Veterans’ Health Today

Summer 2015

Veterans Choice Program Q & A

What is the Veterans Choice Program?

The Veterans Choice Program is a new temporary program to improve Veterans’ access to health care by allowing certain Veterans to elect to receive health care from eligible providers outside of VA. The program was established by section 101 of the Veterans Access, Choice, and Accountability Act of 2014 (Choice Act).

Who is eligible for the program?

A Veteran must have been enrolled in VA healthcare on or before August 1, 2014, or be eligible to enroll as a combat Veteran. Additionally, a Veteran must also meet at least one of the following criteria:

·         The Veteran is told by his/her local VA medical facility that he/she will need to wait more than 30 days for an appointment from the date clinically determined by his/her physician or, if no such date is provided, the Veteran’s preferred date.

·         The Veteran’s residence is more than 40 miles driving distance from the closest VA medical facility.

·         The Veteran resides in a location, other than Guam, American Samoa, or the Republic of the Philippines, that is 40 miles or less from a VA medical facility and the Veteran needs to travel by air, boat, or ferry to reach that VA medical facility.

·         The Veteran resides in a location (other than Guam, American Samoa, or the Republic of the Philippines) that is 40 miles or less from a VA medical facility and faces an unusual or excessive burden in traveling to a VA medical facility based on the presence of a body of water (including moving water and still water) or a geologic formation that cannot be crossed by road.

·         The Veteran resides in a State or a United States Territory without a full-service VA medical facility that provides hospital care, emergency services, and surgical care having a surgical complexity of standard, and resides more than 20 miles from such a VA facility. NOTE: This criterion applies to Veterans residing in Alaska, Hawaii, New Hampshire, Guam, American Samoa, Commonwealth of the Northern Mariana Islands and the U.S. Virgin Islands. Also, some Veterans in New Hampshire reside within 20 miles of White River Junction VAMC.

How do Veterans get care authorized and make an appointment?

Veterans must call the Choice Program Call Center at 866-606-8198 to verify eligibility and set up an appointment.

What is the Veterans Choice Card?

VA mailed all enrolled Veterans a Veterans Choice Card and information about the Choice Program. The Choice Card doesn’t replace the identification card Veterans already use to access other VA benefits. If a Veteran is satisfied and wishes to continue with his/her current VA care, there is nothing they need to do at this time. Veterans should save their Choice Cards in case they would like to use the Program in the future. If a Veteran can’t find his/her Choice Card, he/she can still call the Choice Program Call Center at 866-606-8198 for information.

What is the new expanded eligibility for the Veterans Choice Program?

VA expanded eligibility for the Choice Program by changing the method used to measure the distance between a Veteran’s residence and the nearest VA medical facility from a straight-line distance to driving distance. Accordingly, Veterans who live more than 40 miles (driving distance) from the nearest facility are now eligible for the Program. Driving distance will also be used to determine eligibility under the other residence criteria, described above.

For more information, visit www.va.gov/opa/choiceact


STROKE – When Seconds Count

Every 40 seconds, someone in the United States has a stroke. Every four minutes, someone dies of a stroke. How can you help save a life—yours or someone else’s—if a stroke occurs?

“The most important thing is DO NOT ignore stroke symptoms,” said Dr. Thomas Hemmen, Professor and Clinical Service Chief, Department of Neurosciences Director for the University of California–San Diego Stroke Program. “Many people ignore weakness, confusion and trouble seeing or walking. They often lie down to take a nap and hope things get better. That’s the wrong thing to do.”

Dr. Stephanie Lessig, Neurologist for VA San Diego Health Care System, agreed. “Often people believe there is ‘nothing to be done’ for a stroke, so they delay seeking medical attention. This is not only untrue, but places one at risk of further complications on top of the initial stroke symptoms if it is not evaluated.”

Stroke symptoms such as those Hemmen mentioned are usually sudden. They include some or all of the following:

·         Numbness or weakness of the face, arm or leg—especially on one side of the body

·         Confusion; trouble speaking or understanding words

·         Trouble seeing in one or both eyes

·         Difficulty walking, dizziness or loss of balance or coordination

·         Severe headache with no known cause

Hemmen said if you or someone else has ANY of these symptoms, call 911 immediately. What causes a stroke is a blockage or rupture of a blood vessel that normally carries blood (and oxygen) to your brain. Your brain cells quickly begin to die and lose the ability to control parts of your body.

“We estimate about 1.9 million brain cells die every minute once a stroke is ongoing,” explained Hemmen. “Strokes can be deadly, but quick treatment often reduces the brain damage strokes cause.”

He added first responders can’t provide treatment at home or in the ambulance. Instead, hospital staff must perform a computerized tomography (CT) scan to determine the type of stroke you’re having, which then dictates the treatment you need. In addition to calling 911 as soon as you notice symptoms, Hemmen said it is critical to note when the stroke symptoms began by reporting when the person suffering the stroke last felt normal (time before the stroke started) because that helps medical staff know which treatments may work.

“Once we know what type of stroke a patient is having, we can begin treatment. We administer a drug for some stroke patients with blocked arteries, but we must do it within 4.5 hours. We can also go in with a catheter similar to the type used for heart attack patients and use a tool to clean out an artery, but we can only perform the procedure within eight hours after a stroke,” he said. “The clock is ticking and brain cells are dying, so it’s important to first call 911 and then document when symptoms started or when you last felt OK.”

Hemmen said there is a hereditary component to strokes, so having a loved one who has experienced a stroke may put you at higher risk of having one, too. You can’t control your genetics, of course, but you can—and should—control other risk factors.

“The best thing you can do is monitor your blood pressure and get treatment if you have high blood pressure,” he explained. “A resting blood pressure—taken when you are not physically active and you are not experiencing stress or pain—should be 120/80 or lower.” Additional risk factors include high cholesterol and glucose intolerance, said Lessig, all of which should be regularly monitored by your primary physician.

If you think someone may be having a stroke, remember to act F.A.S.T.!

Face: Ask the person to smile. Does one side of the face droop, or is it numb?

Arms: Ask the person to raise both arms. Does one arm drift downward, or is it weak or numb?

Speech: Ask the person to repeat a simple phrase, such as “The sky is blue.” Is the person’s speech slurred or hard to understand?

Time: If you observe any of these signs, call 911 immediately, even if symptoms go away. Note the time symptoms first appeared, as some treatments are only effective if given within a short time frame.

As with any illness, it’s critical to follow-up with your health care team after discharge from the hospital following a stroke. In addition to lifestyle changes and/or rehabilitation, you may need routine testing to monitor potential side effects of medication that thins your blood and prevents future clots from forming.

What do your blood pressure numbers mean?

Blood pressure is measured by two numbers.

Systolic

120

80

Diastolic

Your provider will read this blood pressure as “120 over 80.

The first (or top) number—systolic—is the pressure in your blood vessels when your heart beats. The second (or bottom) number—diastolic —is the pressure in your blood vessels between heartbeats.

FOR MORE INFORMATION …

·         Taking care of a stroke survivor requires time, patience, and understanding. The Resources & Education for Stroke Caregivers’ Understanding & Empowerment (RESCUE) pages help caregivers “keep their head above water” when caring for a loved one. Learn more at www.rorc.research.va.gov/rescue.

·         The Centers for Disease Control and Prevention (CDC) explains the signs and symptoms of different types of strokes at www.cdc.gov/stroke/types_of_stroke.htm.

·         The American Stroke Association helps you learn about stroke prevention and life after a stroke. See www.strokeassociation.org.


 

A Call Away

For Veterans in need of help or advice, VA provides help at their fingertips, with a variety of resources just a call away — 24 hours a day, 7 days a week.

·         Nurses are available for health care advice at 1-877-252-4866

·         The Veterans Crisis Line aids Veterans in crisis (as well as their families and friends) at 1-800-273-8255, by texting 838255, or online at www.veteranscrisisline.net

·         The National Call Center for Homeless Veterans hotline provides homeless or at-risk Veterans access to trained counselors at 1-877-4AID VET (877-424-3838) or online at www.va.gov/homeless/nationalcallcenter.asp


 

Patient Safety is Everyone’s Business

All hospitalized Veterans share a common goal: to leave the hospital in much better condition than when they were admitted. We have numerous programs in place to ensure patient safety happens.

Before surgery, for example, a doctor or surgical team member may use a pen to mark the place on your body where the surgery will happen or may ask you seemingly odd questions, such as your name and what part of the body will be operated on. The team obviously knows the answers to those questions, but cross-check procedures like these help to prevent errors.

Dr. Kandace Woodruff, Patient Safety Officer for VA Desert Pacific Healthcare Network, spoke about some of the many other initiatives and explains how Veterans can help.

“We use an approach adopted from the National Aeronautics and Space Administration (NASA) that represents a unified and cohesive patient safety effort. This award winning program is unique to health care. The process is targeted at identifying and eliminating system weaknesses and allows all of our staff to be actively engaged in the safety process,” she said. “In the operating room, for example, we reduce surgical errors by allowing every person in the room an opportunity to speak up if they have concerns. This is how we can ensure that we do not leave surgical items (such as surgical instruments or sponges) inside a patient and that we perform the correct procedure every time. At all of our hospitals, we believe patient safety is everyone’s business.”

Woodruff said a big aspect of patient safety involves communication with Veterans—telling them what to expect or explaining what is occurring. It is important to empower Veterans, giving them a voice and encouraging them to speak up if they have questions or concerns. “We want our Veterans to actively participate in their own treatment planning by engaging them in the decision-making process,” she said.

“We also look at what we can do as an organization to reduce or eliminate infections,” she added. This includes encouraging friends, family, and health care providers to wash and sanitize their hands before coming into direct contact with Veterans while they receive care.

Our staff want to give Veterans an experience that changes their life in a meaningful and positive way. “We want them to be comfortable and to feel confident that when entering one of our facilities, they can expect to receive the absolute best care,” she concluded. “It is our privilege to provide care for our Veterans and it is our duty to ensure that we do so in a safe and efficient manner.”

Your role in patient safety is to SPEAK UP!

·         Please ask questions about your condition, prescriptions, procedures, test results, treatment plan, discharge instructions, or anything else that concerns you.

·         Please provide accurate information about changes to your condition, medical history, allergies, etc.

The National Center for Patient Safety (NCPS) was established in 1999 to lead VA’s patient safety efforts and to develop and nurture a culture of safety throughout the Veterans Health Administration. The goal of the NCPS is to reduce and prevent inadvertent harm to patients as a result of their care. To learn more, see www.patientsafety.va.gov.

 

 

Hepatitis C: Treat or Wait?

Have you heard about a disease called hepatitis C and wondered what it is?

Hepatitis C is a blood infection—a virus that can seriously affect your liver and eventually make you very ill. Several million people in the United States may have it and not even know it.

But there is good news! Many people with hepatitis C do not develop severe liver disease, and new medications have the potential to cure some patients. But not everyone with the disease needs treatment right away. Dr. Jeffrey Sayers, Chief of Pharmacy Service, VA Greater Los Angeles Healthcare System, explained.

“Historically, the drugs for managing hepatitis C took almost a year to work, required injections, and caused serious side effects,” he said. “In 2014, two new drugs were approved that required shorter treatment courses and offered remarkable cure rates. Still, some patients required injections, depending on the genotype (or strain) a person has.” Genotype 1 is the most common and the most serious.

“In 2015,” he continued, “two more new drugs came out that tout approximately 90 percent cure rates, and they’re much easier to take. So the excitement has built over time.”

Dr. Jennifer Kryskalla, Pharmacoeconomist in VA Desert Pacific Network (VISN 22), agreed and said our facilities are seeing excellent results so far. “We have started over 1,200 patients on treatment since 2014. Of those who completed treatment and had the necessary follow-up lab tests, we are seeing 85 percent cure rates, which is really exciting.” She added the newer drugs are not entirely free of side effects, but those that occur are much milder, such as rash, fatigue, or headache.

“Veterans should talk with their primary care provider,” suggested Sayers. “Depending on their hepatitis C test results, some patients can prolong starting treatment because more new drugs or improved versions of the current ones will likely come out in the next few years.”

Kryskalla added that while some Veterans can wait for treatment, others definitely cannot. “Your doctor determines whether the liver is healthy enough to wait. But we are actively looking for patients with cirrhosis, a chronic disease of the liver, because they are in more advanced stages of the disease. They have less time to wait, so we really need to see them right away.”

Depending on the facility where you seek treatment, a pharmacist, physician’s assistant, or nurse practitioner may be managing your treatment and will maintain regular contact with you. “We are investing the time to make sure the treatment continues because the cure rates are so remarkable,” said Sayers, “as long as the patient continues to take the drug.”

FOR MORE INFORMATION:

·         Contact your doctor.

·         Go to www.hepatitis.va.gov.

·         See the VA booklet titled Hepatitis C: An Introductory Guide for Patients at www.hepatitis.va.gov/pdf/hepatitisC-booklet.pdf.


 

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