cost saving initiative – by using an already establish network of providers across the nation who readily accept Tricare, by removing the VA’s vastly over-bureaucratic system from the decision-making and operational process, and by allowing additional providers across the nation who are both qualified to provide the care needed, and interested in program participation, to join the network – and an effective alternative policy implementation process that did not allow VA involvement. It could have prevented yet another VA episode of refusing care to the only client they exist to serve.
VIVE LE “CHOICE”!!
Military.com Week of June 25, 2018
Roscoe Butler, American Legion deputy director for health care in the Veterans Affairs and Rehabilitation Division, recently testified before the Subcommittee on Health to voice the Legion’s support for five pieces of pending legislation, which included bills addressing the severe staffing shortages plaguing the Department of Veterans Affairs (VA). According to a recent study, there will be a shortage of more than 100,000 doctors by 2030, including medical officers, nurses, psychologists, physician assistants and medical technologists. A video of the hearing along with relevant documents is available on the House Committee on Veterans Affairs website.
!!All well and good, but these bills need to have the appropriation of funds to put the legislation into action.
This is the one crucial step your elected officials neglect to tell you. Without the funding, these and all other pieces of legislation aren’t worth the paper they’re printed on!!
In local news:
Looks like “Chatty” Cathy is looking to dump one of her chiefly duties, the Care in the Community Program, on someone else…
Job opening - VAMC Northport:
The Northport VA Medical Center has an excellent opportunity for a motivated and organized physician with excellent interpersonal skills to become the:
Medical Director/Care in the Community Program
§ Collateral duty (0.5 FTEE) for which your clinical time will be adjusted to accommodate
§ Responsible for the development and continuing implementation of the Care in the Community Program
· Programmatically oversee all Care in the Community provided to
veterans of the Northport VAMC
o Evaluate and approve as appropriate Care in the Community requests as Chief of Staff designee
o Evaluate Northport VAMC use of Care in the Community on an ongoing basis
■ Collaborate with the Business Office and Fiscal Service on budgetary status
■ Strategize as needed to insure that fiscal requirements are met
· Collaborate closely with the Community Care Manager to develop agreements with community providers and organizations as needed
o Collaborate closely with Community Care Manager to manage referrals received efficiently and effectively
o Collaborate closely with RN Case Managers, Group Practice Manager and Telehealth staff to maximize VA offering of care
o Collaborate with Care in the Community Physician Leads within the VISN and nation to insure maximum use of VA resources and streamlined referral processes
o Represent Northport VAMC on VISN and national calls and at meetings as needed. Some travel may be required
o Review data from national/VISN Care in the Community sources, share with Northport VAMC clinical staff as needed Develop and implement action plans as needed.
• Reports to Chief of Staff for these duties
If interested, please send your CV to Dr. Cathy Cruise by email with a copy to Ms. Susan Spector by COB Friday July 6, 2018.
Please feel free to contact Dr. Cathy Cruise or Susan Spector with any questions or concerns.
Many thanks, Cathy
Cathy Cruise MD
Chief of Staff Northport VAMC
You gotta be shittin’ me! This is a ½-time job? I really have to find out what this girl is smoking...must be some pretty good shit. Please do call.....early and often!
One more tidbit on your new “director” and Chief of Staff, “Chatty” Cathy:
Regarding the eligibility for the “New Veterans Community Care Choice” option, seems like “Chatty” Cathy has this all figured out. Remember that “40-mile” rule? Well, “Chatty” is including any and all VA related clinics, Vet Centers, and Outposts in the mileage determination. If you live in Greenport, there is a Facility in Riverhead; you don’t qualify for “Choice”. If you live in Long Beach, there is a Facility in Valley Stream; you don’t qualify for “Choice”. Even if a veteran require services like Neurosurgery that are not offered anywhere locally except Manhattan VA, Chatty Cathy invokes the 40 mile rule simply because there is a clinic on Long Island – even if the services a veteran requires are not available at any Long Island VA clinic. If a veteran is eligible for Choice Care and they have private insurance, Chatty Cathy has instructed the staff to tell the patients to use their private insurance rather than the VA benefits they have EARNED.
Corrupt little cookie that “Chatty” Cathy! Looks like she needs an Ethics Consult from the Chair of the Ethics Committee… Wait a minute ! The Chair of the Ethics Committee is Dr. Hussein “The Horrible” Foda, who hired “Jumping” Gerry Cruise, Cathy’s husband, to be the Chief of Primary Care without even interviewing other applicants for the position. Whoops ! The both of them appear to be in need of an Ethics Consult.
Good Riddance, Scotty!:
The moving vans have packed Scotty “Lock The Door” all up and moved him out of his palatial estate by the Guard House.
July 2, 2018:
1) Unit 22 evacuated and shuttered due to lack of A/C
July 3, 2018:
1) Lab shuttered due to lack of A/C
2) Entire 4th floor shuttered due to lack of A/C
1) The HVAC system will not be fixed until further notice. The management is “estimating” a fix for Friday, July 13, 2018. Right...........!
Bldg. # 63
July 7 & 8, 2018:
1) Bldg. #63 was shut down and fumigated due to a full building infestation of insects. When do we get the plague of locusts?
Patient Access / Emerg. Rm.
July 10, 2018:
1) Either the attending Physician didn’t show up for work, or there was no one scheduled...OOOPS! I guess “Chatty” will be on this at first light (July 11, 2018).
In other local news....
1) The long arm of the law may catch up with Steve “The Snake” Snyder in Honolulu, Hawaii. Seems someone has notified the local Press and Stevie’s Supervisors all about his shenanigans and misdeeds in Northport. The saga continues!
2) Apparently, this covert practice of “2-PC’ing” as a disciplinary action for out-of-favor employees is quickly seeing the sunshine - and the spotlight. I’m thinking Charlene “The Charlatan” Thomesen might think about ducking for cover on this.
3) Don’t blink! The Brooklyn VAMC is in a deep pile of poo. No Staff in their Operating Rooms. No supplies. Equipment is ancient and out of calibration. All surgery being outsourced to Manhattan VA...but, oops, see below! Look for their doors to close before Northport. Thank you, Joan “Of Arc” McInerney, Dear Leader, VISN 2
4) NYU/Langone has cancelled their involvement with the Choice Program. Seems like NYU hasn’t been paid by VA in quite a while for the services they were providing.
5) Both NYU and Downstate Medical School are pulling trainees out of Brooklyn VA at record speed.
Do you see a pattern here? Can you read the writing on the wall?
On a happier note, this.......
VA Telehealth Goes Anywhere
Military.com Week of June 25, 2018
The Department of Veterans Affairs recently marked its go-live date for a policy shift that now allows qualified practitioners to log in to VA's telehealth system and see patients without regard to state rules and regulations. The VA delivers telehealth in clinical settings and in the home. In VA clinics, patients and local caregivers and technicians can connect with remote physicians and specialists, giving patients access to providers across the VA system. Also, the new VA Video Connect application allows in-home users to connect with doctors, mental health specialists, nurses and others to conduct medical visits, follow-up care and psychotherapy. VA Video Connect is available to Android and desktop users via the VA's website and to iOS users via Apple app stores.
And, oh boy, don’t you know “Chatty” Cathy and Joan “Of Arc” are driving this train. That light at the end of the tunnel is actually their little choo-choo train headed right for you. All you Veterans and VA employees may want to consider making other plans.
MY LITTLE GIRL DOESN’T
LIKE YOU VERY MUCH!