ÿþ<html> <head> <title> U.S. Medicine Institute - Federal Health Update </title> <script type="text/javascript" src="../javascript/ddtabmenu.js"></script> <script type="text/javascript"> //SYNTAX: ddtabmenu.definemenu("tab_menu_id", integer OR "auto") ddtabmenu.definemenu("ddtabs4", 0) //initialize Tab Menu with ID "ddtabs1" and select 1st tab by default </script> <link rel="stylesheet" type="text/css" href="../css/style.css" /> <link rel="stylesheet" type="text/css" href="../javascript/ddcolortabs.css" /> </head> <body style="text-align:center"> <table width="800px" border="0" cellpadding="0" cellspacing="0"> <tr> <td style="text-align:center" valign="top"> <a href="../index.html"><img src="../images/banner.gif" style="border:0;"/></a> </td> </tr> <tr> <td valign="top"> <div id="ddtabs4" class="ddcolortabs"> <ul> <li><a href="../index.html">Home</a></li> <li><a href="../forums.html">Forums</a></li> <li><a href="../roundtables.html">Roundtables</a></li> <li><a href="../partners.html">Partner Organizations</a></li> <li><a href="../sponsor.html">Sponsorship Information</a></li> <li><a href="../aboutus.html">About USMI</a></li> </ul> </div> <div class="ddcolortabsline">&nbsp;</div> </td> </tr> </table> <table width="750px" border="0" cellpadding="0" cellspacing="0" style="height:560px;"> <tr> <td style="text-align:left;" valign="top"> <a href="../newsletter_archive.html">< Back to Federal Health Update Archives</a> <div style="border:0;width:750px;height:560px;overflow-x:hidden;overflow-y:auto;text-align:left;"> <table width="700px" border="0" cellpadding="0" cellspacing="0" style="text-align:center;"> <tr> <td colspan="3"> <br /><h4>FEDERAL HEALTH UPDATE</h4> <h5>Feburary 1, 2008</h5> <p /><i>Produced by Kate Connelly Theroux in collaboration with the U.S. Medicine Institute for Health Studies (USMI) <p />To subscribe, please visit <a href="../subscriber.cfm">http://usminstitute.org/subscriber.cfm</a>.</i> <p />Sponsored by <br /><a href="http://www.triwest.com/" target="_blank"><img src="../images/newsletter/TriWestLogoNEW.jpg" border="0"/></a> <p />Additional sponsorship by </td> </tr> <tr> <td style="text-align:center;"><a href="http://www.tricaredentalprogram.com/tdptws/home.jsp" target="_blank"><img src="../images/newsletter/UCCIlogobluetagline.jpg" border="0"/></a></td> <td style="text-align:center;"><a href="http://www.USFamilyHealthPlan.org" target="_blank"><img src="../images/newsletter/NewUSFHP_logo.jpg" border="0"/></a></td> <td style="text-align:center;"><a href="http://www.expressscripts.com/" target="_blank"><img src="../images/newsletter/redu2colorPMS.jpg" border="0"/></a></td> </tr> <tr> <td colspan="3" style="text-align:left;"> <b><a name="top">Menu</a></b> <ul type="square"> <li><a href="#cong">Congressional Schedule</a></li> <li><a href="#mhc">Military Health Care News</a></li> <li><a href="#vhc">Veterans Health Care News</a></li> <li><a href="#hcare">Health Care News</a></li> <li><a href="#reserve">Reserve/Guard</a></li> <li><a href="#reports">Reports/Policies</a></li> <li><a href="#leg">Legislation</a></li> <li><a href="#hill">Hill Hearings</a></li> <li><a href="#meetings">Meetings / Conferences</a></li> </ul> </td> </tr> <tr> <td colspan="3" style="text-align:left;"> <h1> <font face="Arial Black" size="3"><a name="cong">Congressional Schedule</a></font> </h1> <ul type="DISC"> <li><font face="Arial" size="2">On Jan. 28, 2008, .President Bush signed H. R. 4986, the National Defense Authorization Act for Fiscal Year 2008, into law.</font> </li> </ul> <ul> <p align="right"> <font color="#0000ff" face="Arial" size="2"><a href="#top">Back to Top</a></font> </p> </ul> <p> <font face="Arial Black" size="3"><a name="mhc">Military Health Care News</a></font></p> <ul type="DISC"> <li><font face="Arial" size="2">On Jan. 28, the 2008 Military Health System (MHS)  Caring for America s Heroes conference began. The goal of this year s conference was to illustrate the MHS role in global healthcare delivery, while featuring plenary sessions aligned with the MHS strategic plan, goals and objectives. </font></li> </ul> <ul> <p> <font face="Arial" size="2">Dr. David S. C. Chu, Under Secretary of Defense for Personnel and Readiness and Dr. S. Ward Casscells, Assistant Secretary of Defense for Health Affairs gave the opening remarks.  Listening and Working Together was the theme of Dr. Chu s speech. He discussed the lessons learned from listening, and the opportunities gained from working with different partners. </font> </p> </ul> <ul> <p> <font face="Arial" size="2">Dr. Casscells focused on the different steps that the MHS is taking to make fewer mistakes, honor the staff and achieve success.&nbsp; He commented on the Base Realignment and Closure (BRAC) process and MHS goal to continue to deliver quality patient care during the BRAC moves. </font> </p> </ul> <ul> <p> <font face="Arial" size="2">Other goals include enhancing deployable medical capability, providing top-quality patient-centered care, providing globally accessible health information, and building and sustaining the best hospitals and clinics. The four plenary sessions held centered on these goals of the MHS.&nbsp; To read more detailed information, please visit </font><a href="http://www.health.mil/Press/Release.aspx?ID=27" target="_blank"><font color="#0000ff" face="Arial" size="2"><u>Grand Rounds from the Front Lines</u></font></a><font face="Arial" size="2"> and </font><a href="http://www.health.mil/Press/Release.aspx?ID=28" target="_blank"><font color="#0000ff" face="Arial" size="2"><u>Leveraging and Sharing Information to Ensure Seamless Care</u></font></a><font face="Arial" size="2">.</font></p> </ul> <ul> <p> <font face="Arial" size="2">Dr. James B. Peake, Secretary of Veterans Affairs (VA), also spoke to the conference attendees, who include MHS senior leaders, military commanders, local and regional office staff, healthcare leaders and professionals, administrators and federal and national agency partners.&nbsp; In his remarks, Dr. Peake commented on the partnership between VA and DoD, highlighting the efforts to change and adapt the VA s systems with the ultimate goal of making things better for service members and veterans. </font> </p> </ul> <ul> <p> <font face="Arial" size="2">To read Dr. Casscell s entire speech, please go to </font> <a href="http://www.health.mil/Press/speeches.aspx" target="_blank"><font color="#0000ff" face="Arial" size="2"><u>http://www.health.mil/Press<wbr></wbr>/speeches.aspx</u></font></a><font face="Arial" size="2">.</font></p> </ul> <ul type="DISC"> <li><font face="Arial" size="2">According to news reports describing a study in the <i>New England Journal of Medicine</i>, about one in six combat troops returning from Iraq has suffered at least one concussion in the war  injuries that, while temporary, could heighten risk of developing post-traumatic stress disorder.</font> </li> </ul> <ul> <p> <font face="Arial" size="2">The </font><a href="http://content.nejm.org/cgi/content/full/358/5/453" target="_blank"><font color="#00b0f0" face="Arial" size="2"><u>study</u></font></a><font face="Arial" size="2"> is the military s first large-scale effort to gauge the effect of mild head injuries  concussions, many of them from roadside blasts  that some experts worry may be causing a host of undiagnosed neurological deficiencies.</font></p> </ul> <ul> <p> <font face="Arial" size="2">The new report found that soldiers who had concussions were more likely than those with other injuries to report a variety of physical and mental symptoms in their first months back home, including headaches, poor sleep and balance problems. But they were also at higher risk for the stress disorder, or PTSD, and that accounted for most of the difference in complaints, the researchers concluded. Symptoms of the disorder include irritability, sleep problems and flashbacks. </font> </p> </ul> <ul> <p> <font face="Arial" size="2">Experts cautioned that the study had not been designed to detect subtle changes in mental performance, like slips in concentration or short-term memory, that might have developed in the wake of a concussion and might be unrelated to stress reactions. Many returning veterans are still struggling with those problems, which can linger for months. </font> </p> </ul> <ul> <p> <font face="Arial" size="2">The findings are in line with previous research linking concussions to post-traumatic stress disorder that develops after frightening events outside a military context, like car accidents; concussions from athletic collisions rarely lead to the disorder. </font> </p> </ul> <ul> <p> <font face="Arial" size="2">Experts conclude that the link to post-traumatic stress suggests that mild brain injuries have a significant psychological component, which can improve with treatment.&nbsp; The next step should be to assess troops cognitive functioning early on and track it over time, before and after combat. </font> <a href="http://www.nytimes.com/2008/01/31/health/31brain.html?ei=5070&en=ccd9ff5e96b9e2be&ex=1202446800&emc=eta1&pagewanted=" target="_blank"><font color="#00b0f0" face="Arial" size="2"><u>http://www.nytimes.com/2008/01<wbr></wbr>/31/health/31brain.html?ei<wbr></wbr>=5070&amp;en=ccd9ff5e96b9e2be&amp;ex<wbr></wbr>=1202446800&amp;emc=eta1&amp;pagewanted<wbr></wbr>=print</u></font></a></p> </ul> <ul type="DISC"> <li><font face="Arial" size="2">On the first day of the Military Health System s 2008 Annual Conference, Vice Adm. Donald C. Arthur (Ret.), former Navy surgeon general, received the Dr. William C. Menninger Award.&nbsp; Dr. Menninger was a Special Consultant to the US Surgeon General during WWII, and a pioneer in recognizing the importance of mental health.&nbsp; Vice Adm Arthur was the first recipient of the award, which recognizes achievements in advancing psychological health.&nbsp; </font></li> <li><font face="Arial" size="2">Dr. Gail Wilensky was awarded the newly established <i>The</i> <i>Senator John Warner -- Champion for Military Health Award</i>, by Senator Warner on the second day of the 2008 Military Health System s Annual Conference.&nbsp; Dr. Wilensky received the award for her work on the Defense Health Board and Chairmanship of the Task Force on the Future of Military Health Care.</font> </li> </ul> <ul> <p align="right"> <font color="#0000ff" face="Arial" size="2"><a href="#top">Back to Top</a></font></p> </ul> <p> <a name="0.1_01000018"></a><font face="Arial Black" size="3"><a name="vhc">Veterans Health Care News</a></font> </p> <ul type="DISC"> <li><font face="Arial" size="2">The Department of Veterans Affairs (VA) released the results of two investigations into concerns involving patient care at its Marion, Ill., facility.</font> </li> </ul> <ul> <p> <font face="Arial" size="2">VA s Inspector General was contacted by Dr. Michael J. Kussman, VA s Under Secretary for Health, on Sept. 10, 2007, and also subsequently by Congress, to perform a comprehensive review of surgical services at the facility after VA s National Surgical Quality Improvement Program (NSQIP) found there was a higher death rate than expected during the period from Oct. 1, 2006, through March 31, 2007. &nbsp;Representatives of the NSQIP program visited Marion from August 29-30, 2007. &nbsp;Their follow-up report led to the immediate suspension by Veterans Health Administration (VHA) leadership of all major surgeries at the hospital, which have not been resumed.</font></p> </ul> <ul> <p> <font face="Arial" size="2">The Inspector General s </font><a href="mailto:http://www.va.gov/health/docs/2007-D-1356Marion.pdf" target="_blank"><font color="#0000ff" face="Arial" size="2"><u>report</u></font></a><font face="Arial" size="2">, augmented by a separate internal review by VA s Medical Inspector begun on Sept.4, 2007, identified four areas in which Marion employees failed to comply with federal and local regulations and VA directives and procedures. &nbsp;They include:</font></p> </ul> <ul> <ul> <ul type="DISC"> <li><font face="Arial" size="2">Quality management: Some reviews of the quality of care at the facility were improperly done; cases selected for review by physicians peers (a required practice in health care settings called  peer reviews ) were not always properly evaluated; and patient deaths were inadequately and insufficiently evaluated to be able to address issues in a timely manner. </font></li> <li><font face="Arial" size="2">Credentialing: Credentialing is the process by which health care organizations screen and evaluate medical providers in terms of licensure, education, training, experience, competence and health status. &nbsp;The facility, at times, failed to document its consideration of important credentialing information such as malpractice claims; and documentation related to the verification of licensure, registration and certification requirements was not always done in a timely manner. </font></li> <li><font face="Arial" size="2">Privileging: Privileging is the process by which physicians are granted permissions to practice and to perform various diagnostic and therapeutic procedures. &nbsp;The Inspector General found instances in which surgeons performed procedures they were not authorized to perform. &nbsp;The medical center also failed to adequately consider past performance and outcomes in decisions whether to renew surgeons permission to continue to perform certain procedures. &nbsp;In addition, both the Inspector General and the Medical Inspector s reports criticize the facility for allowing surgeries to be performed that were more complex than the facility could handle based on its staff and capabilities. &nbsp;Concerns include the fact the medical center did not have 24-hour coverage in respiratory therapy, pharmacy, and radiology. </font></li> <li><font face="Arial" size="2">Facility Leadership: &nbsp;The Inspector General believed there were warnings on many of the problems identified in NSQIP s site visit, including NSQIP s own data, that Marion s leadership should have acted upon before others discovered the problem. &nbsp;According to the IG, though, most of this information was  not disseminated to other VHA managerial entities such as VISN 15 (the facility s parent network) or VA headquarters in Washington, DC. </font> </li> </ul> </ul> </ul> <ul> <p> <font face="Arial" size="2">VA is examining each of these areas, not only at Marion but throughout the department s health care system, to ensure these types of issues are not present at other facilities, and to enhance regulations to prevent these problems from occurring in the future. &nbsp;A VHA work group has been convened to develop new requirements for peer reviews, augmenting peer reviews conducted at smaller facilities by requiring external reviews and establishing improved parameters for future peer reviews of all types. &nbsp;These additional directives will be enacted within the month.</font></p> </ul> <ul> <p> <font face="Arial" size="2">Both the Inspector General and the Medical Inspector s reports agree there had been numerous instances of poor medical care at the facility. &nbsp;The Inspector General s report states the care of three patients who died following surgical procedures during Fiscal Year 2007 had  significant problems. The Medical Inspector s report, which reviewed Fiscal Years 2006 and 2007, and therefore substantially more cases, identifies a total of nine deaths directly attributable to substandard care. There were 34 cases in which care complicated patients health, including 10 others who died. &nbsp;In these cases, the Medical Inspector could not determine if the care they received caused their deaths.</font></p> </ul> <ul> <p> <font face="Arial" size="2">VA will begin immediately to contact those veterans and families of veterans who are believed to have been harmed by surgical care at the facility within the past two years to review their care with them, and known instances of substandard care will be disclosed. &nbsp;The Department will also assist patients and families who believe they have been harmed in their efforts to receive compensation. &nbsp;The Department has set up a toll-free phone number for patients and their families who are concerned about the care they received at the Marion VA hospital to call to receive additional information. &nbsp;</font></p> </ul> <ul> <p> &nbsp; &nbsp;<font face="Arial" size="2">The Department also announced it has initiated an Administrative Board of Investigation to review quality of care issues and issues raised by employee groups at the Marion campus. </font><a href="http://www1.va.gov/opa/pressrel/pressrelease.cfm?id=1444" target="_blank"><font color="#0000ff" face="Arial" size="2"><u>http://www1.va.gov/opa/pressrel<wbr></wbr>/pressrelease.cfm?id=1444</u></font></a></p> </ul> <ul type="DISC"> <li><font face="Arial" size="2">Deputy Secretary of Veterans Affairs Gordon H. Mansfield was named as the first recipient of the <i> Robert Dole National Award for Service </i> on Jan. 28 during the annual conference of the Military Health System.</font> </li> </ul> <ul> <p> <font face="Arial" size="2">Mansfield, a long-time official with the Paralyzed Veterans of America and the second ranking officer in the Department of Veterans Affairs (VA) since January 2004, described former Senator Dole as  one of my personal heroes. </font></p> </ul> <ul> <p> <font face="Arial" size="2">The award was established in Senator Dole s name to recognize veterans who continue to serve the nation through public service. &nbsp;</font></p> </ul> <ul> <p> <font face="Arial" size="2">Last year, Dole served as co-chair of the President s Commission on Care for America s Returning Wounded Warriors, a landmark look at ways to improve VA s and the Defense Department s help for injured service members returning to the private sector.</font></p> </ul> <ul> <p> <font face="Arial" size="2">A combat-wounded veteran of the Vietnam War, Mansfield has also served as an assistant secretary in the Department of Housing and Urban Development. &nbsp;He was honored as Outstanding Disabled Veteran of the Year in 2006 at the national convention of Disabled American Veterans. </font><a href="http://www1.va.gov/opa/pressrel/pressrelease.cfm?id=1446" target="_blank"><font color="#0000ff" face="Arial" size="2"><u>http://www1.va.gov/opa/pressrel<wbr></wbr>/pressrelease.cfm?id=1446</u></font></a></p> </ul> <ul type="DISC"> <li><font face="Arial" size="2">The Department of Veterans Affairs (VA) awarded a $3.2 million contract to Economic Systems Inc. of Falls Church, Va., to develop information relating to possible changes in the composition of disability payments to disabled veterans.</font> </li> </ul> <ul> <p> <font face="Arial" size="2">The contact is based upon recommendations of the Dole-Shalala Commission, which issued its final report in July 2007, and the October 2007 final report of the Veterans Disability Benefits Commission.</font></p> </ul> <ul> <p> <font face="Arial" size="2">The contractor will provide its findings in August 2008. &nbsp;Economic Systems Inc. will address three basic research questions in two studies. &nbsp;One study will examine the nature and feasibility of making  long-term transition payments to service members separated from the military due to disability while those veterans undergo rehabilitation.</font></p> </ul> <ul> <p> <font face="Arial" size="2">A second study will provide information on the appropriate levels of compensation necessary to compensate for any loss in earnings capacity caused by service-incurred or service-aggravated conditions. &nbsp;It will also provide information on potential  quality of life payments called for by both studies. </font><a href="http://www1.va.gov/opa/pressrel/pressrelease.cfm?id=1445" target="_blank"> <font color="#0000ff" face="Arial" size="2"><u>http://www1.va.gov/opa/pressrel<wbr></wbr>/pressrelease.cfm?id=1445</u></font></a></p> </ul> <ul type="DISC"> <li><font face="Arial" size="2">The Department of Veterans Affairs (VA) announced that the beneficiary travel mileage reimbursement rate will increase more than double beginning Feb. 1, 2008, for eligible veterans traveling VA medical facilities.</font> </li> </ul> <ul> <p> <font face="Arial" size="2">The 2008 appropriations act provided funding for VA to increase the beneficiary travel mileage reimbursement rate from 11 cents per mile to 28.5 cents per mile. &nbsp;</font></p> </ul> <ul> <p> <font face="Arial" size="2">After little more than a month on the job, Secretary Peake used his authority to establish the first increase in the mileage reimbursement in 30 years, fulfilling a pledge he made during his Senate confirmation hearing last month.</font></p> </ul> <ul> <p> <font face="Arial" size="2">While increasing the payment, VA, as mandated by law, also equally increased the deductible amounts applied to certain mileage reimbursements. &nbsp;The new deductibles are $7.77 for a one way trip, $15.54 for a round trip, with a maximum of $46.62 per calendar month. &nbsp;However, these deductibles can be waived if they cause a financial hardship to the veteran. </font><a href="http://www1.va.gov/opa/pressrel/pressrelease.cfm?id=1447" target="_blank"><font color="#0000ff" face="Arial" size="2"><u>http://www1.va.gov/opa/pressrel<wbr></wbr>/pressrelease.cfm?id=1447</u></font></a></p> </ul> <ul type="DISC"> <li><font face="Arial" size="2">The Iraq and Afghanistan Veterans of America (IAVA) released a group of reports outlining what they call the five most urgent issues facing veterans of the wars in the Middle East and their families. </font></li> </ul> <ul> <p> <font face="Arial" size="2">According to IAVA, today s veterans face a host of health and health care issues. This includes mental health issues such as Post Traumatic Stress Disorder and traumatic brain injuries (TBI), which afflict between 10 and 20 percent of Iraq veterans. </font> </p> </ul> <ul> <p> <font face="Arial" size="2">PTSD and TBI have been linked in another study published today in the <i>New England Journal of Medicine</i>. According to a survey of 2,500 soldiers taken at Walter Reed Army Institute of Research, five percent of soldiers had had concussions in combat. Of these five percent, 45 percent had PTSD. </font> </p> </ul> <ul> <p> <font face="Arial" size="2">In addition, inefficiencies and complications in the veteran s health care system make it difficult for vets to get timely and adequate medical care and disability compensation for these and other issues, IAVA reports.</font></p> </ul> <ul> <p> <font face="Arial" size="2">The reports also cite other problems faced by soldiers and veterans. One report says that the overextension of the military, especially after the spring 2007 surge, is threatening its effectiveness, both in the current wars in Iraq and Afghanistan where troops experience equipment shortages and in the military s ability to respond to new threats as they arise.</font></p> </ul> <ul> <p> <font face="Arial" size="2">The full reports can be downloaded at </font><a href="http://www.iava.org/iava-issue-reports" target="_blank"><font color="#0000ff" face="Arial" size="2"><u>IAVA s Web site</u></font></a><font face="Arial" size="2">.</font></p> </ul> <ul> <p align="right"> <font color="#0000ff" face="Arial" size="2"><a href="#top">Back to Top</a></font></p> </ul> <p> <a name="0.1_01000019"></a><font face="Arial Black" size="3"><a name="hcare">Health Care News</a></font></p> <ul type="DISC"> <li><font face="Arial" size="2">A </font><a href="http://pediatrics.aappublications.org/cgi/content/full/peds.2007-3638v1" target="_blank"><font color="#0000ff" face="Arial" size="2"><u>study</u></font></a><font face="Arial" size="2"> by the Centers for Disease Control and Prevention estimates that 7,000 children ages 11 and younger are treated in hospital emergency departments each year because of cough and cold medications. Approximately two-thirds of those incidents were due to unsupervised ingestion (i.e., children taking the medication without a parent2 s knowledge). </font></li> </ul> <ul> <p> <font face="Arial" size="2">This study found that children ages 2 to 5 accounted for 64 percent of all adverse drug events from cough and cold medications and nearly 80 percent of the events for this age group were from unsupervised ingestions. Among all age groups, 93 percent of the children did not require hospital admission, however, one-fourth needed additional treatment to eliminate the medicine from their bodies.</font></p> </ul> <ul> <p> <font face="Arial" size="2">The CDC researchers reviewed 2004-2005 data from the National Electronic Injury Surveillance System  Cooperative Adverse Drug Event Surveillance (NEISS-CADES) project to describe emergency department visits related to cough and cold medications.</font></p> </ul> <ul> <p> <font face="Arial" size="2">Recently, such products marketed to infants and toddlers less than 2 years old were voluntarily withdrawn from the market because of safety concerns. The safety of these products for children ages 2 to 11 is currently being reviewed by the U.S. Food and Drug Administration (FDA). The CDC recommended that parents also not use products intended for older children to treat young children, and, as stated in the FDA s mandated label warning, parents should keep all cough and cold medications out of the reach of children. </font><a href="http://www.cdc.gov/od/oc/media/pressrel/2008/r080128.htm" target="_blank"><font color="#0000ff" face="Arial" size="2"><u>http://www.cdc.gov/od/oc/media<wbr></wbr>/pressrel/2008/r080128.htm</u></font></a></p> </ul> <ul type="DISC"> <li><font face="Arial" size="2">According to a new study by National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health, research shows that in people with high blood pressure as part of metabolic syndrome, a cluster of conditions that increases the risk for heart disease, diuretics offer greater protection against cardiovascular disease, including heart failure, and are at least as effective for lowering blood pressure as newer, more expensive medications. The findings run counter to current medical practices that favor ACE-inhibitors, alpha-blockers, and calcium channel blockers for treatment of high blood pressure in those with metabolic syndrome. In addition, the results provide important new evidence supporting the use of diuretics for initial blood pressure-lowering therapy in black patients with metabolic syndrome.</font> </li> </ul> <ul> <p> <font face="Arial" size="2">The report <i>"Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial, or ALLHAT </i>published in the January 28 issue of </font><a href="http://archinte.ama-assn.org/" target="_blank"><font color="#0000ff" face="Arial" size="2"><i><u>Archives of Internal Medicine</u></i></font></a><font face="Arial" size="2">.</font></p> </ul> <ul> <p> <font face="Arial" size="2">ALLHAT is the largest study to compare a diuretic (chlorthalidone) with three newer classes of medications to treat high blood pressure: a calcium-channel blocker (amlodipine besylate), an alpha-blocker (doxazosin mesylate), and an angiotensin-converting enzyme (ACE) inhibitor (lisinopril). Each drug was used to start treatment and other medications could be added if necessary to control blood pressure. The study originally reported in 2002 that diuretics were the most beneficial of the drug classes studied for treating high blood pressure and for protecting against adverse cardiovascular outcomes. </font> </p> </ul> <ul> <p> <font face="Arial" size="2">This latest analysis shows that even among men and women with metabolic syndrome, and for black and non-black (Caucasians, Hispanics, Asians/Pacific Islanders and American/Alaskan Natives) participants, the less costly diuretics consistently control blood pressure, are equally beneficial in preventing heart attack and coronary heart disease death. They are also more beneficial than newer medications in preventing one or more other forms of cardiovascular disease including heart failure and stroke. </font> </p> </ul> <ul> <p> <font face="Arial" size="2">The report cautions that medications to treat hypertension should always be combined with lifestyle approaches to lowering blood pressure.&nbsp; </font><a href="http://www.nih.gov/news/health/jan2008/nhlbi-28.htm" target="_blank"> <font color="#0000ff" face="Arial" size="2"><u>http://www.nih.gov/news/health<wbr></wbr>/jan2008/nhlbi-28.htm</u></font></a>&nbsp;<br /> </p> </ul> <ul type="DISC"> <li><font face="Arial" size="2">The Centers for Medicare and Medicaid Services (CMS) issued a proposed rule in the </font><a href="http://a257.g.akamaitech.net/7/257/2422/25jan20081800/edocket.access.gpo.gov/2008/pdf/E8-1346.pdf" target="_blank"><font color="#0000ff" face="Arial" size="2"><i><u>Federal Register</u></i></font></a><font face="Arial" size="2"> on Jan. 25, 2008, to enhance the enrollment standards for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers.&nbsp; The proposed rule is intended to increase protections for Medicare and its beneficiaries from potentially dishonest or low quality suppliers.&nbsp;</font> </li> </ul> <ul> <p> <font face="Arial" size="2">By creating five new standards and strengthening seven of the 21 existing standards that suppliers must meet, the proposed rule would provide Medicare beneficiaries with additional assurance that they are being served by suppliers who meet the highest standards of quality.&nbsp;</font></p> </ul> <ul> <p> <font face="Arial" size="2">The proposed additions and revisions to the DMEPOS supplier enrollment standards are expected to help ensure that only legitimate DMEPOS suppliers participate in Medicare.&nbsp;</font></p> </ul> <ul> <p> <font face="Arial" size="2">The enrollment standards would affect all suppliers for these items, not just those who participating in the durable medical equipment bidding program. The standards also will apply to suppliers of all types of DMEPOS prescribed by the beneficiary s physician, from simple canes and walkers to complex power wheelchairs, oxygen supplies and equipment, and hospital beds.&nbsp;</font></p> </ul> <ul> <p> <font face="Arial" size="2">For example, one of the new standards would require DMEPOS suppliers, except suppliers of prosthetics and orthotics, to be open to the public for at least 30 hours a week.&nbsp; </font> </p> </ul> <ul> <p> <font face="Arial" size="2">Comments will be accepted until March 25, and a final rule will be published later this year.&nbsp; </font><a href="http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=2866&intNumPerPage=10&checkDate=&checkKey=&srchType=1&nu" target="_blank"><font color="#0000ff" face="Arial" size="2"><u>CMS NR 01-25-2008</u></font></a><font face="Arial" size="2"> </font> </p> </ul> <ul type="DISC"> <li><font face="Arial" size="2">The California Senate Health Committee on voted 7-1, with three abstentions, to reject the Health Care Security and Cost Reduction Act (</font><a href="http://www.leginfo.ca.gov/cgi-bin/postquery?bill_number=abx1_1&sess=CUR&house=A&search_type=bill_update" target="_blank"><font color="#394b6b" face="Arial" size="2"><u>ABX1 1</u></font></a><font face="Arial" size="2">), supported by Gov. Arnold Schwarzenegger (R) and Assembly Speaker Fabian Nunez (D), on Jan. 28, 2008.</font> </li> </ul> <ul> <p> <font face="Arial" size="2">The proposal, approved by the California Assembly last month, would have required most state residents to obtain health coverage. Under the bill, residents with incomes up to 250 percent of the federal poverty level would have received state subsidies for coverage, and residents with incomes up to 400 percent of the poverty level would have received tax credits to ensure that health care premium costs do not exceed 5.5 percent of their incomes. Insurers would have been prohibited from denying coverage to residents because of pre-existing medical conditions. A ballot initiative submitted by Schwarzenegger and Nunez would have asked voters to approve about $9 billion in fees and taxes to partially fund the $14 billion plan. The initiative, which would have gone before voters in November, called for an increase in the state tax on cigarettes, as well as a fee on hospital revenues. It also included an employer requirement to contribute towards health coverage in amounts ranging from 1 to 6.5 percent of their payrolls, depending on the level of payroll.</font></p> </ul> <ul> <p> <font face="Arial" size="2">Last week, the state Legislative Analyst's Office released a </font><a href="http://www.lao.ca.gov/2008/hlth/health_reform/health_reform_012208.aspx" target="_blank"><font color="#0000ff" face="Arial" size="2"><u>study</u></font></a><font face="Arial" size="2"> that found by fiscal year 2014-2015, the annual cost of the program could exceed revenue by $300 million to $1.5 billion. Legislators raised concerns about approving the measure at a time when the state is facing a $14.5 billion budget shortfall. </font>&nbsp;<br /> &nbsp;<br /> &nbsp;<br /> </p> </ul> <ul> <p align="right"> <font color="#0000ff" face="Arial" size="2"><a href="#top">Back to Top</a></font></p> </ul> <h1> <font face="Arial Black" size="3"><a name="reserve">Reserve/Guard</a></font> </h1> <ul type="DISC"> <li><font face="Arial" size="2">The total number of Guard and Reserve currently on active duty has <b>decreased</b> by 248 from the last report to 94,481. The totals for each service are Army National Guard and Army Reserve, 73,197; Navy Reserve, 5,024; Air National Guard and Air Force Reserve, 7,231; Marine Corps Reserve, 8,695; and the Coast Guard Reserve, 334. </font><a href="http://www.defenselink.mil/" target="_blank"> <font color="#0000ff" face="Arial" size="2"><u>www.defenselink.mil</u></font></a> </li> </ul> <ul> <p align="right"> <font color="#0000ff" face="Arial" size="2"><a href="#top">Back to Top</a></font></p> </ul> <p> <font face="Arial Black" size="3"><a name="reports">Reports/Policies</a></font></p> <ul type="DISC"> <li><font face="Arial" size="2">The Institute of Medicine (IOM) released <i> Knowing What Works in Health Care: A Roadmap for the Nation, </i>on Jan. 24, 2008.&nbsp; The report provides a blueprint for a national program to assess the effectiveness of clinical services and to provide credible, unbiased information about what really works in health care. </font><a href="http://www.iom.edu/CMS/3809/34261/50718.aspx" target="_blank"><font color="#0000ff" face="Arial" size="2"><u>http://www.iom.edu/CMS/3809<wbr></wbr>/34261/50718.aspx</u></font></a> </li> </ul> &nbsp;<br /> <ul type="DISC"> <li><font face="Arial" size="2">The GAO published <i> VA and DOD Health Care: Administration of DOD's Post-Deployment Health Reassessment to National Guard and Reserve Servicemembers and VA's Interaction with DoD, </i> (GAO-08-181R) on Jan 25, 2008.&nbsp; The report describes how DoD administers the post-deployment health reassessment (PDHRA) to National Guard and Reserve service members and what information it obtains and how VA interacts with DoD in the PDHRA process for these service members and the information VA obtains.&nbsp; </font><a href="http://www.gao.gov/new.items/d08181r.pdf" target="_blank"> <font color="#0000ff" face="Arial" size="2"><u>http://www.gao.gov/new.items<wbr></wbr>/d08181r.pdf</u></font></a> </li> </ul> &nbsp;<br /> <ul type="DISC"> <li><font face="Arial" size="2">The GAO published <i> Medical Devices: Challenges for FDA in Conducting Manufacturer Inspections. </i> (GAO-08-428T) on Jan. 29, 2008.&nbsp; This report assesses FDA's management of inspections of establishments--particularly those in foreign countries--manufacturing devices for the U.S. market, and provides the status of FDA's programs for third-party inspections of medical device manufacturing establishments.&nbsp; The report concluded that the FDA has not met the statutory requirement to inspect certain domestic establishments manufacturing medical devices every two years and the agency faces challenges inspecting foreign establishments.&nbsp; </font><a href="http://www.gao.gov/new.items/d08428t.pdf" target="_blank"><font color="#0000ff" face="Arial" size="2"><u>http://www.gao.gov/new.items<wbr></wbr>/d08428t.pdf</u></font></a> </li> </ul> &nbsp;<br /> <ul> <p align="right"> <font color="#0000ff" face="Arial" size="2"><a href="#top">Back to Top</a></font></p> </ul>