So What Makes The VA Work So Well?

Of course there are still problems within the VA but the implementation of an electronic records system provides the opportunity to practice outcome based medicine which has become the Holy Grail of all health care systems.  The computerized records allow tracking outcomes for various medical conditions and finding those that work best.  This weeds out expensive procedures that are no more effective than other less expensive ones.  Prescriptions for medications are also tracked on the computer and potential drug interactions are avoided.  According to studies, VA has the lowest drug interaction incidents and deaths in the country.

The electronic records also prevent duplication of expensive medical tests.  Some surveys indicate that 60% of the time, private sector providers order duplicates or triplicates of the same test.  This is because paper records make it difficult or almost impossible to track tests between different care providers.  Even in the same hospital, estimates are that one out of five tests are unneecessarily reordered.

Finally, electronic records help the veterans health system to maintain a more cost effective and smaller drug formulary.  Fewer categories of drugs allow VA to negotiate with drug companies for larger quantities at a lower price  If an existing, less expensive drug is proven through electronic records computer data to be just as effective as newer more expensive medicines, then obviously the older medicine will be favored.

Why the VA Health Care System Works so Well

Actually it's not that VA is such a marvelous system since any large scale organization employing over 200,000 people is bound to have its inefficiencies.  VA simply comes closer to the mark of providing excellent care than the rest of the health care providers in the country.  One big reason is the veteran system does not rely on insurance reimbursements so money saved through efficient operation remains in the system and does not transfer to insurance companies.  This type of operational structure encourages innovation and change.

However, being a single payer health plan alone wold not necessarily result in a better system.  The outstanding reawakening of VA health care is largely a result of the vision and leadership of Doctor Kizer and his successor.  Here are some of the operational advantages that make VA health care so successful.

As a government entity, the agency cannot be sued by patients who have been mistreated.  This obviously saves the time and money involved in lawsuits.  However, in order to be responsive to medical errors, Doctor Kizeer instituted the "Sorry Now" program that holds staff accountable for their actions and provides damage awards to patients.

Veterans who are part of the system have the opportunity to remain with the system throughout their lives.  This allows VA to practice preventative medicine by scheduling regular checkups, performing regular lab tests and intervening before a medical condition becomes to advanced.  The provider/contractor insurance reimbursemeent model used in the United States typically does not allow for this type of preventative medicine.

In the next post I will discuss the advantages gained through the VA's electronic records system.

The Best Health Care System in America

It comes as a surprise to some people who had experience with VA health care during the 1970's and 1980's that this same system is now considered the best medical care in the Unite States.  In a Business Week article on July 17, 2008 it was reported that "To much of the public, though, the VA's image is hobbled by its inglorious past.  For decades the VA was the health care system of last resort...The huge system had deteriorated so badly by the early 90's that Congress considered disbanding it.  Instead the VA was reinvented in every way possible.  In the mid-1990's, Dr. Kenneth Kizer, then the VA's Health Under Secretary, installed the most extensive electronic medical records system in the U.S.  Kizer also decentralized decision making, closed underused hospitals, reallocated resources and most critically, instituted a culture of accountabliity and quality measurements."  "Our whole motivation was to make the system work for the patient," says Kizeer, now director of the National Quality Forum, a nonprofit dedicated to improving health care. We did a top-to-bottom makeover with that goal always in mind".

Things Family Members Can Do To Help With Medications

There are a number of things family members can do to help manage a loved ones medication:

* Make a list of medicines prescribed and all supplements being taken..  Give this list to the doctor and pharmacist and have one on hand for emergencies.

*  Use the same pharmacy to fill all prescriptions.  Pharmacies keep a record of your prescribed drugs and

will  verity your doctor's instructions.  They will also tell you if foods or over the counter supplements will

interact with a prescription.

*  Dispense pills in a daily pill organizer box ie. mediset..  Have a family member be responsible to call or physically monitor the taking of medications.

Family members who live long distances from their elders have available to them new technology in medication monitoring. For instance alarms for pill boxes, watch alarms, medical alarm bands and necklaces that ring a reminder.  There are also computerized pill box dispensers that ring a designated number if the pills have not been taken. In addition Home Care Agencies offer a variety of service options in helping families care for and properly dispense medication to their elder parents.

Overmedication or taking medication incorrectly may lead to early mental confusion and decline in health in seniors. "If medication problems were ranked as a disease in cause of death it would be the 5th leading cause in the Unite States." (from article on Long Term Lining)

Medication Problems and the Elderly

At 83 years old, Martha still lived in her own home and enjoyed working in her garden and canning peaches.  It was becoming harder to motivate herself to get up in the mornings and accomplish the day's tasks.  She confided to her daughter that she felt anxious and tired.  Her daughter, who was taking medication for her anxiety, took Martha to her own doctor, not Martha's, and got her a prescription for Valium.  In doing so, the daughter's doctor, who had never seen Martha and who did not have her medical history, was only aware of a few medications they told him she was taking.  Martha, in fact, was taking nine different medications as well as herbal supplements.

The addition of Valium to her existing list of prescribed drugs sent her to the emergency room with respiratory distress.  If she had gone to her own doctor, he would have found that a dosage adjustment of her current medication would have solved her anxiety.

Medications errors are common in the elderly.  Many seniors take on average six to eight different prescfriptions as well as over the counter drugs.  Many times the elderly will not go back to their doctor to have their dosage evaluated and changed if necessary.  Family members should be aware, that elderly parents may tend to take the family's advice over going to their own doctor.  Even though children want to help increase the health and stamina of their parents, they many in fact be causing damage by misdirecting their loved ones.

Where a younger person can benefit from herbal supplements like Ginkgo, Saw Palmetto and others, in older people, these herbals may cause adverse reactions with their prescription medications.

In 2003, a panel of experts put together a list of potential medications that would not be appropriate to give to seniors.  This is called the "Beers List", named after one of the research professionals.