<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 29, 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 size="2" face="Arial">The Senate passed (83-10), as amended, the Indian Health Care Improvement Act Amendments of 2007, on Feb. 26, 2008.  The bill authorizes more than $35 million over the next ten years to expand Medicare, Medicaid and SCHIP reimbursement for a wider range of Indian health services.</font></li> <li><font size="2" face="Arial">The House Appropriations Subcommittee on Defense held a hearing on Feb. 28, 2008, to examine the Defense Health Program.  Assistant Secretary of Defense for Health Affairs, Dr. S. Ward Casscells, as well as the service surgeons general testified.</font></li> <li><font size="2" face="Arial">The House Armed Services Committee held hearings this week to hear testimony from the Army and Air Force regarding the Fiscal Year 2009 National Defense Authorization Budget. Navy officials will testify before the committee on March 6, 2008</font></li> </ul> <ul type="DISC"> <li><font size="2" face="Arial">The Senate Armed Services Committee held hearings this week to receive testimony from the Navy and Army in review of the Defense Authorization Request for Fiscal Year 2009 and the Future Years Defense Program.  Air Force officials will testify before the committee on March 5, 2008.</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 size="2" face="Arial">The Department of Defense (DoD) awarded McKesson Corp. of San Francisco, Calif., a firm-fixed price, prime-vendor contract valued at up to $822 million for pharmaceutical supplies in support of the TRICARE Mail Order Pharmacy (TMOP). The DoD is exercising its option for a fifth year under an earlier contract with the pharmaceutical wholesaler. Contract funds will not expire at the end of the current fiscal year. Date of performance completion is Feb. 28, 2009. The contracting activity is Defense Supply Center Philadelphia (DSCP), Philadelphia, Pa. (SPM200-03-D-1666).    </font></li> <li><font size="2" face="Arial">The Secretary of Health and Human Services, Michael Leavitt, became the first recipient of the Grace Hopper Knowledge to Wisdom Award on Feb. 26, 2008, during the Healthcare Information and Management Systems Society (HIMSS) Conference in Orlando, Fla. The award, presented by Dr. S. Ward Casscells, assistant secretary of defense for health affairs, recognizes Leavitt s efforts to make health care more transparent to the consumer, as well as to protect the health of all Americans.</font></li> </ul> <ul> <p>   <font size="2" face="Arial">Named after Admiral Grace Hopper, an American naval officer who was a revered mathematician and a pioneer in data processing, the Grace Hopper Knowledge to Wisdom Award recognizes a leader in federal health care who already has a distinguished career and uses his or her influence and persuasive abilities to implement positive changes around the globe.  Adm. Hopper was known not only for her technical brilliance, but also for her communication and leadership skills. </font><a href="http://www.tricare.mil/pressroom/news.aspx?fid=367" target="_blank"><font color="#0000FF" size="2" face="Arial"><u>http://www.tricare.mil/pressroo<WBR>m/news.aspx?fid=367</u></font></a></p> </ul> <ul type="DISC"> <li><font size="2" face="Arial">The Military Health System (MHS) announced it has created an Infectious Disease (ID) Institutional Review Board (IRB) to streamline the review and approval process for some military-relevant infectious disease research while ensuring high quality scientific and ethical review and human subjects protection.  The ID IRB is being implemented through a Memorandum of Understanding (MOU), signed by Dr. Charles Rice, the president of the Uniformed Services University (USU); the component designated officials for the Office of the Under Secretary of Defense for Personnel and Readiness; Ms. Ellen Embrey, deputy assistant secretary of defense for force health protection and readiness; and the surgeons general for each of the services, Maj. Gen. Eric Schoomaker, Vice Adm. Adam Robinson, Jr., and Lt. Gen. James Roudebush. </font></li> </ul> <ul> <p><font size="2" face="Arial">The MOU applies to research protocols that are partially or fully supported by the Infectious Disease Clinical Research Program (IDCRP). The IDCRP was established in 2006 at USU through an Interagency Agreement with the National Institutes of Health s National Institute of Allergy and Infectious Diseases (NIAID). Its mission is to develop and conduct collaborative clinical infectious disease research of importance to both DoD and NIAID through the establishment of an effective network to rapidly respond to evolving infectious disease threats. The network ID IRB will be administered centrally through the USU but will include participation from across the medical commands and NIAID.  </font></p> </ul> <ul> <p>   <font size="2" face="Arial">The IDCRP is a collaborative effort currently involving seven medical commands representing all three service components and the USU.  Until now, collaborative research can require as many as seven reviews by the military training facilities, one review at USU, and four headquarters-level reviews.  With the MOU, this process has been reduced to a single scientific review by the IDCRP Programmatic and Scientific Review Board (PSRB), a single ethical review by the newly created Infectious Disease IRB, and a single headquarters administrative review by the newly created USD(P&amp;R)/Tri-service Headquarters panel. </font><a href="http://www.health.mil/Press/Release.aspx?ID=75" target="_blank"><font color="#0000FF" size="2" face="Arial"><u>http://www.health.mil/Press<WBR>/Release.aspx?ID=75</u></font></a></p> </ul> <ul type="DISC"> <li><font size="2" face="Arial">The Department of Defense (DoD) announced it has implemented a joint pilot program with the Department of Veterans Affairs (VA) to streamline the path wounded service members must take to leave active duty and enter the Veterans Affairs (VA) care. </font></li> </ul> <ul> <p>   <font size="2" face="Arial">The pilot, <i>Joint DoD/VA Disability Evaluation System (DES),</i> eliminates certain redundancies previously experienced by service members and shortens the amount of time a service member spends waiting to begin receiving VA benefits and compensation. The pilot includes a VA Medical Center and three major military medical centers in the National Capital Region. </font></p> </ul> <ul> <p>   <font size="2" face="Arial">Until now, transferring from DoD to VA benefits has taken extended time periods for some members to receive their VA awards for disabilities.  This delay was due in part to both DoD and VA administering their individual medical disability evaluations.  The Joint DoD/VA DES pilot reduces redundancy and changes the once sequential processes into concurrent ones.  DoD and VA will share clinical data from a standardized, single disability evaluation used across all military services and the VA and both will rely on a single disability rating established by the VA. In short: one exam, one rating, less burden on the service member.  </font><a href="http://www.health.mil/Press/Release.aspx?ID=70" target="_blank"><font color="#0000FF" size="2" face="Arial"><u>http://www.health.mil/Press<WBR>/Release.aspx?ID=70</u></font></a></p> </ul> <ul type="DISC"> <li><font size="2" face="Arial">Secretary of Defense Robert M. Gates announced the nominations of Navy Rear Adm. (lower half) David J. Smith and Navy Rear Adm. (lower half) Richard R. Jeffries to the rank of rear admiral upper half. </font></li> </ul> <ul> <p><font size="2" face="Arial">Smith serves as joint staff surgeon, J4, Joint Staff, Washington, D.C. Jeffries serves as commander, Navy Medicine Capital Area and commander, National Naval Medical Center, Bethesda, Md. </font></p> </ul> <ul> <p><font size="2" face="Arial">Rear Adm. Smith, in his role as Joint Staff Surgeon, is the top medical advisor to the Chairman of the Joint Chiefs of Staff and coordinates all issues related to operational medicine, force health protection and readiness among Combatant Commands, the Office of the Secretary of Defense, and the services. Smith recently served as assistant deputy chief health care operations at the Bureau of Medicine and Surgery, and chief of staff of TRICARE Management Activity. </font></p> </ul> <ul> <p><font size="2" face="Arial">Rear Adm. Jeffries is Medical Officer for the Marine Corps, which is the service s highest medical position. His service of 32 years with the Navy encompasses strong leadership in family medicine, having been appointed to the position of head, family practice department, acting director clinical services, and chief, medical staff at Branch Naval Hospital Twenty-nine Palms, Calif. </font><a href="http://health.mil/Press/Release.aspx?ID=77" target="_blank"><font color="#0000FF" size="2" face="Arial"><u>http://health.mil/Press<WBR>/Release.aspx?ID=77</u></font></a></p> </ul> <ul type="DISC"> <li><font size="2" face="Arial">Health Net Federal Services (HNFS) appointed Joyce Grissom, M.D., as medical director. In her new role, Dr. Grissom will serve as clinical liaison to Military Treatment Facilities (MTFs), TRICARE Regional Office (TRO), TRICARE Management Activity (TMA) and Health Net TRICARE providers, as well as review referrals and authorizations, quality and compliance issues, and grievances. </font></li> </ul> <ul> <p><font size="2" face="Arial">Dr. Grissom has an established career as a physician executive and board certified neurologist with 22 years experience within the Military Health System. Most recently, she served as the Medical Director, Director of Quality for TRICARE Management Activity and previously as Chief Medical Officer for TRICARE Southwest and Staff Neurologist for Wilford Hall Medical Center. Dr. Grissom has served in the U.S. Air Force for 22 years.</font><font color="#333333" size="2" face="Arial"> </font><a href="http://www.pr-inside.com/health-net-federal-services-hires-medical-r461849.htm" target="_blank"><font color="#0000FF" size="2" face="Arial"><u>http://www.pr-inside.com<WBR>/health-net-federal-services<WBR>-hires-medical-r461849.htm</u></font></a></p> </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="vhc">Veterans Health Care News</a></font><font face="Arial" size="3"> &nbsp;</font></p> <ul type="DISC"> <li><font size="2" face="Arial">The Department of Veterans Affairs (VA) announced that military veterans who served in combat since Nov. 11, 1998, including veterans of Iraq and Afghanistan, are now eligible for five years of free medical from the VA care for most conditions. This measure increases a two-year limit that has been in effect nearly a decade.</font></li> </ul> <ul> <p><font size="2" face="Arial">The five-year deadline has no effect upon veterans with medical conditions related to their military service.  Veterans may apply at any time after their discharge from the military even decades later for medical care for service-connected health problems.  </font></p> </ul> <ul> <p><font size="2" face="Arial">The new provision, part of the National Defense Authorization Act of 2008 signed by President Bush on Jan. 28, 2008, applies to care in a VA hospital, outpatient clinic or nursing home.  It also extends VA dental benefits previously limited to 90 days after discharge for most veterans -- to 180 days.</font></p> </ul> <ul> <p><font size="2" face="Arial">Combat veterans, who were discharged between Nov. 11, 1998, and Jan. 16, 2003, and who never took advantage of VA s health care system, have until Jan. 27, 2011, to qualify for free VA health care.</font></p> </ul> <ul> <p><font size="2" face="Arial">The five-year window is also open to activated reservists and members of the National Guard, if they served in a theater of combat operations after Nov. 11, 1998, and were discharged under other than dishonorable conditions.</font></p> </ul> <ul> <p><font size="2" face="Arial">Veterans who take advantage of this five-year window to receive VA health care can continue to receive care after five years, although they may have to pay co-payments for medical problems unrelated to their military service.  Co-payments range from $8 for a 30-day supply of prescription medicine to $1,024 for the first 90 days of inpatient care each year. </font><a href="http://www1.va.gov/opa/pressrel/pressrelease.cfm?id=1454" target="_blank"><font color="#0000FF" size="2" face="Arial"><u>http://www1.va.gov/opa/pressrel<WBR>/pressrelease.cfm?id=1454</u></font></a></p> </ul> <ul type="DISC"> <li><font size="2" face="Arial">The Veterans Health Administration hosted a symposium for senior leaders from the Departments of Veterans Affairs (VA) and Defense (DoD) on Feb. 19, 2008, to examine the accomplishments and challenges faced when providing care for the new generation of combat veterans. The topics addressed were closely aligned with the Senior Oversight Committee s (SOC s) lines of action and included traumatic brain injury, the polytrauma system of care, DoD/VA data sharing, case management, and the evolution of the disability system. Michael Kussman, M.D., VA under secretary for health, and S. Ward Casscells, M.D., assistant secretary of defense for health affairs, both praised the progress made over the past year, encouraged participants to continue to identify what can be improved, and emphasized the need for even more collaboration and partnerships.  </font><a href="http://www.mhs.mil" target="_blank"><font color="#0000FF" size="2" face="Arial"><u>www.mhs.mil</u></font></a></li> <li><font size="2" face="Arial">The Department of Veterans Affairs awarded DKI Consulting a $5 million contract for the design, implementation and software support of the VA&#39;s new national health care system.</font></li> </ul> <ul> <p><font size="2" face="Arial">DKI, a Houston-based company affiliated with Cimarron Software Services, said it was chosen by the VA to work on the venture because of its work with NASA&#39;s Exploration Systems Mission Directorate.</font></p> </ul> <ul> <p><font size="2" face="Arial">DKI will upgrade the Veteran Health Information Systems and Technology Architecture (VistA), a suite of software packages comprised of more than 100 applications.</font></p> </ul> <ul> <p><font size="2" face="Arial">VistA is currently used at 128 VA health care facilities nationwide to create electronic health records that provide the VA with essential clinical, financial, infrastructure and management tools.  </font><a href="http://www.bizjournals.com/houston/stories/2008/02/25/daily22.html" target="_blank"><font color="#0000FF" size="2" face="Arial"><u>http://www.bizjournals.com<WBR>/houston/stories/2008/02/25<WBR>/daily22.html</u></font></a></p> </ul> <ul type="DISC"> <li><font size="2" face="Arial">Secretary of Veterans Affairs (VA) Dr. James B. Peake announced that 15 of 23 new planned Vet Centers, which provide readjustment counseling and outreach services to returning combat veterans, are operational.</font></li> </ul> <ul> <p><font size="2" face="Arial">In February 2007, VA announced it would open 23 new centers during the next two years.  In addition to the 15 centers that are open, five others are seeing patients in temporary facilities while finalizing their leases.  The other three facilities will begin operations later this year.</font></p> </ul> <ul> <p><font size="2" face="Arial">The community-based Vet Centers are a key component of VA s mental health program, providing veterans with mental health screening and post-traumatic stress disorder (PTSD) counseling, along with help for family members dealing with bereavement and loved ones with PTSD.</font></p> </ul> <ul> <p><font size="2" face="Arial">The 15 new Vet Centers that are open in permanent locations are in Binghamton, N.Y.; Middletown, N.Y.; Watertown, N.Y.; Hyannis, Mass.; DuBois, Pa.; Gainesville, Fla.; Melbourne, Fla.; Macon, Ga.; Manhattan, Kansas; Escanaba, Mich.; Saginaw, Mich.; Grand Junction, Colo.; Baton Rouge, La., Killeen, Texas; and Las Cruces, N.M. </font></p> </ul> <ul> <p><font size="2" face="Arial">Five additional Vet Centers are providing services in temporary space while they finalize their leases:  They are in Toledo, Ohio; Ft. Myers, Fla.; Montgomery, Ala.; Everett, Wash.; and Modesto, Calif.</font></p> </ul> <ul> <p><font size="2" face="Arial">The final three locations where Vet Centers will open for clients later this year are in Berlin, N.H., Nassau County, N.Y., and Fayetteville, Ark.</font></p> </ul> <ul> <p><font size="2" face="Arial">Vet Centers provide counseling on employment, plus services on family issues, education and outreach, to combat veterans and their families.  Vet Centers are staffed by small teams of professional counselors, outreach specialists and other specialists, many of whom are combat veterans themselves.  </font><a href="http://www1.va.gov/opa/pressrel/pressrelease.cfm?id=1456" target="_blank"><font color="#0000FF" size="2" face="Arial"><u>http://www1.va.gov/opa/pressrel<WBR>/pressrelease.cfm?id=1456</u></font></a></p> </ul> <ul type="DISC"> <li><font size="2" face="Arial">The Department of Veterans Affairs (VA) and Disabled American Veterans (DVA) will cosponsor the 22<sup>nd</sup> National Disabled Veterans Winter Sports Clinic in Snowmass Village, March 30  April 4, 2008.  More than 450 disabled veterans, including nearly 120 recently injured during Operation Iraqi Freedom and Operation Enduring Freedom (OIF/OEF), will participate in the clinic. </font></li> </ul> <ul> <p><font size="2" face="Arial">The clinic is an annual rehabilitation program open to U.S. military veterans with traumatic brain injuries, spinal cord injuries, orthopedic amputations, visual impairments, certain neurological problems and other disabilities who receive care at a Department of Veterans Affairs (VA) medical facility or military treatment facility.</font></p> </ul> <ul> <p><font size="2" face="Arial">At the six-day event, veterans will also learn rock climbing, scuba diving, snowmobiling, curling and sled hockey.  The U.S. Secret Service will provide a course on self-defense. All activities are designed to help participants develop winter sports skills and take part in a variety of other adaptive sports and workshops, which demonstrate that having a physical or visual disability need not be an obstacle to an active, rewarding life.</font></p> </ul> <ul> <p><font size="2" face="Arial">This year, the clinic will again offer an innovative race training and development program designed for elite-level skiers.  The program has been made possible through an agreement with the United States Olympic Committee and is used to identify potential Paralympic athletes, the Olympic equivalent for world class athletes with disabilities.  A number of these elite athletes began their winter sports endeavors through skills they learned at the National Disabled Veterans Winter Sports Clinic.  </font><a href="http://www1.va.gov/opa/pressrel/pressrelease.cfm?id=1455" target="_blank"><font color="#0000FF" size="2" face="Arial"><u>http://www1.va.gov/opa/pressrel<WBR>/pressrelease.cfm?id=1455</u></font></a> </p> </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="hcare">Health Care News</a></font></p> <ul type="DISC"> <li><font size="2" face="Arial">On Feb. 26, 2008, the Centers for Medicare and Medicaid (CMS) published a report projecting the growth in health care spending in the United States to be 6.7 percent in 2007 and to remain near that rate through 2017, the report said.</font></li> </ul> <ul> <p><font size="2" face="Arial">The report, <i>Health Spending Projections Through 2017: The Baby-Boom Generation Is Coming To Medicare</i></font><font size="3" face="Arial">, </font><font size="2" face="Arial">was prepared by CMS s Office of the Actuary and published online by the journal </font><a href="http://content.healthaffairs.org/cgi/content/abstract/hlthaff.27.2.w145v1" target="_blank"><font color="#0000FF" size="2" face="Arial"><i><u>Health Affairs</u></i><u>.  </u></font></a><font size="2" face="Arial">Over the full projection period (2007-2017), annual growth in health spending is anticipated to be higher than annual growth in both the overall economy (4.9 percent) and in general inflation (2.4 percent). </font></p> </ul> <ul> <p><font size="2" face="Arial">As a percentage of gross domestic product (GDP) health care spending is projected to increase to 16.3 percent in 2007 from 16.0 percent in 2006.  By the end of the projection period, health care spending in the United States is expected to reach just over $4.3 trillion and comprise 19.5 percent of GDP. </font></p> </ul> <ul> <p><font size="2" face="Arial">For health spending through public programs, growth is anticipated to decelerate to 6.8 percent in 2008 after the 8.2 percent growth in 2006 that was largely influenced by the implementation of the Medicare Part D drug benefit.  Public health spending growth is then expected to gradually increase toward the end of the projection period, as the leading edge of the baby boom generation begins to enroll in Medicare. </font></p> </ul> <ul> <p><font size="2" face="Arial">Through 2017, growth in health spending is expected to outpace that of GDP by an annual average of 1.9 percentage points.  This projected differential in growth rates is smaller than the 2.7 percentage-point average difference experienced over the past 30 years, but wider than the average differential (0.3 percentage point) observed for 2004 through 2006. </font></p> </ul> <ul> <p><font size="2" face="Arial">Growth in private health expenditures, which includes out-of-pocket and private health insurance spending, is expected to rebound to 6.3 percent in 2007 following the somewhat slow growth of 5.4 percent in 2006 that was related to the implementation of Medicare Part D.  Private spending growth is expected to peak in 2009 at 6.6 percent, then decelerate through 2017 in response to projected slower economic growth in the latter years of the projection period. </font></p> </ul> <ul> <p><font size="2" face="Arial">Prescription drug spending growth is expected to slow to 6.7 percent in 2007 (from 8.5 percent in 2006), driven largely by slower drug price growth.  For 2008 through 2017, prescription drug spending is projected to accelerate due in part to the projected leveling off of growth in the generic dispensing rate and evolving treatment guidelines that call for earlier introductions of pharmacotherapy.  The Medicare Part D benefit, on the other hand, is expected to have very little impact on total national health expenditure growth through 2017, as per capita spending growth for Medicare beneficiaries is expected to be identical to that of the rest of the population.    </font></p> </ul> <ul> <p><font size="2" face="Arial">Medicare spending growth is expected to slow to 6.5 percent in 2007, following the 18.7 percent growth experienced in 2006.  Nearly all the projected slowdown in growth for Medicare in 2007 is related to the new spending that was devoted to the Medicare Part D benefit in 2006, spending that simply continues into 2007 and is no longer new to the program.  Also contributing modestly to the projected slowdown are reduced increases in Medicare Advantage plan payments for 2007 as a result of risk adjustments made to these payments.  In the latter years of the projection, Medicare growth is expected to accelerate, reaching 8.0 percent by 2017, as the baby boom generation begins to enroll in the program. </font></p> </ul> <ul> <p><font size="2" face="Arial">For more information regarding the health care spending projection data, please visit </font><a href="http://www.cms.hhs.gov/NationalHealthExpendData/03_NationalHealthAccountsProjected.asp" target="_blank"><font color="#0000FF" size="2" face="Arial"><u>http://www.cms.hhs.gov/National<WBR>HealthExpendData/03_NationalHea<WBR>lthAccountsProjected.asp</u></font></a><font size="2" face="Arial">.</font></p> </ul> <ul type="DISC"> <li><font size="2" face="Arial">U.S. Health and Human Services Secretary Michael Leavitt called for mandated electronic prescribing for Medicare patients at the 2008 HIMSS Conference in Orlando on Feb. 26.  He also indicated mandates on use of electronic health records under Medicare are a distinct possibility. </font></li> </ul> <ul> <p><font size="2" face="Arial">Electronic prescribing can enable physicians to access formulary data at the point of care and prescribe appropriate but less expensive drugs. During his keynote address, Leavitt said that inefficient and expensive practices are unsustainable and systems that encourage such practices must be reformed.  He also suggested that payers like Medicare must help physicians adopt IT. </font></p> </ul> <ul> <p><font size="2" face="Arial">The Centers for Medicare and Medicaid Services is ramping up a demonstration program under which up to 1,200 small- and medium-sized primary care practices would receive Medicare incentive payments for adopting certified EHRs. </font></p> </ul> <ul type="DISC"> <li><font size="2" face="Arial">On Feb. 27, 2008, the Centers for Disease Control and Prevention (CDC) announced it has expanded the recommended ages for annual influenza vaccination of children to include all children from 6 months through 18 years of age.  The previous recommendation was for vaccination of children from 6 months to 59 months of age. The expanded recommendation is to take effect as soon as feasible, but no later than the 2009  2010 influenza season.</font></li> </ul> <ul> <p><font size="2" face="Arial">The Advisory Committee on Immunization Practices (ACIP), which advises the CDC on vaccine issues, voted on the new recommendation during its February 27-28, 2008, meeting in Atlanta. The new recommendation increases the number of children recommended for vaccination by approximately 30 million.</font></p> </ul> <ul> <p><font size="2" face="Arial">Studies have shown that healthy children bear a significant burden from influenza disease and are at increased risk of needing influenza-related medical care. In addition, there is evidence showing that reducing influenza transmission among children has the potential to reduce influenza among their household contacts and within the community.</font></p> </ul> <ul> <p><font size="2" face="Arial">The ACIP continues to recommend vaccination of all children who have certain chronic medical conditions such as asthma, diabetes, kidney disease or weakened immune systems. In addition, vaccinating children younger than 5 years old should continue to be a priority because they are at higher risk for more severe influenza complications compared to older children. Household contacts of children younger than 6 months old should be vaccinated because children younger than six months cannot be given influenza vaccine, but they are the pediatric group at highest risk of influenza complications.</font></p> </ul> <ul> <p><font size="2" face="Arial">In addition, results from a vaccine efficacy study among children 6 months to 23 months of age were presented at the meeting. The study findings indicated vaccine efficacy of about 75 percent in preventing influenza hospitalizations among fully vaccinated children in this age group during the 2005-06 and 2006-07 seasons. In contrast, the study found that children who received only one dose of vaccine did not receive statistically significant protection. This new data underscores the importance of existing ACIP recommendation that children younger than nine years of age who will be receiving the influenza vaccine for the first time need two doses. </font><a href="http://www.cdc.gov/od/oc/media/pressrel/2008/r080227.htm" target="_blank"><font color="#0000FF" size="2" face="Arial"><u>http://www.cdc.gov/od/oc/media<WBR>/pressrel/2008/r080227.htm</u></font></a></p> </ul> <ul type="DISC"> <li><font size="2" face="Arial">In a multi-site trial conducted by the National Institutes of Health&#39;s National Institute of Mental Health (NIMH), researchers found that teens with difficult-to-treat depression who do not respond to a first antidepressant medication are more likely to get well if they switch to another antidepressant medication and add psychotherapy rather than just switching to another antidepressant.  The results of the Treatment of SSRI-resistant Depression in Adolescents (TORDIA) trial were published in the </font><a href="http://jama.ama-assn.org/cgi/content/full/299/8/901" target="_blank"><font color="#0000FF" size="2" face="Arial"><i><u>Journal of the American Medical Association</u></i></font></a><font size="2" face="Arial"><i> </i> .</font></li> </ul> <ul> <p><font size="2" face="Arial">Adolescents with treatment-resistant depression have unique needs, for which standard treatments do not always work.</font></p> </ul> <ul> <p><font size="2" face="Arial">TORDIA was conducted at six regionally dispersed clinics with 334 adolescents ages 12 to 18. The teens in the study all had major depression and had not responded to a previous two-month course of a selective serotonin reuptake inhibitor (SSRI), a type of antidepressant. The teens were randomly assigned to one of four interventions for 12 weeks:</font></p> </ul> <ul> <ul type="DISC"> <li><font size="2" face="Arial">Switch to another SSRI paroxetine (Paxil), citalopram (Celexa) or fluoxetine (Prozac) </font></li> <li><font size="2" face="Arial">Switch to a different SSRI plus cognitive behavioral therapy (CBT), a type of psychotherapy that emphasizes problem-solving and behavior change </font></li> <li><font size="2" face="Arial">Switch to venlafaxine (Effexor) another type of antidepressant called a serotonin and norepinephrine reuptake inhibitor (SNRI) </font></li> <li><font size="2" face="Arial">Switch to venlafaxine plus CBT </font></li> </ul> </ul> <ul> <p><font size="2" face="Arial">The researchers chose to compare SSRIs with an SNRI because some studies on adults have found that venlafaxine is more effective than an SSRI in managing treatment-resistant depression.</font></p> </ul> <ul> <p><font size="2" face="Arial">About 55 percent of those who switched to either type of medication and added CBT responded, while 41 percent of those who switched to another medication alone responded. There were no differences in response between those who switched to an SSRI and those who switched to an SNRI, nor were there differences in response among the three SSRIs tested. </font></p> </ul> <ul> <p><font size="2" face="Arial">Unlike similar studies on adolescent depression, TORDIA did not exclude teens who were thinking about suicide or had attempted suicide. They were included so that TORDIA would mirror real-world treatment situations, and its findings would be readily applicable to community settings. </font></p> </ul> <ul> <p><font size="2" face="Arial">More than half of the participants expressed suicidal thinking and behavior (suicidality) before treatment began, and all teens were monitored weekly for side effects related to suicidality and predictive symptoms like hostility and irritability. </font></p> </ul> <ul> <p><font size="2" face="Arial">None of the TORDIA treatment groups, however, showed any measurable effects on suicidality, a finding consistent with other studies that have discovered suicidality does not necessarily subside when the depression does. The researchers reiterated the need for new treatments that specifically prevent or alleviate suicidality.</font></p> </ul> <ul> <p><font size="2" face="Arial">The findings echo those of the </font><a href="http://www.nimh.nih.gov/health/trials/practical/tads/index.shtml" target="_blank"><font color="#0000FF" size="2" face="Arial"><u>NIMH-funded Treatment for Adolescents with Depression Study (TADS)</u></font></a><font size="2" face="Arial">, which concluded that depressed teens benefited most from a combination of medication and psychotherapy over both the short and long terms. They are also consistent with results from the NIMH-funded </font><a href="http://www.nimh.nih.gov/health/trials/practical/stard/index.shtml" target="_blank"><font color="#0000FF" size="2" face="Arial"><u>Systematic Treatment Alternatives to Relieve Depression (STAR*D)</u></font></a><font size="2" face="Arial"> study, which showed that adults with persistent depression can get well after trying several treatment strategies.</font></p> </ul> <ul type="DISC"> <li><font size="2" face="Arial">The U.S. Food and Drug Administration (FDA) approved Nexium (esomeprazole magnesium) for short-term use in children ages 1-11 years for the treatment of gastroesophageal reflux disease (GERD). The agency approved Nexium in two forms, a delayed-release capsule and liquid form. Nexium is approved in 10 milligrams (mg) or 20 mg daily for children 1 to11 years old compared to 20 mg or 40 mg recommended for pediatric patients 12 to 17 years of age.</font></li> </ul> <ul> <p><font size="2" face="Arial">Nexium, manufactured by AstraZeneca of Wilmington, Del., is part of a class of drugs known as proton pump inhibitors (PPIs). PPIs decrease the amount of acid produced in the stomach and help heal erosions in the lining of the esophagus known as erosive esophagitis. </font></p> </ul> <ul> <p><font size="2" face="Arial">FDA approved the use of Nexium in patients 1 to 11 years for short-term treatment of GERD based upon the extrapolation of data from previous study results in adults to the pediatric population, as well as safety and pharmacokinetic studies performed in pediatric patients. </font><a href="http://www.fda.gov/bbs/topics/NEWS/2008/NEW01802.html" target="_blank"><font color="#0000FF" size="2" face="Arial"><u>http://www.fda.gov/bbs/topics<WBR>/NEWS/2008/NEW01802.html</u></font></a> <br> </p> </ul> <ul type="DISC"> <li><font size="2" face="Arial">The Robert Wood Johnson Foundation announced it has formed a two-year, national commission that will focus on factors beyond the health care system to improve health care for all Americans. </font></li> </ul> <ul> <p><font size="2" face="Arial">The <i>Commission to Build a Healthier America,</i> a national, independent and nonpartisan health commission, will focus on factors outside the health care system and identify non-medical, evidence-based strategies both short- and long-term to improve the health of all Americans. The 14-member commission will investigate how factors, such as education, environment, income and housing, shape and affect personal behavioral choices through an extensive inquiry that will include regional field hearings. The commission members represent a diverse group of innovators and experts with the ability to cross traditional boundaries, mobilize partners to action and identify practical, timely solutions.</font></p> </ul> <ul> <p><font size="2" face="Arial">Mark McClellan, former CMS administrator who now serves as a director at the Brookings Institution in Washington, will co-chair the commission with Alice Rivlin, a former director of