How do you begin remaking the broken politics of veterans’ healthcare?
Read Part I and Part II of VHPI’s conversation with Stephen Trynosky about how Congress, Veteran Service Organizations and advocates, and the Department of Veterans Affairs can better work together to improve care for veterans.
COVID-19 cases spike in the VA
From Connecting Vets:
The number of Department of Veterans Affairs patients and staff sick because of the coronavirus have reached record highs for five straight days as of Nov. 6 -- more than doubling since this time last month.
The department recorded 7,215 active cases in the very early hours of Nov. 5, though those numbers dropped down to 6,890 by Thursday afternoon. From Nov. 2-6, the department recorded its highest levels of active cases ever, starting at 6,459 on Nov. 2 and gradually increasing each day.
The last peak in active cases at VA was on July 20, when the department recorded 6,424 cases.
Boise, Idaho VA struggles to keep up amid state-wide outbreak
From Idaho News 6:
Dr. Wilper says his biggest concern comes from the VA having more hospitalizations than it has ever had during the pandemic.
"That is incredibly troublesome, and I will tell you for people who are doubting the reality of this infection COVID is real, it is deadly and it has taken the lives of some of our veterans," said Dr. Wilper. "We currently have an outbreak at the state veterans home, and currently, the Boise VA is sending help to the state home to assist their clinical operations."
The Idaho Department of Veterans Services manages the Idaho State Veterans Home, we tried to get in contact to learn more, but in fairness, we made that call on Friday afternoon.
As for Dr. Wilper, he wants to get a message out to the public in hopes that they will follow health district guidelines, avoid large gatherings and wear masks for the sake of the veterans in our community.
"Putting on a mask is a minor inconvenience to help stop the spread of a disease that is dramatically impacting hospital operations at the Boise VA," said Dr. Wilper. "It is affecting the health of our veterans and our staff."
The staff has also been in the trenches since March, working through the pandemic, and there is no sign of the virus slowing down as we head towards winter.
"We are very concerned about their morale and potential for burnout because there really haven't been any breaks in the last six months," said Dr. Wilper. "Now things appear to be getting worse, so in response to the current surge, we are actually considering and activating today, a shutdown of more of our services to help shift staff from outpatient and elective care to acute care for COVID positive patients."
The Boise VA has also joined the fight against COVID-19 in other ways by providing tens of thousands of tests for the state, the VA has sent ventilators to eastern Idaho and is assisting over at the Idaho State Veterans Home.
Big Stories, Short Links
Veterans Health Administration begins to 3D Print Medical Devices
From HealthcareITNews:
The Veterans Health Administration has entered into a contract with South Carolina-based 3D Systems to establish manufacturing facilities within their hospitals for the production of medical devices.
3D Systems announced in a press release this week that the partnership will allow the VA network to streamline its supply chain and enhance personalized care for their patients.
"Through this collaboration, 3D Systems will not only be installing 3D printers at the VHA sites, but we’ll also be helping them install a quality management system that includes the processes, documentation, and training required to be compliant as a medical device manufacturer," said Ben Johnson, director product development, healthcare, at 3D Systems, in a statement.
WHY IT MATTERS
According to the company, 3D Systems will collaborate with the VA to design medical devices and usher them through the U.S. Food and Drug Administration clearance process. At first, 3D Systems will manage the regulatory paperwork and development of a quality management system at VHA facilities.
Eventually, however, the VHA will take over the process.
"In a highly regulated environment like healthcare, the technology is only a small part of the solution,” said Johnson. Regulatory adherence, he said, is also vital.
Early on in the COVID-19 pandemic, 3D Systems collaborated with the VHA to develop face masks and nasopharyngeal swabs that could be printed on production-level equipment. This latest move is an expansion of that collaboration.
"What began during the pandemic in response to a critical need has expanded to change the way healthcare is delivered,” said Menno Ellis, 3D Systems executive vice president for healthcare solutions, in a statement.
Healthcare tech company partners with VA for AI-assisted suicide prevention tracking
Press Release, via Street Insider:
Ontrak, Inc (NASDAQ: OTRK) (“Ontrak” or the “Company”), a leading AI-powered and telehealth-enabled, virtualized healthcare company, today announced a cooperative research and development agreement with the Veterans Health Administration (VHA) to conduct a 3-year research study on the effect of intensive care coaching in addition to the standard of care for Veterans at high risk of suicide-related behaviors after psychiatric hospital discharge.
Suicidal ideation has been elevated since the pandemic and the CDC reported on August 14 that a survey of U.S. adults in June 2020 indicated that 11% had seriously considered suicide in the past 30 days, which was twice as high as in the previous 12 month period.
The study will leverage AI developed by Dr. Ronald Kessler of the Harvard Medical School, as well as the core analytics of the Ontrak platform. Dr. Kessler is the McNeil Family Professor of Health Care Policy at Harvard Medical School and a principal in the STARRS Longitudinal Study of suicide prevention among US Army soldiers. “We are excited to have Ontrak helping us evaluate the effects of an intensive intervention to prevent suicidal behaviors among Veterans at very high risk,” stated Dr. Kessler.
More on AI at the VA, via Forbes: How The Department Of Veterans Affairs Uses AI To Help Vets
VA clinics slowly reopen during pandemic
From KPBS:
The medical center has begun seeing more patients after it initially sharply restricted care at the beginning of the COVID-19 pandemic. But to do that, it has moved most of its emergency department outside.
Patients with minor issues like sprained ankles can receive treatment in the garage and never have to step foot inside the hospital.
"The goal of setting this up out here was to protect our very vulnerable patients inside and our staff," said Dr. Timothy McGuirk, who runs the hospital's emergency room.
Tampa stands out even among other VA medical centers with its parking garage setup; this is one of the few that has moved its emergency services outdoors. But all of the agency's facilities are taking steps to prevent the spread of COVID-19.
While many civilian health facilities have allowed patients to come in for routine care for months and even opened for visitors, that's still largely off-limits at many VA's.
McGuirk said VA patients are typically older and sicker than the general population, making potential outbreaks more dangerous.
"They have heart disease, they have kidney disease, they have liver disease, they have lung disease that makes them more at risk," he said. "Plus, we don't have pediatrics here, we don't have young healthy people for the most part."
Navy veteran David Tootle, 62, pulled into the garage with severe back pain. Because of the pandemic, his other doctor's visits lately have been remote.
"Telephone but not video," he said, adding with a laugh, "I'm not 'techno' like that."
While the VA has increased virtual care by nearly 1500 percent since March, many veterans have been anxious to return to face-to-face visits.
Some outpatient and specialty clinics that were shut down for months have gradually started welcoming patients who need hands-on procedures or can't use virtual care.
Facilities are also taking steps to limit the number of people inside. Most aren't accepting walk-in patients yet except for outdoor services like drive-thru flu shots. Many have also cleared furniture from their waiting rooms and are telling vets to wait in their cars until staff contact them to come in for their appointment.
"Just decreasing risk of exposure, so cars have been a great extension of our facility space in a lot of these efforts, whether it's drive-thru services or using them as an extension of our waiting rooms," said Dr. Kameron Matthews, Chief Medical Officer for the Veterans Health Administration.
Health sector has spent $464 million on lobbying in 2020
From Internal Medicine News:
The Pharmaceutical Research and Manufacturers of America led the health sector in spending on lobbying through the first three quarters of 2020, and health care as a whole spent more than any of the other 12 sectors of the U.S. economy, according to the Center for Responsive Politics.
…
The largest share of health sector spending came from pharmaceuticals/health products, with a total of almost $233 million, just slightly more than the sector’s four other constituents combined: hospitals/nursing homes ($80 million), health services/HMOs ($75 million), health professionals ($67 million), and miscellaneous health ($9.5 million), the center said on OpenSecrets.org.
How the innovative environment of the VA prepared it for the pandemic
From Federal News Network:
Over the past few years, VHA has tried support its employees who, throughout the course of their day-to-day work, saw a problem and found a solution. Through VHA’s Innovation Ecosystem, it’s built an infrastructure to fund, develop and spread viable solutions throughout the VA network.
Annual events like VHA’s Innovation Experience help train employees to pitch their ideas and gather support from leadership.
Then the pandemic hit.
“We were ready,” Vega said. “VA was ready when the pandemic hit to deploy this workforce and deploy this innovative spirit to the pandemic relief.”
Research Roundup
The perfect storm for suicide mortality, via JAMA Psychiatry:
Suicide rates have been rising in the US over the last 2 decades. The latest data available (2018) show the highest age-adjusted suicide rate in the US since 1941.1 It is within this context that coronavirus disease 2019 (COVID-19) struck the US. Concerning disease models have led to historic and unprecedented public health actions to curb the spread of the virus. Remarkable social distancing interventions have been implemented to fundamentally reduce human contact. While these steps are expected to reduce the rate of new infections, the potential for adverse outcomes on suicide risk is high. Actions could be taken to mitigate potential unintended consequences on suicide prevention efforts, which also represent a national public health priority.
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