FEDERAL HEALTH UPDATE
Feb 6, 2009Produced 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
Campaign headquarters is located at DoD’s tobacco cessation Web site, http://www.ucanquit2.org, online headquarters of the multi-year campaign, “Quit Tobacco – Make Everyone Proud.” Military installations can register their GASpO event at http://www.ucanquit2.org/facts/gaspo to promote it to the military community and those in the local area of their participation in the Great American Spit Out. The award-winning Ucanquit2.org Web site provides high-tech and interactive tools to help service members follow through with their plans to quit. In the new My QuitSpace area of the site, registered users can create a blog, either public or private, to document their journey or share their experiences. They may also download a customizable quit plan and quit calendar, adding personalized information, goals, tips and dates. The Web site has introduced an Ask the Expert feature for GASpO. Navy Capt. Larry N. Williams, Tobacco Clinical Cessation Champion, will be the guest expert throughout the month of February, responding to questions from smokeless (or smoked) tobacco users and those who support their intention to quit, including health promotion and health care professionals on military installations. Service members and others are encouraged to visit the Web site and submit questions about smokeless tobacco usage, health risks, quit strategies and more. Williams’ responses will be posted on a daily basis. Through Live Chat, a unique online service, users get immediate real-time help from trained tobacco cessation coaches. TRICARE also has a special Web page geared to quit tobacco efforts at http://www.tricare.mil/tobaccofree.
This “unprecedented and transformational” decision ushers in a new model for health care delivery in the National Capital Region. While military hospitals have traditionally provided care to beneficiaries from all services, Military Treatment Facilities have never been staffed with a representative mix of medical personnel from the service medical departments. This decision is the second in a series designed to implement an integrated regional approach to military healthcare. The first decision approved by the Deputy Secretary of Defense on Oct. 20, 2008, was the use of a single Department of Defense (DoD) civilian personnel staffing model at National Capital Region (NCR) medical facilities. This means that, ultimately, current Army, Navy, or Air Force civilian personnel in the region will become a DoD civilian workforce. Plans for implementation of these transformational decisions are in development. The Defense Base Closure and Realignment (BRAC) law requires that the new facilities be fully operational by Sept. 15, 2011. Additional information about transitional changes in the NCR will be posted on www.JTFCAPMED.mil.
TriWest also has established a standard of confidentiality for information about a range of medical conditions that are considered sensitive. Information that is deemed to be "sensitive health information" is anything related to the treatment of reproductive health, sexually transmitted diseases, substance abuse, mental health, HIV, domestic abuse and rape. Personal health information about the range of medical diagnoses that are considered particularly sensitive is not available to registered users of www.triwest.com. Beneficiaries with a secure www.triwest.com account will receive QuickAlert e-mails only for non-sensitive authorizations and referrals. The restriction of access to sensitive diagnosis information add to ways TriWest protects the privacy of TRICARE beneficiaries. Sensitive diagnosis information will be mailed to the beneficiary or it may be requested by calling 888-TRIWEST (874-9378). In addition, TriWest has recently expanded the viewing capability of sponsors on www.triwest.com. Previously, authorizations, referrals and other information about family members age 12 and older were not accessible. Sponsors now have the ability to view all non-sensitive diagnosis authorization, referral and claims information about family members under age 18. To see non-sensitive information for spouses and family members age 18 and older, specific access must be granted by the spouse and family member.
Gould worked in the public sector as the chief financial officer and assistant secretary for administration at the Commerce Department and deputy assistant secretary for finance and management at the Treasury Department from 1994 to 1999. As a White House Fellow, he worked at the Export-Import Bank of the United States and in the Office of the White House Chief of Staff. Prior to his job at IBM, he was chief executive officer of The O’Gara Company, a strategic advisory and investment services firm, and chief operating officer of Exolve, a technology services company. As a naval reservist, Gould served at sea aboard the guided missile destroyer Richard E. Byrd and as assistant professor of naval science at Rochester University. He was recalled to active duty for both Operations Noble Eagle and Enduring Freedom as a naval intelligence reservist. During President Obama’s campaign and after his election, Gould was co-chair of the National Veterans Policy Team, Obama for America, and co-chair of the Veterans Agency Review Team for the Presidential Transition Team. A fellow of the National Academy of Public Administration, Gould is a former member of the National Security Agency’s Technical Advisory Group and the Malcolm Baldrige National Quality Award Board of Overseers. He has been awarded the Department of Commerce Medal, the Treasury Medal and the Navy Meritorious Service Medal and is coauthor of The People Factor: Strengthening America by Investing in the Public Service.
As assistant secretary, Duckworth will direct VA's public affairs, internal communications and intergovernmental relations. She also will oversee programs for homeless veterans, consumer affairs and special rehabilitative events. Duckworth was appointed director of the state Veterans office in Illinois in 2006. In previous testimony before Congress, she expressed her commitment to Veterans and the need for transformation of the Department. She is serving as a major in the Illinois National Guard and was previously deployed to Operation Iraqi Freedom where, as a captain, she was assistant operations officer for a 500-soldier aviation task force. She also served as a logistics officer and company commander. As a helicopter pilot flying combat missions in 2004, she suffered grave injuries when her helicopter was struck by a rocket-propelled grenade, losing both legs and partial use of one arm. Her previous managerial experience includes coordinating the Center for Nursing Research at Northern Illinois University in DeKalb, and working for Rotary International's Asia-Pacific region from 2002 to 2004. Duckworth earned a bachelor's degree from the University of Hawaii and a master's degree from George Washington University in Washington, D.C. Born in Thailand, she is the daughter of a U.S. Marine who fought in Vietnam. She is married to Iraq war veteran and National Guard officer, Major Bryan Bowlsbey.
The heart of the outreach effort is an FDA-maintained database listing all recalled peanut products. The database (www.accessdata.fda.gov/scripts/peanutbutterrecall/index.cfm) can be searched by brand name or browsed by product category, i.e., cracker-product recalls. A widget has been created so news, parenting, health care and other concerned parties can access the database information directly from their Web sites. Other social media tools used to broadcast information about the recall, the Salmonella outbreak and the related investigation include podcasts, YouTube video, Twitter and a blog. Full information about these tools is available on a new HHS, FDA and CDC social media Web page at http://www.cdc.gov/socialmedia. Information about the Salmonella typhimurium outbreak and the product recall is available at: The latest information is also available from CDC-INFO (800-232-4636, TTY: 888-232-6348, and cdcinfo@cdc.gov). The social media outreach effort is being directed by the department’s new Social Media Center, which promotes the collaborative use of social media tools to better communicate health and human service information. Many of these resources are available in both English and Spanish.
The Medical Group Management Association in Englewood, Colo., recently launched Project SwipeIT. MGMA believes the cards could save providers up to $1 billion a year by reducing unnecessary administrative work and denied claims. Humana has tested ID swipe card technology in Florida. Some practices participating in the tests had more than a 50 percent cut in manual keystroke errors and cut denied transactions in half. For more information, please visit swipeit.org.
A recent study and an accompanying editorial published in the journal Critical Care Medicine reported an increased risk of serious bleeding events and death in patients with sepsis and baseline bleeding risk factors who received Xigris. The study, a retrospective review of medical records of 73 patients who were treated with Xigris, found that serious bleeding events occurred in seven of 20 patients (35 percent) who had a bleeding risk factor versus two of 53 (3.8 percent) of patients without any bleeding risk factors. Xigris is known to increase the risk of bleeding. The drug’s current prescribing information (labeling) includes a warning that describes bleeding as the most common serious adverse effect and lists a number of risk factors that should be carefully considered when deciding whether to use Xigris. The labeling contraindicates the use of Xigris in several clinical situations where bleeding could lead to significant adverse reactions or death. The FDA is not recommending that prescribers stop administering this medication. Consumers and health care professionals should notify the FDA of any complaints or problems associated with this product. These reports may be made to MedWatch, the FDA’s voluntary reporting program, by calling 800-FDA-1088, or electronically at www.fda.gov/medwatch/report.htm. The FDA will announce its conclusions and any resulting recommendations to the public when the review of Xigris is completed, which may take several months. The full announcement can be found at http://www.fda.gov/cder/drug/early_comm/drotrecogin_alfa.html
The study focused on 1965 patients who were undergoing 64 slice cardiac CT scans, also known as cardiac CT angiography, at 50 medical centers in various countries including the United States. The researchers found the radiation varied more than six-fold and ranged from 331 mGy x cm (a measure of absorbed radiation) to 2,146 mGy cm. The median of exposure was roughly equivalent to 600 chest X-rays, or about 12 milliSievert (mSv) of radiation. Traditional angiography involves a catheter inserted through a blood vessel and dye is injected near the heart. This procedure is said to expose patients to roughly half the dose that a CT angiography does and about the same as other standard cardiac screenings such as nuclear stress tests do. There were variations in the exposure depending on the medical center as well as the way the tests were performed. Approximately 80 percent of the centers used radiation-reducing techniques such as adjusting the CT scan to the size of the patient wherein the smaller the patient the less the radiation, or by precisely timing the radiation dose to a particular point in the heart rhythm and thereby shortening the duration of the exposure. The wide range of exposure seen in the study was not due to technician's level of competence. Numerous factors affect the amount of radiation, including the heart rate of the person being scanned, the regularity of the heart rate and other factors. A lower-radiation technique called sequential scanning has being introduced which can reduce radiation exposure by 78 percent and is being widely adopted. The overall the danger posed by radiation is very small. Being exposed to 10 mSv increases an individual's cancer risk by 0.02 percent, however, the greater the exposure to radiation, the greater the risk. Both studies concluded that when cardiac CT angiography is used appropriately for people with chest pain suggesting blocked heart arteries, rather than just as a screening test for people with no symptoms of heart disease, the benefits far outweigh the risk of the radiation.
The nonprofit Consumers' Checkbook group won a lower court ruling in 2007 that directed the government to release the records under the federal Freedom of Information Act. The Health and Human Services department, joined by the American Medical Association, appealed. In a split decision issued on Jan. 31, 2009, a three-judge panel of the federal appeals court for Washington, DC, handed the consumer group a defeat. The judges said freedom-of-information laws are mainly intended to shed light on government operations, not the workings of private businesses. The case is being closely watched as an important battle in the effort to reshape the nation's health care system. Consumer advocates, employers and insurers argue that access to Medicare claims filed by doctors' offices could help independent groups monitor quality and ferret out waste. Patients would not be identified. But doctors are worried that such disclosures would violate their privacy and that resulting ratings could portray some physician's offices inaccurately.
Fewer hospital readmissions and emergency department visits also translate to lower total costs. The study found that total costs (a combination of actual hospitalization costs and estimated outpatient costs) were an average of $412 lower for the patients who received complete information than for those who did not. Currently, one in five patients has a complication or an adverse event, such as a drug interaction, after being discharged from the hospital. These can impair patients' recovery and can cause patients a trip to the emergency department or to be readmitted to the hospital, both of which are costly. The research team, led by Brian W. Jack, M.D., at Boston University Medical Center's Department of Family Medicine, developed a multi-faceted program to educate patients about their post-hospital care plans. The program, called the Re-Engineered Hospital Discharge Program (RED), was tested through a randomized controlled trial. It used specially trained nurses to help one group of patients arrange follow-up appointments, confirm medication routines and understand their diagnoses using a personalized instruction booklet. A pharmacist contacted patients between two and four days after hospital discharge to reinforce the medication plan and answer any questions. Thirty days after their hospital discharge, the 370 patients who participated in the RED program had 30 percent fewer subsequent emergency visits and readmissions than the 368 patients who did not. Nearly all (94 percent) of the patients who participated in the RED program left the hospital with a follow-up appointment with their primary care physician, compared to 35 percent for patients who did not participate. And nearly all (91 percent) participants had their discharge information sent to their primary care physician within 24 hours of leaving the hospital. However, making medication review available to patients did not prevent problems from occurring, the study noted. Nearly two-thirds (65 percent) of the RED program participants who completed the medication review with the pharmacist had at least one problem with their drugs. In half of those cases, the pharmacist needed to take corrective action, such as contacting the patient's doctor. Despite the patient safety and cost benefits, a lack of financial incentives to implement a discharge program such as this poses a barrier to widespread adoption among hospitals, the study authors noted. However, the growing importance to hospitals of demonstrating their quality performance could spur added interest in this type of program. AHRQ also is supporting ongoing research by Dr. Jack and his colleagues that is testing the automation of the reengineered hospital discharge principles reflected in the RED program.
African-American Media Resources include:
For more information, please visit http://www.cdc.gov/media/pressrel/2009/a090204.htm
The new feature uses software that IBM developed based on guidelines from Continua Health Alliance, an organization that supports interoperable health care technology products. It is also based in part on open-source software available now from Eclipse and Open Health Tools, two open-source communities dedicated to supporting advancements in health care. The new features of Google Health let patients exchange their personal health data with doctors or other authorized parties.
Sponsor: Representative Louise McIntosh Slaughter [NY-28]
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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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