U.S. healthcare system should look to VA as baby boomers turn to Medicare

WHAT IT MEANS AND WHY IT’S IMPORTANT — That Medicare doesn’t universally cover the use of retail clinics — and even create a structure that encourages their use for certain services — is a key symptom of what is wrong with the U.S. healthcare system.

THE NEWS: Duane Reade Walk-In Medical Care clinics to accept Medicare. For the full story, click here)

With the first wave of baby boomers now hitting the social security and Medicare rolls, these federal entitlement programs are expected to come under back-breaking pressure. Medicare should take a page from the Veterans Administration, which faced the same reality in the mid-1990s, when Congress expanded the number of veterans eligible to receive VA benefits. “Moreover, the large cohort of World War II veterans means that almost 40% of veterans are aged 65 or older, compared with 13% of the general population,” noted the recent report, “The Future of Nursing: Leading Change, Advancing Health,” the result of a two-year research initiative led by the Institute of Medicine in conjunction with the Robert Wood Johnson Foundation.

The crush of aging vets — and the sheer number of them — forced VA officials to re-examine the way in which it provided care, looking for ways to improve efficiency and ultimately reduce cost. The answer: Put more of an emphasis on preventive health, and use nurse practitioners to extend primary care to VA members.

“Anticipating the challenges it would face, the VA began transforming itself from a hospital-based system into a healthcare system that is focused on primary care, and it aims to provide more services as appropriate, closer to the veteran’s home or community,” according to “The Future of Nursing” report. “This strategy required better coordination of care and chronic disease management. … More NPs were hired as primary care providers. … The VA uses NPs as primary care providers to provide care for patients across all settings, including inpatient and outpatient settings.”

If it’s good enough for our veterans, why isn’t it good enough for seniors on Medicare? Actually, it appears to be better from a quality standpoint.

“The results of the VA’s initiatives using both front-line RNs and [advance practice nurses] are impressive,” the report continued. “One study found that VA patients received significantly better health care — based on various quality of care indicators — than patients enrolled in Medicare’s fee-for-service program. In some cases, the study showed between 93% and 98% of VA patients received appropriate care in 2000; the highest score for comparable Medicare patients was 84%.”

Furthermore, analysis from the former Congressional Office of Technology Assessment found that NPs could safely and effectively provide more than 75% of general primary care services.

Then there’s the little matter of cost.

“In addition, the VA’s spending per enrollee rose much more slowly than Medicare’s. … After adjusting for different mixes of population and demographics, the Congressional Budget Office determined that the VA’s spending per enrollee grew by 30% from 1999 to 2007, compared with 80% for Medicare over the same period,” according to the report. Typically, Medicare pays NPs 85% of the average physician fee for basic office-visit services.

The U.S. military revolutionized the Internet and the cell phone. Today, that technology has become so ubiquitous, consumers couldn’t imagine life without either. Perhaps efforts to reform the American healthcare system should borrow from the Pentagon’s experience as well.

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