TREA Washington Update for Monday, February 22nd 2016


From TREA’s LAO:

TREA Washington Update for Monday, February 22nd 2016
All last week DC was focused on non-legislative matters: the death of Supreme Court Associate Justice Antonin Scalia and his empty seat on the Court, the Presidential primaries and caucuses, the fight between the FBI and Apple and the President’s planned trip to Cuba. But things are moving on issues concerning the American military family…. And here are a few of them.
Some more information of DoD Budget Proposal and Military Health Care
New Proposal Would Make it Easier to Fire Nonperforming VA Employees
Cincinnati VA Medical Center Under Investigation
Military Not Meeting Mental Health Needs of Combat Veterans
VA Celebrates 70 Years of Partnering with Medical Schools
Members of the Leap Frogs, the Navy’s parachute team, perform during a training demonstration in San Diego, Feb. 15, 2016. U.S. Navy photo by James Woods
Some more information of DoD Budget Proposal and Military Health Care
The proposals to make many changes in TRICARE are still very short on detail but we still have some new information for you.
First: for current TFL beneficiaries DoD’s latest enrollment fee proposals DO NOT include you. You are grandfathered
That is the good news. Now for everyone else. For TFL enrollees who enter on January 1st 2017 or later there is a proposed $300 annual fee. (That is, of course, in addition to the yearly Medicare Part B fees.) Also we have just checked and if the sponsor has already turned 65 and enrolled but his/her spouse is under 65 and will enter TFL after January 1st 2017 they will be required to pay the yearly enrollment fee.
The Department of Defense wants to change the names of the TRICARE programs again. “TRICARE Select” will include the present TRICARE Prime and Military Treatment Facility (MTF) medical treatment programs. “TRICARE Choice” will cover what are presently TRICARE Standard and TRICARE Extra.
The TRICARE Select means to center care primarily in military hospitals and clinics. Enrollees would pay lower fees and deductibles and no “cost-sharing” for treatment obtained in military facilities. But DoD does not explain how they are going to increase the facilities capacities. (which are already insufficient.)
Yet again, the people who would be hurt most under DoD’s plan are retirees and their families under the age of 65. If one signs up for TRICARE Select they are proposing an annual enrollment fee of $350 for an individual and $700 for family coverage. If a retiree under the age of 65 signs up for TRICARE Choice (please remember there is no requirement or fee for TRICARE Standard) the annual cost would be $450 for an individual and $900 a year for family coverage. These are huge increases in costs being put on the backs for military retirees and their families. We need to fight them.
Additionally DoD wishes to create an annual enrollment requirement. If a qualified beneficiary did not enroll during the open enrollment period they would be closed out for the year. And all of this is proposed without any explanation as to how they expect to improve access in both MTFs and in the private sector.
Additionally they are proposing to have means testing when setting fees in TFL and increasing the present annual catastrophic caps from the present $1,000 for active duty family members to $1,500 and from the present $3,000 for retired families to $4,000.
Pharmacy co-payments would double in the next 10 years…And all the various fees and co-payments would be indexed to the “national health expenditure index” (medical inflation.) All of this is being proposed at a time when military health care costs have actually dropped.
These are totally unacceptable proposals which we will all fight against .
New Proposal Would Make it Easier to Fire Nonperforming VA Employees
The new FY 2017 budget proposal from the Department of Veterans Affairs contains an interesting new idea on how to punish non-performing senior executives at the agency. It would accomplish this goal – one that TREA and Congress have been seeking for years now – by keeping control in the hands of VA leadership and exclude involvement of an outside agency.
The idea was floated by VA Deputy Secretary Sloan Gibson after the Merit Systems Protection Board (MSPB) overturned three VA punishments for senior executives in a row in the past few weeks.
The actions by the MSPB embarrassed the agency and frustrated Gibson, who said the board had taken away his ability to hold senior executives accountable.
The idea would put all senior executives (SES) under the regulatory Title 38 statute – the same one used for VA medical professionals – which would allow the agency to fire executives at will. It may force VA to pay more for SES employees, but it would give VA the ability to terminate the nonperforming ones in a timely manner.
It appears that this idea has united lawmakers, at least on the House Veterans’ Affairs Committee, and VA leadership on accountability issues at a department that has been plagued by scandal. For nearly two years, lawmakers on the oversight committees have been critical of VA leadership for failing to take executives to task, after details emerged of huge appointment and benefits wait times and of cover-ups that left veterans dying while languishing on hidden wait lists.
Last week the board reversed the VA’s attempt to fire Linda Weiss, the director of the Albany Stratton VAMC following revelations that she ignored allegations of patient abuse. That reversal followed earlier decisions by the board to undo disciplinary actions in high-profile cases against executives Diana Rubens and Kimberly Graves, for their actions involving their reassignments to different positions while collecting hundreds of thousands of dollars in relocation incentives.
Gibson vowed last week that despite the board’s reversal, he would not return Weiss to any position where she would be responsible for patient care.
TREA will keep you updated on this important issue.
Cincinnati VA Medical Center Under Investigation
Reports surfaced last week about dozens of whistleblower complaints being ignored, as well as several conflicts of interest, by and among senior VA officials at the Department of Veterans’ Affairs in Cincinnati, Ohio. VA officials in Washington DC have started two internal investigations.
VAMC Cincinnati, which is normally in VISN 10 region, will temporarily report in to VISN 4 executives in Pittsburgh. The move was to “ensure no conflict of interest” during the inquiry, the U.S. Department of Veterans Affairs said, according to Scripps, which broke the story.
Last September 34 current and former medical center staff members, including 18 doctors from several departments, sent an unsigned letter to McDonald in September describing “urgent concerns about quality of care” at the facility. The allegations involve the VISN 10 Regional Director Hetrick, his wife, and VAMC Cincinnati acting chief of staff Dr. Barbara Temeck. They allege a pattern of cost cutting that forced out experienced surgeons, reduced access to care and put patients in harm’s way.
Here are some of the Scripps-WCPO findings, all based on interviews and documents:
  • Services to veterans have been reduced, including spine and orthopedic surgeries, along with customized prosthetic services for artificial limbs.
  • Dr. Temeck prescribed controlled substances, including hydrocodone and a generic form of Valium, to Mrs. Hetrick, the wife of her regional boss, Jack Hetrick. State and federal authorities confirm Dr. Temeck does not have a valid controlled substances license that would allow her to write prescriptions privately for Mrs. Hetrick.
  • Dr. Temeck cut around-the-clock staffing by emergency airway specialists to save money, resulting in at least one close call involving a patient who could not breathe
  • Dr. Temeck told operating-room staff they were being “too picky” when they reported surgical instruments delivered to operating rooms with blood and bone chips from previous surgeries.
  • Dr. Temeck is paid separately as a VA administrator and cardiothoracic surgeon. But whistleblowers say she has never served as the operating surgeon since coming to Cincinnati.
Obviously the twin VA investigations have a long way to go before any of this can be confirmed, but if any of it is true TREA is shocked an appalled at the terrible judgment shown by VA’s regional leadership in VISN 10. TREA will keep you informed of any developments.
Military Not Meeting Mental Health Needs of Combat Veterans
A newly released study says that the military is not meeting the needs of troops suffering from post-traumatic stress disorder and depression, according to an article in USA Today. The study by the Rand Corporation says that “…only a third of troops with PTSD and less than a quarter who are clinically depressed receive the minimum number of therapy sessions after being diagnosed,”.
Even though the military has increased the number of mental health professional on staff by 42% since 2009, “We just don’t have enough mental health professionals to meet the demand,” according Brad Carson, acting principal deputy undersecretary of defense for personnel and readiness.
VA Celebrates 70 Years of Partnering with Medical Schools
Caring for the nation’s Veterans is a shared honor and a shared responsibility, which is why the Department of Veterans Affairs (VA) this year is celebrating the 70th anniversary of its partnership with the nation’s medical and health professional schools.
Since 1946, VA has worked with academic institutions to provide high quality, state-of-the-art health care to America’s Veterans and to train new health professionals to meet the rapidly evolving health care needs within VA and the nation.
“We are extremely proud of the long-standing, close relationships built over the past 70 years among VA and academic institutions across the country,” said VA Secretary Robert A. McDonald. “These partnerships strengthen VA’s healthcare system, and provide high quality training for the nation’s healthcare workforce. We cannot do what we do without them.”
The partnership between VA and academic affiliates dates back to the end of World War II. Following the allied victory, VA faced the imminent arrival of over 100,000 new patients and was confronted with a severe lack of resources as it had only 98 mostly rural hospitals offering fewer than 84,000 beds and 1,000 physicians. To meet this challenge, VA created a landmark partnership with U.S. medical schools to establish a dynamic, talented workforce of students, physician residents, and faculty who provide world class care to Veterans while providing training to generations of future physicians that has evolved to include more than forty health care professions over the decades.
“Through this historic collaboration, VA has become the largest single provider of medical training in the country, where more than 40,000 residents and 20,000 medical students receive clinical training each year,” said Darrell G. Kirch, President and CEO of the Association of American Medical Colleges.
“VA benefits enormously from its relationship with its partners in the medical academic community. We are able to do the work we do because of this synergistic relationship,” said VA Under Secretary for Health Dr. David Shulkin. “We have the benefit of the top medical professionals being produced by leading academic institutions. In turn, the medical community and patients around the country benefit from VA innovations – innovations such as the implantable cardiac pacemaker; the nicotine patch to help smokers quit; liver transplants and electronic medical records. We are both proud and grateful for these relationships.”
Today, VA conducts the largest education and training programs for health professionals in the United States. VA has affiliations with more than 1,800 educational institutions; more than 70 percent of all doctors in the U.S. have received training in the VA healthcare system. VA invests $900 million annually to provide clinical education and training programs to more than 120,000 interns, residents, fellows and students in more than 40 clinical health professions. Among them are over 10,000 graduate medical education (GME) positions training more than 40,000 physicians in training annually.
For more information about VA’s Office of Academic Affiliations, visit To learn more about the 70thanniversary of VA’s partnership with medical schools, visit and

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