Medicare Meltdown Looming As Steep Medicare Cut Begins

/PRNewswire/ -- The U.S. Senate's failure to act before this week's 21 percent Medicare physician payment cut has put seniors' health care at grave risk. A new American Medical Association (AMA) physician survey shows that many physicians are already limiting the number of Medicare patients they treat. The AMA today launched a multi-million dollar national advertising campaign, with ads on TV and radio and in newspapers, including The New York Times, USAToday and The Wall Street Journal.

"The Senate has turned its back on our nation's seniors and the physicians who care for them by leaving for vacation and failing to stop a 21 percent Medicare cut before their self-imposed June 1 deadline," said AMA President J. James Rohack, M.D. "Today, the AMA is unveiling a new multi-million dollar ad campaign encouraging the public to contact their Senators and tell them to get back to work and fix Medicare now."

The 21 percent cut also hurts our nation's military families, as TRICARE rates are tied to Medicare. "It is sad and ironic that Senators raced home to celebrate Memorial Day without first voting to preserve health care for active duty military families," Dr. Rohack said.

Yesterday, the AMA received a call from Joan, a retired nurse, who was looking for a Maryland physician for her 72-year-old sister and could not find one who took Medicare. Both physician offices she called said that as of this June 1 they were no longer accepting new Medicare patients -- a real life example of how decisions made in Washington hurt real people.

Our new online survey of 9,000 physicians who care for Medicare patients confirms that seniors are already being hurt by Congress' mismanagement of the Medicare program. About one in five physicians (17%) say they have already been forced to limit the number of Medicare patients in their practice. Nearly one-third of primary care physicians (31%) have already been forced to take that action. The top two reasons physicians gave for these actions were the ongoing threat of future cuts and the fact that Medicare payment rates were already too low.

"Make no mistake: Physicians want to care for seniors and military families, but the chronic instability caused by the threat of future payment cuts has already taken its toll - and a 21 percent cut will make matters much worse," Dr. Rohack said.

"This is the third time this year that Congress has allowed a Medicare deadline to expire without action," Dr. Rohack said. "Each time Congress delays fixing the Medicare physician payment cut makes the problem worse and the price tag higher for the American taxpayer. Enough is enough. The Senate needs to fix the Medicare physician payment system for America's seniors once and for all."

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Humana Military Healthcare Services Receives Accreditation in Diabetes Disease Management Program

Re-accreditation also awarded for Asthma and Heart Failure

Humana Military Healthcare Services, a wholly owned subsidiary of Humana Inc. (NYSE: HUM), recently received accreditation for its Disease Management Program – Diabetes and its first re-accreditation for Disease Management programs in Asthma and Heart Failure.

“We are proud URAC recognizes our commitment to providing quality health care to our men and women in uniform, retirees and dependents,” said Dave Baker, president and CEO of Humana Military. “Our disease management programs help beneficiaries understand and manage their special health conditions and we are happy to offer this benefit.”

“By applying for and receiving Disease Management Accreditation, Humana Military has demonstrated a commitment to quality health care,” said Alan P. Spielman, URAC president and CEO. “Quality health care is crucial to our nation’s welfare and it is important to have organizations that are willing to measure themselves against national standards.”

In addition, Humana Military has current URAC accreditation for Case Management, Health Information Portability and Accountability Act (HIPAA) Privacy, Health Network, Health Utilization Management, and Health Web Site.

URAC, an independent, nonprofit organization, is a leader in promoting health care quality through accreditation and certification programs. URAC’s standards keep pace with the rapid changes in the healthcare system, and provide a mark of distinction for health care organizations to demonstrate their commitment to quality and accountability. Through its broad-based governance structure and an inclusive standards development process, URAC ensures all stakeholders are represented in setting meaningful standards for the health care industry. For more information, visit www.urac.org.
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Team Teaches CPR to Afghan Medical Providers

Six Afghan medical providers learned basic lifesaving skills at a Panjshir Provincial Reconstruction Team cardiopulmonary resuscitation course held at the Rokha Clinic on June 18.

Air Force Staff Sgt. Janine Duschka, a PRT medical technician deployed from Andrews Air Force Base, Md., taught the course.

"It is important to teach the local medical providers, because it gives them another tool to save lives," Duschka said. "The tools they take home with them today are not ones they have to carry in their medical bags, and they're not something that they have to spend their money on. They're taking home knowledge that they can share with the rest of their staffs."

The medical providers were from six different clinics and four of the province's seven districts.

"This training is crucial, because most of the province's health care providers are in rural locations, so they need to be able to do [CPR] in order to get their critical patients to the hospital or to a better clinic," said Dr. Shirdell, Panjshir health and medical services officer.

The CPR class is the one-day American Heart Association course for health care providers authorized by the Military Training Network in Bethesda, Md. It covers not only CPR for patients of all ages, but also how to handle someone who is choking and the proper use of an automated external defibrillator unit.

The course also focuses on how to assess a patient to see if CPR is even necessary, and Duschka said she sees patient assessment as one of the main tools taught by the course.

"Now the medical providers know how to assess the signs the patient is giving instead of just reacting to a patient when they arrive," Duschka said. "Many of the Afghan medical providers I've dealt with in the past would have immediately started to give artificial breathing or CPR just because a patient's eyes were closed or they were unconscious, even if the patients were breathing normally already."

While some of the medical providers had learned prior forms of resuscitation, this course was new to most of them.

"They didn't have a preconceived notion of what CPR should be, since they've never taken any of the older CPR courses, so it was actually easier for me to teach them than it is teaching American students," Duschka said. "These providers all know how important this training is, and they all came ready to learn."

This is the first class out of a 15-class schedule, and I think it went very well and we all learned something from the class, Duschka said.

While Duschka taught her students the requirements from the course, they taught her some creative ways they've come up with to handle some of the trickier everyday medical situations.

For example, if a pregnant woman were choking, the providers said, they'd use a head-scarf to wrap around the woman if they couldn't reach their arms around her. Their solution uses an item that every Afghan woman keeps with her.

"Even though we're taught to use everything and anything that you have available to save the patient, using the scarf is an ingenious option that I never would have considered," Duschka said. "Although using the scarf is not a treatment of choice, the solution shows the providers clearly think outside of the box to help their patients in any way they can."

After spending the day teaching and learning from the local providers, Duschka was comfortable they would be able to provide better care to anyone who came into their clinics.

"If I came into their clinics, I know they could assess me, understand what was happening and treat me properly," she said. "Hopefully they won't ever have to use this course, but I'm happy to have been able to give the extra knowledge."

Shirdell agreed with Duschka.

"Whether they need to use [CPR] or not, they are learning that they always need to be in touch with the patient, and it is important to know what to do with a patient in any emergency situation," Shirdell said.

The PRT's CPR training program will continue throughout the year, and Duschka said she hopes to get out to different clinics in each of the province's seven districts.

Author Air Force Capt. Jillian Torango serves with the Panjshir Provincial Reconstruction Team Public Affairs Office

Soldiers Help Iraqis Revitalize Hospital

Photo: Army Staff Sgt. Matthew Jemison, of Headquarters Company, 1st Battalion, 15th Infantry Regiment, talks to two members of the Sons of Iraq security group Feb. 4, 2008, at a hospital in Salman Pak, Iraq, as regiment leaders and members of 489th Civil Affairs Battalion tour the facility. Photo by Sgt. Natalie Rostek, USA

With help from U.S. soldiers, work is under way in Salman Pak, about 15 miles south of the Iraqi capital, to revitalize a hospital that has not been fully operational for about five years.

Soldiers and leaders from 1st Battalion, 15th Infantry Regiment, and Team 915 of Company A, 489th Civil Affairs Battalion, from Knoxville, Tenn., attached to 1-15th Infantry Regiment, visited the hospital Feb. 4.

Army Maj. John Wolfe, from Scottsboro, Ala., a 489th Civil Affairs Battalion team leader, said the Iraqi National Police have been using the facility as a headquarters and barracks since 2005.

"The national police were forced by circumstance to work out of the hospital and other key facilities," explained Army Maj. Cliff Faulkner, from Silverton, Colo., commander of Company A, 489th CA. "Now that security has improved, they can give physical possession of key infrastructure back to local residents."

Wolfe said the first step in revitalizing the hospital was negotiating with the city council to relocate the police from the building. The next step is establishing community access to the hospital.

Several council leaders, a leader of the local Sons of Iraq security group, and maintenance representatives led the tour through the hospital's cold, dark halls.

Wolfe said he believes coalition forces and Iraqi leaders can restore the hospital to full operation. If the facility returns to its former capacity, jobs will be available for doctors, nurses, and other medical professionals.

"Past insecurity and sectarian violence kept many medical professionals away," Faulkner said. "We are optimistic that the improved security and stability will permit the return of these professionals and essential services."

Army Capt. Jason Carney, from Knoxville, Tenn., a 489th CA team leader, said changes have been made since the national police vacated the facility. The Sons of Iraq, members of a neighborhood watch-type program, took over security for the hospital, and three doctors see patients daily from morning to early afternoon.

"Doctors and patients are still leery to stay overnight," Carney acknowledged.

Wolfe said the Iraqi Health Ministry is helping fund improvements. The hospital in Salman Pak already has used Health Ministry funds to buy water pipes and porcelain sinks.

"Now we just need to get the people to understand that the hospital is open," Wolfe said.

Photo 2: Army Capt. William Clark, commander of Company A, 1st Battalion, 15th Infantry Regiment, looks through the operating room during a tour of a hospital in Salman Pak, Iraq, Feb. 4, 2008. Photo by Sgt. Natalie Rostek, USA

(Army Sgt. Natalie Rostek serves with the 3rd Infantry Division's 3rd Heavy Brigade Combat Team, in the Multinational Division Center Public Affairs Office.)

Army Aims to Better Identify Soldiers with Brain Injuries

By C. Todd Lopez
Special to American Forces Press Service

An Army report released yesterday outlines how the service can better identify and help soldiers who have suffered traumatic brain injuries.

The report contains some 47 recommendations to help the Army better prevent, screen, diagnose, treat and research traumatic brain injury, said Brig. Gen. Donald Bradshaw, who led the task force charged with investigating TBI. Bradshaw is commander of Southeast Regional Medical Command and Eisenhower Regional Medical Center, at Fort Gordon, Ga.

"Our report indicates that, like our civilian counterparts, the Army has done well in the identifying and treatment of severe or penetrating traumatic brain injury, but is challenged to understand, diagnose and treat personnel who have suffered short-term or persistent symptoms of mild TBI," he said. "The task force identified opportunities for improvement as well as best-practice guidelines."

The general said 80 percent of those who suffer from mild TBI, commonly known as a concussion, recover completely. Some 10 to 20 percent of soldiers and Marines returning from Iraq and Afghanistan with experience in combat may have suffered symptoms consistent with mild TBI.

Today, eight of the recommendations made by the task force have already been implemented, said Col. Judith Ruiz, deputy director for rehabilitation and reintegration with the Office of the Surgeon General.

"We have made significant progress to take care of soldiers and to standardize practices across the Army medical department," she said.

Some of the recommendations that have already been implemented include:

-- Working with interagency and civilian groups to better define TBI;

-- Implementing in-theater TBI screening and documentation for all soldiers exposed to brain injury-inducing trauma;

-- Adding TBI-specific questions to deployment-related health assessments;

-- Developing a proposal on the appropriate functions of a "TBI center of excellence";

-- Proposing the Defense and Veterans Brain Injury Center as the core of the new center of excellence;

-- Optimizing the positioning of clinical, educational and research activities;

-- Centralizing the evaluation of the scientific merit, clinical utility, and priority of new treatment strategies, devices or interventions; and

-- Adapting the Military Acute Concussion Evaluation overprint as an approved Department of the Army form to document mild TBI closest to the point of injury.

Ruiz said 31 additional recommendations are in progress, four are planned, and four are in the process of being transferred to other agencies.

For soldiers in theater, the most common cause of brain injury is a blast, such as from an improvised explosive device. But sometimes such blasts do not cause visible external injuries.

"Brain injury does not have to have outside symptoms, such as bleeding," Bradshaw said. "It may, but doesn't have to. That is one of the compounding things; folks may look totally normal, but be dazed."

Because some victims of IEDs or other blasts do not have external injures, they may feel they have not been injured at all -- even if they did sustain a mild TBI.

"It's hard to identify TBI when soldiers don't come forward and don't identify," Bradshaw said. "Some of the actions that have been taken (include) a very big ongoing education process for leaders, soldiers and family members."

The Army launched the post-traumatic stress disorder/mild traumatic brain injury chain teaching program in 2007 to help soldiers better identify signs and symptoms of these conditions and to reinforce the collective responsibility to take care of each other.

The Army is also working to educate the civilian medical community about mild TBI so that soldiers in the reserve components, who may not have full-time access to military medical care, also can be identified, said Col. (Dr.) Jonathan Jaffin, deputy commander of the U.S. Army Medical Research and Material Command.

"One of the things we are concerned with and ... one of the points behind the whole chain teaching was trying to get the message out to the country, not just the active-duty force, Guard and reserve," he said. "(We wanted) the country, including providers throughout the country, to be aware of mild TBI and concussions and the long-term symptoms that some people may be having."

Bradshaw said Army leaders at all levels are committed to the good health and well-being of all soldiers and are proactively addressing the issue of TBI. "Continued research in this area can only help us more clearly understand the medical impacts of the war and the best ways to prevent, recognize and treat soldiers with TBI," he said.

(C. Todd Lopez works for the Army News Service.)