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FEDERAL HEALTH UPDATE

May 9, 2008

Produced by Kate Connelly Theroux in collaboration with the U.S. Medicine Institute for Health Studies (USMI)

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Congressional Schedule

  • The House Veterans Affairs Committee held a hearing on May 6, 2008, to examine the rise in suicides among the veteran population, especially those returning from Iraq and Afghanistan.  Chairman Bob Filner called for VA Secretary James Peake to remove Under Secretary for Health Dr. Michael Kussman and Dr. Deputy Chief Patient Care Services Officers for Mental Health Dr. Ira Katz from their positions at the VA for their role in allegedly obfuscating veteran suicide data.  VA Secretary James  Peake and Katz were questioned on the veracity of previous testimony regarding the Department’s knowledge of problems among veterans.  Secretary Peake said he couldn’t verify whether the VA’s numbers were accurate but described the efforts the VA has taken to address the problem.

Military Health Care News

  • TRICARE Management Activity (TMA) announced it has expanded coverage for active duty service members (ADSMs) who are stationed overseas.  TMA has directed the TRICARE Global Remote Overseas (TGRO) contractor, International SOS, to assist ADSMs with emergency and urgent care needs — even if they are in the vicinity of Military Treatment Facilities (MTFs) overseas.

    Previously, if an ADSM needed urgent care and was within 40 miles or an hour’s drive of an MTF, the MTF was the only option.  Urgent care is medical attention for a condition that, while not life or limb threatening, could become more serious if not treated.

    The MTF still has the first right of acceptance for urgent care cases and the TGRO contractor will contact the MTF before arranging urgent care to determine if the service member can be seen there instead.  The TRICARE access standard for urgent care is 24 hours.

    In emergencies, ADSMs overseas are advised to go directly to the nearest emergency care facility or contact the TGRO Alarm Center to seek immediate emergency assistance.  If the TGRO was not notified in advance, the ADSM should contact the TGRO Alarm Center to coordinate the claims payment while still in the emergency room, if possible .

    If the ADSM is admitted to the facility, the TGRO contractor will coordinate with the ADSM’s enrolled MTF or with the nearest available MTF, whichever is appropriate, to determine whether the patient should be transferred to another facility.  The TGRO contractor will also coordinate emergency transport.

    ADSMs within 40 miles or one hour’s drive of an MTF should contact the MTF when seeking urgent care services.  However, ADSMs who are unsure of an MTF location or are not near an MTF may contact the TGRO Alarm Center for assistance.  If an MTF is nearby, the TGRO contractor will routinely check with the MTF first to see if it can provide the needed care.

    The TGRO contractor does not operate in the Commonwealth of Puerto Rico.  Active duty service members serving in Puerto Rico should contact the TRICARE Puerto Rico Prime Call Center for emergency and urgent care assistance.

  • In a news release, TRICARE Management Activity (TMA) highlighted the memorandum of agreement (MOA) between the Department of Defense (DoD) and the Department of Veterans Affairs (VA) that coordinates specialty care with VA medical facilities for health care and rehabilitative services for eligible active duty service members who sustain spinal cord injury, traumatic brain injury, or blindness.

    In 2006, an average of 316 service members per month received care as a result of the MOU. In 2007, that number increased to 438 per month, and in the first quarter of 2008 about 504 service members per month received care.  Those figures include inpatient and outpatient care.

    DoD military treatment facilities (MTF), VA medical centers (VAMC), VAMC staff, and the TMA Military Medical Support Office (MMSO) all work closely to determine when a service member should be referred to a VA facility for care.  MMSO works with MTF and VAMC staff to facilitate the healthcare authorizations needed to ensure timely admission of eligible service members to VA facilities.

    Ideally, the injured service member will be treated at the VA facility that is as close as possible to family and home.  Service members may be eligible for care under the MOA regardless of whether they have been seriously injured on the battlefield or in an accident while they are off-duty, such as a car accident or a serious fall.

  • The American College of Physician Executives recently awarded Fellowship, one of its highest levels of achievement, to Army Maj. Gen. Elder Granger, MD, CPE, FACPE.  

    Granger is the deputy director of TRICARE Management Activity.

    ACPE’s board of directors honored Dr. Granger for demonstrating significant and enduring contributions to the advancement of medical management. 

    ACPE is the nation’s largest organization of physicians in health care leadership. A non-profit organization, the college is recognized by the American Medical Association as the specialty society representing physicians in management and holds a seat in the AMA House of Delegates.  http://www.tricare.mil/pressroom/news.aspx?fid=400

  • The TRICARE Management Activity published a proposed rule in the Federal Register on May 5, 2008, to implement the statutory provision in 10 United States Code that TRICARE payment methods for institutional care be determined to the extent practicable in accordance with the same reimbursement rules as those that apply to payments to providers of services of the same type under Medicare. This proposed rule implements a reimbursement methodology similar to that furnished to Medicare beneficiaries for services provided by critical access hospitals (CAHs).
  • The Chairman of the Joint Chiefs of Staff, Navy Adm. Mike Mullen, established the Joint Staff Wounded Warrior Integration Team in late April to examine the broad range of care and support services for wounded warriors, identify any gaps, and implement as best practices ones that should be shared across the force.   Mullen appointed his strategic plans and policy chief, Marine Lt. Gen. John F. Sattler, to lead the new team.

    The team will evaluate all programs that affect wounded warriors and their families to see which are working best, which can be improved, and how to make the services more accessible.

    The  team consists of experts from the legal, legislative affairs, public affairs and personnel fields, as well as commanders with recent combat experience. The variety of perspectives reflects the intent of making it the best we can for our men and women. http://www.defenselink.mil/news/newsarticle.aspx?id=49809

Veterans Health Care News  

  • On May 7, 2008, the Department of Veterans Affairs (VA), in collaboration with a Department of Defense and the Department of Health and Human Services, announced the establishment of the new joint Federal Recovery Coordinator Program office. 

    The joint Federal Recovery Coordinator Program is designed to cut across bureaucratic lines and reach into the private sector as necessary to identify services needed for seriously wounded and ill service members, veterans and their families.

    A key recommendation of a Presidential commission chaired by former Sen. Bob Dole and former Health and Human Services Secretary Donna Shalala, the recovery coordinators do not directly provide care but coordinate federal health care teams and private community resources to achieve the personal and professional goals of an individualized "life map" or recovery plan developed with the service members or veterans who qualify for the federal recovery coordinator program.

    The VA is coordinating the recovery coordinators’ office and has appointed Ginnean Quisenberry to be the director.  The team consists of six field staff members who are actively working with 85 patients at three major military treatment facilities, with four additional coordinators expected to be appointed soon.

    Currently the federal recovery coordinators are based at three military hospitals most likely to receive severely wounded service members evacuated from the combat theater: Walter Reed Army Medical Center in Washington, National Naval Medical Center in Bethesda, Md., and Brooke Army Medical Center in San Antonio.

    A fourth site, Naval Medical Center San Diego, will receive two of the additional four field staff expected to be appointed soon.

    Though initially based in military facilities, the coordinators’ work extends into the patient's civilian life after discharge. Coordinators actively link the veteran with public and private resources that will meet their rehabilitation needs after being release from the military hospitals.

    Participating patients will include those with seriously debilitating burns, spinal cord injuries, amputations, visual impairments, traumatic brain injuries and post-traumatic stress disorder.

    While initially focused in early stages for current military hospital inpatients, the FRCP involvement is expected to be a lifetime commitment to veterans and their families.  The coordinators will maintain contacts by phone, visits and e-mail.

    When a veteran settles in a remote area, VA will be able to use multimedia systems that integrate video and audio teleconferencing so that veterans may visit a federal clinic or private center near their homes to link up with their case coordinator for a meeting.  http://www1.va.gov/opa/pressrel/pressrelease.cfm?id=1499

  • The Department of Veterans Affairs (VA) announced it will continue to provide services at its four Boston-area campuses—Bedford, Brockton, Jamaica Plain, and West Roxbury.  

    In 2006, former VA Secretary James Nicholson rejected consolidation of all Boston health care services at one location, but selected for further study the possibility that Bedford’s services could be moved to the Brockton campus and that VA’s Jamaica Plain and West Roxbury might be consolidated. 

    These options were investigated thoroughly, along with another more limited transfer of Bedford’s services to Brockton that would have retained nursing home and outpatient services at the Bedford campus.  VA’s review of these options found there was no convincing data that consolidations would significantly improve quality of care, access, or achieve significant financial savings at this time.  

    VA will continue to strategically plan for the needs of veterans in the Boston area, taking into account veteran population trends, enrollment projections and changes in demographics of veteran health care needs and utilization.  http://www1.va.gov/opa/pressrel/pressrelease.cfm?id=1498

  • The Department of Veterans Affairs (VA) is awarding a grant of $12,675,000 for improvements at the state veterans home in Sulphur, Okla.

    The VA grant, for safety renovations, covers 65 percent of the cost of the project, which includes construction and purchase of equipment.  Total cost of the upgrades is $19.5 million.  Most residents receive nursing care.

    Oklahoma has seven veterans centers providing intermediate to skilled nursing care and domiciliary care for wartime veterans and their spouses.  The centers are located in Ardmore, Claremore, Clinton, Lawton, Norman, Sulphur and Talihina. The Sulphur Veterans Center is located on 17 acres in Southern Oklahoma, overlooking the scenic Chickasaw National Recreation Area.  http://www1.va.gov/opa/pressrel/pressrelease.cfm?id=1497 

Health Care News

  • The Centers for Medicare and Medicaid Services (CMS) announced a new project that expands its efforts to encourage beneficiaries covered by traditional Medicare to take advantage of Internet-based resources to track their health care services and better communicate with their providers. 

    The CMS pilot uses an on-line tool called a Personal Health Record (PHR) to give Medicare beneficiaries the ability to collect and then access information about their health or health care services, such as medical conditions, hospitalizations, doctor visits and medications, and to collect information about their health.  CMS is ensuring that strict privacy and security safeguards are in place to protect all beneficiary data.    

    The pilot test will take place in South Carolina, where beneficiaries will be given an opportunity to use a PHR populated by their own Medicare claims data.  Key information from hospital and provider medical claims will be automatically entered into the PHR once the individual registers and requests the data.  Prescription drug information, even for individuals who participate with a Part D Drug Plan, will not be automatically entered into the PHR, but the individual may choose to enter his or her own prescription drug and over-the-counter medications into the PHR.

    A PHR is a record of health information that is under the control of the consumer or patient.  Sometimes it contains only data entered by the individual or his or her provider, but it can also include information from a health plan – as is the case in this pilot, where Medicare provides information from its claims database.  A PHR is different from an electronic health record (EHR), which is owned by and under the control of the physician.

    The beneficiary also will control who is able to see the information in the PHR, and will decide whether and with whom the information can be shared – from health care providers to caregivers and family members.  

    The pilot, which began on April 4, 2008, is expected to run for 12 months, and CMS will use information gathered from the pilot to determine future steps with respect to PHRs. 

    The PHR tool selected for this pilot is offered by HealthTrio, which currently offers PHRs to thousands of individuals through employer contracts.  The Medicare data will be provided through Palmetto GBA, a Medicare contractor serving the region, which includes South Carolina.  The pilot is being managed by QSSI, headquartered in Gaithersburg, Maryland, and is called “MyPHRSC,” where the “SC” stands for South Carolina.  The pilot is accepting enrollment online at www.MyPHRSC.com  and at local events in South Carolina.

    The South Carolina PHR pilot follows another initiative launched in June of 2007, in which CMS is collaborating with seven health plans to test the use of PHRs for beneficiaries who are enrolled in a Medicare Advantage or Part D Prescription Drug Plan. CMS NR 05-07-08

  • The Centers for Medicare and Medicaid Services (CMS) awarded a $148 million contract to National Heritage Insurance Corporation (NHIC) for five years for the combined administration of Part A and Part B Medicare claims payment in Alaska, Idaho, Oregon and Washington. 

    NHIC will serve as the first point of contact for the processing and payment of Medicare fee-for-service claims from hospitals, skilled nursing facilities, physicians and other health care practitioners in the four states.  The new Part A/Part B Medicare Administrative Contractor (A/B MAC) was selected using competitive procedures in accordance with federal procurement rules.

    The new contractor will take claims payment work now performed by two fiscal intermediaries and one carrier in the four states. The A/B MAC contract will fulfill the requirements of the Medicare Modernization Act’s (MMA) contracting reform provisions.

    Under the current system, fiscal intermediaries process claims for Medicare Part A providers, such as hospitals, skilled nursing facilities and other institutional providers.  Carriers process claims for physicians, laboratories and other practitioners under Medicare Part B. 

  • The Substance Abuse and Mental Health Services Administration (SAMHSA) appointed nine new members to the Advisory Committee for Women’s Services (ACWS).  The committee, established in 1992, meets twice yearly and advises, consults with and makes recommendations to the associate administrator for women’s services, the SAMHSA administrator and the U.S. Department of Health and Human Services regarding activities and policies with respect to women’s substance abuse and mental health services. 
  • In an unprecedented initiative, U.S. and Canadian experts have developed a comprehensive framework to optimize and manage critical care resources during times of pandemic outbreaks or other mass critical care disasters. The new proposal suggests legally protecting clinicians who follow accepted protocols for the allocation of scarce resources when providing care during mass critical care events. The framework represents a major step forward to uniformly deliver sufficient critical care during catastrophes and maximize the number of victims who have access to potential life-saving interventions.

    Published as a supplement to the May issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians (ACCP), Definitive Care for the Critically Ill During a Disaster offers guidance for hospitals, medical professionals, and public health authorities on how to prepare for and provide essential critical care when the need for critical care resources far exceeds availability.

    To prepare for a mass critical care event, the task force proposes that hospitals with ICUs aim to meet several standards, including the ability to provide sufficient critical care for at least triple their usual ICU capacity and sustain this surge for up to 10 days without external assistance. Suggested surge capacity requirements include stockpiling medical equipment, including mechanical ventilators; optimizing medication; designating auxiliary critical care areas; and augmenting critical care staff.

    Prior to the rationing of critical care resources, hospitals and surrounding areas must first experience a "trigger" event that includes a declared state of emergency and lack of critical equipment or infrastructure. The decision to initiate EMCC must occur in conjunction with local and regional Medical Emergency Operations Command authority and not by individual hospitals.

    The task force advises rationing scarce critical care resources only after surge capacity has been exceeded and all attempts to use outside resources have been made. Under these circumstances, the task force proposes a formal EMCC triage and resource allocation protocol.

    EMCC protocol allows the triage officer and supporting triage team to make decisions that benefit the greatest number of patients with potentially limited resources. Consequently, lifesaving care may be withheld from one patient and given to another, prompting ethical and legal implications. To reassure critical care providers and ensure consistent allocation of critical care resources, the task force advocates legal protection of health-care professionals and institutions that follow accepted EMCC protocols while providing care during times that require critical care resource rationing. Government endorsement of a protocol for EMCC triage and resource allocation ideally would shield practitioners and institutions acting in good faith from liability.

    The task force consists of 37 senior-level participants with broad expertise relevant to EMCC representing military medicine, medical societies and institutions, and government agencies, including the Centers for Disease Control and Prevention and the U.S. Department of Health and Human Services. The task force also includes members of the Critical Care Collaborative (CCC), a group of medical professional societies who collectively represent more than 100,000 health-care professionals. Members of the CCC include the American College of Chest Physicians, the American Association of Critical-Care Nurses, Society of Hospital Medicine and the American Society of Health-System Pharmacists. http://www.sciencedaily.com/releases/2008/05/080505072809.htm

  • The Centers for Medicare and Medicaid Services (CMS) issued a final National Coverage Determination (NCD) expanding Medicare coverage of artificial hearts when they are implanted as part of a study that is approved by the Food and Drug Administration (FDA) and that meets CMS’ Coverage with Evidence Development (CED) clinical research criteria.

    Artificial hearts are used in patients with severe heart failure who are at imminent risk of death.  Heart failure affects more than 5 million patients in the United States.  Over 500,000 new cases are diagnosed annually and more than 50,000 heart failure patients die from the disease every year.

    Artificial hearts can be used so that a patient will live until a donor heart becomes available for transplant or, for patients who cannot receive transplants, to extend their lives.  Since the device requires that a portion of the patient’s heart be removed, an artificial heart patient must be supported by the device through the end of life or until heart transplantation. 

    The use of artificial heart technology has not been available to Medicare beneficiaries because of a 1986 non-coverage policy.  Since the 1986 policy, two artificial heart device manufacturers have conducted clinical trials studying the safety and health outcomes of using their devices in these very sick patients.  CMS believes there is now sufficient scientific evidence on the use of artificial hearts to allow coverage of these devices for beneficiaries in the carefully controlled clinical environment of an FDA-approved study.

    This controlled clinical environment is one of the protections afforded beneficiaries under the Coverage with Evidence Development (CED) framework.  CED allows CMS to determine that a technology can be covered when it is provided within a research setting where there are added safety, patient protections, monitoring, and clinical expertise available to the beneficiary. 

    This additional data will develop into new clinical evidence that can assists in the Medicare coverage process. An even more important outcome of this CED framework, however, is the production of evidence that will influence clinical practice and help Medicare beneficiaries and providers make the most appropriate diagnostic and therapeutic decisions.

  • An updated clinical practice guideline released today by the U.S. Public Health Service has identified new counseling and medication treatments that are effective for helping people quit smoking.

    Treating Tobacco Use and Dependence: 2008 Update was developed by a 24-member, private-sector panel of leading national tobacco treatment experts that reviewed more than 8,700 research articles published between 1975 and 2007. The review found that there are now seven medications approved by the Food and Drug Administration as smoking cessation treatments that dramatically increase the success of quitting. The medications are: bupropion SR, nicotine gum, nicotine inhaler, nicotine lozenge, nicotine nasal spray, nicotine patch, and varenicline.

    The 2008 PHS guideline update also found evidence that counseling by itself or especially in conjunction with medication can greatly increase a person's success in quitting. In particular, quit-lines were found to be effective and can reach a large number of people; 1-800-QUIT-NOW, a national quit-line, is an access number that connects people to their state-based quitline. It also provides broad access to cessation counseling for diverse populations and is easy for clinicians and patients to use.

    A consortium of eight federal and private-sector, nonprofit organizations collaborated to sponsor the 2008 PHS guideline update. They are the Agency for Healthcare Research and Quality (AHRQ), which coordinated the update; the Centers for Disease Control and Prevention; the National Cancer Institute; the National Heart, Lung, and Blood Institute; the National Institute on Drug Abuse; the Robert Wood Johnson Foundation; the American Legacy Foundation; and the Center for Tobacco Research and Intervention at the University of Wisconsin School of Medicine and Public Health. In addition, more than 40 broad-based organizations have endorsed the guideline

Reserve/Guard

  • The total number of Guard and Reserve currently on active duty has decreased by 541 from the last report to 100,471. The totals for each service are Army National Guard and Army Reserve, 78,085; Navy Reserve, 5,014; Air National Guard and Air Force Reserve, 8,503; Marine Corps Reserve, 8,522; and the Coast Guard Reserve, 347. www.defenselink.mil

Reports/Policies

  • The GAO published “Medicare: Competitive Bidding for Medical Equipment and Supplies Could Reduce Program Payments, but Adequate Oversight Is Critical,” (GAO-08-767T) on May 6, 2008.  In this report, the GAO described the effects that competitive bidding could have on Medicare program payments and suppliers and the need for adequate oversight to ensure quality and access for beneficiaries in a competitive bidding environment. http://www.gao.gov/new.items/d08767t.pdf
  • The GAO published “Prescription Drugs: Trends in FDA's Oversight of Direct-to-Consumer (DTC) Advertising,” (GAO-08-758T) on May 8, 2008. In this report, the GAO examined DTC advertising materials FDA reviews; FDA's process for issuing regulatory letters citing DTC advertising materials and the number of letters issued; and the effectiveness of FDA's regulatory letters at limiting the dissemination of false or misleading DTC advertising. http://www.gao.gov/new.items/d08758t.pdf
  • The Congressional Budget Office (CBO) and the Joint Committee on Taxation (JCT) released a report “Preliminary Analysis of a Proposal for Comprehensive Health Insurance,” on May 1, 2008.  The letter to Sens. Ron Wyden and Robert Bennett analyzes the modified proposal for comprehensive health insurance based on S. 334, the “Healthy Americans Act.” http://www.cbo.gov/doc.cfm?index=9184

Legislation

  • H.R.5979 (introduced May 6, 2008): To amend the Public Health Service Act to provide for the national collection of data on stillbirths in a standardized manner and for other purposes was referred to the House Committee on Energy and Commerce. 
    Sponsor: Representative Peter T. King [NY-3]
  • H.R.5985 (introduced May 7, 2008): To amend title 38, United States Code, to clarify the service treatable as service engaged in combat with the enemy for utilization of non-official evidence for proof of service-connection in a combat-related disease or injury was referred to the House Committee on Veterans' Affairs. 
    Sponsor: Representative Bruce L. Braley [IA-1]
  • H.R.5989 (introduced May 7, 2008): To direct the Secretary of Health and Human Services to implement a National Neurotechnology Initiative and for other purposes was referred to the House Committee on Energy and Commerce. 
    Sponsor: Representative Patrick J. Kennedy [RI-1]
  • S.2983 (introduced May 6, 2008): A bill to amend the Public Health Service Act to prevent and cure diabetes and to promote and improve the care of individuals with diabetes for the reduction of health disparities within racial and ethnic minority groups, including the African-American, Hispanic American, Asian American and Pacific Islander, and American Indian and Alaskan Native communities was referred to the Committee on Health, Education, Labor, and Pensions. 
    Sponsor: Senator Frank R. Lautenberg [NJ]
  • S.2988 (introduced May 7, 2008): A bill to amend the Public Health Service Act to enhance public and private research efforts to develop new tools and therapies that prevent, detect, and cure diseases was referred to the Committee on Health, Education, Labor, and Pensions. 
    Sponsor: Senator Joseph I. Lieberman [CT]
  • S.2989 (introduced May 7, 2008): A bill to direct the Secretary of Health and Human Services to implement a National Neurotechnology Initiative, and for other purposes was referred to the Committee on Health, Education, Labor, and Pensions. 
    Sponsor: Senator Patty Murray [WA]
  • S.2981 (introduced May 6, 2008): A bill to amend the Servicemembers Civil Relief Act to provide a one-year period of protection against mortgage foreclosures for certain disabled or severely injured servicemembers, and for other purposes was referred to the Committee on Veterans' Affairs. 
    Sponsor: Senator Robert P. Casey, Jr. [PA]
  • S.2984 (introduced May 6, 2008): A bill to amend title 38, United States Code, to expand and enhance veterans' benefits, and for other purposes was referred to the Committee on Veterans' Affairs. 
    Sponsor: Senator Daniel K. Akaka [HI]

Hill Hearings

  • The House Armed Services Committee will hold a hearing on May 14, 2008, to mark up the H.R. 5658, the National Defense Authorization Act of 2009.
  • The Senate Veterans Affairs Committee will hold a hearing on May 21, 2008, to examine pending health care legislation.
  • The House Veterans Affairs Subcommittee on Health will hold a hearing on May 22, 2008, to examine the human resources challenges within VHA.

Meetings / Conferences


If you need further information on any of the items in the Federal Health Update, please contact Kate Connelly Theroux at (703) 447-3257 or by e-mail at kate@usminstitute.org. To subscribe, please visit http://usminstitute.org/subscriber.cfm. To unsubscribe, please send an email to update@usminstitute.org with UNSUBSCRIBE as the subject.

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