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FEDERAL HEALTH UPDATE
*Click to print newsletter in pdf format August 22, 2008Produced by Kate Connelly Theroux in collaboration with the Institute of Federal Health Care (IFHC) To subscribe, please visit http://fedhealthinst.org/subscriber.cfm. Sponsored by
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Congressional Schedule
Prior to the approved enhancement, which became effective in June, the TDP coverage allowed for two cleaning procedures in a consecutive 12-month period. The modification allows for a third cleaning for mothers-to-be in the 12-month period. The American Dental Association (ADA) stresses that maintaining good oral health is an important part of overall health, especially during pregnancy. Research suggests there may be a correlation between maternal gum disease and pre-term and low birth weight babies and that pregnant woman with gum disease may be more likely to develop gestational diabetes. For more information about dental health during a pregnancy, visit http://www.ada.org/public/topics/pregnancy_faq.asp and for more about the TRICARE Dental Program visit http://www.tricare.mil/mybenefit/home/Dental/DentalProgram
The senior author, Lynn Lawry, M.D., MSPH, MSc, is director of research and education with the Uniformed Services University of the Health Sciences’ (USU) Center for Disaster and Humanitarian Assistance Medicine (CDHAM). According to the findings, more than 40 percent of the Liberian household population showed symptom criteria for major depressive disorder MDD and 44 percent showed symptoms of PTSD. One third of the men surveyed who served time as a combatant, experienced sexual violence compared to 7.4 percent of men who did not serve in the fighting forces. As a general category, 57 percent of combatants demonstrated characteristics of PTSD as compared with 37 percent of non-combatants. The study also considered the role of gender, concluding that male combatants who reported sexual violence had worse mental health outcomes than females with reported sexual violence. http://www.health.mil/Press/Release.aspx?ID=308
These provisions apply to eligible family members who become eligible for TRICARE as a result of their Reserve Component (RC) sponsor (including those with delayed effective date orders up to 90 days) being called or ordered to active duty for more than 30 days in support of a federal/contingency operation and choose to participate in TRICARE Standard or Extra, rather than enroll in TRICARE Prime. The first provision gives the Secretary the authority to waive the annual TRICARE Standard (or Extra) deductible, which is set by law (10 U.S.C. 1079(b)) at $150 per individual and $300 per family ($50/$100 for families of members in pay grades E-4 and below). The second provision gives the Secretary the authority to increase TRICARE payments up to 115 percent of the TRICARE maximum allowable charge, less the applicable patient cost share if not previously waived under the first provision, for covered inpatient and outpatient health services received from a provider that does not participate (accept assignment) with TRICARE. These provisions help ensure timely access to health care and maintain clinically appropriate continuity of health care to family members of Reservists and Guardsmen activated in support of a federal/contingency operation; limit the out-of-pocket health care expenses for those family members; and remove potential barriers to health care access by Guard and Reserve families. This rule was effective Aug. 12, 2008.
In addition, HMHS has current URAC accreditation for Case Management, Disease Management–Asthma, Disease Management–Heart Failure, Health Web Site, and HIPAA Privacy.
As joint staff surgeon, Smith serves as the chief medical advisor to Chairman of the Joint Chiefs Michael Mullen, as well as the combat commanders. Smith is also the U.S. delegate to the North Atlantic Treaty Organization Council of Medical Directors (COMEDS), and is involved in other international medical relationships. He also serves on the congressionally directed Future of Military Health Care Task Force.
Dr. Tornberg served as the deputy assistant secretary of defense for clinical program and policy from March, 2002 to March, 2007. In May, 2005, he assumed an additional duty as the deputy director of the TRICARE Management Activity. In that role, he implemented the TRICARE Reserve Select program that provided Reserve members the opportunity to purchase comprehensive and affordable health care coverage. Under his direction, the health care transition team provided leadership to the Coalition Provisional Authority, supporting the reconstruction of Iraq's healthcare system, facilitating transfer of the Ministry of Health and oversight of $2 billion in related funds to the Iraqi government. Additionally, Tornberg provided oversight of the DoD's international HIV/AIDS prevention activities in 67 countries and established the Katrina Response Task Force providing DoD related beneficiary and humanitarian support efforts.
A new electronic delivery system is up and running and subscribing is fast and secure by clicking on the “little red envelope” at http://www.tricare.mil. Subscribers can choose alerts by topics or beneficiary category. Subscribers also have a unique page they can manage 24/7 and can choose to be notified as soon as news or benefit changes are posted or select daily, weekly or monthly updates. The new subscription service also links users up to similar alerts available on other Military Health System (MHS) Web sites including http://www.health.mil, which features MHS news, debates, videos and blogs; as well as Force Health Protection and Readiness and the Uniformed Services University of the Health Sciences. TRICARE’s e-alerts are sent through GovDelivery, which also provides services to dozens of other Department of Defense and federal agencies including the FBI, the United States departments of Health and Human Services, the CDC and the United States Food and Drug Administration. http://www.tricare.mil/Pressroom/News.aspx?fid=442
RESOLVED features dynamic presentations on milestones in forensic identification, including the development of tools such as dog tags and DNA analysis. The exhibit discusses the six disciplines critical to a positive scientific forensic identification: material evidence, fingerprinting, forensic dentistry, forensic anthropology and forensic pathology and DNA analysis. Visitors can examine a variety of objects on display - including a portable dental x-ray device, an FBI Disaster Squad fingerprinting kit, and astonishing new "virtual autopsy" technologies - while photographs immerse the visitor in the working environment of today's forensic anthropologist and DNA technician. Historical case studies detail the events that precipitated the development of new policies and technologies. DNA analysis, for instance, was critical to the positive identification of U.S. Air Force For more information, please visit http://www.nmhm.washingtondc.museum
A second article features a unique program on the beaches of Malibu, where veterans do physical and mental therapy on a surfboard. All of the participants in this surf workshop are disabled veterans. The series is designed to inform active-duty members, veterans, their families and communities about the services and benefits they have earned and to honor them. Aimed at veterans of all eras, VA also tells stories of heroism and sacrifice; and relives moments in history with those who were there, reminding veterans of the bond of service they share. VA’s Office of Public Affairs offers the program to local broadcasters and cable outlets and makes it available for viewing on the VA Web site, www.va.gov. Just click on the “American Veteran” icon at the bottom of the page. http://www1.va.gov/opa/pressrel/pressrelease.cfm?id=1547
The centers will serve as satellite offices for VA’s Office of Rural Health. The eastern center will be located in Vermont at the White River Junction VA Medical Center, the central region in Iowa at the Iowa City VA Medical Center and the western region at the Salt Lake City VA Medical Center. Each resource center will be staffed with administrative, clinical and research staff who will identify disparities in health care for rural veterans and formulate practices or programs to enhance the delivery of care. http://www1.va.gov/opa/pressrel/pressrelease.cfm?id=1548
As deputy director, Dr. Carter will assist NIAMS Director Stephen I. Katz, M.D., Ph.D. In addition, he will contribute to the NIAMS' pursuit of cutting-edge research on a broad spectrum of investigations, from basic science to clinical studies, with translational research as a particular area of interest. Dr. Carter is professor of medicine at UAB and has most recently served as director of the Division of Clinical Immunology and Rheumatology. He is the principal investigator (PI) of the NIAMS-supported UAB Rheumatic Disease Core Center, and the PI of an Autoimmunity Center of Excellence supported by the NIH's National Institute of Allergy and Infectious Diseases (NIAID). He also serves as staff physician at the Birmingham Veterans Affairs Medical Center. Dr. Carter is board certified in rheumatology and internal medicine and has an established record of exemplary career achievements in the fields of rheumatology and immunology. Specifically, Dr. Carter and his colleagues have been leaders in contributing to the understanding of molecular regulation of B lymphocyte activation to identify targets for therapeutic control of autoantibody production. His work is funded by grants from the NIAMS, the NIAID, the U.S. Department of Veterans Affairs (VA) and private industry. Dr. Carter received his bachelor's degree from Williams College in Williamstown, Mass., in 1978, Magna cum Laude, in biology. He received his medical degree from Harvard Medical School in 1982. He trained in internal medicine at the University of Virginia Health Sciences Center in Charlottesville. In addition, he was a fellow in rheumatology and immunology at Brigham and Women's Hospital in Boston, and in molecular and clinical rheumatology at the Johns Hopkins University School of Medicine in Baltimore.
The vaccine used in this study is designed to stimulate an immune response against prostate-specific antigen (PSA), a protein produced by the prostate that is often found at elevated levels in the blood of men who have prostate cancer and some non-cancerous prostate conditions. In the study, researchers examined the side effects and immune responses of patients treated with a three-pronged approach: the vaccine, radiation therapy, and an alternative dosing regimen of an immune system booster, interleukin-2 (IL-2). The patients all had localized prostate cancer, had not undergone surgery to remove the prostate and were candidates for radiation therapy as their primary form of treatment. Therapeutic cancer vaccines are designed to treat cancer by stimulating the immune system to attack tumor cells without harming normal cells. These immune system boosters, such as IL-2, often given with the vaccines, have been frequently associated with substantial side effects, including fatigue and high blood sugar. In a previous study involving the same prostate cancer vaccine, IL-2 was given to 19 patients daily for five days during each 28-day vaccine treatment cycle and a large majority of the patients had to have the dose of IL-2 reduced or discontinued, primarily because of fatigue. In this new study, the researchers sought to decrease the side effects associated with IL-2 by providing more frequent, lower doses to equal the amount given in the previous study. With metronomic dosing, less than a quarter of the patients had side effects that required their dose of IL-2 to be reduced. The research team also found that metronomic dosing of IL-2 produced effects on immune cell populations and immune responses that were similar to those observed previously with the standard dosing method. Five of eight evaluated patients had at least a three-fold increase in immune cells that were directed against PSA. The researchers also noted that, similar to the standard dosing method, metronomic dosing of IL-2 induced immune responses against other prostate cancer antigens in some patients. http://www.nih.gov/news/health/aug2008/nci-15.htm
As a result, the 10 groups earned $16.7 million in incentive payments under the demonstration that rewards health care providers for improving health outcomes and coordinating the overall health care needs of Medicare patients assigned to the groups. All 10 of the participating physician groups achieved benchmark or target performance on at least 25 out of 27 quality markers for patients with diabetes, coronary artery disease and congestive heart failure. The groups are:
Five of the physician groups -- Forsyth Medical Group, Geisinger Clinic, Marshfield Clinic, St. John’s Health System, and the University of Michigan Faculty Group Practice achieved benchmark quality performance on all 27 quality measures. This demonstration is one of CMS’ value-based purchasing (VBP) initiatives. The goal of VBP is to tie Medicare payments to performance on health care cost and quality measures. VBP is part of CMS’ drive to transform Medicare from a passive payer to an active purchaser of higher quality, more efficient health care. The 10 physician groups participating in the PGP Demonstration agreed to place their PQRI incentive payments at risk for performance on the 27 quality measures reported under the demonstration. All physician groups received at least 96 percent of their PQRI incentive payments, with five groups earning 100 percent of their incentive payments. A total of $2.9 million in PQRI incentive payments was paid out to the 10 groups under the demonstration. The groups also improved the quality of care delivered to Medicare beneficiaries on the chronic conditions measured. Physician groups increased their quality scores an average of 9 percentage points across the diabetes mellitus measures, 11 percentage points across the heart failure measures, and 5 percentage points across the coronary artery disease measures. The four physician groups – Dartmouth-Hitchcock Clinic, The Everett Clinic, Marshfield Clinic, and the University of Michigan Faculty Group Practice – earned $13.8 million in performance payments for improving the quality and cost efficiency of care as their share of a total of $17.4 million in Medicare savings. This compares to two physician groups that earned $7.3 million in performance payments under the first year of the demonstration. The results are for the second performance year of the demonstration which covered April 1, 2006 through March 31, 2007. The initial three-year demonstration was extended for a fourth performance year, which runs through March 2009. CMS NR 08-14-2008
The New Access Point grants will establish 42 new health center sites in 23 states, providing an estimated 160,000 Americans with health center services. The grants were awarded to health care organizations in areas where more primary medical care is needed. HRSA grants typically account for about 20 percent of a health center’s total revenue. Medicare, Medicaid and other federal grants total about 45 percent of revenue; remaining operating funds come from state and local grants and foundations and from patient payments. The HRSA health centers represent more than 7,000 service delivery sites, including community health centers, migrant health centers, health care for the homeless centers and public housing primary care centers. The grant awards can be viewed at http://newsroom.hrsa.gov/releases/2008/newaccesspoint.htm
In 2000, under authority provided by the Health Insurance Portability and Accountability Act of 1996 (HIPAA), the ICD-9-CM code sets were adopted for use in the administrative transactions by both the public and private sectors to report diagnoses and inpatient hospital procedures. Covered entities required to use the ICD-9-CM code sets include health plans, health care clearinghouses and health care providers who transmit any electronic health information in connection with a transaction for which a standard has been adopted by HHS. Developed almost 30 years ago, ICD-9 is now widely viewed as outdated because of its limited ability to accommodate new procedures and diagnoses. ICD-9 contains only 17,000 codes and is expected to start running out of available codes next year. By contrast, the ICD-10 code sets contain more than 155,000 codes and accommodate a host of new diagnoses and procedures. The additional codes will help to enable the implementation of electronic health records because they will provide more detail in the electronic transactions. This will also help to improve efficiencies by helping to identify specific health conditions. The ICD-10 code sets proposed rule would concurrently adopt the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) for diagnosis coding, and the International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS) for inpatient hospital procedure coding. Both regulations may be viewed at www.cms.hhs.gov/TransactionCodeSetsStands/02_TransactionsandCodeSetsRegulations.asp#TopOfPage.
The premiere series on CDC-TV is “Health Matters.” The first segment of the series, “Break the Silence: Stop the Violence,” addresses the topic of teen dating violence. In this video, parents and teens discuss the problem of dating violence and how to prevent it. The library of available videos through CDC-TV will expand to include single-topic presentations as well as series for children, parents and public health professionals. Most are short and all include captioning for the hearing-impaired. The videos are part of CDC′s efforts to increase access to information that can help people prevent illness and injury. The videos are available at http://www.cdc.gov/CDCtv/.
Medicare’s administrative contractor, Noridian Administrative Services (NAS), released a solicitation to potential PHR vendors today. The program is scheduled to begin in January 2009 and is expected to offer Medicare beneficiaries in the two states a choice of several PHR options. PHRs are tools that can help consumers manage their health and health care services. A PHR is a record of health information that is under the control of the consumer or patient. Sometimes it only contains data entered by the individual or his or her provider, but it can also include information from a health plan – as is the case in this pilot, where Medicare provides health information from its claims data base. A PHR is different than an electronic health record (EHR), which is owned by and under the control of the physician. Beneficiaries who select one of the participating PHR vendors can also add other personal health information if they choose. Depending on the specific product, they may be able to authorize links to other personal electronic information such as pharmacy data. PHRs can offer links to tools that help consumers manage their health, such as wellness programs for tracking diet and exercise, medical devices, health education information and applications to detect potential medication interactions. Beneficiaries can elect to allow family members to have access to their PHR. They can also provide access to the PHR to their health care providers. The PHR vendors will have until Sept. 8, 2008 to submit their applications to participate in this pilot with CMS. If PHR vendors want more information about this pilot, they can visit http://www.NoridianMedicare.com/phr/ or they can send an email to solicitation@medicarephr.org.
Between Jan. 1 and July 31, 2008, 131 cases were reported to CDC′s National Center for Immunization and Respiratory Diseases (NCIRD). At least fifteen patients, including four children younger than 15 months of age, were hospitalized. No deaths have been reported. In the decade before the measles vaccination program began, an estimated 3–4 million persons in the United States were infected each year. Of these, 400–500 died, 48,000 were hospitalized and another 1,000 developed chronic disability from measles encephalitis. Of the 131 patients, 112 were unvaccinated or had unknown vaccination status. Among the 112 unvaccinated U.S. residents with measles, 16 were younger than 12 months of age and too young for vaccination, and one had presumed evidence of measles immunity because the person was born before 1957. Of the 95 patients eligible for vaccination, 63 were unvaccinated because of their or their parents′ philosophical or religious beliefs. Although immunization coverage rates for measles vaccine remain high, unvaccinated persons are at risk for measles, and sizeable measles outbreaks can occur in communities with a high number of unvaccinated persons. Measles is consistently one of the first diseases to reappear when immunization coverage rates fall. Increases in the proportion of the population declining vaccination for themselves or their children might lead to large-scale outbreaks in the U.S. Currently, Israel and a number of countries in Europe -- including Switzerland, Austria, Italy, United Kingdom -- are reporting sizeable measles outbreaks among populations refusing vaccination. There were 55 cases of measles reported during 2006; 66 cases during 2005; 37 cases during 2004; 56 cases during 2003; and 44 cases during 2002. http://www.cdc.gov/media/pressrel/2008/r080821.htm
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If you need further information on any of the items in the Federal Health Update, please contact Kate Connelly Theroux at (703) 447-3257 or by e-mail at katetheroux@fedhealthinst.org. To subscribe, please visit http://fedhealthinst.org/subscriber.cfm. To unsubscribe, please send an email to newsletter@fedhealthinst.org with UNSUBSCRIBE as the subject. Back issues availiable at Federal Health Update Archives. |
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