Sunday, 30 July 2017

2017 - 10 Things About The Veterans Choice Program

10 Things About The Veterans Choice Program

Doctor and patient shaking hands
The Veterans Choice Program (VCP) is a benefit that allows eligible Veterans to receive health care from a community provider rather than waiting for a VA appointment or traveling to a VA facility.
1. Am I eligible for the Veterans Choice Program?
To be eligible for the program, you must be enrolled in VA health care and must also meet at least one of the following criteria:
  • You are told by your local VA medical facility that you will need to wait more than 30 days for an appointment.
  • You residence is more than a 40 mile driving distance from the closest VA medical facility with a full time primary care physician.
  • You need to travel by air, boat, or ferry to the VA medical facility closet to your house.
  • You face an unusual or excessive burden in traveling to the closest VA medical facility based on a geographic challenge, environmental factor, medical condition, or other specific clinical decisions. Staff at your local VA medical facility will work with you to determine if you are eligible for any of these reasons.
  • You reside in a State or a United States Territory without a full-service VA medical facility that provides hospital care, emergency services and surgical care, and reside more than 20 miles from such a VA medical 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 note that some Veterans in New Hampshire reside within 20 miles of White River Junction VAMC and are therefore not eligible for the Veterans Choice Program.
2. What if I think I am eligible?
  • Call the VCP Call Center at 866-606-8198 or visit the Veterans Choice Program website to verify eligibility and set up an appointment here.
3. Can I call my non-VA doctor to make an appointment?
  • No, please call the VCP call center at 866-606-8198 to verify eligibility and set up an appointment.
4. How is the 40 mile calculation determined?
  • This calculation is based on the driving distance from your permanent residence (or active temporary address) to the closest VA facility, including Community-Based Outpatient Clinics and VA Medical Centers. You are eligible if you live more than 40 miles driving distance from the closest medical facility that has a full-time primary care physician.
5. If I am eligible for the Veterans Choice Program, can I receive Beneficiary Travel for travel to appointments with a VCP provider?
  • Yes, the Choice Act does provide funding to pay for travel to VCP providers for Veterans who are eligible for Beneficiary Travel. However, it did not provide any new Beneficiary Travel eligibility.
6. If I didn’t get my Choice Card or I lost my Choice Card, what do I do?
  • You do not need your Choice Card to access the VCP. If you didn’t receive a Choice Card or lost your Choice Card, simply call 866-606-8198 to find out if you are eligible and to make an appointment.
7. How do I get my prescription filled if I use the Veterans Choice Program?
  • The community provider you see through the VCP can issue a prescription for up to a 14 day supply of a national formulary drug. You may have the 14 day supply filled at any non-VA pharmacy of your choosing.
  • Prescriptions can be reimbursed through the Business Office/Non-VA Care Coordination Office at VA facilities. This reimbursement may take 30-45 days to process, and requires a copy of the prescription and the original receipt. Veterans cannot be reimbursed at the VA Pharmacy.
  • For prescriptions needed past 14 days, please follow standard procedures to fill a prescription at the VA pharmacy.
8. If I use the Veterans Choice Program, does that affect my VA health care?
  • No, not at all. You do not have to choose between the two. The VCP is here to make it easier to access the care you need. VA is building a high-performing integrated health care network to deliver the best of VA and the community. This integrated network will give Veterans more choices to access care and ensure care is delivered where and when you need it.
9. What is my responsibility for co-payments to my other insurance?
  • Nothing. VA is now the primary coordinator of benefits for VCP, so you are only responsible for your VA copayment.
  • Your VA copayment will be determined by VA after the care is provided. VA copayments will be billed by VA after the appointment.
10. How does the new VCP extension law affect me?
  • Public Law 115-26, enacted April 19, 2017, made three key changes to help improve the VCP. The law removed the expiration date for the program, made VA primary coordinator of benefits for services provided to you, and it removed barriers with sharing necessary health information with community providers.
More Information
  • Please refer to the Veterans Choice Program website for more information about the program, its benefits, and eligibility criteria here.
  • Providers interested in participating must establish a contract with one of the contractors, Health Net Federal, or TriWest Healthcare Alliance. For more information, about how to participate please visit Veterans Choice Program website for providers.

Monday, 10 July 2017

2017 - The Global Trend in Health Expenses and Current Electronic Medical Records

Veterans of War, the global trend in health expenses and current Electronic Medical Records.

                                       Eduardo C. Gerding

The purpose of this article is to point out the increase in health expenses worldwide and the possibility of improving benefits through the use of Electronic Medical Records in active and retired military personnel but above all in the universe of our Veterans of war.

Health expenditures

In a decade, nearly $1 in every $5 spent in the United States by 2024 will be on health care, and this spending grew faster than the entire economy. 19

Pie chart showing the spending percentages invested in the UK for Fiscal Year 2017. Health occupies 18 percent

In Argentina, health spending in 2014 was 2.65% of GDP, a drop of 0.09 points compared to 2013, at which time spending represented 2.74% of GDP.

In 2014, Argentina spent 6.92% of its total public expenditure on health, while the previous year had devoted 7.72%, five years earlier to 17.13% and if we go back ten years ago the percentage was 16.92% of public spending, that is to say, the proportion destined to health has fallen in recent years.

In reference to the percentage that implies the investment in sanity with respect to the governmental budget (public expenditure), Argentina is in position 154.

In 2014, public spending on health in Argentina was 262 Euros per inhabitant and in 2013, 298 Euros. Based on public expenditure on health per capita, Argentina ranks 74 out of 192 published countries.

In 2014 the public expenditure per capita in sanitation in Argentina was 244 Euros. It is the total expenditure on health divided among all its inhabitants, regardless of their age or situation. Currently, according to its public expenditure on health per capita, Argentina is ranked 74 out of 192 published. 2

Interesting studies have been done comparing the health systems of Argentina, Canada and the USA. 12

Health spending on US war veteransHow is spending on military personnel health divided?

In 2012 at least, the expenses of the US Department of Defense were divided into three areas: $ 32 billion for the TRICARE health program that provides assistance to active military personnel, $ 19.7 trillion for the TRICARE Lifetime Program Medicare supplemental insurance for retired military personnel and then a mix that includes payment to military hospitals and health workers. The program covers 9.6 million Americans.

Unlike TRICARE that hires providers in the private sector, the Veterans Administration is a single payer system and follows the NHS guidelines in which the government owns the hospitals and pays the bills. 11,16,20

Health expenditures for military personnel are increasing faster than inflation. 11

How much does the US spend on its war veterans? In 2014 they spent $ 154 billion representing 4 percent of the federal budget. This included veteran benefits, hospital medical care, housing, education, training, and rehabilitation. 17

War veterans have an increased risk of suicide, homelessness, mental health disorders such as Post Traumatic Stress, disabilities, and even unemployment. 17

On the other hand, military spending accounts for 17 percent of federal spending; A little more than half of the spending at the discretion of 2014. Military expenditures include the basic defense budget, nuclear weapons, international assistance and Overseas Contingency Operations. 17

Spending on the Military and on Veterans in 2014.

In a very tough article Jasmine Tucker asked: What does it say about our priorities as a nation that for every dollar the U.S. spends on its military this year, it will spend less than 24 cents caring for its veterans? 17

Military personnel and access to medical providers in the US

The active duty military personnel has priority of assistance.

In 1866 the Civil Medical Assistance Program of the Uniformed Services (CHAMPUS) was created and it allowed the Secretary of Defense to contract civilian providers.

In 1980 came the Reform to the CHAMPUS Initiative (CRI). Under the latter, three types of benefits were offered to the patient: 1) TRICARE Prime (possibility of choosing provider), 2) TRICARE Extra (offered a list of providers) and 3) TRICARE standard (could choose provider but costs were higher ). The latter was also offered to retired staff.

With the TRICARE system USA was divided into 12 health regions with a responsible agent in each of them. Seven civilian welfare providers were hired to meet the needs of the 12 regions.

In 2014, Senate Committee Chairman Bernie Sanders (Senator for Vermont) and Senator John McCain announced a bill that expanded veterans' access to various health facilities and increased reliability In the Department of Veterans Affairs.

Basically the Sanders-McCain Bill what was established was: 13,14   

  1. War Veterans who have a long waiting time or who live more than 40 km. away from a Veterans Administration´s provider will be authorized to would allow veterans to seek private care. An audit revealed that there were 75,000 war veterans who had to wait more than three months to be assisted by a Veterans Administration professional. It also would require the VA to establish disciplinary procedures for employees who knowingly falsify wait time data.
  2. US $ 500 million would probably be authorized to hire more doctors and nurses.
  3. The Senate bill would require the VA to post on the Internet current wait times for appointments in primary and specialty care at each VA medical center.
  4. Construction of 26 medical centers in 18 states. 6

Electronic Medical Record systems (EMRs)

An Electronic Medical Record system is an accumulation of digitized information from a patient population. Data include clinical history, prescriptions, allergies, vaccination, laboratory analysis, imaging studies, vital signs, age, weight, demographic information and billing. The paperwork is eliminated and the information kept up to date.

According to the US Veterans Administration This system improves its efficiency by 6% each year elapsed.

Systems have been implemented (Intermedic Trip Tix) that automatically read the written by the health agents during the ambulance transfer and turn it into digital information.

With the RME it improves the quality of care. It would serve to reduce costs primarily in large institutions and not so much in small offices. According to a study by the Annals of Internal Medicine reduces the hours of identification of a patient from 130 to 46 hours. 3

Professionals can synchronize their cell phones with EMRs. The threats to EMRs are: a) By personnel or hackers, b) Environmental disasters (hurricane, fires), c) Technological failures and traffic accidents.

The general public has not received the EMRs completely because of the possibility that the government may use these data beyond the purpose for which they were created or that the information falls into the wrong hands. Several countries have issued very strict laws in this regard. The European Union made a General Regulation of Data Protection. 4

In UK, the NHS (similar to our PAMI) has pledged not to use more papers and to register all health data as EMR by 2020 (Five Year Forward View, NHS England October 2014) 4

A survey conducted in London in 2015 on 2761 patients reported that 79% were concerned about RME safety. However 55% support this technique. 9


In the USA. The MiCare System not only effectively manages the healthcare demands but also controls the expenses they generate. It has two components: a) The direct cost of care and b) The indirect administrative cost. There is also the RelayHealth founded in 1999 by Giovanni Colella with his headquarters in Atlanta, Georgia. 8.10

Recall that in October 2016 the Legislature of Buenos Aires unanimously approved the law to create the Integrated System of Electronic Clinical Histories (ECH), which is already implemented in 10 community centers (CeSAC) and that by the end of 2017 will be effective in 43 Districts. 1

 Electronic Medical Record screen

US Secretary of War Veterans Affairs Dr David J. Shulkin announced on June 5 of this year his decision to implement the EMR for the Department of Veterans Affairs. 18


The MHS GENESIS is the last word in EMR that has acquired the US Department of Defense. It holds all medical and dental records. It will replace various systems and will comprise the Armed Forces Longitudinal Health Technology Applications (AHLTA), the Joint Compound System (CHCS) and the Joint Medical Theater Program (TMP-J). The Office of Management of the Joint Medical Operational Information System (JOMIS) is responsible for the operation of the MHS GENESIS.

The acronym IOC refers to Initial Operational Capacity and describes the first destinations that will receive the MHS GENESIS. These are: Army Madigan Medical Center, Bremerton Naval Hospital, Oak Harbor Naval Hospital and Fairchild Air Force Base (92nd Medical and Dental).

Those patients who move to destinations where MHS GENESIS is not yet applied may continue to use the RelayHealth / MiCare or Tricare systems online.


 At the MHS GENESIS Patient web patients will be able to:
1.      Manage medical and active duty dental appointments.
2.      View notes from the clinical visits and certain lab/tests results such as blood tests.
3.      Request the prescription renewal of medications.
4.      Exchange secure messages with the health team.
5.      Monitor the health information of the holder and their relatives and corroborate the care profile.

6.      Complete a pre-visit active duty dental health questionnaire online.
7.      Look up information related to their health concerns and medications.
8.      View, download, transmit and print their health data.
9.      Receive alerts about their medical exams and connect with health education links.

The patients can access the MHS GENESIS portal:
1.      From 0-12 years: Parents or caregivers will have access to the child's records.
2.      From 13 to 17 years: To enter require a password.
3.      More than 18 years: To enter require a password
4.      National Guard / Reserve / Retired: Enter your password.
5.      Personnel who have been separated from force but not retired: That is, personnel who have completed their military service and are on their way to retirement. They are allowed a period of six months in which they keep their password.
6.      Deaths: The account of deceased personnel is deactivated but
Your family members can still access the portal.

The password is obtained through the Human Resources Data Center of the US Department of Defense.


1.     Aprobaron la ley de historias clínicas electrónicas para los hospitales públicos de la Ciudad
2.      Argentina-Gasto Publico en Salud
3.      Baron, Richard MD- Quality Improvement with an Electronic Health Record: Achievable, but Not Automatic- 16 October 2007 Annals of Internal Medicine Volume 147 • Number 8
4.      Electronic Health Record
5.      Electronic Health Record-Houses of Parliament
6.      Herb, Jeremy-Sanders-McCain strike VA deal -06/05/2014.
7.      MHS GENESIS-Health.Mil
8.      MiCare
9.      Papoutsi, C, J. E. Reed, C. Marston, R. Lewis, A. Majeed, D. Bell, ‘Patient and public views about the security and privacy of Electronic Health Records (EHRs) in the UK: results from a mixed methods study’, BMC Medical Informatics & Decision Making, 2015, 15 (1).
11.  Roy, Avik-How Health-Care Spending Strains the U.S. Military- Forbes-March 12, 2012
13.  Simon, Richard-A primer on how the VA crisis broke the usual congressional gridlock .Los Angeles Times, June 10, 2014.
14.  Simon, Richard, Zarembo, Alan-VA audit sparks outrage in Congress over long waits for medical care-Los Angeles Time, June 24, 2017-
15.  Total Pie Chart UK for 2017
17.  Tucker, Jasmine- How Much Do We Spend on Our Nation’s Veterans?-National Priorities Project-Nov 11, 2014
18.  US Department of Veterans Affair-News Release-Secretary's Blog, Top Stories by OMR-June 5, 2017

Sunday, 21 May 2017

2017-The road to resilience

The Road to Resilience

American Psychological Association

How do people deal with difficult events that change their lives? The death of a loved one, loss of a job, serious illness, terrorist attacks and other traumatic events: these are all examples of very challenging life experiences. Many people react to such circumstances with a flood of strong emotions and a sense of uncertainty.

Yet people generally adapt well over time to life-changing situations and stressful conditions. What enables them to do so? It involves resilience, an ongoing process that requires time and effort and engages people in taking a number of steps.

This brochure is intended to help readers with taking their own road to resilience. The information within describes resilience and some factors that affect how people deal with hardship. Much of the brochure focuses on developing and using a personal strategy for enhancing resilience.

What is resilience?

Resilience is the process of adapting well in the face of adversity, trauma, tragedy, threats or significant sources of stress — such as family and relationship problems, serious health problems or workplace and financial stressors. It means "bouncing back" from difficult experiences.

Research has shown that resilience is ordinary, not extraordinary. People commonly demonstrate resilience. One example is the response of many Americans to the September 11, 2001 terrorist attacks and individuals' efforts to rebuild their lives.

Being resilient does not mean that a person doesn't experience difficulty or distress. Emotional pain and sadness are common in people who have suffered major adversity or trauma in their lives. In fact, the road to resilience is likely to involve considerable emotional distress.

Resilience is not a trait that people either have or do not have. It involves behaviors, thoughts and actions that can be learned and developed in anyone.

Factors in Resilience

A combination of factors contributes to resilience. Many studies show that the primary factor in resilience is having caring and supportive relationships within and outside the family. Relationships that create love and trust, provide role models and offer encouragement and reassurance help bolster a person's resilience.

Several additional factors are associated with resilience, including:

  • The capacity to make realistic plans and take steps to carry them out.
  • A positive view of yourself and confidence in your strengths and abilities.
  • Skills in communication and problem solving.
  • The capacity to manage strong feelings and impulses.

All of these are factors that people can develop in themselves.

Strategies For Building Resilience

Developing resilience is a personal journey. People do not all react the same to traumatic and stressful life events. An approach to building resilience that works for one person might not work for another. People use varying strategies.

Some variation may reflect cultural differences. A person's culture might have an impact on how he or she communicates feelings and deals with adversity — for example, whether and how a person connects with significant others, including extended family members and community resources. With growing cultural diversity, the public has greater access to a number of different approaches to building resilience.

Some or many of the ways to build resilience in the following pages may be appropriate to consider in developing your personal strategy.

10 ways to build resilience

Make connections. Good relationships with close family members, friends or others are important. Accepting help and support from those who care about you and will listen to you strengthens resilience. Some people find that being active in civic groups, faith-based organizations, or other local groups provides social support and can help with reclaiming hope. Assisting others in their time of need also can benefit the helper.

Avoid seeing crises as insurmountable problems. You can't change the fact that highly stressful events happen, but you can change how you interpret and respond to these events. Try looking beyond the present to how future circumstances may be a little better. Note any subtle ways in which you might already feel somewhat better as you deal with difficult situations.

Accept that change is a part of living. Certain goals may no longer be attainable as a result of adverse situations. Accepting circumstances that cannot be changed can help you focus on circumstances that you can alter.

Move toward your goals. Develop some realistic goals. Do something regularly — even if it seems like a small accomplishment — that enables you to move toward your goals. Instead of focusing on tasks that seem unachievable, ask yourself, "What's one thing I know I can accomplish today that helps me move in the direction I want to go?"

Take decisive actions. Act on adverse situations as much as you can. Take decisive actions, rather than detaching completely from problems and stresses and wishing they would just go away.

Look for opportunities for self-discovery. People often learn something about themselves and may find that they have grown in some respect as a result of their struggle with loss. Many people who have experienced tragedies and hardship have reported better relationships, greater sense of strength even while feeling vulnerable, increased sense of self-worth, a more developed spirituality and heightened appreciation for life.

Nurture a positive view of yourself. Developing confidence in your ability to solve problems and trusting your instincts helps build resilience.

Keep things in perspective. Even when facing very painful events, try to consider the stressful situation in a broader context and keep a long-term perspective. Avoid blowing the event out of proportion.

Maintain a hopeful outlook. An optimistic outlook enables you to expect that good things will happen in your life. Try visualizing what you want, rather than worrying about what you fear.

Take care of yourself. Pay attention to your own needs and feelings. Engage in activities that you enjoy and find relaxing. Exercise regularly. Taking care of yourself helps to keep your mind and body primed to deal with situations that require resilience.

Additional ways of strengthening resilience may be helpful. For example, some people write about their deepest thoughts and feelings related to trauma or other stressful events in their life. Meditation and spiritual practices help some people build connections and restore hope.

The key is to identify ways that are likely to work well for you as part of your own personal strategy for fostering resilience.

Learning from your past

Focusing on past experiences and sources of personal strength can help you learn about what strategies for building resilience might work for you. By exploring answers to the following questions about yourself and your reactions to challenging life events, you may discover how you can respond effectively to difficult situations in your life.

Consider the following:

  • What kinds of events have been most stressful for me?
  • How have those events typically affected me?
  • Have I found it helpful to think of important people in my life when I am distressed?
  • To whom have I reached out for support in working through a traumatic or stressful experience?
  • What have I learned about myself and my interactions with others during difficult times?
  • Has it been helpful for me to assist someone else going through a similar experience?
  • Have I been able to overcome obstacles, and if so, how?
  • What has helped make me feel more hopeful about the future?

Staying flexible

Resilience involves maintaining flexibility and balance in your life as you deal with stressful circumstances and traumatic events. This happens in several ways, including:

  • Letting yourself experience strong emotions, and also realizing when you may need to avoid experiencing them at times in order to continue functioning.
  • Stepping forward and taking action to deal with your problems and meet the demands of daily living, and also stepping back to rest and reenergize yourself.
  • Spending time with loved ones to gain support and encouragement, and also nurturing yourself.
  • Relying on others, and also relying on yourself.

Places to look for help

Getting help when you need it is crucial in building your resilience. Beyond caring family members and friends, people often find it helpful to turn to:

  • Self-help and support groups. Such community groups can aid people struggling with hardships such as the death of a loved one. By sharing information, ideas and emotions, group participants can assist one another and find comfort in knowing that they are not alone in experiencing difficulty.
  • Books and other publications by people who have successfully managed adverse situations such as surviving cancer. These stories can motivate readers to find a strategy that might work for them personally.
  • Online resources. Information on the web can be a helpful source of ideas, though the quality of information varies among sources.

For many people, using their own resources and the kinds of help listed above may be sufficient for building resilience. At times, however, an individual might get stuck or have difficulty making progress on the road to resilience.

Different people tend to be comfortable with somewhat different styles of interaction. A person should feel at ease and have good rapport in working with a mental health professional or participating in a support group.

Continuing on your journey

To help summarize several of the main points in this brochure, think of resilience as similar to taking a raft trip down a river.

On a river, you may encounter rapids, turns, slow water and shallows. As in life, the changes you experience affect you differently along the way.

In traveling the river, it helps to have knowledge about it and past experience in dealing with it. Your journey should be guided by a plan, a strategy that you consider likely to work well for you.

Perseverance and trust in your ability to work your way around boulders and other obstacles are important. You can gain courage and insight by successfully navigating your way through white water.

Trusted companions who accompany you on the journey can be especially helpful for dealing with rapids, upstream currents and other difficult stretches of the river.

You can climb out to rest alongside the river. But to get to the end of your journey, you need to get back in the raft and continue.

Information contained in this brochure should not be used as a substitute for professional health and mental health care or consultation. Individuals who believe they may need or benefit from care should consult a psychologist or other licensed health/mental health professional.


APA gratefully acknowledges the following contributors to this publication:

  • Lillian Comas-Diaz, PhD, Director, Transcultural Mental Health Institute, Washington, D.C.
  • Suniya S. Luthar, PhD, Teachers College, Columbia University, New York City, N.Y.
  • Salvatore R. Maddi, PhD, The Hardiness Institute, Inc., University of California at Irvine, Newport Beach, Calif.
  • H. Katherine (Kit) O'Neill, PhD, North Dakota State University and Knowlton, O'Neill and Associates, Fargo, N.D.
  • Karen W. Saakvitne, PhD, Traumatic Stress Institute/Center for Adult & Adolescent Psychotherapy, South Windsor, Conn.
  • Richard Glenn Tedeschi, PhD, Department of Psychology, University of North Carolina at Charlotte
American Psychological Association

APA, located in Washington, D.C., is the leading scientific and professional organization representing psychology in the United States. APA works to advance psychology as a science and profession and as a means of promoting health and human welfare.
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