1. ASAM Disclosure of Relevant Financial Relationships Content of Activity: 2013 Medical Scientific Course Conference NameCommercial Interests Relevant Financial Relationships: What Was Received Relevant Financial Relationships: For What Role No Relevant Financial Relationships with Any Commercial Interests Jeff Goldsmith MD xxxxxxx

2.  By R. Jeffrey Goldsmith MD, FASAM, DLFAPA  Trauma Recovery Center, Cincinnati VAMC

3.  Nation’s largest integrated health care system  Over 1500 sites  About 175 Hospitals  For more information, visit: www.va.gov/healthwww.va.gov/health

4.  Despite demographic changes, VA enrolled 5.3 million veterans in 2010 compared to 3.3 million in 2000.  2006 study of life expectancy among the elderly, VA men 40% fewer died than Medicare Advantage over next two years.  2006 study of life expectancy among elderly, VA women 24% fewer died over next two years compared to Medicare Advantage.  NEJM 2003, 11 quality of care measures compared VA services to fee-for-service Medicare. VA superior in all 11 categories.

5.  JAMA 2005 (Leape and Berwick), “quickly emerged as a bright star in the constellation of safety practice”  BMJ 2007 (Woolhandler and Himmelstein), VA “has recently emerged as a widely recognized leader in quality improvement and information technology. At present, the Veterans Health Administration offers more equitable care, at higher quality, at comparable or lower cost than private-sector alternatives.

6.  2009 Tea Party Website  LOOK AT THE VETERANS HOSPITALS AND ALL THE PROBLEMS OUR VET HAVE EXPERIENCED. WE MUST KEEP THE FEDERAL GOVERNMENT OUT OF HEALTHCARE.

7.  Served in active military, naval, or air service  Discharged or released under conditions other than dishonorable  Reservists and National Guard members  Called to active duty (other than for training)  By a Federal order  Completed the full period for which they were called or ordered to active duty

8.  Enlisted after 9/7/80 or entered active duty after 10/16/81  Served 24 continuous months or the full period for which they were called to active duty  May not apply to veterans discharged for hardship, early out or a disability incurred or aggravated in the line of duty

9.  For most veterans, enter VA health care system by applying for enrollment  Can apply online using www.1010ez.med.va.gov/sec/vha/10104z/ www.1010ez.med.va.gov/sec/vha/10104z/  In person using VA Form 1010EZ, submit in writing  Call 1-877-222-VETS(8387) 8am to 8pm Eastern Time, Mon-Fri  Any VA health care facility or VA regional benefits office  Afforded privacy rights under federal law  VA’s Notice of Privacy Practices  Can find Notice of Privacy Practices online: www.va.gov/vhapublications/viewpublication.asp?pub_ID=1089 www.va.gov/vhapublications/viewpublication.asp?pub_ID=1089

10.  Group 1: SC disabilities rated 50% or more and/or Veterans determined unemployable due to SC conditions.  Group 2: SC disabilities rated 30 or 40%  Group 3: former POWs, Purple Heart Medal, Medal of Honor, discharged for a disability incurred or aggravated in the line of duty, SC 10% or 20%, awarded special eligibility under Title 38, U.S.C. 1151

11.  Group 4: increased compensation or pension based on need for regular Aid and Attendance or permanently housebound or catastrophically disabled.  Group 5: Nonservice-connected veterans and noncompensable SC 0% whose annual income +/or net worth are not greater than VA thresholds. Veterans receiving VA Pension and Veterans eligible for Medicaid benefits.

12.  Group 6: complicated special ratings  Group 7: income below the geographically- adjusted income threshold and agree to pay copayments  Group 8 includes those veterans above income threshold and agree to pay copayments, and other details.  There are not eligible veterans

13.  Veterans with 0 Dependents: $30,978  Veterans with 1 Dependent: $37,175  Veterans with 2 Dependents: $39,304  Veterans with 3 Dependents: $41,433  Child Income exclusion, Medicare deductible, Income and/or Asset Threshold, Maximum Annual Rate of Pension