AUSA President Meets with DoD Health Affairs Nominee


AUSA President Gen. Gordon R. Sullivan, USA, Ret., met recently with Dr. S. Ward Casscells, the nominee to be the new Assistant Secretary of Defense for Health Affairs.

Dr. Casscells, a cardiologist and Vice President of Biotechnology at the University of Texas Health Science Center at Houston is also a colonel in the Army Reserve. He recently returned from a three-month tour of duty in Iraq.

After touching on several topics important to the Association and its members, Gen. Sullivan assured Dr. Casscells that the Association is prepared to assist him in any way with his new endeavor.

During his confirmation hearing last week, we were pleased to hear Dr. Casscells' response to a question regarding TRICARE from Sen. John Warner, R-Va., ranking member of the Senate Armed Services Committee.

Sen. Warner noted that Dr. Casscells said in his written responses to the committee's advance questions that one of the TRICARE's strengths is that it is very inexpensive for the beneficiary compared to other health care plans. Sen. Warner said, “This statement may well be inconsistent with the views of senior leaders in the department who have described TRICARE as unsustainable in its present form. So therein rests a challenge for you to sort that out. I don't presume at this point in time that you can give us a great deal of insight into how you would treat TRICARE, but it's viewed by the men and women of the Armed Forces and their families as a very essential part of the contract America makes with these families when they undertake their role in the military. I hope that you give us your assurances you'll do the best you can to strengthen that program.”

Dr. Casscells replied, “I share your concern…, that increasing copays and deductibles, particularly at this time, runs the risk of making it harder for us to recruit and retain the very best because people value enormously the health care given in the military. They are willing to sleep in tents, on cots -- they don't demand the Ritz, but they would like and deserve the very best medical care. And this is true for the families, and their budgets are lean. And I know that the copays and the deductibles have been flat for 12 or 13 years, and there's understandable interest in raising them because the private sector is raising theirs to decrease utilization. But sir, there are other efficiencies which can be sought.”

Additionally, in an exchange with Sen. James Inhofe, R-Okla., regarding recent problems at Walter Reed Army Medical Center, Dr. Casscells, who was wounded in Iraq, said he’d bring a patient’s perspective to the job if confirmed. He told the senators he’d experienced DoD health care firsthand and was frustrated by “the bureaucracy that has been in the news lately” upon his return.

“If it's frustrating for a colonel, you can imagine how frustrating it is for a sergeant or corporal,” he said, “particularly if they've had a head injury or their family is 1,000 miles away and can't be advocates for them. So… we've got to fix that and make it fair and fast.”

Dr. Casscells suffered an elbow injury when the Humvee he was riding in swerved to avoid an improvised-explosive-device tripwire. The injury became infected, and he was treated at the 10th Combat Support Hospital in Baghdad.

“I wasn't badly injured,” he said. “It was a small injury, but it was just enough to get me into the system as a patient.” He added that his experience gave him “an interesting insight” into the dedication of the military’s medical personnel.

Dr. Casscells said he would continue -- and accelerate, if possible -- efforts by current Assistant Secretary of Defense for Health Affairs Dr. William Winkenwerder Jr. to implement electronic medical records and other improvements to efficiency and accountability. He cited his own experience in acknowledging that the current system needs attention.

“I do know that when I was in Iraq, it amused me to look up my record on Army Knowledge Online -- one of our Web sites -- and to find that my deployment status was ‘amber,’ which means I was not fit to be deployed, and yet there I was,” he said. “So clearly there are issues like that.”

He also said that, if confirmed, he’ll need time to assess the findings of various task forces and hearings investigating issues related to military health care and its bureaucracy, but he added it’s clear to him the military is taking these matters “very seriously.”

“It sounds like there’s a lot of support for improving things – to take a system which is very good and make it absolutely superb,” he said.


Bill to Improve Education Benefits for Veterans Introduced
In early January, Senator James Webb (D-VA) introduced the Post-9/11 Veterans Educational Assistance Act of 2007 (S.22) which would expand the level of education assistance to veterans to levels equivalent to that enjoyed by World War II veterans under the original G.I. Bill. The proposed legislation would cover tuition, room and board, and a monthly stipend of $1,000. Funds provided by the existing Montgomery GI Bill do not cover all costs associated with higher education. The increased benefits would be targeted at Servicemembers who have served on active duty since September 11, 2001.

DOD Investigates Reports of myPay Hacking
According to the Defense Finance and Accounting Service (DFAS), about two dozen users of MyPay have had their accounts hacked in recent months. MyPay allows Servicemembers and Defense Department civilians to check their finances online. It’s likely that the problem occurred after users’ personal information was stolen from their home computers using spyware. DFAS has provided a fact sheet to help users protect their computers and personal data: http://www.dod.mil/dfas/news/2007pressreleases/release02070001.html. The original Stars and Stripes article about the MyPay security issue is available by clicking here.

County Veteran Service Officers Can Help Veterans Obtain Benefits
The National Association of County Veterans Service Officers (NACVSO) is an organization made up of local government employees who assist veterans, family members, and survivors in developing and processing claims for veterans’ benefits. Veteran Service Officers are trained to understand the benefits process and work collaboratively with the Department of Veterans Affairs and other nationally chartered veterans’ organizations to ensure veterans and family members receive the benefits to which they are entitled. To locate a Veteran Service Officer visit the NACVSO website at http://www.nacvso.org.

AAFES Building Stronger Exchange Benefit
The Army & Air Force Exchange Service (AAFES) will invest more than $1 billion over the next four years to improve and expand exchange facilities. The program comes in response to changing demographics within the military and Base Realignment and Closure actions. AAFES is a valuable benefit for military shoppers but and in order to continue serving military families in a dynamic retail market they must design better exchange facilities and provide their customers with great value products and competitive pricing. To learn more about AAFES’s improvements please visit http://www.aafes.com/pa/news/07news/07-019.htm.

DeCa Announces Best Commissary Nominees
The Defense Commissary Agency has announced this year’s nominees for its Best Commissary awards. Nominees in their respective categories are:
· Scott Air Force Base, Ill., best superstore
· Fort Lewis, Wash., best superstore
· Fort Huachuca, Ariz., best large commissary, United States
· Marine Corps Air Station New River, N.C., best large commissary, United States
· Naval Air Station Barbers Point, Hawaii, best small commissary, United States
· Rock Island Arsenal, Ill., best small commissary, United States
· Camp Humphreys, South Korea, best large commissary, overseas
· Schweinfurt, Germany, best large commissary, overseas
· Camp Kure, Japan, best small commissary, overseas
· Izmir Air Station, Turkey, best small commissary, overseas
The annual awards recognize overall excellence in commissary operations and service. Awards will be presented at the DeCA/American Logistics Association 2007 Training Event and Conference held in Richmond, Va., in April.

VFW Calls VA Claims Process Broken

In testimony March 6 before a joint hearing of the House and Senate Veterans Affairs Committees, the national commander of
the Veterans of Foreign Wars declared the claims processing system at the Department of Veterans Affairs broken. Commander
Gary Kurpius, of Anchorage, Alaska, said it was because VA has an unmanageable backlog of more than 800,000 claims, that it
takes a half year for a claims rating, and that more than 100,000 claims are decided wrongly every year, or one in every
eight claims. "It is unacceptable, because each delay and every wrong decision have real human costs," he said. "Fixing the
Veterans Benefits Administration is important because the VBA is the gateway to all of VA. No disabled veteran should have to
wait for benefits many of them need to care for themselves and their families."

VA Offers Claims Expediting Advice

In the face of complaints about delays by the Department of Veterans Affairs in processing disability claims (previous
item), the VA offers advice to speed up claims. First, veterans should file their claims immediately after separation or
retirement, or as soon as possible if a service-connected illness or injury occurs after separation. Veterans also should
use a trained Veteran’s Service Officer to assist with their claim. In addition, the application should be completely filled
in and include ample supporting documentation. And claimants should respond promptly to any request for additional
information because the claim process stops until they reply.

More Third Tier Drugs

On March 22, a DoD panel proposed moving several pain narcotic, glaucoma, and anti-depressant medications to the third tier ($22 copay vs $3 or $9 for drugs on first and second tiers), along with some newer sedatives.

Ultram ER (extended release) will be moved to the third tier with a 90-day implementation time. There are 38 other medications in this class that remain available at the lower copays, including the immediate-release form of Ultram.

Glaucoma drugs Travatan, Istalol, Betimol, and Azopt to the third tier, while 18 medications in this class will still be available at the lower copay.

Among anti-depressants, the Emsam patch will move to the third tier, leaving Marplan, Nardil and Parnate available at lower copays.

Some newer sedatives -- Rozerem, Sonata, and Ambien CR (controlled release) - also will move to the third tier. Ambien and Lunesta will remain on the lower-copay list, along with eight other older drugs. However, a "prior-authorization" requirement is being proposed for first-time use of all drugs in this class other than Ambien, which is the most commonly prescribed and cost-effective drug in this class. The prior-authorization requirement would not apply to patients who previously had another first- or second-tier sleep agent prescribed in the last six months. NOTE: the panel indicated that Ambien is scheduled to be available in generic form in April. When that happens, use of that generic will be made mandatory. Other drugs in the class will be available only if the doctor demonstrates that there is a medical necessity to prescribe one of the other drugs in the class for the particular patient (e.g., to avoid adverse side effects).

Explanations of Benefits to be Limited by TRICARE for Life

We recently learned of a cost-saving measure instituted by Wisconsin Physicians Services (WPS), the claims administrator for all TRICARE for Life (TFL) claims, and approved by the TRICARE Management Activity (TMA) to stop the mailing of a printed Explanation of Benefits (EOB) when a beneficiary’s balance due is zero. Most beneficiaries will receive no advance notice of this change, which was effective April 1, 2007.