Military health care spending is rising twice as fast as the nation’s overall health care costs, consuming a larger chunk of the defense budget as the Pentagon struggles to pay for two wars, military budget figures show. The surging costs are prompting the Pentagon and Congress to consider the first hike in out-of-pocket fees for military retirees and some active-duty families in 15 years, said Rear Adm. Christine Hunter, deputy director of TRICARE, the military health care program.
Pentagon spending on health care has increased from $19 billion in 2001 to a projected $50.7 billion in 2011, a 167% increase.
The rapid rise has been driven by a surge in mental health and physical problems for troops who have deployed to war multiple times and by a flood of career military retirees fleeing less-generous civilian health programs, Hunter said.
Here’s one to ponder: How is the electronic health record (EHR) system used by the Department of Veterans Affairs similar to a fighter jet? This article from Federal Computer Week plays out the comparison:
Dr. Steve Ondra, senior policy adviser for health affairs at the VA, was talking about the development and modernization of legacy electronic health record systems at the department, including VistA, and how those systems eventually will synchronize with new record programs, such as the VA/Defense Department Virtual Lifetime Electronic Record.
He compared the evolution of VistA to the VLER, as being comparable to the evolution of World War II-era planes into modern fighter jets. The comparison became more complex as it went along.
To illustrate his point, Ondra said the VA started out with electronic record systems comparable to a P-51 Mustang, a World War II-era fighter plane, and to a Sabre Jet, which dates from the Korean War.
“The Sabre is a good jet, but a little dated,” Ondra said, apparently still talking about the VA’s legacy systems such as VistA.
The next step, which includes creating the VLER, aims to be upgrade the legacy VA systems to make them comparable to an F-15 or F-22 modern fighter jet, Ondra added.
The Honorable Erik Shinseki, Veterans Affairs Secretary, testified today before Congress on the VA’s appropriations process, specifically citing Milliman’s role in this process. As you might expect, a relatively accurate advanced budgeting capability is crucial to the mission of an organization like the VA, which has so many patients and such a large and sophisticated organization.
Here is an excerpt from the Secretary’s testimony:
Implementing an advance funding mechanism is not without challenges and careful planning is needed to ensure timely funding without unintended consequences. Budget projections are rarely right on the mark, and the further out they are made, the farther off the mark they are likely to be. For an advance appropriations mechanism to function effectively, it must be linked to a forecasting model that is both reliable and accurate, to the extent possible. Today I will concentrate on VA’s principal forecasting model — the Enrollee Health-Care Projection Model.
The Enrollee Health-Care Projection Model, or VA Model, is a comprehensive enrollment, utilization, and expenditure projection model. It was originally developed in 1998 in partnership with Milliman, Inc., the largest actuarial firm in the country. Through the past 11 years of periodic updates and continuous refinement, VA and Milliman have developed a strong partnership that has resulted in a powerful modeling tool. VA guides the overall development of the VA Model and ensures that it meets the needs of stakeholders. VA program staff provide expertise on the unique needs of Veterans, patterns of practice in the VA health-care system, and how the system is expected to evolve over the next 20 years. Milliman brings specialized expertise, access to extensive amounts of health-care utilization data VA, and excellent research to the overall modeling effort.
Ron Sims, Rich Moyer, Gail Graham, and Scott Armstrong continue to respond to Wednesday’s question about adoption of electronic health records.
Ron Sims: The original question was, “Who is going to come with the standards?” And I believe you’re going to see the Federal Government move on them with a great deal of aggression over the next couple of years, and there’s several reasons why. If you look at the issues that the three car companies face, one of the things that they’ve been raising on a pretty consistent basis is their healthcare costs, not only their pension costs, but their healthcare costs.
Gail Graham, Veterans Health Administration Director of Health Data and Informatics, and Joe Scherger, MD, Consulting Medical Director Lumetra, address this question as panelists at Healthcare Town Hall.
Barry: It sounds like everyone agrees that interoperability and some level of standardization with records and record systems and the language of them is important. Can anybody help me understand how that’s likely to actually be achieved? At the present time, Microsoft has its solution, Google has its solution, I’m sure many other providers working with software solution providers working with pairs and healthcare providers are offering all sorts of other solutions. There’s sort of a cacophony, a Tower of Babel potentially out there right now, am I right?
Gail Graham: Well, I think there are some breakthroughs. VA among about 14 other participants were in a demonstration project to display that we could send summary information of data through the healthcare continuum for patients.
Gail Graham explains how electronic health records have transformed VA.
Q: Gail Graham, the Veterans Administration has been using electronic health records for some time also on a very large cohort of patients in a very large system. What have been the results from your point of view?
Gail Graham: Well, they reflect in our quality measures, for example, which have been much higher than external report findings in the HEDIS measures. But I think the biggest thing for a closed referral system such as VA where we’re seeing patients in rural, very rural, and referral sites is the fact that the continuity of their care is there regardless of where they’re being seen. It also gave way to implementation of things like telemedicine, teleradiology, and other services that really take away the geographic boundaries that may have limited the care that people were getting in certain areas. For VA, it started 20 years ago with clinicians being used to looking up all results electronically.
Will electronic health records (EHRs) minimize mistakes that may arise from sloppy handwriting and illegible files? How do we certify the accuracy of patient-provided health information?
Q: How do you resolve issues from inaccurate information in these records?
Gail Graham: I don’t think this a different problem than we had in paper, actually—if you have patients who are not the best historians at the time, for example, or if people forget what allergies they have. You have them admitted in different states and their family providing the information. We had a lot of questions about this from our providers as we bring in other information. What we’ve decided to do is really make it clear where this information came from. Was this a physician? Was this a nurse? Was this a pharmacist? So that the clinician looking at the information can make some judgment calls on the validity of the information. Read more…
Of all the initiatives endorsed by outgoing Secretary of Health Mike Leavitt, few are likely to be met with as much agreement by his likely successor, Tom Daschle, as the need for wider adoption of electronic health records (EHR). While there is general agreement on the need for this technology investment—both presidential campaigns included EHR in their health platforms—the cost ramifications are still up for debate. Will electronic health records reduce costs? There are compelling reasons to answer both “yes” and “no.” Read more…