- The House and Senate are in recess until Dec. 3 and
Dec. 4, 2007, respectively.
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Military Health Care News
- According to the National Naval Medical Center’s Journal, military medical
leaders from the National Capital Area and members of Congress broke ground on the
new Fort Belvoir Community Hospital in November.
The new 120 room facility will replace the current 45-room
DeWitt Army Medical Center at the cost of $747 million. The scheduled construction
completion date is summer 2010.
The Base Realignment and Closure Act of 2005 determined
that Walter Reed Army Medical Center will be closed. Its resources will be dispersed
to the soon-to-be-built Walter Reed National Military Medical Center in Bethesda
and the new Fort Belvoir Community Hospital.
The new Fort Belvoir hospital will be three times bigger
than the current building. Several services will be added to the facility,
including a cancer center, a behavioral health center and a community-based outpatient
clinic.
The construction of the new medical center is only part
of the Defense Department’s plan to increase health care efficiency for those in
uniform.
- The Department of Defense (DoD) and Department of Veterans
Affairs (VA) recently implemented a pilot test for disability cases originating
at the three major military treatment facilities and the VA hospital in the national
capital region. This pilot will run for one year. The leadership of DoD and VA will
review pilot progress during this period to assist in determining when the program
can be expanded to other locations.
The pilot program will test a new DoD and VA disability
system. It will be a service-member-centric initiative designed to eliminate the
duplicative and often confusing elements of the two current disability processes
of the departments. Key features of the pilot program include one medical examination
and a single-sourced disability rating. One goal of the pilot is to enable service
members to more effectively transition to veteran status and provide them with their
VA benefits and compensation.
The DoD and VA are examining the continuum of care they
provide from the point of injury through rehabilitation to community reintegration.
The objectives of the pilot are to improve timeliness, effectiveness, and transparency
by integrating DoD and VA processes, eliminating duplication, and improving information
provided to service members and their families.
To ensure a seamless transition of wounded, ill and injured
between the DoD to the VA systems, the pilot will also test enhanced case management
methods and identify opportunities to improve the flow of information and identification
of additional resources to the service member and family. As soon as the service
members in the pilot transition from the military, the VA will provide benefits
and compensation to these veterans.
The scope of the pilot includes all non-clinical care and
administrative activities, such as case management and counseling requirements,
associated with disability case processing from the point of service member referral
to a military department medical evaluation board to the point of compensation and
provision of benefits to veterans by the VA.
The pilot process has been developed over the last several
months and is focused on recommendations that could be implemented without legislative
change from the reports of the Task Force on Returning Global War on Terrorism Heroes,
the Independent Review Group, the President’s Commission on Care for America’s Returning
Wounded Warriors and the Commission on Veterans’ Disability Benefits.
http://www.defenselink.mil/releases/release.aspx?releaseid=11522
- TriWest Healthcare Alliance, the Department of Defense’s
contractor administering the TRICARE program, which provides health care support
and services to approximately 2.9 million active duty and retired military personnel
and their eligible family members in the 21-state West Region, unveiled a new version
of its Web site, http://www.triwest.com, which includes enhanced features and a fresh design to help service members
and their families manage TRICARE benefits from anywhere with an Internet connection.
The redesigned site features improvements that are based
on firsthand feedback from beneficiaries and providers. New or enhanced site features
include:
- Claims -- How to file a claim, check claim status and
update other health insurance.
- Authorizations and Referrals – How to navigate the auth/referral
process and register to receive a QuickAlert e-mail once an auth/referral is processed.
- Enrollment -- Enroll in TRICARE Prime or TRICARE Prime
Remote, change primary care managers and download appropriate forms.
- Life-changing Events -- Ensure TRICARE coverage during
life events, such as marriage, new baby and retirement.
- Healthy Living -- Find tips to maintain a healthy lifestyle,
review a schedule of recommended immunizations for adults and children.
- Health care providers will have faster access to downloadable
forms and other frequently used features on the new site. http://www.reuters.com/article/pressRelease/idUS91837+29-Nov-2007+PRN20071129?sp=true
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Veterans Health Care News
- The Department of Veterans Affairs (VA) awarded contracts
for the next two phases of the new medical center under construction in North Las
Vegas.
The Phase II contract, for constructing foundations for
the medical center and accompanying warehouse, was awarded to Whiting-Turner Construction
Company, Las Vegas, in the amount of $9,170,000. Completion of this phase
is scheduled for June 2008.
VA awarded the Phase III contract in the amount of $47,800,000
to Clark Construction Group, LLC of Las Vegas for the design and construction of
a new 100,000 square foot, 120-bed nursing home care unit which will be built adjacent
to the future medical center. Completion of Phase III construction is scheduled
for September 2009.
Phase IV construction on the main medical center
is scheduled for completion in mid-2011.
In Nevada, VA operates two major health care systems --
the VA Sierra Nevada Health Care System in Reno and the VA Southern Nevada Healthcare
System in Las Vegas. In fiscal year 2007, VA facilities in Nevada treated
about 40,000 patients, accounting for more than 2,400 inpatient admissions and nearly
435,000 outpatient visits.
The current project is a result of VA’s Capital Asset Realignment
for Enhanced Services (CARES) plan, which included the recommendation to construct
a new VA medical center complex that would include a 90-bed inpatient hospital,
120-bed nursing home care unit, and a large outpatient clinic to meet future demand.
http://www1.va.gov/opa/pressrel/pressrelease.cfm?id=1425
- On Nov. 28, 2007, the Department of Veterans Affairs
(VA) awarded $39 million contract to LDV-Doan/Pyramid of Cleveland to upgrade the
electrical systems at the James A. Haley VA Medical Center in Tampa Bay. The contract
will upgrade normal, emergency and standby electrical distribution systems to provide
100 percent campus generator backup for four consecutive days. http://www1.va.gov/opa/pressrel/pressrelease.cfm?id=1424
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Health Care News
- The Department of Health and Human Services (HHS) announced
the members of the new Interagency Autism Coordinating Committee. This committee
coordinates efforts within the department to combat autism spectrum disorder through
research, screening, intervention, and education. The committee will facilitate
the efficient and effective exchange of information on autism activities among member
agencies, and coordinate autism-related programs and initiatives.
Authorized under the Combating Autism Act of 2006, the Interagency
Autism Coordinating Committee advises the HHS Secretary and the Director of the
National Institutes of Health (NIH). HHS Secretary Michael Leavitt delegated
the authority to establish the committee to the NIH, which designated its National
Institute of Mental Health (NIMH) to lead this activity.
Federal members of the new panel:
- Duane Alexander, M.D., is director of the National
Institute of Child Health and Human Development at NIH.
- James Battey, M.D., Ph.D., is director of the
National Institute on Deafness and Other Communications Disorders at NIH.
- Ellen Blackwell, M.S.W., is a health insurance
specialist of the Division of Community and Institutional Services, Disabled and
Elderly Health Programs Group, Center for Medicaid and State Operations, Centers
for Medicare and Medicaid Services, where she serves as an expert on policies that
affect individuals with autism spectrum disorders.
- Margaret Giannini, M.D., F.A.A.P., is director
of the HHS Office on Disability.
- Gail Houle, Ph.D., is associate division director
of the Research-to-Practice Division, Early Childhood Programs, Office of Special
Education Programs, Department of Education where she oversees programs for children
with disabilities and their families funded through the Individual with Disabilities
Education Act.
- Larke Huang, Ph.D., is senior advisor on children
and a licensed clinical-community psychologist who provides leadership on federal
national policy pertaining to mental health and substance use issues for children,
adolescents and families for the Substance Abuse and Mental Health Services Administration.
- Thomas Insel, M.D., (named chairman of the committee)
is director of the National Institute of Mental Health at NIH. The Institute’s
mission is to reduce the burden of mental illness and behavioral disorders through
research on mind, brain, and behavior.
- Story Landis, Ph.D., is director of the National
Institute of Neurological Disorders and Stroke at NIH.
- Cindy Lawler, Ph.D., is scientific program director
of the Cellular, Organs, and Systems Pathobiology Branch, Division of Extramural
Research and Training, National Institute of Environmental Health Sciences at NIH.
- Patricia Morrissey, Ph.D., is commissioner of
the Administration on Developmental Disabilities at the Administration for Children
and Families.
- Edwin Trevathan, M.D., M.P.H., is director of
the National Center on Birth Defects and Developmental Disabilities (NCBDDD) at
CDC.
- Peter van Dyck, M.D., M.P.H., is associate administrator
of Maternal and Child Health at the Health Resources and Services Administration
(HRSA). .
- Elias Zerhouni, M.D., is director of the National
Institutes of Health.
Non-federal members:
- Lee Grossman is president and CEO of Autism Society
of America (ASA) and the parent of a young adult son with autism.
- Yvette Janvier, M.D., is the medical director
for Children’s Specialized Hospital in New Jersey. Her specialties are autism
and developmental and behavioral pediatrics.
- Christine McKee, J.D., has developed and manages
an in-home therapy for her autistic child, creating and/or assembling all of the
therapy related materials.
- Lyn Redwood, RN, MSN, is co-founder and president
of the Coalition for Safe Minds. Ms. Redwood is also on the board of the National
Autism Association.
- Stephen Shore, Ed.D., is executive director of
Autism Spectrum Disorder Consulting. He also serves on the board of the Autism
Society of America, as board president of the Asperger’s Association of New England,
and is on the board of directors for Unlocking Autism, the Autism Services Association
of Massachusetts, MAAP Services, The College Internship Program, and the KEEN Foundation.
- Alison Tepper Singer, MBA, is executive vice
president of Autism Speaks and is a member of the board of directors.
http://www.hhs.gov/news/press/2007pres/11/pr20071127b.html
- The Department of Health and Human Services (HHS) launched
a new Childhood Overweight and Obesity Prevention Initiative, which targets obesity
prevention and the promotion of healthy weight for children.
According to the Centers for Disease Control and Prevention,
data from two National Health and Nutrition Examination Surveys (NHANES) (1976-1980
and 2003-2004) show that prevalence of childhood overweight is increasing.
For children aged 2-5 years, the prevalence increased from 5.0 percent to 13.9 percent;
for those aged 6-11 years, prevalence increased from 6.5 percent to 18.8 percent;
and for those aged 12-19 years, prevalence increased from 5.0 percent to 17.4 percent.
As chair of HHS’ Childhood Overweight and Obesity Coordinating
Council, Rear Adm. Steven Galson, acting surgeon general of the Public Health Service,
will work with HHS officials and community stakeholders as they develop and foster
programs that share the goal of providing options for community-based interventions.
The programs include
- Centers for Disease Control and Prevention’s School
Health Index: A Self-Assessment and Planning Guide;
- National Institutes of Health’s We Can! (Ways to Enhance
Children’s Activity and Nutrition) program;
- Indian Health Service’s diabetes prevention activities;
- Food and Drug Administration’s Using the Nutrition Facts
Label to Make Healthy Food Choices activities; and
- President’s Council on Physical Fitness and Sports’
National Fitness Challenge.
The National Center for Physical Development and Outdoor
Play will help Head Start programs evaluate their playgrounds, and educate children
and their families about the value of healthy food and structured physical activity.
HHS’ Administration for Children and Families (ACF) will oversee a competition for
a $12 million, four-year grant to establish the center and will allocate up to $10
million to fund the construction or improvement of Head Start playgrounds.
http://www.hhs.gov/news/press/2007pres/11/pr20071127a.html
- The National Cancer Institute (NCI) published a report
in
JNCI on Nov. 27, 2007, which details a new model the NCI has developed
to better calculate invasive breast cancer risk, called the CARE model, in African
American women 50 to 79 years of age.
The NCI investigators worked with colleagues from the Women’s
Contraceptive and Reproductive Experiences (CARE) Study, the Women’s Health Initiative,
and the Study of Tamoxifen and Raloxifene trial (a breast cancer prevention trial)
to produce and test the new model. Some members of the team had worked on both the
CARE and earlier model, called BCRAT (Breast Cancer Risk Assessment Tool). Because of the higher
accuracy of the CARE model for African American women, the NCI authors are now recommending
its use for counseling these women regarding their risk of breast cancer.
While the BCRAT allows for projections for African American
women and for women from other racial and ethnic groups, these projections are based
on certain assumptions. In particular, it is assumed that the relative risk of breast
cancer associated with having a specific profile of risk factors for white women
applies to African American women and to women from other racial and ethnic groups
as well.
To develop a new model that would more accurately assess
an African American woman’s chance of developing breast cancer, researchers in the
CARE study examined data from 1,607 African American women with invasive breast
cancer and 1,637 African American women of similar ages who did not have breast
cancer. The factors used in the model were age at first menstrual period, number
of first degree relatives (mother or sisters) who had breast cancer, and number
of previous benign breast biopsy examinations. A woman’s age at the birth of her
first child, a risk factor for white women, did not improve prediction in African
American women and so was not included in the model. Risk was calculated by combining
information on these factors with African American rates of new invasive breast
cancer from NCI’s Surveillance, Epidemiology and End Results Program and with national
mortality data.
To test the accuracy of the model, researchers compared
data in the CARE model with data from the 14,059 African American women aged 50-79
in the Women’s Health Initiative (WHI) study who had no prior history of breast
cancer. From the risk factor profiles for breast cancer that were collected at entry
into the WHI, the researchers used the CARE model to estimate the number of women
who would be expected to develop invasive breast cancer and found that the model
predicted that 323 would be affected, close to the 350 breast cancers in African
American women that actually occurred during the WHI follow up.
http://www.nih.gov/news/pr/nov2007/nci-27.htm
- The Secretary of Health and Human Services delivered
to Congress a Report on the Medicare Hospital Value-Based Purchasing Program (VBP),
suggesting ways to continue transforming Medicare into a prudent purchaser of higher
quality health care for Medicare beneficiaries.
The Report to Congress contains a plan for all facets of
the proposed Medicare Hospital VBP program and provides associated supporting materials.
Under the plan, additional information would be collected
and publicly disseminated to patients and health care providers on the CMS Hospital
Compare Web site at www.medicare.gov, so that they can make better health care decisions. Examples of hospital
quality of care measures that are currently reported by some hospitals include how
soon heart attack patients are given aspirin after arriving at a hospital and how
soon pneumonia patients are given an antibiotic. Inclusion of a broad range
of such measures in value-based purchasing will enable Medicare beneficiaries and
other consumers to compare hospitals and make informed decisions about where to
seek care.
In addition, the plan to implement the Medicare Hospital
VBP program builds on the foundation of the current pay-for-reporting program, Reporting
Hospital Quality Data for Annual Payment Update, which ties a portion of the Annual
Payment Update under the Medicare Inpatient Prospective Payment System (IPPS) to
a hospital’s reporting on a defined set of inpatient quality measures.
Under VBP, a percentage of the hospital’s base operating
payment for each discharge (the diagnosis related group or DRG payment) would be
contingent on the hospital’s actual performance on a specific set of measures. The
transition from pay-for-reporting to an incentive based completely on performance
would occur over a three-year period. Public reporting of quality measures
on Medicare’s Hospital Compare site, a key component of the Reporting Hospital Quality
program, would remain an essential component of VBP.
The proposed VBP program strengthens CMS’ recently announced
policy on hospital-acquired conditions, including infections such as methicillin-resistant
Staphylococcus aureus (MRSA). By tying a portion of hospital payments
to actual performance on quality measures, VBP would provide additional incentives
for hospitals to prevent infections.
The proposed VBP program contains the following
key components:
- A measure development and selection process, including
selection criteria for choosing performance measures for the VBP financial incentive
and candidate measures to support ongoing expansion of the measure set.
- A Performance Assessment Model that incorporates quality
measures, including clinical process of care, patient perspectives of care, and
clinical outcomes, to calculate a hospital’s Total Performance Score. The proposed
model scores a hospital’s performance on each measure during a 12-month measurement
period based on the higher of “attainment” compared with national thresholds and
benchmarks or “improvement” compared with the hospital’s own performance in the
preceding 12-month baseline period
- The incentive is created by making a specified percentage
of the base operating payment amount for all discharges contingent on performance.
The percentage of incentive earned would be determined by the hospital’s Total Performance
Score.
- Enhancements to the Hospital Compare site to support
expanded and more user-friendly public reporting.
- Ongoing evaluation and monitoring efforts to assess
experiences early in VBP implementation, allowing for timely corrective action and
building the evidence base for future VBP programs in other settings.
http://www.hhs.gov/news/press/2007pres/11/pr20071126a.html
- According to KaiserNetwork.org, the American
Health Information Community (AHIC) recommended that HHS Secretary Michael Leavitt
seek authority from Congress to mandate electronic prescribing in Medicare.
The recommendations would allow Leavitt to make exceptions to the mandate at his
discretion. AHIC also recommended that the agency create incentives for physicians
and pharmacies that use certified electronic health record systems; allow prescriptions
to be electronically submitted to the pharmacy chosen by a patient; and authorize
the Agency for Healthcare Research and Quality to designate patient safety organizations
that would monitor and address any potential problems with e-prescribing.
The group's recommendations follow a proposal by CMS that
would develop new standards in e-prescribing to supplement those already adopted
by the agency governing transactions between physicians and pharmacies. Medicare
does not require e-prescribing, but health and stand-alone prescription drug plans
that provide Medicare Part D coverage must have the capacity to support e-prescribing
and must follow CMS' standards.
- The Centers for Medicare and Medicaid Services (CMS)
released the first ranking of the nation’s poor-performing nursing homes.
Release of the national list of facilities, identified as
special focus facilities (SFFs), is expected to offer individuals seeking long-term
health care services and their families new information when choosing nursing homes.
Release of the list was prompted by the number of facilities
that were consistently providing poor quality of care, yet were periodically instituting
enough improvement that they would pass one survey only to fail the next (for many
of the same problems as before). Such facilities with a “yo-yo” compliance history
rarely addressed underlying systemic problems that were giving rise to repeated
cycles of serious deficiencies.
Once a facility is selected as an SFF, the state survey
agency conducts twice the number of standard surveys and will apply progressive
enforcement until the nursing home either (a) significantly improves and is no longer
identified as an SFF, (b) is granted additional time due to promising developments,
or (c) is terminated from Medicare and/or Medicaid. CMS and the state can more quickly
terminate a facility that is placing residents in immediate jeopardy.
The CMS policy of progressive enforcement means that any
nursing home, not just those identified as an SFF, that reveals a pattern of persistent
poor quality is subject to increasingly stringent enforcement action. If problems
continue, the severity of penalties will increase over time, ranging from civil
monetary penalties, denial of payment for new admissions and, ultimately, removal
from Medicare and/or Medicaid.
As of October 2007, there were 128 SFFs out of about 16,000
active nursing homes. The number of SFFs in each state varies according to the number
of nursing homes in the state. These nursing homes, had survey results that were
among the poorest five or 10 percent in each state.
The list includes 54 facilities that are at the top of the
poorest performers in those states and among those facilities that have failed to
improve significantly.
Typically, these facilities achieve improved survey results
after being selected for the initiative. The CMS data indicate that about 50 percent
of the nursing homes identified as SFFs significantly improve their quality of care
within 24-30 months, while about 16 percent are terminated from Medicare and Medicaid.
CMS NR 11-29-2007
- HHS’ Office of the National Coordinator (ONC) for Health
Information Technology (IT) named Charles P. Friedman, Ph.D., to be the deputy national
coordinator for Health IT, effective Nov. 11, 2007. Dr. Friedman had recently been
serving as senior advisor to the National Coordinator for Health IT, Robert M. Kolodner,
M.D.
Prior to joining ONC, Dr. Friedman was institute associate
director for research informatics and information technology at the National Heart,
Lung, and Blood Institute of the National Institutes of Health (NIH). Dr. Friedman
joined NIH in 2003 as a senior scholar at the National Library of Medicine. Previously,
Dr. Friedman was professor and associate vice chancellor for biomedical informatics
at the University of Pittsburgh, where he established a health sciences-wide Center
for Biomedical Informatics.
As deputy national coordinator, Dr. Friedman will serve
as operations officer for ONC’s health IT initiatives to develop, maintain, and
direct the implementation of the strategic |
