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Flu season open in Wyoming — get your shot!

in Health care/News
2223

It’s fall in Wyoming and that means the Wyoming Health Department is issuing its annual reminder to residents to get their flu vaccine to protect themselves against the kind of severe flu season seen last year.

According to the Health Department, 23 people died from the flu during the 2018-19 flu season and hundreds were hospitalized.

Although the department isn’t predicting what kind of flu season may be in store for Wyoming in 2019-2020, it is urging everyone to get vaccinated.

“There are a lot of things about the flu we do know,” said Kim Deti, the department’s spokeswoman. “We know it’s coming every year. We know every year we’re going to see deaths, hospitalizations and illnesses. We want you to get that shot.”

Autumn is the best time of year to get a flu shot, Deti said, because it coincides with the beginning of the typical flu season, which generally runs from October through May.

“We don’t necessarily have a time frame,” she said. “But this is a great time of year to get it. We don’t want people to wait until folks around them are ill. That’s not going to help you very much.”

The vaccine takes about two weeks to become fully effective, Deti said, meaning if someone waits until people around them are ill, they may have waited too long.

“If you wait until people around you are sick, you may still get exposed,” she said.

In addition to preventing the flu, the vaccination can reduce the severity of influenza if someone who has received the shot gets sick anyway, Deti said.

“We’re not going to promise it’s 100 percent ironclad protection,” she said. “But it’s the best weapon we have to fight influenza.”

Being vaccinated also helps prevent the spread of flu to others, she added.

“You might be able to bounce back from the flu, but you don’t want to pass the disease on to someone else who is more vulnerable than you are,” she said. “It’s about protecting other people who have more struggles with the flu.”

The Health Department identifies people who may be particularly susceptible to the flu as young children, pregnant women, people with chronic health conditions such as asthma or diabetes and those over the age of 65.

In addition to getting the vaccine, the Health Department urges people to take precautions against spreading the flu, such as washing their hands often.

“Hand washing is extremely important, particularly with the flu and how it’s spread,” Deti said.

Health officials: Vaping no safe alternative to smoking

in Health care/News
2194

By Cowboy State Daily

As the number of people with reported respiratory ailments linked to vaping rises, Wyoming’s health officials are warning residents that vaping is not a safe alternative to cigarettes.

“Vaping is not safe for adolescents, for young adults, for pregnant women or for anybody who is not a current smoker,” said Dr. Alexia Harrist, the state’s health officer and epidemiologist.

National reports indicate more than 1,100 people are suffering from lung illnesses related to vaping, with 23 deaths reported. In Wyoming, Harrist said two cases of vaping-related illnesses have been reported.

Officials are unsure what is causing people to become sick, Harrist said.

“What we’re seeing now is an outbreak of severe pulmonary disease related to vaping,” she said. “And we’re still trying to figure out what the specific substance or device is that is causing this illness.”

Most of the people reporting the illness appear to be young adults, Harrist said.

“This certainly does seem to be something new and something different,” she said. “Because these are young, healthy people being admitted to the hospital with respiratory problems and sometimes even respiratory failure.”

Cheyenne resident Kathleen Jaure said she began vaping last year to stop smoking cigarettes. She theorized that the rise in lung ailments may be related to the rise in use of the electronic smoking devices.

“Maybe the potency is going up, that makes it more problematic,” she said. “Also, more people are doing it and so you’re going to see problems. And usually with something, it doesn’t happen overnight that there’s a problem. So I think as it goes on, then we’re starting to recognize the effects of vaping.”

Health officials report that lung ailments related to vaping display symptoms similar to those seen with the flu or pneumonia.

Ransomware attack still affecting Campbell County Health

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Ransomware attack
2092

By Tim Mandese, Cowboy State Daily

A ransomware virus attack on Campbell County Health continued to plague its computer network, causing disruptions in service to Campbell County Hospital and connected systems on Monday. 

According to Kelly Ruiz, public information officer with the Department of Homeland Security in Cheyenne, two other institutions, both connected to Campbell County Health, were also affected by the attack. 

One was the Legacy Living and Rehabilitation Center in Gillette, a long-term care and short-term rehabilitation facility, Ruiz said. The other, according to Dane Joslyn, CCH public information officer, was Wright Clinic and Occupational Health, part of the Campbell County Medical Group.

Ruiz advised the public to follow common computer safeguards to defend against such virus attacks.

“There are some basic things that everyone whether it’s private industry or individuals can do … use strong passwords, don’t click on links, don’t open unknown email attachments,” she said. “Also use cyber security software, a good antivirus.”

It is unknown how the ransomware was transmitted to the CCH network. 

“It is still under investigation.” said Ruiz. “We are currently coordinating but we don’t yet know.”

Due to the ongoing criminal investigation, officials are not disclosing the nature of the ransom being demanded by the virus’ attacker. Most ransomware attacks direct the infected user to send an electronic payment through a given link before the system will be released. 

During a press conference at CCH Monday afternoon, hospital officials, affected department heads and investigators fielded questions about the attack and the investigation. 

“Our goal here is to bring in people that can help identify and go after the perpetrators,” said Leland Christensen, deputy director of the Department of Homeland Security.

Ian Swift, chair of the CCH board of directors, said work continues at the CCH despite the disruption.

“There is a sense of calm in CCH right now,” he said.

There is no estimate as to when the situation might be resolved, said Matt Sabus, information technologies director for CCH.

According to the CCH website, the county’s Emergency Medical Services, CCMH Emergency Department, Maternal Child (OB) and the CCMG Walk-in Clinic are open to assess patients and treat or transfer patients to area hospitals as appropriate.

Ransomware attack shuts down computer network at Campbell County Health

in Health care/News/Technology
Randomware virus
2074

By Tim Mandese, Cowboy State Daily

Gillette — A “ransomware” virus shut down the Campbell County Health computer system on Friday, forcing the Campbell County Memorial Hospital to direct incoming emergency patients to other facilities, according to the health system’s website.

According to the CCH website, “All CCH computer systems have been affected, which impacts the organization’s ability to provide patient care.”

“We have processes in place to continue to treat inpatients appropriately and safely,” Colleen Heeter, Chief Operating Officer, said in the statement. “We will continue to update this information as it becomes available.” 

CCH first became aware of the ransomware attack about 3 a.m. Friday morning. As of Friday night, there was no information as to when computer systems would be restored. 

Services disrupted at at CCH include:

  • No outpatient lab, respiratory therapy and radiology exams or procedures;
  • No new inpatient admissions;
  • Some surgery cancellations;
  • Patients coming to the emergency department and walk-in clinic will be triaged and transferred to an appropriate care facility if needed.

Patients are urged that before coming to appointments, to contact their clinic or department to see if they still scheduled. Phone systems remain operational.

According to Dame Joslyn, CCH Public Information Spokesperson, current patients are being treated as normal, but new patients are being diverted to hospitals in Casper, Sheridan and Rapid City, South Dakota. 

“We have transferred six patients since 11:30 Friday morning.” “We (CCH) have enlisted numerous local, state and federal officials,” added Joslyn.

As Wyoming tries to control supply of opioids, patient, prescriber complications emerge

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As Wyoming tries to control supply of opioids, patient, prescriber complications emerge
1969

By Laura Hancock, Cowboy State Daily

Through decades of numerous, unpredictable illnesses, pain has become a constant for Cody resident Dawn Scott.

But with the opioid epidemic raging in Wyoming and throughout the U.S., obtaining painkillers has become as unpredictable as epithelioid hemangioendothelioma, the rare cancer she fought in the late 1990s. 

The guarantee of a doctor prescribing opioids can be as uncertain as her thoracic outlet syndrome, the illness that resulted in 21 surgeries between 2014 and 2016, which left her with most of her collarbone removed and muscles that had been attached to the clavicle reattached to other parts of her body. 

“Once I tell them the amount of opioids I’m going to need to get relief — which is significant after 21 years of surgeries — I’m almost instantly labeled a seeker,” she said. “Unless it’s an ER doctor who knows me and knows my history. Newer doctors or loaner doctors don’t offer any form of pain control.”

As state leaders try to control the flow of opioids in Wyoming, complications have emerged. Chronic pain patients have had trouble getting the medicine they need to be comfortable and live productive lives. Physicians and other prescribers – already under watch by private insurers and government health care programs – have new laws to consider in their practice. 

But state leaders, concerned about addiction and its effects on families and communities in Wyoming, felt it necessary to change the law and make it harder to dispense and obtain opioids.

Last month, the Cowboy State Daily reported more than 100 million painkillers were shipped to Wyoming pharmacies between 2006 and 2012. The state, local governments and Indian tribes have sued drug makers and distributors, saying they aggressively marketed the medicines and downplayed their addictive tendencies. 

In February, the Wyoming Legislature passed Senate File 46 and Senate File 47 – its own response to the opioid epidemic. 

S.F. 46 prohibits prescribing and dispensing more than a 7-day supply of opioids in a 7-day period to an acute pain patient, with the Wyoming State Board of Pharmacy to establish “reasonable exceptions” for chronic pain, cancer treatment, palliative care and other clinical exceptions.  The pharmacy board is working on rules

The 7-day law is similar to restrictions in about 15 other states

S.F. 47 requires licensed health care professionals to take continuing education courses in the responsible prescribing of controlled substances, which includes opioids. 

The law also requires prescribers to upload controlled substance prescriptions electronically to the Wyoming Online Prescription Database by Jan. 1, 2021, so that doctors, pharmacists and other professionals can review what drugs a patient is on — and prevent abuse or adverse side effects.

The federal government has touted state-level prescription drug monitoring programs as a way to spot and close down “pill mills,” and reduce addiction and overdose deaths. Wyoming physicians — who feel they don’t have a problem with over-prescribing, save for a few extreme examples – say the new state laws are heaping on more regulations on top of various insurance and government health care programs, said Sheila Bush, the Wyoming Medical Society’s executive director.

For instance, Medicare encourages physicians to check the prescription drug monitoring program when writing opioid scripts. One private insurer may prohibit opioids for patients under a certain age, another may limit patients to three days of opioids. There are federal laws, and now state laws, she said. 

“Separate from all of this, you still have good clinical knowledge – the ability for a physician to look at a patient and know the history and say, ‘This is the best care for you today,’” Bush said.  “They’re inundated. There’s no consistency.”

The Medical Society was supportive of the Wyoming legislation because it knew the public had asked for changes in the law. The organization felt that having a seat at the table and providing doctors’ expertise could make the measures better, she said. 

But Wyoming patients with serious medical issues may suffer as a result of these policies. 

Scott, the Cody chronic pain patient, had a miscarriage in a 2016. She asked the physician for painkillers for her cramping. She received just one pill – two milligrams of the opioid Dilaudid. 

“My normal dosage to give me maximum relief is between 12-16 milligrams of Dilaudid,” she said, describing the following days as agonizing. 

Scott has since found a pain specialist in Billings, Montana, who has reduced her trips to the emergency room when migraines, cluster headaches and other pain flares up. 

Scott, who as an attorney has represented people with chronic pain, believes opioids aren’t addictive for everyone. Some patients use them responsibly to relieve pain, she said. Scott said she’s gone through periods in which she didn’t have to take any painkillers. 

“It’s sad, and I’ve watched addiction first-hand, not with opioids – but my dad died of alcoholism,” she said. “I understand the power of addiction. I understand there needs to be control. But there also needs to be a case-by-case basis, not just a blanket decision that, ‘I’m not going to ever offer over 2 milligrams of Dilaudid.’ They feel like their discretion is being scrutinized because of regulations. Some doctors want to help people and they’re limited.”

More than 100 million prescription painkillers ended up in Wyoming in six years

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More than 100 million prescription painkillers ended up in Wyoming in six years
1785

By Laura Hancock, Cowboy State Daily

Drug makers distributed nearly 126.7 million painkillers in Wyoming between 2006 to 2012, according to a federal prescription database recently made public.

That includes hydrocodone, which goes under the name brands of Vicodin and Lortab, and oxycodone, which goes under the name brand of OxyContin

The U.S. Drug Enforcement Administration database is being used in litigation by more than 2,000 entities such as state governments, local governments, tribes, labor unions and hospital systems – including several in Wyoming – in a federal courtroom in Cleveland. The litigation alleges drug manufacturers and distributors aggressively marketed the medicines, downplayed their addictive tendencies and created an opioid scourge that’s become a national epidemic. 

The Washington Post and the Charleston Gazette-Mail in West Virginia successfully fought to make the information public, and the Post created a searchable database — from which the Wyoming data was pulled.

The following describes prescription opioids sent to each Wyoming county between 2006 and 2012:

Albany4.5 million pills18 pills per person each year.
Big Horn3.7 million pills45 pills per person each year.
Campbell10.6 million pills35 pills per person each year.
Carbon3.1 million pills28 pills per person each year.
Converse2.9 million pills31 pills per person each year. 
Crook250,100 pills5 pills per person each year. 
Fremont7.8 million pills28 pills per person each year. 
Goshen2.2 million pills25 pills per person each year. 
Hot Springs1.8 million pills53 pills per person each year. 
Johnson1.2 million pills21 pills per person each year. 
Laramie20 million pills32 pills per person each year. 
Lincoln3.9 million pills32 pills per person each year. 
Natrona20.4 million pills39 pills per person each year. 
Niobrara421,800 pills25 pills per person each year. 
Park10.3 million pills53 pills per person each year. 
Platte2.2 million pills35 pills per person each year. 
Sheridan7.1 million pills35 pills per person each year. 
Sublette1.5 million pills23 pills per person each year. 
Sweetwater9 million pills30 pills per person each year. 
Teton3.3 million pills22 pills per person each year. 
Uinta5.8 million pills40 pills per person each year. 
Washakie3.1 million pills54 pills per person each year. 
Weston1.6 million pills32 pills per person each year. 

Several Wyoming governments are involved in separate litigation over opioids, including the state, Carbon County, Rock Springs, Green River, Casper, Cheyenne, and the Eastern Shoshone and Northern Arapaho tribes. Lawsuits have been filed in state and federal court

The plaintiffs in all of the lawsuits argue that drug treatment has cost them millions of dollars through Medicaid and community treatment facilities. Many people, hooked on prescription opioids, have turned to street drugs – including fentanyl-laced heroin. Some have overdosed and some have died— including nearly 50,000 across the U.S. in just 2017 alone

State Rep. Charles Pelkey, D-Laramie, said he was pleased to see the state taking action in the face of large distribution numbers.

“Much of the responsibility lies with the pharmaceutical companies who marketed aggressively, unaware or intentionally ignorant of the consequences,” he said in an email. “We can some things legislatively, but I am pleased to see that the state is pursuing the matter in the courts as well. If legislation doesn’t achieve the desired goal, maybe hitting them in the pocket, where it counts, will.”

Wyoming’s case is pending in district court in Laramie County, where OxyContin maker Perdue Pharma wants it dismissed. The state is opposing the motion.

Michael Pearlman, spokesman for Gov. Mark Gordon, said this week that the Wyoming Attorney General’s Office is waiting for the district court to rule on dismissal. 

“In the meantime, the court entered a scheduling order, including among other things, discovery deadlines which the AGs office is following,” he said in an email.

According to filings, the case is expected to continue at least through 2020.
The lawsuits filed by Wyoming cities and tribes are in federal court, all consolidated in U.S. District Judge Dan Polster’s Ohio courtroom. Bloomberg reported Tuesday that McKesson Corp., Cardinal Health and other drug distribution companies have offered a $10 billion settlement in lawsuits filed by the various states. A group representing some plaintiffs countered with $45 billion. 

Drug makers haven’t yet begun settlements with the plaintiffs in federal court in Ohio, but the judge is pushing for the parties to settle soon to end all the suits and help set aside money for drug treatment and prevention. Perdue Pharma separately settled with Oklahoma for $270 million.

Pearlman, Gordon’s spokesman, said opioids aren’t just an addict’s problem. Their families and communities are affected too. 

“It causes extra burdens on our law enforcement agencies and first responders,” he said. 

Public health officials continue to eye Wyoming’s immunization rates

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Graph of Wyoming vaccination rates
1639

By Laura Hancock, Cowboy State Daily

At a time when all-but-eradicated diseases are making a comeback, immunization rates among young children in Wyoming tend to closely mimic national trends, according to an analysis of federal data. 

Some years, Wyoming’s rate is lower than the national average. Other years it’s higher. 

However, looking at data for four common vaccines tracked by the National Immunization Survey, Wyoming’s rates increase and decrease by more percentage points than the national average. 

That could be the result of the margin of error that comes from polling the country’s smallest population state, said Alexia Harrist, the Wyoming state health officer and epidemiologist. 

Although signs are good that Wyoming hasn’t significantly deviated from the national norm, that doesn’t necessarily mean Wyoming has escaped the “anti-vax” movement, which inaccurately pushes the belief that vaccines are harmful. Research shows that vaccine reactions are rare and the one study linking vaccinations to autism contained falsified information

“We are seeing some increases in the amount of waivers (for vaccination) that we’re getting,” Harrist said. “That is concerning that we may be seeing fewer children getting vaccinations.”

Wyoming is one of 45 states and Washington, D.C. where parents can seek waivers from required vaccinations for their children due to religious beliefs. 

Dr. Mark Dowell, the Natrona County health officer, remembers the days when he could override a family’s desire to waive their children’s vaccines. 

“I made sure that they had good reasons to prove to me there was a medical contraindication to the vaccine,” he said. “(Otherwise) I’d deny it. That’s how I’ve always felt, and I’ll continue to preach that.”

In 2001, the Wyoming Supreme Court ruled that public health officers exceeded their authority by denying immunization exemptions. Since then, Dowell and others stopped intervening. 

Public health officers stress the concept of “herd” immunity or “community” immunity, in which most people get vaccinated so that the few who cannot – those with cancer or immune deficiencies that prevent them from developing immunity with vaccines – are safe from smallpox, polio and other diseases once thought to be in the Western world’s past, Harrist said. 

That Wyoming hasn’t seen a measles outbreak could be luck. Or it could be the result of the Cowboy State’s vast spaces and few people. 

“The majority of the time I’m not running into major problems in this county,” Dowell said about Natrona County. “But almost all of the counties in Wyoming are very rural. They don’t have a lot of infectious disease.”

News of outbreaks outside of Wyoming may actually boost immunization rates. 

The phone starts ringing at Sheridan County Public Health whenever there is an outbreak. People want the health department to check their records to ensure they’re up-to-date on all their shots, said Debra Harr, the county nurse manager. 

“We’ve seen quite a bit more people calling to see if they are current on their measles,” she said. 

Doctor Shortage in Wyoming; “Almost Impossible to Recruit”

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Doctor Shortage in Wyoming; “Almost Impossible to Recruit”
1471
Wyo Hospital Assoc. President: Federal changes makes it almost impossible for us to be competitive and for us to recruit especially family practice physicians in these rural areas where they’re needed the most.

By James Chilton, Cowboy State Daily

CHEYENNE – When it comes to sheer numbers, Wyoming’s doctor shortage isn’t all that bad, on paper at least.  Just two dozen additional full-time outpatient physicians would be enough to meet the primary care needs of the nearly 188,000 Wyomingites living in federally-designated Health Professional Shortage Areas, or HPSAs.

“The population of designated HPSAs in Wyoming for primary care is 187,903, and only 53.81 percent of that population’s need is met,” said Keri Wagner, of the Wyoming Health Department’s Office of Rural Health. “The practitioners needed to remove that designation is 24 for the entire state.”

While it might not sound like much, getting those 24 full-time doctors into the state, getting them to the communities where they’re needed most, and offering them the compensation and quality of life needed to keep them here have proven uniquely difficult in the Cowboy State. Federal and state programs have made some headway in the effort to bring more doctors, dentists and psychiatrists to all corners of Wyoming. But while the state’s reputation for wide-open natural splendor brings in the tourists and outdoorsmen, it’s not necessarily what most doctors are seeking when looking to relocate.

“It really takes a specific type of person, someone who grew up in these frontier communities that really wants to get back to practicing someplace where they’re relatively isolated. If they’re outdoorsmen or like cross-country skiing or hunting, sure; but there are long distances to get to any other type of entertainment,” Wagner said. “We’re surrounded by states with larger population centers, more enrichment opportunities and educational opportunities, so it can be a really tough sell for some communities that don’t even have a supermarket.”

The HPSA designation seeks to help with this by grading facilities, geographic regions and specific populations on criteria like patient-to-provider ratio, percentage of the population living below the federal poverty level and travel time to the nearest source of care. From this, hospitals, clinics and geographic areas are scored, with higher scores getting the most attention from the U.S. Health Resources and Services Administration.

“If they have the HPSA designation for any of the three disciplines (primary care, dental or mental health services) it opens up the opportunity to participate in the National Health Service Corps,” Wagner said. “We have roughly 30 corps participants every year.”

The National Health Service Corps tries to get practitioners to where the need is by offering scholarships and loan repayment programs to fledgling doctors in exchange for an agreement to work in a designated HPSA for at least two years. Physicians working in geographic HPSAs can also obtain additional bonus quarterly payments from the Centers for Medicare and Medicaid Services.

For HPSA designation and related support, practitioners must submit reports updating the state on statistics such as doctor-to-patient ratios.

“It’s important enough they’ll return their surveys if they’re afraid they’ll lose their designation,” Wagner said. “I’ve seen people where they receive the bonus payment, but there was some cutoff or something wrong with the timing, where the HPSA designation goes away and they have to return it. I think one of the big things that’s happened is the population is so small that just the loss of a quarter of an FTE (full-time equivalent, i.e. 40 hours of work per week) can make or break a designation.”

That’s been a continuing cause for concern for Eric Boley, president of the Wyoming Hospital Association. Boley agreed with Wagner’s assessment that, for whatever reason, the HPSA system seems weighted to apply to more densely-populated areas, where small changes in population don’t move the needle as much.

“The feds have changed the way the HPSA scoring is calculated based on service areas, so areas I and my members would designate as shortage areas no longer meet their criteria,” Boley said. “For example, south Lincoln County used to easily qualify for HPSA funding, where northern Lincoln County, the Star Valley area, didn’t have some of the challenges. But now because of criteria changes, the whole area is lumped into one.”

As a result, Boley said some of the state’s most vulnerable rural communities are left with few resources to attract medical talent from larger hospital systems, and even those that do have the resources have to make steep offers to even stand a chance.

“My facilities are having to pay, in some cases, the 95th percentile for salaries, with sign-on bonuses and really lucrative living expense packages,” Boley said. “It makes it almost impossible for us to be competitive and for us to recruit especially family practice physicians in these rural areas where they’re needed the most.”

Wagner noted the state has led its own effort to try to provide a little more financial leverage to small communities through the Wyoming Provider Recruitment Grant Program, which provides up to $50,000 to a hospital, clinic or community organization attempting to recruit a healthcare provider. Initially funded for the 2009-10 biennium, the program doesn’t level the playing field, Wagner said, but it has helped to recruit more than a dozen physicians, psychiatrists and, following a 2015 legislative change, other health professionals like registered nurses or occupational therapists.

Like most programs, Wyoming’s provider recruitment program has some strings attached that have kept it from being fully utilized. One big problem is that the grants are meant for reimbursement, meaning whoever’s doing the hiring needs to have the money up front and has to have someone recruited within one year for the payments to come through. 

“If they don’t recruit within that one year, they don’t get any money. If they do recruit, the provider has to start within six months of the date they sign them,” Wagner said. “So, is this entity able to fund all of this up front and wait for the reimbursement? Our neediest have applied, but they couldn’t go anywhere without money to front it.”

As such, Wagner said applications made through the program dropped from 45 in the 2009-10 biennium to just nine in the following biennium, and they have remained low ever since. But for those hospitals able to navigate the process and pay for the initial recruitment process, the program has proven a useful tool.

“I think it’s successful in that it provides funding to help recruitment at safety-net facilities. These are organizations that don’t have a ton of funding; they have a hard time competing with larger hospital systems in surrounding states,” she said. “So when a provider is contacted and they’re mulling over whether they should go to a rural health clinic in Colorado that’s offering an $80,000 loan repayment on top of a $40,000 sign-on bonus, versus this hospital in Wyoming … this program improves Wyoming’s negotiating position. It provides them with a little bit more clout.”

VA to implement Mission Act, cutting wait times, enhancing healthcare programs

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Veterans Affairs Health Care
1441

By Ike Fredregill, Cowboy State Daily

A congressional act going into effect June 6 could make it easier for Wyoming veterans to access the health care providers of their choice. The Mission Act will replace the Choice Act of 2014, which was adopted as the congressional response to extreme wait times experienced by veterans seeking medical care through the Department of Veterans Affairs.

“The Choice Act was a three-year law, which was intended solely for the purposes of pulling the VA into a newer era of community care,” said Sam House, a Cheyenne VA Medical Center spokesperson. “Then, President (Donald) Trump extended it for a year. The Mission Act, however, does not have a sunset, so it will be in place until Congress decides to remove it.”

With the Choice Act, veterans could seek primary and mental health care services from a local health care provider rather than from a VA facility if they lived outside a 40-mile radius of a VA medical center or could not schedule an appointment with their primary care provider at the VA within 30 days.

The Mission Act reduces those standards to a wait time of 20 or more days or a drive time of more than 30 minutes.

“They are not using specific matrix to look at drive times, but rather looking at the average drive time and taking into account heavy traffic periods,” House explained. “A guy living in Denver could live 5 miles from the VA, but it might take him 45 minutes to get there.”

For specialized care, the new act reduces the veterans’ wait time to be eligible for services at non-VA facilities from 30 days to 28 and changes the 60-mile radius requirement to a 60-minute radius.

“Congress is focusing on ensuring our vets are getting the best possible care as quickly as they need it,” House said.

Enhancing programs

In addition to easing access requirements, the Mission Act seeks to improve services already in place such as tele-health options, caregiver programs and VA infrastructure.

“The Mission Act streamlines and improves community care,” House said. “It establishes a new urgent care benefit for our veterans, and it expands caregiver eligibility.”

When the Choice Act was implemented, veterans were given the opportunity to seek healthcare providers outside VA facilities, which is referred to as community care, he said.

The VA’s internal software, however, did not communicate with the myriad programs used by health care providers outside its facilities. Simple tasks such as transferring medical records and authorizing payments required mountains of paperwork as well as numerous case-worker hours, House explained. The Mission Act seeks to streamline the process through installing new software, HealthShare Referral Manager (HSRM).

“HSRM is an end-to-end healthcare referral system,” said Josh Benavente, Cheyenne VA Community Care supervisor. “That’s where the VA will build our authorizations for payments and providers can submit medical records.”

The new system goes live in June.

“The biggest problem it’s fixing is previously we were relying on too many outdated programs to get information to and from community providers,” Benavente said. “It allows the VA to communicate with community providers faster and easier.”

Eligibility for the VA’s caregiver program is also slated to expand to include veterans from all eras of service. The expansion is scheduled to roll out during the next two years, starting with veterans who were injured on or before May 7, 1975.

On the tele-health front, the act could facilitate community partnerships in rural areas to increase long-range, video and phone healthcare-conferencing accessibility, House said.  

“What the Mission Act will do is strengthen our ability and reason for going into communities to establish a centralized tele-health port,” he explained. “We have a number of veterans that don’t have internet capability, but they want to stay with the VA and can’t make the trip to the Cheyenne VA every time.”

One such program could soon provide veterans living near Saratoga an opportunity to use equipment at the Saratoga Care Center to access Cheyenne VA tele-health programs, House added.

Bureaucracy

As June 6 rounds the corner, House said the VA is racing to ensure the transition is smooth. 

“It’s been a mad rush for all of the VA to be trained by June 6,” he said. “There are so many pieces and parts to the act.”

Despite more programs and enhanced services, House said the act will not likely lead to an increase of staffing at the Cheyenne VA.

Cowboy State Daily talked to several veterans who were unaware of the changes coming to the VA, but most said they would like the Mission Act to make it easier for veterans living in rural Wyoming to enter the community care program.

“The Choice Program didn’t work too well because of all the bureaucracy,” said John Hursh, a Laramie resident and former captain in the U.S. Marine Corps Reserve. “So, I’m hoping the Mission Act can fix some of that.”

Cheyenne VA services remain intact a year after administrative downgrade

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Cheyenne VA services remain intact a year after administrative downgrade
1357

By Ike Fredregill, Cowboy State Daily

Services at the Cheyenne Veterans Affairs Medical Center remain largely intact a year after the Department of Veteran Affairs downgraded an administrative ranking for the facility, a VA spokesperson said.

“Our lower complexity level has not affected the quality or services we provide,” said Sam House, the Cheyenne VA public affairs officer. “It didn’t affect our funding. The only thing it did was should we get a new director, they would be hired at a lower pay rate.”

According to the department, VA facilities are categorized by “complexity levels,” which are determined by characteristics of the patient population, clinical services offered, educational and research initiatives and administrative complexity. 

“It’s a system of looking at hospitals, and what they are capable of doing,” House explained. “They assign numbers to them, and they base the hospital director’s pay off that number. That’s all the complexity level means.”

The complexity system consists of three levels with level one and its subcategories being the highest and level three being the lowest. The Cheyenne VA, with a budget of $185 million in 2018, was downgraded from level two to level three early in 2018, which House said signifies no research is being conducted at the facility.

“We don’t have a focus on research,” he added. “Our focus is on mental health, primary care and geriatric care.”

House said one service was changed by the downgrade — orthopedic repairs. While the facility still provides othorpedic surgery, its staff no longer repairs orthopedic implants.

Wyoming Veterans Commission Director Steve Kravitsky said he was initially alarmed when he heard about the downgrade, but his fears were allayed after talking to Cheyenne VA Director Paul Roberts.

“(Roberts) assured me not only were they not going to decrease any services, but they were still bringing more services online,” Kravitsky said. “As director of the veterans commission and a veteran myself, I receive care at the VA, and I haven’t seen anything to the contrary.”

Built in 1934, the Cheyenne VA originally employed 100 staff members and provided 100 beds for primary care.

Nowadays, the facility’s area of service, also known as a “catchment” area, stretches from Rawlins to Sydney, Nebraska, and from Douglas down to north of Denver.

About 79,000 eligible veterans live in the catchment area, House said, but only 29,000 used the facility’s services in 2018, a 3 percent reduction from 2017.

House explained that the VA is made up of three entitles to administer three areas: Healthcare, benefits and the national cemetery.

Most of the services offered at the Cheyenne VA are centered around primary healthcare, but all three divisions of the department have offices on the grounds. 

“Recently, we’ve expanded our nursing home and hospice care facility,” House said. “The average age of Cheyenne VA users is 61. Our youngest user is 19, and our oldest is 102.”

A large portion of the facility is dedicated to offering primary care, including physical therapy, orthopedic surgery, cardiopulmonary lab work, audiology and otorhinolaryngology, or ear, nose and throat care.

The Cheyenne VA also provides some emergency services through its emergency room.

“Our ER is open and staffed 24/7, 365,” House said. “But we’re not a trauma center.”

Because of this, ambulances do not deliver patients to the Cheyenne VA, but rather, veterans are transported to Cheyenne Regional Medical Center, and the VA reimburses the medical center for the care provided.

“Because we have CRMC, we don’t have a trauma care unit in our ER,” he added. “We are in partnership with our community, not competition.”

Additionally, the facility offers limited dental care and was the first in the region to install a women’s clinic.

“The need for women-specific care is something I think the VA has really realized in the last nine to 10 years,” House said.

Laramie County is home to the largest concentration of veterans in Wyoming, and as such, the Cheyenne VA is well-placed to provide them with vital services, Kravitsky said.

“There are 12,085 vets living in Laramie County, according to the VA,” he said, “which is about 25 percent of the 47,472 living throughout Wyoming.”

Without the Cheyenne VA, veterans would need to travel to Denver or Sheridan for veterans services, Kravitsky added.

“With 20 veterans committing suicide every day, quality care close to home is essential to potentially reducing that number,” he said.

The veterans commission files veteran claims with the VA benefits division and is occasionally charged with reviewing inquiries into the VA’s quality or frequency of care. 

“Those inquiries are infrequent,” Kravitsky said. “We don’t get a lot of negative feedback about the Cheyenne VA.”

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