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VA’s new Patient-Centered Community Care program (PCCC)

posted Oct 13, 2014, 8:46 PM by Neslo Ventures   [ updated Oct 13, 2014, 8:46 PM ]

va waiting room

Are the days of VA secret-appointment lists over with the new private-VA health-care partnerships? Will vets really get access to primary care providers close to home eliminating long wait times? A VA press release (8/13/14) announced contracts with Healthnet and Tri-West Health Care Alliance.  Tri-West is signing up providers so if you like your local hospital/doc, contact them to see if they are joining.

TriWest was awarded a five-year contract by the Department of Veterans Affairs to administer the Veterans Affairs (VA) Patient-Centered Community Care (PC3) program in all or portions of 28 states (AL, AK, AR, AZ, CA, CO, FL, GA, HI, ID, IL, IN, KS, KY, LA, MS, MO, MT, NV, NM, OH, OK, OR, TN, TX, VA, WA, and WV). The PC3 program ensures Veterans will receive timely, convenient, coordinated, high-quality care in their community by allowing VA to make referrals through TriWest to a network of primary and specialty care providers. Under the PC3 program, TriWest will process the referrals, schedule appointments, track medical documentation, and pay claims on behalf of VA and Veterans.

A notice in the Wall Street Journal (6/25/14) adds that Tri-West and Tenet are partnering to provide services in Arizona, California, Missouri, Tennessee and Texas.

As a result, Veterans will gain access to 41 hospitals, 19 urgent care centers, seven freestanding emergency departments, 18 ambulatory surgery centers, 85 diagnostic imaging centers and nearly 600 employed physicians.

The VA stays in control. All appointments start with the VAMC a vet goes to.  The vet calls the VAMC and requests an appointment as usual.  The VAMC will decide where the veteran will be seen and will notify him/her. A three-way conference call will be set up.   Non-VA physicians can write emergency prescriptions for 10-days and the VA pharmacy provides follow-up meds.  The VA supplies durable medical supplies needed. 

It’s horrible that veterans had to die because Congress did not expand non-VA care years ago and there is NO guarantee that they will continue to fund these programs after the VA contracts end.  And “Eligibility for non-VA medical care is complex and varies for non-Service Connected veterans” and  Non-VA Care “feasibility” rules still apply. See: Accelerating Access to Care Initiative Fact Sheet.  Many questions must be asked.  If a vet has cancer, is non-service connected, and facing long waits, can he see a partnership provider fast?  If a vet is depressed or suicidal, is non-service connected, can he see a partnership provider fast?

TRICARE and Transitioning from the Military

posted Oct 13, 2014, 8:02 PM by Neslo Ventures   [ updated Oct 13, 2014, 8:02 PM ]

Week of October 13, 2014

As you transition from the military, you must continue to have health care coverage under the Affordable Care Act. TRICARE offers the Continued Health Care Benefit Program (CHCBP), which is a premium-based health care program that acts as a bridge for beneficiaries transitioning from military health benefits to a new civilian health plan. Former active duty servicemembers and their families are eligible for 18 months of CHCBP. Beneficiaries must purchase and enroll in CHCBP within 60 days of losing TRICARE eligibility. For more information about CHCBP, visit the CHCBP webpage at www.tricare.mil/CHCBP, download the Continued Health Care Benefit Program Brochure and the Continued Health Care Benefit Program Fact Sheet.

Continued Health Care Benefit Program

The Continued Health Care Benefit Program (CHCBP) is a premium-based plan that offers temporary transitional health coverage for 18-36 months after TRICARE eligibility ends. If you qualify, you can purchase the CHCBP within 60 days of the loss of TRICARE eligibility.

  • The CHCBP acts as a bridge between military health benefits and your new civilian health plan.
  • Coverage is similar to TRICARE Standard, including prescriptions at network pharmacies or through home delivery.
  • Provides the minimum essential coverage required by the Affordable Care Act, but it is temporary. You should consider your options for when CHCBP ends. >>Learn More

Eligible Beneficiaries

You may qualify to purchase the CHCBP in the following scenarios. In all cases, the service member's separation must be under "other than adverse conditionsYou must have an "honorable" or "general" discharge to qualify.."

If you were qualified for one of TRICARE's premium-based plans (e.g. TRICARE Reserve Select [TRS], TRICARE Retired Reserve [TRR], or TRICARE Young Adult) before your loss of eligibility, that coverage must have been purchased and in place at least one day before the loss of TRICARE eligibility for you to qualify to purchase CHCBP when that coverage ends.

Former Category Scenario Length of Coverage
Active Duty Service Member Released from active duty Up to 18 months
Full-time National Guard Member Separated from full-time status Up to 18 months
Member covered by the Transitional Assistance Management Program (TAMP) Loss of TAMP coverage Up to 18 months
Seleted Reserve member covered by TRS Loss of TRS coverage Up to 18 months
Retired Reserve member covered by TRR Loss of TRR coverage (before age 60) Up to 18 months
Dependent spouse or child Loss of TRICARE coverage Up to 36 months
Unremarried former spouse Loss of TRICACRE coverage Up to 36 months*

*Unremarried former spouses may qualify for additional coverage. Please check with Humana Military for details.

CHCBP Contractor

Humana Military, a division of Humana Government Business, is the CHCBP contractor. Humana Military provides services for enrollment, authorization, claims processing and customer service. For more information about CHCBP or to see if you qualify:

TRICARE for Life Pharmacy Pilot

posted Jun 4, 2014, 10:46 PM by Dawn Olsen   [ updated Jun 4, 2014, 10:47 PM by Neslo Ventures ]

TRICARE for Life Pharmacy Pilot –
Mail Order Prescription Requirement


We have recently received a few emails from some readers affected by a new mandate under the 2013 National Defense Authorization Act, the TRICARE for Life Pharmacy Pilot, which went into effect on Feb. 14, 2014. The TFL Pharmacy Pilot requires TRICARE for Life members to refill their prescription medications at Military Treatment Facilities (MFTs) or via the mail order system. Prescription medication refills done at a retail pharmacy may be ineligible for reimbursement. This only applies to maintenance medications, and not for medications to treat acute illnesses. (There are some exceptions; read on).

Here is some more information to see if this applies to you, and how it would affect you.



You could pay more for your next prescription refill.

Who is affected: This only affects TRICARE for Life members who are using affected medications. This does not apply to TFL members who have other prescription coverage. It also does not affect active duty members or retirees under TRICARE Prime.

Which medications are affected? This only applies to maintenance medications, and not for medications to treat acute illnesses. Maintenance medications are those usually used to treat chronic illnesses such as high blood pressure, high cholesterol, diabetes, and similar chronic conditions. Medications prescribed for acute conditions, such as antibiotics, pain killers, etc. are unaffected by this pilot program. Here is a list of affected medications.
How the Pilot Works

You will receive a notification from Express Scripts informing you if you will need to participate in the Pilot program. When you fill a prescription for a medication covered by the Pilot at a network pharmacy, you’ll get a letter from Express Scripts. When you receive the letter, you will need to review your prescription refill options and decide how you want to refill your prescriptions in the future.

If you fill your prescription a second time at a network pharmacy, you’ll get another letter from Express Scripts about switching to Home Delivery. If you fill your prescription a third time at a network pharmacy, you’re responsible to pay 100% of the cost.

Options for Refilling Your Prescriptions

You can refill your prescription medications through these means:


Home delivery: You can set this up by calling the Member Choice Center at 1-877-882-3335, or by requesting your provider to fax your prescription to Express Scripts at 1-877-895-1900. You can also set it up online at Express Scripts.

Fill your prescriptions at a Military Pharmacy: Prescriptions filled at military pharmacies are free, however, military pharmacies have different regulations for transferring prescriptions, and may not stock all medications covered under this Pilot Program. Call ahead to determine if this is the best option for you.

Use generic medications: Most generic drugs aren’t covered on the Pilot program and can continue to be filled at retail pharmacies for $5. This is still relatively low cost and may be more convenient in some circumstances.

Continue filling your prescriptions at a Network Pharmacy: This is the most costly option, as you will be required to pay 100% of the drug refill cost after your third prescription refill at a retail pharmacy.

Waivers may be available in limited circumstances. Some TFL members may be eligible for waivers from the Pilot program, depending on circumstances. Examples include emergencies, hardship, or special circumstances such as living in a nursing home. As you might expect, waivers are granted on a case-by-case basis. Here is more information on qualifying for a waiver from the Pilot program.

How to ensure your prescription medication is reimbursed: The best way to ensure your prescriptions will be reimbursed is to fill your prescriptions at a Military Treatment Facility or get it refilled through the mail. Refills can be ordered by calling 1-877-363-1303 or by going online at Express Scripts.

Everyone Saves Money Under This Pilot Program

The primary driver for this program is to reduce costs for everyone involved. The government spends approximately 17% less on mail order prescription refills compared to retail orders. TRICARE recipients also spend less money when refilling prescriptions at an MTF or through the mail. A generic 90-day refill is free via the mail, but incurs a $5 copay for a 30-day prescription when filled at a retail location. Name brand prescription refills are $13 by mail for a 90-day prescription, or $17 for a 30-day prescription. (More about TRICARE Pharmacy co-pay costs).

The savings adds up for both parties. Individuals could save $15 on a generic refill for a 90-day prescription, or $38 on a name-brand refill for a 90-day prescription. The government determined they could save approximately $120 million per year if all medications were filled via mail or MTFs vs. being filled at retail pharmacy locations.

But the change does require some additional planning on your end if you are affected by this change. You will now need to plan your prescription refills a little more closely if you do not live near a military base. Otherwise, a last minute trip to the neighborhood pharmacy could prove costly.

Opting Out of the Pilot Program

The TRICARE for Life Pharmacy Pilot is currently slated to last 5 years. TFL beneficiaries are able to opt out of the mail-order program after one year, starting from the date they made their first prescription refill under the program.

HBOT for TBI

posted May 24, 2014, 6:01 PM by Dawn Olsen   [ updated May 24, 2014, 6:02 PM by Neslo Ventures ]

Cochrane Database Syst Rev. 2012 Dec 12;12:CD004609. doi: 10.1002/14651858.CD004609.pub3.

Hyperbaric Oxygen Therapy
for the adjunctive treatment of
traumatic brain injury.
  • 1Department of Anaesthesia, Prince of Wales Hospital, Randwick, Australia. m.bennett@unsw.edu.au

BACKGROUND:

Traumatic brain injury is a common health problem with significant effect on quality of life. Each year in the USA approximately 0.56% of the population suffer a head injury, with a case fatality rate of about 40% for severe injuries. These account for a high proportion of deaths in young adults. In the USA, 2% of the population live with long-term disabilities following head injuries. The major causes are motor vehicle crashes, falls, and violence (including attempted suicide). Hyperbaric oxygen therapy (HBOT) is the therapeutic administration of 100% oxygen at environmental pressures greater than 1 atmosphere absolute (ATA). This involves placing the patient in an airtight vessel, increasing the pressure within that vessel, and administering 100% oxygen for respiration. In this way, it is possible to deliver a greatly increased partial pressure of oxygen to the tissues. HBOT can improve oxygen supply to the injured brain, reduce the swelling associated with low oxygen levels and reduce the volume of brain that will ultimately perish. It is, therefore, possible that adding HBOT to the standard intensive care regimen may reduce patient death and disability. However, a concern for patients and families is that using HBOT may result in preventing a patient from dying only to leave them in a vegetative state, entirely dependent on medical care. There are also some potential adverse effects of the therapy, including damage to the ears, sinuses and lungs from the effects of the pressure and oxygen poisoning, so the benefits and risks of the therapy need to be carefully evaluated.

OBJECTIVES:

To assess the effects of adjunctive HBOT for traumatic brain injury.

SEARCH METHODS:

We searched CENTRAL, MEDLINE, EMBASE, CINAHL and DORCTHIM electronic databases. We also searched the reference lists of eligible articles, handsearched relevant journals and contacted researchers. All searches were updated to March 2012.

SELECTION CRITERIA:

Randomised studies comparing the effect of therapeutic regimens which included HBOT with those that did not, for people with traumatic brain injury.

DATA COLLECTION AND ANALYSIS:

Three authors independently evaluated trial quality and extracted data.

MAIN RESULTS:

Seven studies are included in this review, involving 571 people (285 receiving HBOT and 286 in the control group). The results of two studies indicate use of HBOT results in a statistically significant decrease in the proportion of people with an unfavourable outcome one month after treatment using the Glasgow Outcome Scale (GOS) (relative risk (RR) for unfavourable outcome with HBOT 0.74, 95% CI 0.61 to 0.88, P = 0.001). This five-point scale rates the outcome from one (dead) to five (good recovery); an 'unfavourable' outcome was considered as a score of one, two or three. Pooled data from final follow-up showed a significant reduction in the risk of dying when HBOT was used (RR 0.69, 95% CI 0.54 to 0.88, P = 0.003) and suggests we would have to treat seven patients to avoid one extra death (number needed to treat (NNT) 7, 95% CI 4 to 22). Two trials suggested favourably lower intracranial pressure in people receiving HBOT and in whom myringotomies had been performed. The results from one study suggested a mean difference (MD) with myringotomy of -8.2 mmHg (95% CI -14.7 to -1.7 mmHg, P = 0.01). The Glasgow Coma Scale (GCS) has a total of 15 points, and two small trials reported a significant improvement in GCS for patients treated with HBOT (MD 2.68 points, 95%CI 1.84 to 3.52, P < 0.0001), although these two trials showed considerable heterogeneity (I(2) = 83%). Two studies reported an incidence of 13% for significant pulmonary impairment in the HBOT group versus 0% in the non-HBOT group (P = 0.007).In general, the studies were small and carried a significant risk of bias. None described adequate randomisation procedures or allocation concealment, and none of the patients or treating staff were blinded to treatment.

AUTHORS' CONCLUSIONS:

In people with traumatic brain injury, while the addition of HBOT may reduce the risk of death and improve the final GCS, there is little evidence that the survivors have a good outcome. The improvement of 2.68 points in GCS is difficult to interpret. This scale runs from three (deeply comatose and unresponsive) to 15 (fully conscious), and the clinical importance of an improvement of approximately three points will vary dramatically with the starting value (for example an improvement from 12 to 15 would represent an important clinical benefit, but an improvement from three to six would leave the patient with severe and highly dependent impairment). The routine application of HBOT to these patients cannot be justified from this review. Given the modest number of patients, methodological shortcomings of included trials and poor reporting, the results should be interpreted cautiously. An appropriately powered trial of high methodological rigour is required to define which patients, if any, can be expected to benefit most from HBOT.

PMID:
23235612
[PubMed - indexed for MEDLINE]

In setback for veterans, mental health ruling is withdrawn

posted Nov 20, 2011, 11:22 PM by Info @NesloVentures   [ updated Nov 20, 2011, 11:22 PM by Neslo Ventures ]

November 16, 2011 |  5:56 pm
 

A federal appeals court Wednesday withdrew its May ruling that ordered sweeping reform of the Department of Veterans Affairs to care for those returning from combat with post-traumatic stress disorder and other psychological injuries.

The full 9th Circuit Court of Appeals will reconsider the case brought by two veterans advocacy groups alleging systemic failures to treat mental health injuries and help lower a suicide rate that takes the lives of 6,500 former service members each year, according to court records.

Chief Judge Alex Kozinski had dissented from the May ruling by a three-judge panel, arguing that “much as the VA's failure to meet the needs of veterans with PTSD might shock and outrage us, we may not step in and boss it around.”

It was not immediately clear from the court’s brief announcement when an 11-judge panel would reconsider the lawsuit brought four years ago by Veterans for Common Sense and Veterans United for Truth on behalf of the nation’s 25 million former service members.

The veterans groups submitted a 2008 Rand Corp. report to the court in which it was estimated that 300,000 veterans suffer from PTSD or severe depression, most of them among the 1.6 million who have served in Iraq or Afghanistan over the last decade.

Gordon Erspamer, the San Francisco lawyer representing the veterans pro bono, expressed concern over the issues raised by the government in its petition for review by the larger court. He said the challenges included a new contention that veterans “lack any due process protection under the Constitution” entitling them to efficient handling of their treatment and benefit claims.

The government’s positions “threaten all veterans and their families and the enforceability of all veterans’ benefits, not only service-connected disability and death compensation, but also education, medical care, burial and every type of statutory entitlement,” Erspamer said.

Attorneys for the government could not be immediately reached for comment.

Medicare and TriCare - VERY IMPORTANT!

posted Jun 11, 2011, 3:17 PM by Info @NesloVentures   [ updated Dec 14, 2011, 6:27 PM by Neslo Ventures ]

Do I have to cancel employer’s policy to use Tricare for Life?

December 9th, 2011 | TriCare Help | Posted by Military Times

I will turn 65 later this year and become eligible for Medicare and Tricare for Life. I have another health insurance policy through my employer. I’ve heard that I have to cancel the other policy to use Tricare for Life, but my wife and children still need that coverage. I asked and was told that I can’t cancel just my own coverage and leave my family insured under my employer’s plan. What can I do?

You were misinformed. You do not need to cancel your other health insurance policy to qualify for Tricare for Life. The legal requirement regarding other health insurance is that Tricare must always be last payer to all other coverage, except welfare-related plans such as Medicaid.

When Tricare beneficiaries become entitled to Medicare and are enrolled in Part B, they are covered under Tricare for Life. If they have no other health insurance, Tricare Standard acts as a free Medicare supplement and last payer to Medicare.

After it processes a claim and makes whatever payment is due, Medicare automatically transfers the claim to Tricare electronically. In the vast majority of claims, Tricare pays whatever Medicare did not pay for Tricare-covered services — usually the beneficiary’s Medicare deductible and co-payment.

Your situation will be different because of your other health insurance. As you read the following, keep in mind that Tricare must always be last payer to all your other coverage, regardless of which plan is first or second payer.

Let me summarize the situation regarding your family:

Tricare for Life rules do not require you to cancel or alter your employer’s health insurance policy. You and your family may continue coverage under your employer’s plan. Regardless of decisions you make about your Medicare coverage, your family’s Tricare coverage as second payer to your employer’s plan will not be affected.

Now, the following pertains to you only, not your family:

When you become entitled to Medicare, you will be told that Medicare does not require you to enroll in Part B as long as you continue to work for the employer that provides the other health insurance. Also, for as long as you continue to work for that employer, your employer’s plan will be your primary coverage. Medicare will be second payer.

Although Medicare’s rules allow you to postpone Part B enrollment for as long as you continue to work, Tricare’s rules do not allow that.

According to law, retirees or their family members who become entitled to Medicare must enroll in Part B of Medicare in order to retain Tricare eligibility.

If you feel that Medicare Part A plus your employer’s plan is enough health insurance for you (yourself only) while you continue to work, you might want to postpone Part B enrollment during that period. That will allow you to avoid paying the monthly premium for Part B. But you will be ineligible for Tricare for Life until you enroll in Part B.

That’s a decision only you can make. Before you do, I suggest you contact Medicare for details about the kinds of health care services Part A covers.

You’ll want to enroll in Part B, however, as soon as you stop working. Your Tricare eligibility will be restored as soon as you do that and your Defense Enrollment Eligibility Reporting System (DEERS) record has been updated.

For as long as you continue to work, you must file claims with your employer’s plan first. Medicare Part A will be second payer to that plan. You will no longer have Tricare as a last-payer backup because you are not enrolled in Medicare Part B.

When you are no longer working, you will file claims with Medicare first. Your employer’s plan will be second payer to Medicare. If you have enrolled in Part B, Tricare will be last payer to your other coverage.

Depending on the extent of the other plan’s coverage, it will very likely pay what Medicare does not pay in much the same way that Tricare would. After Medicare and the other plan have both completed processing and you have the explanations of benefits from both, you may file a claim with Tricare for any amounts they left unpaid.

As I said earlier, regardless of decisions you make, your family members will continue to have your employer’s plan as their primary coverage and Tricare as second payer on their claims. Their Tricare coverage will not be affected by your Medicare entitlement or the decision you make about Part B enrollment.



Upon becoming disabled and the decision to sign up for social security benefits, information arrives in the mail about Medicare.  Hopefully you’ve read all the information sent.  Nowhere in the information does it state that if you accept Medicare what effect it may have on your current health insurance if in fact you have other health insurance.  DO YOUR HOME WORK!

Becoming Medicare Eligible - TriCare

Medicare is a health insurance program for people:

  • age 65 or older
  • under age 65 with certain disabilities
  • with end stage renal disease
  • with Lou Gehrig's disease

Medicare Part A is premium-free hospital insurance.  Medicare Part B is medical insurance, and you must pay Medicare Part B premiums to keep Medicare Part B coverage.  The Centers for Medicare & Medicaid Services manages Medicare.

Medicare and TRICARE
TRICARE beneficiaries who have Medicare Part A, must have Medicare Part B to remain TRICARE-eligible. The only exceptions are if:

  • Your sponsor is on active duty
  • You're enrolled in the US Family Health Plan
  • You're enrolled in TRICARE Reserve Select

If you fall into one of these categories, you are not required to have Medicare Part B to remain eligible for TRICARE. However, we strongly encourage you to get Medicare Part B as soon as you become eligible for Medicare Part A to avoid any future loss of TRICARE coverage. For specific details about your Medicare-eligibility requirements, please enter your profile.

Forced Into Medicare - MARCH 24, 2011

A federal judge tells seniors to take it or lose Social Security.

This week marks the first anniversary of ObamaCare, and if you are wondering where that coercive law is headed, we'd point to a case in federal court. That's where Judge Rosemary Collyer has ruled that Americans have a legal obligation to accept sub par government health benefits.

It remains a remarkable fact that America obliges most citizens over the age of 65 to take that rickety government health plan known as Medicare. Judging by today's growing number of health-savings options (HSAs, medical FSAs), some Americans would prefer to maintain private coverage upon retirement, rather than be compelled into second-rate Medicare. (To read more log in to The Wall Street Journal online).

The above article applies to civilians, per my conversation with TriCare Eligibility on 06/13/2011.  However, once you've seen the title and subtitle you probably cringed.  Nonetheless, even if that ruling was meant for only civilians, why/what/who would make such an obnoxious law?  If the civilians maintain their own insurance, why should they be forced to take Medicare when their insurance most likely pays much better?

Once a veteran is receiving social security disability, they are then “eligible” for Medicare.    Upon the 25th month of receiving SSD (Social Security Disability) payments, the SSA (Social Security Administration) will automatically sign you up for Medicare Part A and offer you Medicare Part B without your knowledge.  Medicare Part A is hospitalization payments and is free to the disabled.  Just so you know, Part A just means you can have a bed at the hospital.  It doesn't cover anything else.  Medicare Part B pays for outpatient healthcare and doctors’ fees.  The Veteran does not have a choice to accept or deny Medicare.  Once you are eligible the SSA reports this information to the DoD (Department of Defense) and TriCare.  TriCare then sends you a letter that your benefits are about to change.  The Veteran is then required to purchase Medicare Part B at the rate of $115 per month or TriCare will not pay any claims or provide you with further coverage if Medicare Part B is not taken.  This means the Veteran lose all TriCare benefits.  However, the Veteran is still eligible to seek health care with the VA, but this does not apply to the Veteran’s beneficiaries.  If the Veteran has beneficiaries (spouse and/or children), they too lose all TriCare benefit coverage.


(Click to read documents)

You Can't Opt Out of Medicare without Losing Social Security, Judge Rules

Elder Law Answers Last Updated: 3/22/2011 12:01:30 PM

Retirees cannot dis-enroll from Medicare Part A without also losing their Social Security benefits and refunding all the money paid to them, a federal judge has ruled.

The judge dismissed a case, Hall v. Sebelius, brought by three retired federal employees who have reached age 65 and are receiving Social Security Retirement benefits, but who would like to drop their Medicare Part A coverage, which pays for care in institutions like hospitals.

Anyone who has reached age 65 and who is entitled to Social Security benefits is also automatically entitled to Medicare Part A without charge. However, the three plaintiffs, one of whom is former Republican House Majority Leader Dick Armey, wanted to drop their Medicare coverage because they claimed it threatened their coverage under the Federal Employees Health Benefit (FEHB) program, which they said was superior. They argued that the Medicare law allows them to drop out of the program without losing their Social Security benefits.

In her March 16, 2011, ruling, Judge Rosemary Collyer of the U.S. District for the District of Columbia acknowledged that the three retirees had a legitimate point that the law does not specifically say that avoiding Medicare Part A means losing Social Security benefits. But in examining the law that Congress enacted in 1965 creating the Medicare program, Judge Collyer found that "[requiring] a mechanism for Plaintiffs and others in their situation to 'disenroll' would be contrary to congressional intent, which was to provide 'mandatory' benefits under Medicare Part A for those receiving Social Security Retirement benefits." [emphasis in original]

The judge also pointed out that the plaintiffs would not gain much by renouncing their Medicare coverage. Even if they were to fore go and repay all Social Security benefits, under the law "their FEHB-paid benefits would be no more, and no less, than what Medicare Part A would provide," Collyer wrote.

The ruling could have implications for the current court cases challenging the new health reform law. A central basis of these challenges is that the "individual mandate," the reform law's requirement that all Americans have health coverage, is illegal because the government can't compel citizens into economic activity. Judge Collyer's ruling suggests that the government may already have been doing this in the area of health care for the past 46 years. Indeed, the Washington Times notes in an editorial that on February 22, "D.C. federal district Judge Gladys Kessler cited preliminary rulings in Hall v. Sebelius to conclude that the [individual] mandate is allowable."

The plaintiffs plan to appeal the decision.

To read the court's decision, click here.

Medicare Part D Prescription Drug coverage Creditable Coverage

Veterans Administration Retrieved 6/10/11

If the Veteran is eligible for Medicare Part D prescription drug coverage, you need to know that the enrollment in the VA health care system is considered creditable coverage for Medicare Part D purposes.  This means that VA prescription drug coverage is at least as good at the Medicare Part D coverage.  Since only Veteran may .enroll in the VA health care system, dependents and family members do not receive credible coverage under the Veteran’s enrollment. 

However, there is one significant area in which AV health care is NOT creditable coverage:  Medicare Part B (outpatient healthcare, including doctors’ fees).  Creditable coverage for Medicare Part B can only be provided through an employer.  As a result, VA health care benefits to Veterans are not creditable coverage for the Part B program.  So although a Veteran may avoid the late enrollment penalty for Medicare Part D by citing VA health care enrollment, that enrollment would not help the Veteran avoid the late enrollment penalty for Part B.

VA does not recommend that Veterans cancel or decline coverage in Medicare (or other health care or insurance programs) solely because they are enrolled in VA health care.  Unlike Medicare, which offers the same benefits for all enrollees, VA assigns enrollees to priority levels, based on a variety of eligibility factors, such as service-connection and income.  There is no guarantee that in subsequent years Congress will appropriate sufficient medical care funds for VA to provide care for all enrollment priority groups.  This could leave Veterans, especially those enrolled in one of the lower-priority groups, with no access to VA health care coverage.  For this reason, having a secondary source of coverage may be in a Veterans’ best interest. 

In addition, a Veteran may want to consider the flexibility afforded by enrolling both VA and Medicare.  For example, Veterans enrolled in both programs would have access to non-VA physicians (under Medicare Part A or Part B) or may obtain prescription drugs that are not on the VA formulary if prescribed by non-VA physicians and filled at their local retail pharmacies (under Medicare Part D).

Additional information on Medicare Part D prescription drug coverage can be found online at http://www.va.gov/healtheligibility/costs/MedicareDEligibility.asp or health and Human Service Medicare website at www.medicare.gov. 

Per my conversation with TriCare Eligibility on 06/13/2011, if the disabled person who is on SSD has TriCare and uses ExpressScripts, your prescription coverage will remain unaffected.

It is important to note that VA health care in NOT considered a health insurance plan.

Unfortunately, I found out the hard way by being disabled and a retired, service-connected disabled Veteran’s wife.  I am in the same boat as thousands of disabled Veterans and their families.  Because I have been determined by the SSA to be disabled, I am forced to pay for health coverage that I am otherwise entitled to  by being married to a service-connected disabled veteran. This is not a political soap box, merely a lightning bolt to cause unsuspecting disabled Veterans to see what’s in the future. 

What will you do?  How will you react when your life is turned upside down and ordered by the government to pay for something you don’t want. Then to have had the well deserved and earned benefits of a service member take a backseat to government required sub par healthcare that you need to pay for?  

Per my conversation with TriCare Eligibility on 06/13/2011,TriCare's stance and rules regarding Medicare with TriCare has been in effect for many years.  The bill was written and has been sitting on a desk just waiting to be passed.  The only coincidence is that the bill was signed into legislation during Obama's term.  So if you want to blame someone for this issue, blame TriCare.  The president just inked the deal.

(The opinions expressed here are not those of the organizations, people or companies in this commentary)


Building Grey Matter at the Brain Gym

posted Jun 2, 2011, 1:33 PM by Info @NesloVentures   [ updated Jun 2, 2011, 1:44 PM by Neslo Ventures ]

Katherine Sullivan, MS, CCC-SLP, CBIS, BrainLine 

Multimedia

It’s not just fun and games; learn what vets and service members are doing at Walter Reed’s Brain Fitness Center.

To an outsider it might just look like fun and games, but at the Brain Fitness Center on the campus of Walter Reed Army Medical Center in Washington, DC, war veterans and service members are using high-tech programs to help their brains heal.

The Brain Fitness Center (BFC) at Walter Reed Army Medical Center (WRAMC) opened in 2009. The BFC’s goal is to give active duty and veteran service members with cognitive dysfunction — that is, difficulty with attention, memory, decision-making, etc. — the opportunity to explore brain-fitness products and perhaps find something new, challenging, and engaging to help in their rehabilitation. The cognitive workout patients receive in the BFC does not replace traditional rehabilitative therapies, but many feel it enhances their recovery.

Over the last decade or so, research has proven that — contrary to years of believing differently — the brain can continue to learn and become stronger at any age. In addition to eating right, staying social, reducing stress, getting sound sleep, and participating in physical exercise, exercising the brain is one of the top ingredients to a healthy body and mind.

Thanks to advances in our understanding of neuroplasticity — that is, the brain’s ability to change itself — as well as demand from the aging Baby Boomer generation, brain training programs have proliferated and become widely available. “Brain gyms” are popping up around the country with products to help you “think younger.” Fun and affordable online games and smartphone apps are also now widespread.

Although originally designed for people as they age, these brain-stimulating products can also help people who have sustained a traumatic brain injury (TBI).

“Think sharper”

There are a variety of ways to maintain brain health, including staying socially active and physically fit, and choosing “brain foods” (eat more berries and salmon!). Just as physical exercise is necessary for physical fitness, brain exercise is important for maintaining brain fitness. The most important aspect of brain exercise is doing something novel and challenging — something that offers a variety of stimuli. At any age, taking up knitting, a foreign language, or a musical instrument will challenge your brain. Once you’ve mastered one skill, you should find a new one to try so that your brain is challenged with new stimuli. The benefit of computer-based products is that computers can generate thousands of different stimuli in a short time-frame and in an entertaining, game-like format.

Most brain training programs assess a person’s level of cognitive function and provide exercises at an appropriately challenging level. Brain exercises should not be frustrating; however, they should be challenging. Like physical exercise, if you push yourself a little more each time you work out, you receive increasing benefits.

As most people know from exercising, finding a sport or routine that you like is important. If you don’t like swimming laps, playing tennis, or lifting weights, you probably won’t stick with it. By the same token, it’s important to find a brain-fitness product that fits your lifestyle demands and personal needs. There are brain games, more clinically focused brain exercises, and then there is focused brain training for a specific cognitive function or group of functions. Some products are designed to cross-train multiple areas and others target one specific area. For example, some programs may provide exercises for your memory, attention, and language skills while others to target a specific area like visual processing. The research on the effectiveness of these products varies, but currently, the jury is still out on how useful these products are for recovery from TBI. However, new research is addressing the direct and indirect benefits of some of these programs for patients with TBI and post-traumatic stress disorder (PTSD).

With the variety of brain training products on the market, it can be daunting for someone with a brain injury to sort through and evaluate each product to find what works best. It’s great to have choices, but you need to do your homework. Many of these products are expensive and may require a subscription with additional payments. The Brain Fitness Center at WRAMC offers a library of products for test driving and for regular use. The goal is to make tools for good brain health easily accessible. The BFC offers computer programs that can be used in the center by appointment, software that can be taken home, web-based technology, and brain games for hand-held devices. This way, you get to try them out and find the ones that best fit your needs and preferences.

Brain training products can vary from free iPhone apps to $400 software programs. The BFC works closely with the American Red Cross chapter at Walter Reed to provide software to service members through donations. If you are an active-duty service member or veteran and you want to purchase a product but the cost is too high, contact your local VA or Military Treatment Facility (MTF) to see if there is a Red Cross or other charitable organization able to provide these items. Many groups raise money for items such as smartphones, laptops, and assistive devices, and these groups may be able to include brain training software as part of their donations. These groups may be especially helpful for people who live in rural areas or for those who cannot get to the BFC.

What’s out there?

The products and resources listed below are used in the Brain Fitness Center at WRAMC, although there are other excellent programs on the market. Please note that Walter Reed, the Department of the Army, and the Department of Defense do not endorse these or any other specific products.

  • Brain Fitness Classic by Posit Science: This product aims to sharpen auditory processing skills. Increasing the speed and accuracy of information you hear has been shown to make you “think quicker” and improve certain aspects of memory. PositScience recommends that you use this product daily for 60 minutes over an eight-week period. Brain Fitness Classic is available on CD for your home computer (Mac or PC).
    http://www.positscience.com/our-products/brain-fitness-program
  • Dakim BrainFitness: Dakim uses a cross-training model, with exercises in memory, visual processing, critical thinking, language, and calculation. The stimuli are varied and include video clips of movies, famous songs as well as trivia. This program is designed to be used over the long term and to provide continuously novel content. Dakim recommends using the program 20 minutes a day at least two to three times a week. Dakim BrainFitness is available on CD for your home computer (Mac or PC).
    http://www.dakim.com/
  • Insight by Posit Science: This program is designed to increase the accuracy and efficiency of visual information processing. Reacting more quickly to visual stimuli and expanding the visual field are two goals of the program. Many of the exercises in the program are part of their driving-safety software, designed to reduce the risk of accidents. Posit Science recommends that you use this product daily for 60 minutes over an eight-week period. Insight is available on CD for your home computer (Mac or PC).
    http://www.positscience.com/our-products/insight
  • Lumosity: Lumos Lab’s website provides exercises targeting memory, attention, speed, flexibility, and problem solving. Users can design their own personalized training, including “courses” with TBI- and/or PTSD-specific content. Users have some control over what exercise they select on given day, and the content adapts to the appropriate challenge level. Lumosity is available on the web and as an iPhone app.
    http://www.lumosity.com/
  • Nintendo Brain Age I and II: These two products are specifically designed for the Nintendo DS, a hand-held game device. The initial assessment tests your “brain age,” which could be “70 years old” even if you are only 27. From there, you work to decrease your brain age with exercises. The program has familiar games such as Sudoku, and the difficulty adjusts for the user. Two different Nintendo DS owners can compete in games. Brain Age is only available for the Nintendo DS.
    http://www.brainage.com/

Brain games don’t replace traditional rehab

The staff at the BFC is part of WRAMC’s traumatic brain injury rehabilitation team and works to accommodate each person’s unique needs. The BFC does not replace traditional cognitive therapy. If a person is currently in, or has been recently discharged from, speech or occupational therapy, BFC staff works with that person’s therapist to best help him with his rehabilitation goals.

If you suspect an undiagnosed cognitive dysfunction and have not been evaluated by a neuropsychologist, speech or occupational therapist, you should first seek out an appropriate evaluation. If you do not have a specific diagnosis of TBI or have already been through TBIrehabilitation and are looking for ways to improve your overall brain health, a commercially available product may be worth exploring. Take some time to peruse the websites of the companies that have developed these brain products. Look for free demos and promotions. Try to get a good grasp on the time commitment recommended and the targeted areas of improvement. Just like working out at the gym, maintenance is important. If you use a program intensely for a few months, it is likely you will notice some benefits, and conversely, if you stop using the program, your benefit will decrease over time. Continuing with a program — for brain and body — provides long-term benefits. So consider whether the program will become boring or too time-consuming. Pick something that fits your needs and is something that will be engaging in the long term.

Studies not only show that maintaining a healthy brain can help reduce the risk for dementia,1 but some brain training products also show evidence of improving overall quality of life.2 However, since most studies for these products have been conducted with the aging population, the Brain Fitness Center at Walter Reed hopes to help provide outcomes for its unique population. The center is committed to investigating the effectiveness of these products by collecting data that may shed light on subjective and objective changes after the use of these products. We have seen more than 130 patients in the last year-and-a-half. A retrospective analysis of those first 100 patients is underway, and staff is currently recruiting for a randomized-controlled prospective research study comparing two of the products. The BFC was recently awarded a government grant for a multi-site randomized study to examine the effectiveness of a new product.

Sound mind in sound body

Cognitive exercise is only one factor in brain health. Our brains benefit from overall physical and mental health. So eat well, sleep and exercise more, find ways to reduce the stress in your life, and maintain your social relationships.

About the author

Kate Sullivan M.S., CCC-SLP, CBIS completed her undergraduate and graduate degrees in Communication Sciences and Disorders at James Madison University. She has been a speech-language pathologist at Walter Reed Army Medical Center for 10 years where she recently helped launch the Brain Fitness Center (BFC), located in the WRAMC’s Military Advanced Training Center, to complement traditional care approaches.

The views expressed in this presentation are those of the authors and do not reflect the official policy of the Department of Army, Department of Defense, or U. S. Government.

Sources

  1. Wilson, R. S., Scherr, P. A., Schneider, J. A., Tang, Y., Bennett, D. A. (2007). Relation of cognitive activity to risk of developing Alzheimer's disease. Neurology 69(20):1911-20.
  2. Smith GE, Housen P, Yaffe K, Ruff R, Kennison RF, Mahncke HW, Zelinski EM. A cognitive training program based on principles of brain plasticity: results from the improvement in memory with plasticity-based adaptive cognitive training (IMPACT) study. J Am Geriatr Soc 2009 Apr;57(4):594-603.

Written exclusively for BrainLine by Katherine Sullivan, MS, CCC-SLP, CBIS, Brain Fitness Center, Walter Reed Army Medical Center. www.wramc.amedd.army.mil.

Study: Secondary PTSD Overdiagnosed

posted May 31, 2011, 8:40 AM by Info @NesloVentures   [ updated May 31, 2011, 8:42 AM by Neslo Ventures ]

May 31, 2011 Military.com by Amy Bushatz

Study: Secondary PTSD Overdiagnosed

More than half of military spouses who think they are suffering from secondary PTSD symptoms may have been misdiagnosed, a new study finds.

"A lot of times, people see a spouse that's distressed and say it's secondary PTSD," said Keith Renshaw, a psychology professor at George Mason University who authored the study. "There's kind of an over-assumption that this is prevalent, and that anything and everything that comes up for a spouse is due to that."

Secondary post-traumatic stress disorder has become a common catch-all label in the military community for the intense stress many spouses feel while living with a veteran suffering from PTSD. Unlike caretaker stress or stress from traumatic events in their own lives, secondary PTSD has sudden, specific characteristics including vivid dreams about the service member's traumatic event or avoiding reminders of that event, Renshaw said.

The study, due for release this fall, found that up to 41 percent of the 190 spouses it surveyed had symptoms similar to those linked with secondary PTSD. But when questioned further, only about 15 percent of respondents pointed to their husbands' military experience as the sole cause for their stress -- a key trait of secondary PTSD.

The popularity of the term "secondary PTSD" may have been caused by the desire among spouses to give a name to the feelings they are experiencing, Renshaw said. But without mental health expertise to sort through their issues, spouses can easily misidentify their symptoms -- a mistake that may lead to improper treatment, he said.

"The treatment implications are the bigger piece," Renshaw said. "If you say you have secondary PTSD, then you are saying you have to do something very specific that actually is not called for."

While treatment options for some symptoms of secondary PTSD and caretaker stress may cross, others are going to be vastly different, Renshaw said. For example, caretaker stress would never be treated with cognitive processing therapy, a process in which patients are asked to confront their traumatic memories, he said.

But some spouses are worried Renshaw's study may have negative mental health repercussions. Brannan Vines, founder of FamilyofaVet.com, was diagnosed with secondary PTSD in 2007 after her husband, who has PTSD, returned from Iraq and retired from the Army. Her organization focuses almost entirely on educating military spouses, families and their caretakers about the realities of the disease. FamilyofaVet.com now has about 70 volunteers and works with over 200,000 visitors each year, mostly on secondary PTSD issues.

Rather than being over diagnosed, Vines said she believes the problem is just the opposite.

"In my opinion, through my work, secondary PTSD is not overly diagnosed, it's underdiagnosed," she said. "My concern with this study is that they are about to put out that we don't need to be monitoring caregivers for PTSD. And caregivers that are already having trouble getting people to take them seriously are going to be told 'well this study says you just have caregiver stress, you just need to relax.' "

But Renshaw said that is exactly what they don't want to have happen.

"We don't want to just say [secondary PTSD] doesn't exist, because it does," he said. "What I worry about is that people who are struggling [will] latch onto it as the explanation, when in fact it's actually not going to help them. … But for this to be used to say to people 'you're full of it, you're just struggling with caregiver stress,' that would be the worst possible outcome."

Fighting never ends for soldiers

posted May 25, 2011, 4:42 PM by Info @NesloVentures   [ updated May 25, 2011, 4:46 PM by Neslo Ventures ]

Berkshire Eagle May 22, 2011

They've fought battles in faraway lands; they've saved lives under a hail of gunfire and shrapnel. And now, after months or years abroad, they've finally come home.

But that doesn't mean the war is over.

"Being out of your native country for a year or so at a time is very strange to a lot of us," said David Robbins, 30, who served in Iraq with the National Guard until last year and now works in North Adams for the state Department of Veterans' Services. "[Civilians] just don't know what it's like to actually leave and know that your life could possibly end."

For many veterans, coming home is the ultimate reward for time spent on the battlefield. But for others, the return to civilian life is more challenging than they ever thought it would be.

Transitioning from military rules and vigilance to a family and job can be stressful -- and that's before post-traumatic stress disorder, traumatic brain injury, drugs or financial troubles are added to the mix.

The stresses can become tragic.

n The U.S. Army said 2010 was the sixth consecutive year in which military suicides increased, and April alone last year had 16 suspected suicides.

n The U.S. Department of Veterans Affairs -- which provides patient care and federal benefits to veterans and their dependents -- estimates that nearly 107,000 veterans are homeless every night, comprising nearly one-fifth of the nation's homeless population.

New Treatment Options for Tinnitus Sufferers

posted May 25, 2011, 4:13 PM by Info @NesloVentures   [ updated May 25, 2011, 4:16 PM by Neslo Ventures ]

Books on a tableIn 2010, every VA medical facility audiology clinic received copies of the PTM clinical handbook, counseling guide and hundreds of patient-education workbooks.

The repetitive stutter of a machine gun, shocking boom of mortars, the deafening drone of helicopter rotors; the sounds of war are hard to ignore and can leave many Veterans with permanent hearing damage.

Tinnitus is the number one disability among Veterans and it affects at least one in every 10 American adults.

Some describe ringing sounds, a buzzing sound, a high-pitched whistle, or numerous other sounds. The causes and effects of tinnitus vary from individual to individual, so researchers at the National Center for Rehabilitative Auditory Research approached treatment options the same way.

“Because tinnitus has many causes, many of which are outside the audiology scope of practice, the approach to tinnitus should be interdisciplinary,” explained Dr. Paula Meyers, Audiology Section Chief at the Tampa VA Hospital.

“Some of these services are performed by audiologists and some are referred to appropriate professionals. The goal is not to silence tinnitus, because there is no cure. Rather, the goal is for patients to learn to self-manage their reactions to the tinnitus.”

Dr. Meyers is a member of the VA research team that developed the Progressive Tinnitus Management (PTM) approach. The culmination of years of studies and clinical trials, PTM evolved into a national management protocol for VA medical centers.

The model is designed to address the needs of all patients who complain about tinnitus, while efficiently utilizing clinical resources. There are five hierarchical levels of management: (1) Triage, (2) Audiologic Evaluation, (3) Group Education, (4) Interdisciplinary Evaluation, and (5) Individualized Support. Throughout the process, patients work with a team of clinicians to create a personalized action plan that will help manage their reactions to tinnitus and make it less of a problem.

“A lot can be done for tinnitus”

“Patients have often been told to go home and learn to live with it, nothing can be done — and it’s really not true. A lot can be done for tinnitus,” said Dr. James Henry, PTM author and Research Professor in Otolaryngology at the Oregon Health & Science University.

Educating patients and providers is a significant element in the PTM approach. For health care providers, the authors of PTM organized a triage procedure to help identify tinnitus patients and access exactly what kind of medical services will best serve their needs. Typically, audiologists coordinate all tinnitus care.

“That’s our front line, when they come in for the hearing test,” said Dr. Cheri Ribbe, audiologist at the Boston VA Healthcare System where they started using PTM over two years ago. Her audiology clinic has seen over 500 Veterans take part in PTM — some who just came in for more information, and some who have gone on to higher levels of the PTM program.

The majority of people with tinnitus, about 80 percent, are not bothered by it; it doesn’t affect their sleep or their ability to concentrate. The small percentage of people who struggle with the noise in their head can be more prone to other debilitating mental health problems, like depression and anxiety. It is not yet understood why tinnitus affects people so differently.

After years of having few resources to offer tinnitus patients, Dr. Ribbe said she was excited to institute the PTM protocol. “It’s been gratifying and satisfying for us and the patient to know that we are offering something for them.”

Veteran account No.1
August Firgau, an Army Veteran, has been living with tinnitus since 1951.

The main thing that helped me was when we set goals for ourselves in cognitive behavioral therapy. We talked about deep breathing, practicing deep breathing 3-4 times a week. And we practiced imagery, which helped me the most.

What I usually imagine — I like to do outdoor fishing. Finding a place, a very restful fishing spot, and enjoying taking in the different environmental sounds and the smells. Like birds chirping away, water rippling over stones, that can be very restful. The sounds of fish jumping out of the water and jumping back in again. It’s a very pleasant place to be in. You’re in deep nature and there’s no one there to interrupt you. This is what I like to imagine.

You want to just pretend it’s not there. I can go along in the daily things of life and not be aware of the tinnitus — not because it’s not there, because I can ignore it.

Sound Therapy

Once referred into the program, all patients with tinnitus are given a hearing exam. During the exam audiologists counsel patients regarding hearing loss, tinnitus and provide Veterans with educational materials.

Patients that need more guidance in finding a way to live with tinnitus are referred to group education workshops. Five sessions teach both audiologic and cognitive behavioral coping techniques.

Veterans are given a comprehensive self-help workbook with supporting materials, like worksheets and audio samples. Dr. Meyers explained that instructors have the flexibility of using the provided handouts, slides, sound demonstration CDs, and DVDs to teach the workshops. She also noticed that group dynamics played an important role in the learning process.

“Patients love to talk about their tinnitus,” she said. “Which, as an audiologist, is what you don’t want your patient to do. You want to get their mind off the tinnitus. But in a group session, an audiologist is there to guide them through the process of how to manage their reactions to tinnitus.”

The use of sound is an important component of therapy for tinnitus. The self-help workbook offers many sample sounds and patient examples that Veterans can try out. They are taught to test three different sound management techniques: “soothing sounds” that offer relief from the stress they feel from tinnitus; “background sounds” that lessen awareness of the tinnitus; and “interesting sounds” that shift their focus away from the tinnitus.

Following up with management technique results in class has given the instructors a better understanding of the highly-individualized symptom they are trying to manage.

“The idea is to let them be open to sounds that they never would have even thought of,” explained Dr. Ribbe. She said that she never would have considered traffic noise as sound therapy, but for one Veteran who had grown up in the city those sounds brought him back to his childhood and pleasant memories.

Veteran account No.2
Don Parrish had lived with a minor level of tinnitus since leaving the Air Force in 1969, but a few years ago he woke up in the middle of the night to a screaming in his ears.

Can you imagine a whistling in your ears constantly?

You can grow accustomed to anything, and that’s pretty much what I have done.

I wear a hearing device with masking noise in it 24/7 and that’s the most effective for me. I’ve got seven little iPods with more sounds on them; the one like a babbling brook is really helpful to me.

[The class] is great if you do it, but it’s really hard to work at it because you don’t see any immediate results. It took about six months of experimenting…at this point I can pretty much ignore it.

Coping techniques

Another technique covered in the workbook and class is cognitive behavioral therapy (CBT) exercises that address the negative reactions tinnitus can trigger.

“A lot of people with tinnitus develop emotional reactions to tinnitus,” said Dr. Caroline Schmidt, PTM author and Licensed Research Psychologist at the VA Connecticut Healthcare System. “Those could be lack of sleep, feeling anxious, frustration; some people relate the sound to a particularly traumatic event that happened.”

Whether the Veteran is already in contact with a mental health specialist or not, the PTM program introduces them to a series of CBT exercises that have proven effective in helping many tinnitus patients. Relaxation techniques, distraction by planning pleasant activities and changing how patients think about tinnitus are the three main techniques taught in the class.

After completing the workshops, many Veterans are able to come up with an action plan to manage their tinnitus through audiologic, cognitive behavioral techniques or some combination of the two. Providers follow up six weeks later to check on their progress and set up additional assistance for the few patients who need it.

In individual sessions, Dr. Schmidt said, “We review what we did with them during the classes. We review their individual response to those coping skills and help them really focus on problem solving those issues.”

Veteran account No.3
John Foster was serving in World War II when he started hearing a ringing in his left ear. Living with the pain over the years, he lost sleep, gained weight and became a very angry person.

Once you find out it has no cure, the minute you do that, then you start to take steps to get better.

The program works, you’ve got to work the program though. What happens, as you work the program, you find different things that help you.

I bought a little bubbly fountain and I always liked the sound of water; that was kind of soothing. I found out that if I woke up I would hear the water, but I would focus more on the visualization and the breathing.

I picture myself walking on a beach, and I tried to think of the sun hitting me on the side of the face and I think about a breeze and I actually feel the breeze and then when I turn back, I feel the sun on the other side of my face and I actually see my footprints in the sand and by the time I do that I usually fall asleep.

You don’t want to visualize while you’re driving because you’ll get distracted. When I’m driving I do the deep breathing exercises and turn on the radio. You’ve got to put some effort into this; they give you all the techniques.

National protocol

In 2010, every VA medical facility audiology clinic received copies of the PTM clinical handbook, counseling guide and hundreds of patient-education workbooks.

The number of Veterans that complete the group education stage of PTM and go on to need individualized support is very small. So PTM’s hierarchical approach provides VA medical facilities with the most efficient means to educate Veterans and teach them self-management techniques.

“We’re always evolving, so PTM is not a static program,” said Dr. Henry. The patient-education workbook is already in its third edition and Dr. Henry has more clinical studies underway to expand PTM’s availability and effectiveness.

“We can’t cure it and nobody can cure it, so the next best thing is to learn self management techniques.”

Related links:
  National Center for Rehabilitative Auditory Research
  VA National Center for Rehabilitative Auditory Research

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