FEDERAL HEALTH UPDATE
June 13, 2008Produced by Kate Connelly Theroux in collaboration with the U.S. Medicine Institute for Health Studies (USMI) To subscribe, please visit http://fedhealthinst.org/subscriber.cfm. Sponsored by
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Congressional Schedule
Defense Secretary Robert Gates also recommended to President Bush that Gen. Norton Schwartz be nominated to serve as Air Force chief of staff. Mr. Donley is presently the director of administration and management for the Department of Defense. He is responsible for running the Pentagon and its many complex operations. Previously, Donley served as assistant secretary of the Air Force for financial management, for a period, as acting secretary of the Air Force. Gen Schwartz is presently the commander of U.S. Transportation Command, which is in charge of the Department’s extensive transportation network and world-wide operations. Prior to that, Gen. Schwartz served in senior joint military positions as director of the Joint Staff, director for Operations for the Joint Staff and deputy commander of Special Operations Command. In addition, Gates recommended two additional Air Force military leadership changes:
The video is a new component of the Mental Health Self-Assessment Program, a DoD funded initiative that offers service personnel and their families the opportunity to take anonymous mental health and alcohol self-assessments online, via telephone and at events held at installations worldwide. The program is designed to help individuals identify their own symptoms and access assistance before a problem becomes serious. The self-assessments are available online at http://www.militarymentalhealth.org/ or via the telephone at (877) 877-3647. Since the program was launched in 2006, more than 80,000 screenings have been completed online and over the phone. The video will be distributed to family readiness group leaders, chaplains, military behavioral health clinicians, unit commanders, Reserve unit leaders, as well as other military groups who want to raise awareness and encourage seeking help as an act of strength. The video runs approximately 25 minutes. To view a trailer or the full-length version of the video, visit http://www.mentalhealthscreening.org/military
Section 707 of the John Warner National Defense Authorization Act for FY07, section 1097c to title 10, United States Code still allows employers to offer “cafeteria plans” to TRICARE-eligible employees as long as they are offered to all employees, including those that are not TRICARE-eligible. A “cafeteria plan” is a group health plan under which all employees may choose among two or more qualified benefits under the plan. The legislation was initiated after evidence showed many employers were consciously working to shift their health care costs to the government by offering financial incentives urging eligible employees to use TRICARE rather than the employer’s GHP. It applies to any employer, including states and units of local government with 20 or more employees, and mirrors the same prohibition that currently applies to Medicare. For more information about Section 707 of the John Warner National Defense Authorization Act for FY07, visit http://thomas.loc.gov/cgi-bin/query/F?c109:6:./temp/~c109thKqf5:e641071 http://www.tricare.mil/pressroom/news.aspx?fid=413
In an effort to help alleviate some of the physical and emotional stress facing Montana National Guard members and their families when they are deployed, TriWest Healthcare Alliance and the Montana National Guard are placing behavioral health professionals at Montana National Guard armories in Helena and Great Falls, Mont. Through TriWest’s embedded behavioral health provider program, National Guard members have the opportunity to consult a professional about mental health issues in a confidential, face-to-face setting. The providers will also participate in monthly unit level training and function as part of the unit team. In addition to on-site counseling, providers can also make referrals to qualified local providers who specialize in post-traumatic stress disorder (PTSD), insomnia, grief or marital counseling when necessary or requested by the Service member. The program was established in response to findings from the Post Deployment Health Reassessment Task Force (PDHRA) formed by Montana Governor Brian Schweitzer and Maj. Gen. Mosley. The task force analyzed the Montana National Guard’s current PDHRA program, and identified issues and recommended solutions. To date, approximately 90 percent of the task force’s recommendations have been implemented. Currently, more than 3,600 citizen soldiers comprise the Montana National Guard and 80 percent of them have mobilized in support of the Global War on Terrorism. Readjustment to civilian life following deployment to a war zone is a common issue among Montana’s Guard families. According to the National Center for PTSD, one in six returning service members will develop PTSD or other combat-related stress disorders. Affected service members may suffer memory loss, irritability, depression, trouble sleeping and other challenges within 60 to 90 days after coming home, but these symptoms may occur earlier or later. If left untreated, symptoms could cause serious physical and mental health problems for service members and their families.
Among the issues discussed at the meeting were the facility’s infrastructure needs and space requirements. The VA Nebraska-Western Iowa Health Care System serves more than 172,500 veterans in Nebraska, western Iowa and sections of Kansas and Missouri. The Omaha VA Medical Center offers both inpatient and outpatient primary and specialty care services. The system also operates a nursing home care facility in Grand Island, and community-based outpatient clinics in Lincoln, Grand Island, North Platte, Norfolk and Holdrege. http://www1.va.gov/opa/pressrel/pressrelease.cfm?id=1512
Ralph DeFronzo, M.D., professor and chief of the Division of Diabetes at The University of Texas Health Science Center at San Antonio and the South Texas Veterans Health Care System -- Audie L. Murphy Division, received the Banting Medal for Scientific Achievement Award from the American Diabetes Association (ADA). The award is the organization's most prestigious honor. DeFronzo received the award in recognition of his contributions, which have had a major impact on diabetes research and care over the last 38 years. DeFronzo was the first to prove that individuals with type 2 diabetes are insulin resistant. He led and continues to lead development of new frontline diabetes therapies. He also devised methods to define insulin resistance in the muscle and liver and measure beta cell function (beta cells are the cells in the pancreas that secrete insulin). In September, DeFronzo will be honored in Italy with the Claude Bernard Award, the top award of the European Diabetes Association. This is the first time a single researcher has won both the Banting and Bernard awards in the same year. DeFronzo is also the deputy director of the Texas Diabetes Institute, which provides comprehensive outpatient services for diabetics in neighborhoods with large Hispanic populations and high numbers of individuals with type 2 diabetes. http://www.bizjournals.com/sanantonio/stories/2008/06/09/daily33.html
Much of this growth comes from the ranks of the middle class. While low-income people remain vulnerable, middle-income families have been hit hardest. For adults with incomes above 200 percent of the federal poverty level (about $40,000 per year for a family), the underinsured rates nearly tripled since 2003. The study, How Many Are Underinsured? Trends Among U.S. Adults, 2003 and 2007, was published in Health Affairs on June 10, 2008. The authors analyzed data from the Commonwealth Fund 2007 Biennial Health Insurance Survey, which interviewed adults ages 19 and older from June through October 2007. Respondents were identified as underinsured if they spent 10 percent of more of their income (or five percent if they were low-income) on out-of-pocket medical expenses or if they had deductibles that equaled five percent or more of their income. An estimated 14 percent of all non-elderly adults were underinsured in 2007 and more than one of four were uninsured for all or part of the year. Adding these two groups together, 75 million adults—42 percent of the under-65 population—had either no insurance or inadequate insurance in 2007, up from 35 percent in 2003. The study found that lack of adequate insurance coverage has expanded beyond low-income people to include middle-income population. For those with annual incomes of $40,000 to $59,000, the underinsured percentage rate reached double digits in 2007. In terms of access problems and financial stress, underinsured people—even though they have coverage all year—report experiences similar to the uninsured. More than half of the underinsured (53 percent) and two-thirds of the uninsured (68 percent) went without needed care—including not seeing a doctor when sick, not filling prescriptions and not following up on recommended tests or treatment. Only 31 percent of insured adults went without such care. In addition, about half of the underinsured (45 percent) and uninsured (51percent) reported difficulty paying bills, being contacted by collection agencies for unpaid bills or changing their way of life to pay medical bills. Many reported that they took on a loan, a mortgage against their home or credit card debt to pay their bills. In contrast, only 21 percent of insured adults reported financial stress related to medical bills. For more information about the study, please visit http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=688615
The $15 million will be distributed in June. It is the second of three installments that will total more than $50 million. CMS distributed $36 million to SHIPs on April 1 and will distribute an additional $1.5 million in performance-based awards in September. This funding represents a $20 million increase in SHIP funding over fiscal year 2007. SHIPs are state-based programs that use community-based networks to provide Medicare beneficiaries with local, personalized assistance on a wide variety of Medicare and health insurance topics. A significant accomplishment of the SHIPs has been their success in helping to educate many of the nation’s 44 million Medicare beneficiaries about Medicare as well as their prescription drug coverage options so that they can make a choice about their health care that best meets their needs. CMS expects the SHIPs to use the increased 2008 funding to conduct community-based programs targeted at reaching more beneficiaries who are unable to access other sources of information such as the CMS online tools at www.medicare.gov. SHIPs will continue their outreach and assistance to currently and newly eligible Medicare beneficiaries and their caregivers, as well as reaching out to beneficiaries with limited incomes who may be eligible for the extra help with prescription drug costs. CMS will continue to support the SHIPs in 54 states and territories with training and technical assistance. This will help to ensure that the community networks remain fully capable of accessing and using all of CMS’ regional office resources, as well as the online tools at www.medicare.gov to provide assistance to beneficiaries. CMS NR 06-06-2008
The communities selected to work with the Centers for Medicare and Medicaid Services (CMS) on the EHR demonstration project range from county- and state- level to multi-state collaborations. They include:
These 12 communities were selected through a competitive process from a field of more than 30 applicants. They demonstrated active collaboration among stakeholders, including physicians and other providers, health plans, employers, government and consumers; existing or planned private sector initiatives related to health information technology and quality reporting; and adequate size to recruit a sufficient number of primary care physician practices. They also demonstrated close ties to the medical community and ability to work closely with CMS to recruit physician practices to participate in the demonstration. Over the five-year demonstration project, financial incentives will be provided to as many as 1,200 primary care physician practices in the selected communities that use certified EHRs to improve quality as measured by their performance on specific clinical quality measures. In addition to the incentive payments, bonus payments may be awarded based on a standardized survey measuring the number of EHR functionalities a physician group has incorporated into its practice. Total payments under the demonstration for all five years may be up to $58,000 per physician or $290,000 per practice. Findings from the demonstration will help determine the role of EHRs in delivering high-quality care and reducing errors. The demonstration will also assess the role of incentive payments in encouraging adoption and use of EHRs. The project will be implemented in two phases. CMS will begin working with partners in four Phase I communities over the coming months to develop site-specific recruitment strategies, and recruitment of physician practices will start in the fall. For Phase II sites, these activities will begin in 2009. To learn more about Connecting to Better Health Care, please visit www.hhs.gov/secretary/connecthealthcare.
Under the budget amendment, FDA will be able to expedite steps to improve import safety, including:
The increase brings the Administration’s total proposed increase in the FDA's budget for FY 2009 to $404.7 million -- a 17.8 percent boost in funding from FY 2008. Some new authorities requested for federal agencies in the Action Plan for Import Safety that Congress has not yet granted include:
The budget amendment proposes an increase to allow FDA to intensify actions to implement FDA’s Food Protection Plan. Announced on Nov. 6, 2007, the Food Protection Plan is an integrated, risk-based strategy to help ensure the safety of domestic and imported food and feed. The $125 million increase adds to the $42.2 million increase proposed for food protection in the budget announced in February 2008. The proposal also increases the FDA’s medical product programs by $100 million to strengthen FDA’s ability to ensure the safety and effectiveness of medical products--from product development and pre-approval testing, through approval, and post-approval safety surveillance. The budget amendment also proposes increases to strengthen FDA’s capacity to support product safety and development in areas of emerging science such as nanotechnology, cell and gene therapies, robotics, genomics, advanced manufacturing, and the critical path initiative. FDA will also improve laboratories and other facilities that are essential to carrying out FDA’s mission and invest in science training, professional development, and fellowship programs to strengthen and modernize the FDA workforce. The program increases listed above include $65 million to modernize FDA’s information technology infrastructure. Additional information is available online at: www.importsafety.gov; www.fda.gov; and http://www.fda.gov/oc/initiatives/advance/food.html.
CMS is current sending letters to eligible beneficiaries, which includes a brochure about the new program and a list of Medicare contract suppliers in their area. CMS is also sending similar information about the new program and the list of Medicare contract suppliers to local partner groups and durable medical equipment (DME) referral agents, such as hospital discharge planners, physicians’ office staff and home health agency social workers. The ten Round One communities include certain ZIP codes in the areas of Charlotte, N.C.; Cincinnati and Cleveland, Ohio; Dallas/Fort Worth, TX; Kansas City KS-MO; Miami and Orlando, Fla.; Pittsburgh, Pa.; Riverside, Calif. and San Juan, Puerto Rico. The new program, required by the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA), uses the competitive marketplace to establish prices for certain durable medical equipment, prosthetics, orthotics and supplies. Under the new program, bids submitted by suppliers were evaluated and the bids within the winning range established the competitive prices that beneficiaries – and Medicare – will pay. Suppliers who were accredited, met financial and quality standards and bid within the winning range were offered contracts under the competitive bidding program. By using these selected contract suppliers, Medicare beneficiaries should receive high quality items at an average saving of 26 percent from approved suppliers. To take advantage of these savings, most people with Medicare who live in one of these areas and are enrolled in original Medicare may choose a new supplier if their current supplier is not a contract supplier. Beneficiaries can choose to continue to rent certain durable medical equipment, such as oxygen equipment and hospital beds, from their current suppliers even if they are not a contract supplier. But in those cases, the supplier must become a grandfathered supplier. Beneficiaries may continue using the grandfathered supplier until the rental period for their equipment ends (at which point the beneficiary takes ownership of the item) or beneficiaries may switch to a contract supplier. Beneficiaries renting equipment from a non-contract supplier that is not a grandfathered supplier should be aware that the current supplier should pick up the equipment and then the beneficiaries should switch to a Medicare contract supplier if they want Medicare to continue to pay for the items. The beneficiary can contact a new contract supplier to arrange for delivery of new items. If beneficiaries do not hear from their supplier before July 1 and they live in a covered area, they should contact their supplier or Medicare to find out if the supplier intends to continue services as a grandfathered supplier. Beneficiaries and the general public can find a list of Medicare contract suppliers in the ten initial areas of the program by visiting www.medicare.gov or by calling 1-800-MEDICARE. CMS NR 06-09-2008
The 2006 age-adjusted death rate fell to 776.4 deaths per 100,000 from 799 deaths per 100,000 in 2005, the CDC report said. In addition, death rates for eight of the 10 leading causes of death in the United States all dropped significantly in 2006. These included a very sharp drop in mortality from influenza and pneumonia. The preliminary infant mortality rate for 2006 was 6.7 infant deaths per 1,000 live births, a 2.3 percent decline from the 2005 rate of 6.9. The data are based on over 95 percent of death certificates collected in all 50 states and the District of Columbia as part of the National Vital Statistics System. The report, “Deaths: Preliminary Data for 2006” is available at www.cdc.gov/nchs.
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If you need further information on any of the items in the Federal Health Update, please contact Kate Connelly Theroux at (703) 447-3257 or by e-mail at katetheroux@fedhealthinst.org. To subscribe, please visit http://fedhealthinst.org/subscriber.cfm. To unsubscribe, please send an email to newsletter@fedhealthinst.org with UNSUBSCRIBE as the subject. Back issues availiable at Federal Health Update Archives. |
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