FEDERAL HEALTH UPDATE
August 1, 2008Produced by Kate Connelly Theroux in collaboration with the Institute of Federal Health Care (IFHC) To subscribe, please visit http://fedhealthinst.org/subscriber.cfm. Sponsored by
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Congressional Schedule
TRICARE reimbursement rates are tied by statute to Medicare. While maximum reimbursements rates are limited by law, regional contractors use incentives such as good customer service, expedited payments and patient volume to encourage providers to join the TRICARE network. More than 325,000 providers are currently in the TRICARE network with more than a million providers accepting TRICARE beneficiaries. The Department of Defense Survey of Civilian Physician Acceptance of TRICARE Standard showed that in Fiscal Year 2007 almost 93 percent of responding physicians in 53 areas were aware of the TRICARE program. Almost 85 percent of those physicians accepted new TRICARE Standard patients. To see how provider networks have grown within the last year, visit http://tricare.mil/tma/Announcement-07-04-2008.aspx.
TriServ Alliance, LLC, is an independent, community-based company established in anticipation of providing access to health care services to TRICARE beneficiaries in the South Region, which includes Alabama, Arkansas, Florida, Georgia, Kentucky (Fort Campbell only), Louisiana, Mississippi, Oklahoma, South Carolina, Tennessee and Texas (excluding certain areas of Western Texas). http://www.earthtimes.org/articles/show/triserv-alliance-submits-bid-for-tricare-south-region-contract,486529.shtml
In his new role at BearingPoint, Aument will strengthen the firm's team helping the DoD and VA provide critical benefits and services to service members, veterans and their families. As deputy under secretary from 2004 to 2008, Aument served in the capacity of chief operating officer of the VA organization charged with delivering financial benefits to veterans and their families through five business lines, including programs for disability compensation and income security, educational assistance, home loan guaranties, life insurance, and vocational rehabilitation and employment. Annual benefits payments for the five programs totaled more than $45 billion in 2007. From 2000 to 2004, Aument was the VA's deputy chief of staff, supporting the department's diverse mission of providing healthcare, financial benefits, and burial and memorial services to veterans and their families. Prior to 2000, Aument held other leadership, operational and financial management positions during his 35-year distinguished career with the Department. The firm's federal health care clients include the U.S. Army Medical Department, TRICARE Management Activity, U.S. Army Medical Research & Material Command, Navy Bureau of Medicine and Surgery, the Department of Veterans Affairs, and various agencies throughout the Department of Health and Human Services, including the Office of the Secretary and Office of the National Coordinator for Health Information Technology.
Bersin & Associates is a research and advisory services firm focused on research in enterprise learning and talent management. The recently published study examined and identified best practices in the management, organization, operations and governance of corporate training. Of more than 800 companies participating in the study, TriWest is well within the top 10 percent that met Bersin’s research-based criteria for the effective use of learning and development to create business impact. The study identifies the top 18 learning strategies that have highest business impact and 50 key characteristics of a high-impact learning culture. The study included researching TriWest’s Leadership Training and Development, and Human Resources departments. TriWest is listed in Bersin & Associate’s 2008 High Impact Learning Organization Study, which serves as a guidebook for training professionals on how to drive business impact and adapt to the new environment of talent-driven learning. The more-than-300-page report is composed of data providing in-depth analysis, benchmarking and best practices on the 29 critical areas that drive effectiveness efficiency and alignment in training and development. http://www.businesswire.com/portal/site/google/?ndmViewId=news_view&newsId=20080728006130&newsLang=en
The red-white-and-blue displays, the centerpiece of a new three-month outreach campaign, will highlight VA’s suicide prevention hotline —- 1-800-273-TALK. If the campaign is successful in raising awareness, VA officials plan to extend the promotional campaign to other parts of the country. In D.C., 80 buses, 220 Metro cars and 10 Metro stations will carry the displays until mid October. VA officials will measure the effectiveness of the outreach campaign by tracking any increase in calls to its suicide prevention hotline from telephone numbers in the metro D.C. area. VA’s newest outreach to veterans and their families about suicide prevention includes soon-to-be-released public service ads featuring actor Gary Sinese. The ads are the latest outreach tool in a suicide prevention program that includes creation of a toll-free, round-the-clock hotline, which began operation last summer; the expansion of hours at VA’s 153 medical facilities to care for veterans with mental health problems; the hiring of suicide prevention counselors at each VA medical center; and special training programs for all VA employees in medical centers and clinics to alert them to warning signs in veterans for suicide and other emotional problems. VA operates one of the largest mental health programs in the country, with about 9,000 mental health professionals, a yearly mental health budget of about $3 billion and about 1 million patients who have a mental health diagnosis. http://www1.va.gov/opa/pressrel/pressrelease.cfm?id=1538
Under the agreement, five VA senior investigators from the VA's Research and Development program will serve on the Robert Wood Johnson Foundation Physician Faculty Scholars national advisory committee, acting as mentors to VA and non-VA Physician Faculty Scholars and participating in the general oversight and direction of the Physician Faculty Scholars program. In addition, five outstanding junior faculty who are selected for the VA Research Career Development Program will be eligible to participate in the RWJF's Physician Faculty Scholars program. The first group of VA Scholars will be selected for the three-year Physician Faculty Scholars program in March 2009, with appointments beginning July 1, 2009. There is a growing demand for physicians who have the knowledge and research experience necessary to shorten the time between research advances and their effective application in treating patients. The VA and RWJF have a long history of fostering top investigators to meet the demand. In the VA alone, there have been three Nobel Laureates and six Lasker award recipients. VA's Research Career Development Program (CDP) was established to provide mentoring for junior VA researchers so that they can learn from renowned, experienced VA researchers. Under the program, awardees have 75 percent of the time covered for five years to do research and may receive additional research funds. Researchers who have completed the CDP have gone on to make significant contributions to VA health care in areas such as racial disparities in health outcomes, medical decision-making, and effective screening for HIV. Graduates of the CDP have become national and international leaders in their research fields. The RWJF Physician Faculty Scholars program is designed to strengthen the leadership and academic productivity of junior medical faculty who are dedicated to improving health and health care. Scholars receive funds to support a research project; at least 50 percent protected timed for three years to do their research; active mentorship by nationally recognized leaders; and the opportunity to work with other scholars. Candidates are nominated by the deans of their universities. To view the list of appointees to the RWJF Physician Faculty Scholars national advisory committee, please visit http://www.rwjf.org/newsroom/product.jsp?id=33151.
VA provides benefits and services for approximately 60 million veterans and their family members. With more than 230,000 employees, 153 medical centers and 800 Community Based Outpatient Centers, VA is the largest direct health care delivery system in America. By deploying enterprise-wide identity and access management solutions, VA will be able to provide secure delivery and access to Web-based applications; enhance veteran access to benefit and health information; improve regulatory compliance; improve inter-agency collaboration; and enhance overall agency security. http://www.businesswire.com/portal/site/google/?ndmViewId=news_view&newsId=20080729005170&newsLang=en
Dr. Lisi will guide the improvement and expansion of the VHA chiropractic program, which was established in 2004 in response to legislation that requires at least one chiropractor at each of its 21 geographic regions. Currently 38 chiropractors work in 32 VHA sites, and the number is expected to grow. More than 263,000 veterans from Iraq and more than 7.8 million veterans total make contribute to VHA’s need to provide chiropractic services, which can play a crucial role in treating various musculoskeletal problems including traumatic injuries due to explosive devices, less-severe injuries, and general back pain. Dr. Lisi supervises the clinical training of interns from the University of Bridgeport’s College of Chiropractic who are assigned to the Connecticut Department of Veterans’ Affairs, where he also serves as chief of chiropractic care. http://www.bridgeport.edu/pages/3218.asp?item=3801
The CBOC, which will serve the state’s six westernmost counties, is slated to start seeing patients on Aug. 20, according to Gene Morris, public affairs officer with the Charles George VA Medical Center at Asheville. When it opens its doors Aug. 20, the Franklin CBOC will operate Monday-Friday, with initial clinic hours of 7:30 a.m.-5 p.m. However, staffing and patients served will ultimately dictate clinic hours. The CBOC will have three primary teams and approximately 30 VA staff members. The Charles George VA Medical Center is examining the patient population in the areas the Franklin CBOC will serve (Macon, Jackson, Swain, Cherokee, Clay and Graham), that is already enrolled in Asheville's VA to see if they are eligible and would benefit from a transfer to Franklin. The CBOC will provide primary care services, optometry and mental health; other services will still be done at Charles George VA. http://www.thefranklinpress.com/articles/2008/07/28/news/01news.txt
The VA Nursing Academy is a virtual organization with central administration in Washington. It expands learning opportunities for nursing students at VA facilities, funds additional faculty positions so competitively selected nursing school partners will accept additional baccalaureate-level students, and increases recruitment and retention of VA nurses. The five-year, $40 million program began in 2007. Seven nursing schools will form new partnerships with nine VA medical centers and join the VA Nursing Academy this year. To view the schools, please visit: http://www1.va.gov/opa/pressrel/pressrelease.cfm?id=1542 Partnerships already in the VA Nursing Academy include the VA medical center in Gainesville, Fla., with the University of Florida; the VA medical center in San Diego with San Diego State University; the VA medical center in Salt Lake City with the University of Utah; and the VA medical center in West Haven, Conn., with Fairfield University in Connecticut. VA expects to add several more nursing-school partnerships. Further information about the pilot program can be obtained from VA’s Office of Academic Affiliations web site at www.va.gov/oaa.
In the study, "Impact of Medical Errors on 90-Day Costs and Outcomes: An Examination of Surgical Patients," published in the July 28 issue of the journal Health Services Research, researchers William E. Encinosa, Ph.D., and Fred J. Hellinger, Ph.D. found that insurers paid an additional $28,218 (52 percent more) and an additional $19,480 (48 percent more) for surgery patients who experienced acute respiratory failure or post-operative infections, respectively, compared with patients who did not experience either error. Researchers also found these additional costs for surgery patients who experienced the following medical errors compared with those who did not:
The study also found that 1 of every 10 patients who died within 90 days of surgery did so because of a preventable error and that one-third of the deaths occurred after the initial hospital discharge. The study was based on a nationwide sample of more than 161,000 patients age 18 to 64 in employer-based health plans who underwent surgery between 2001 and 2002. The authors used AHRQ's Patient Safety Indicators to identify medical errors. Drs. Encinosa and Hellinger also conclude that studies that focus only on medical errors incurred during the initial hospital stay may underestimate the financial impact of patient safety events by up to 30 percent. http://www.ahrq.gov/news/press/pr2008/surgerrpr.htm
Generic divalproex sodium will have the same safety warnings as Depakote, including a Boxed Warning that cautions about the risk of liver damage (hepatotoxicity), including fatalities, and pancreatitis, or an inflamed pancreas, including fatal cases. The Boxed Warning also highlights the risk of birth defects (teratogenicity), including neural tube defects. The following firms have received approval to market divalproex sodium delayed-release tablets: Sun Pharmaceutical Industries Ltd., Mumbai, India; Genpharm Inc., Ontario, Canada; Nu-Pharm Inc., Ontario, Canada; Upsher-Smith Laboratories, Maple Grove, Minn.; Sandoz Inc., Broomfield, Colo.; TEVA Pharmaceuticals USA, North Wales, Penn.; Dr. Reddy’s Laboratories, Hyderabad, India; and Lupin Limited, Mumbai, India. http://www.fda.gov/bbs/topics/NEWS/2008/NEW01867.html
The program is intended to build research capacity in cancer, stroke, lung disease, environmental factors, obesity, lifestyle and the relationship of all these conditions to the genetics of chronic diseases in countries often thought of only in terms of infectious diseases. Up to seven awards and two planning grants are being made available under the "Millennium Promise Awards: Non-communicable Chronic Diseases Research Training Program," a key part of Fogarty’s new strategic plan announced last month: http://www.fic.nih.gov/about/plan/strategicplan_08-12.htm. The plan also amplifies the Center’s longtime effort to fight infectious diseases endemic to poorer regions of the world and calls for a new emphasis on "implementation research." Even in regions where malaria or cholera have been prevalent for a long time and researchers know how to treat patients, educating medical workers and gaining compliance from patients is often the biggest barrier to health. Implementation science could mean finding better ways of communicating to people that malaria is caused by mosquitoes, not rotting fruit; or it could mean developing training guides to teach medical relief organizations how to quickly and efficiently set up a field hospital in case of a sudden infectious disease outbreak. About 60 percent of all deaths worldwide are attributable to chronic diseases and 80 percent of them occur in low- and middle-income countries, according to the World Health Organization. The program is seeking proposals from scientists who have broad understanding of or experience in working across disciplines, such as nutrition, business, behavioral health, health law, economics, environmental health and urban planning. Grantees would receive funding of up to $220,000 a year for up to five years, with planning grants allocated up to $27,000 each year for up to two years. Letters of intent are due Aug. 31 and full applications must be submitted by Sept. 29. More information is available at http://www.fic.nih.gov/programs/training_grants/ncod/index.htm.
The research area of benign prostate disease includes two of the most significant non-cancerous disorders affecting males — benign prostatic hyperplasia (BPH) and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). BPH, an enlargement of the prostate gland, is often associated with lower urinary tract symptoms (LUTS). LUTS, which can include symptoms such as overactive bladder, restricted or excessive urination, and sensations of urgency, affects men of all races and ethnic groups and can become severe over time. An estimated 50 percent of men in their 50s have BPH and 26 to 46 percent of men between the ages of 40 and 79 have moderate to severe symptoms. CP/CPPS is generally described as inflammation of the prostate gland. There is no detectable bacterial basis, but CP/CPPS sometimes is associated with urinary symptoms, pain, and sexual dysfunction. The source of the pain in this syndrome is unknown and there are no generally effective methods for preventing or treating the condition. The NIDDK Prostate Research Strategic Plan addresses the four major research areas judged critical for advancing the field: basic science, epidemiology and population-based studies, translational research, and clinical sciences. The plan is designed to be read by a broad audience of researchers, clinicians, advocacy groups, representatives of funding organizations, and patients. Each major section includes a mission statement, a lay summary, an overview of current knowledge, and high-priority recommendations for future research. http://www.nih.gov/news/health/jul2008/niddk-25.htm
The article from the National Birth Defects Prevention Study (NBDPS), “Diabetes Mellitus and Birth Defects,” shows that pregnant women with pre-gestational diabetes mellitus (pre-pregnancy diagnosis of diabetes, such as type 1 or type 2 diabetes) are more likely than a mother with no diabetes or a mother with gestational diabetes mellitus (pregnancy-induced diabetes) to have a child with various types of individual or multiple birth defects. This includes heart defects, defects of the brain and spine, oral clefts, defects of the kidneys and gastrointestinal tract and limb deficiencies. This study is the first to show the broad range and severity of birth defects associated with type 1 and type 2 diabetes. Researchers also found that some of the pregnant women with gestational diabetes, which occurs in seven percent of all pregnancies, were more likely to have a child with birth defects. Because birth defects associated with diabetes are more likely to occur during the first trimester of pregnancy and before a diagnosis of gestational diabetes is made, the observed associations suggest that some of the mothers with it probably had undiagnosed diabetes before they became pregnant. However symptoms went unnoticed until pregnancy. Further, the associations of gestational diabetes with various birth defects were noted primarily among women who had pre-pregnancy obesity, which is a known risk factor for both diabetes and birth defects. Preconception care also should be considered and promoted for women with pre-pregnancy obesity to prevent birth defects and reduce the risk for health complications. The NBDPS is a population-based, case-control study that incorporates data from nine birth defect centers in the United States—Arkansas, California, Georgia, Iowa, Massachusetts, New York, North Carolina, Texas and Utah. These centers have been working on the largest study of birth defects causes ever undertaken in the United States. Researchers have gathered information from more than 30,000 participants and are using this information to look at key questions on potential causes of birth defects. Birth defects affect one in 33 infants and are a leading cause of infant mortality. For some birth defects, some risk factors or causes have been identified; however, for the majority of birth defects the causes remain unknown. http://www.cdc.gov/media/pressrel/2008/r080730.htm
The Pathwork Tissue of Origin test compares the genetic material of a patient’s tumor with genetic information on malignant tumor types stored in a database. It uses a microarray technology to analyze thousands of pieces of genetic material at one time. The test considers 15 common malignant tumor types, including bladder, breast, and colorectal tumors. This test is the second in vitro diagnostic multivariate index assay (IVDMIA) device to be cleared by the FDA. In July 2007, the FDA issued a draft guidance document to address premarket pathways and post-market requirements for IVDMIAs. IVDMIA tests combine the values of multiple variables to yield a single, patient-specific result. Nearly every cell of the body contains a full set of chromosomes and identical genes but only a fraction of these genes are turned on or expressed in any given cell. Gene expression occurs when certain molecular information contained within DNA is transcribed to create molecules known as RNA. These molecules in turn make the proteins that perform most of the critical functions of cells. Microarray technology can simultaneously measure gene expression levels of large numbers of genes. Small DNA fragments are placed or arrayed on a slide and then RNA, which has been extracted from the tumor tissue and labeled with a fluorescent marker, is spread over this "microarray." Since RNA binds to its complementary DNA strand, how much binding occurs indicates how active the gene being evaluated is. This can be determined by putting the array under a scanning microscope and measuring the intensity of the fluorescent light at each point on the array. Pathwork’s proprietary software converts the scanned image data to gene expression measurements. The gene expression patterns are compared with known gene expression patterns in the database that correspond to different tumor types. The Pathwork Tissue of Origin test has been found to provide patterns that confirm existing tissue of origin of the 15 common tumor types using standard clinical and pathological information. This accuracy of this test is similar to that achieved by expert pathologists using current standards of practice. http://www.fda.gov/bbs/topics/NEWS/2008/NEW01870.html
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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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