FEDERAL HEALTH UPDATE
Feb 20, 2009

Produced by Kate Connelly Theroux in collaboration with the Institute of Federal Health Care (IFHC)

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Congressional Schedule
  • President Barack Obama signed H.R.1, as amended, the American Recovery and Reinvestment Act of 2009, on Feb. 17, 2009.
  • The Senate and House are in recess until Feb. 23, 2009.
  • According to the New York Times, Kansas Gov. Kathleen Sebelius is emerging as President Obama’s top choice for Health and Human Services secretary.  Sebelius has eight years of experience as Kansas insurance commissioner and six years of experience as a governor in charge the state Medicaid program.  http://www.nytimes.com/2009/02/19/us/politics/19health.html?_r=1&scp=1&sq=Sebelius&st=cse

Military Health Care News

  • MinuteClinic, the largest provider of retail health care in the United States, announced that it has become a participating provider in the network of Health Net Federal Services/TRICARE North.

    TRICARE is the uniformed services health care program for active duty service members and their families, retired service members and their families, members of the National Guard and Reserve and their families, survivors and others who are eligible.  Health Net Federal Services provides health care services to more than 3 million uniformed services beneficiaries, active and retired, and their families in the North Region.

    Nearly 1.5 million TRICARE health care beneficiaries now have in-network access to MinuteClinic health care centers located inside select CVS/pharmacy stores in 13 states: Connecticut, Illinois, Indiana, Massachusetts, Maryland, Michigan, St. Louis, Mo area; North Carolina, New Jersey, New York, Ohio, Pennsylvania and Virginia.

    MinuteClinic health care centers are staffed by masters-prepared, board-certified nurse practitioners who specialize in family health care and are trained to diagnose, treat and write prescriptions when clinically indicated for common family illnesses such as strep throat and ear, eye, sinus, bladder and bronchial infections. Common vaccinations such as influenza, tetanus, MMR and hepatitis A & B are also available. MinuteClinic retail locations are open seven days a week. No appointment is necessary. http://news.prnewswire.com/DisplayReleaseContent.aspx?ACCT=104&STORY=/www/story/02-18-2009/0004974334&EDATE=

  • New research from the Defense and Veterans Brain Injury Center (DVBIC) indicates as many as 10 to 20 percent of U.S. troops who had combat exposure may have sustained a concussion during the time they were deployed in Iraq and Afghanistan. 

    The possibility that a significant number of military personnel may have had a brain injury while deployed has made the identification and treatment of returning servicemembers with related symptoms a top priority for policy makers. The Department of Defense has instituted screening for concussion in these servicemembers.  The finding on concussions is one of many described in eight articles by DVBIC researchers published in the January/February special edition of the Journal of Head Trauma Rehabilitation. The special edition is devoted to traumatic brain injury (TBI) in the military. Concussions are also known as mild TBI.

    According to internal DVBIC data, between January 2003 and the end of September 2008, 8,470 individuals with TBI were seen across its network, with more than 1,700 seen at Walter Reed Army Medical Center.

    DVBIC, a congressionally mandated program headquartered in Washington, D.C., has more than 200 staff and employees located among 16 military treatment facilities, veterans hospitals and community programs across the United States and abroad. Its mission is to help active duty military and veterans who have TBI through state-of-the-art medical care, innovative clinical research initiatives and educational programs.

  • The Navy announced that its commands may now access the Deployment Health Assessment (DHA) Program instruction online.

    This change is to help ensure that periodic assessments are conducted prior to and after deployments.

    Sometimes in a hurry to be demobilized or back to their job may not spend sufficient time on the post-deployment. As a result, issues sometimes arise months after a deployment. The post-deployment re-assessment (PDHRA) is designed to pick up those issues.

    Sailors frequently rate their overall general health worse three to six months after returning than they did immediately upon return. The DHA process is designed to identify stress injuries and other health concerns that require further assessment or treatment.

    Sailors are required to undergo a pre-Deployment Health Assessment (Pre-DHA) no earlier than 60 days prior to the expected deployment date. Then, when the sailor returns from deployment a post-Deployment Assessment (Post-DHA) should be completed as close to their homecoming date as possible, not earlier than 30 days before the expected redeployment. Reserve sailors should complete the post-DHA before being released from active duty. The PDHRA should be completed between 90 and 180 days after return from deployment.

    To make life easier, Deployment Health Assessments are submitted electronically by a nurse, corpsman or medical technician. If a servicemember gives positive responses to some questions, the assessment may be bumped up for review by a physician, physician's assistant (PA), nurse practitioner (NP), or independent duty corpsman (IDC). The PDHRA can only be done by a physician, PA, NP, or IDC.

  • Humana Military Healthcare Services has announced its new designation as a signatory member to the Defense Industry Initiative on Business Ethics and Conduct (DII). The DII is a voluntary, non-profit organization seeking to ensure that its members conduct business with the highest degree of integrity and honesty, while meeting special compliance risks established in contracting with the Department of Defense (DoD).

    Humana Military, DoD’s managed care support contractor providing health benefits support and services to almost 2.8 million active duty and retired military and their eligible family members in the 10-state South Region, joins more than 80 defense contractors as a signatory.

  • The MHS Senior Oversight Committee (SOC), created in March 2008, released its final report, which responds to the 12 recommendations from the Task Force on the Future of Military Health Care’s report.  The goals of the SOC was
  • evaluate Task Force recommendations according to the principles adopted by the Task Force, as amended by this Committee;
  • determine a strategy for implementing those Task Force recommendations deemed acceptable by the Committee;
  • translate acceptable Task Force recommendations into operational terms;
  • establish an interface with non-MHS components needed for successful implementation;
  • develop an implementation plan that includes measures to assess progress;
  • conduct assessments of how the recommendations are being implemented; and
  • coordinate with the Health Affairs Program Integration Directorate, strategic communications departments and other offices to avoid duplicative and inconsistent efforts and to engender broad support that is needed for changes.

The report summarizes the SOC’s findings.

Veterans Health Care News  

  • The U.S. Department of Veterans Affairs will open a new clinic in Galveston but close a clinic in Texas City.

    The new island veterans clinic, which will occupy a building that once housed The University of Texas Medical Branch’s Family Health Care Clinic, will open March 4.

    The old island clinic has been closed since Sept. 13, when Hurricane Ike slammed ashore.  Island veterans were redirected to the Texas City clinic, but that clinic will close Feb. 27.  All mainland veterans will be redirected to the island clinic for care. The administration is still searching for space on the mainland to place a clinic.

    In the meantime, the 8,400-square-foot island clinic is large enough to accommodate the more than 6,800 area veterans who need care. The clinic will provide primary care, telemedicine, mental health care, phlebotomy, radiology and women’s health services.

Health Care News

  • The Centers for Disease Control and Prevention (CDC) released Health, United States: 2008 on Feb. 18, 2009. The 32nd annual edition of the report, prepared by CDC′s National Center for Health Statistics, is a compilation of health data from a number of sources within the federal government and in the private sector. The report uses the most current data available at the time of publication.

    This year′s edition features a special section on adults aged 18 to 29, a group making many life choices including decisions about education, marriage, childbearing and health behaviors such as tobacco and alcohol use, which will affect both their future economic and health status.

    Highlights of the report include:

    • Obesity rates have tripled among young adults in the past three decades, from 8 percent in 1971-1974 to 24 percent in 2005-2006.
    • In 2006, 29 percent of young men were current cigarette smokers, compared to 21 percent of young adult women. Between 1997 and 2006, the percentage of women 18–29 years of age who currently smoked cigarettes declined nearly 20 percent. Current smoking did not decline significantly among young men.
    • In 2005, unintentional injuries or accidents, homicide and suicide accounted for 70 percent of deaths among young adults 18–29 years of age. Three-quarters of the 47,000 deaths in this age group occurred among young men. Young adults also have the highest rate of injury-related emergency department visits of all age groups.
    • In 1999–2004, almost 9 percent of adults aged 20–29 reported having major depression, generalized anxiety disorder or panic disorder in the past 12 months.
    • In 2006, adults aged 20–24 were more likely to be uninsured (34 percent) than those aged 18–19 (21 percent) and 25–29 (29 percent).
    • In 2004–2006, 17 percent of adults aged 18–29 reported needing but not receiving one or more of the following services in the past year because they could not afford them: medical care, prescription medicines, mental health care or eyeglasses.

    The full report contains 151 data tables in addition to the special feature on young adults. The tables cover the spectrum of health topics, serving as a comprehensive snapshot of the nation′s health. http://www.cdc.gov/media/pressrel/2009/r090218.htm

  • The U.S. Department of Health and Human Services (HHS) and the Federal Trade Commission (FTC) announced that CVS, the nation’s largest retail pharmacy chain, will pay the U.S. government a $2.25 million settlement and take corrective action to ensure it does not violate the privacy of its millions of patients when disposing of information used on pill bottle labels.

    The settlement, which applies to all of CVS’s more than 6,000 retail pharmacies, follows an extensive investigation by the HHS Office for Civil Rights (OCR) for potential violations of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule.

    In a coordinated action, CVS Caremark Corp., the parent company of the pharmacy chain, also signed a consent order with the FTC to settle potential violations of the FTC Act.

    OCR, which enforces the Privacy Rule, opened its investigation of CVS pharmacy compliance with the privacy rule after media reports alleged that patient information maintained by the pharmacy chain was being disposed of in industrial trash containers outside selected stores that were not secure and could be accessed by the public. At the same time, the FTC opened an investigation of CVS.

    OCR and the FTC conducted their investigations jointly.  This is the first instance in which OCR has coordinated investigation and resolution of a case with the FTC.

    HIPAA requires health plans, health care clearinghouses and most health care providers (covered entities), including most pharmacies, to safeguard the privacy of patient information, including such information during its disposal.

    Among other issues, the reviews by OCR and the FTC indicated that:

    • CVS failed to implement adequate policies and procedures to appropriately safeguard patient information during the disposal process; and
    • CVS failed to adequately train employees on how to dispose of such information properly.

    Under the HHS resolution agreement, CVS agreed to pay a $2.25 million resolution amount and implement a robust corrective action plan that requires Privacy Rule compliant policies and procedures for safeguarding patient information during disposal, employee training and employee sanctions for noncompliance.

    HHS and FTC also will require CVS to actively monitor its compliance with the resolution agreement and FTC consent order.  The monitoring requirement specifies that CVS must engage a qualified independent third party to conduct assessments of CVS compliance and render reports to the federal agencies. The HHS corrective action plan will be in place for three years; the FTC requires monitoring for 20 years.

  • According to a new study by Dartmouth researchers, consumers are more likely to receive information about medications from magazine advertisements that include a "drug facts box," rather than the brief summaries currently used.

    The study, published in the Annals of Internal Medicine, tested the effectiveness of drug facts boxes for a statin and the blood thinner Plavix, both medications for heart disease, as well as a proton pump inhibitor and an H2 blocker, both treatments for heartburn.

    The drug facts boxes included information about the side effects of the medications, as well as the rate that the side effects occurred in clinical trials. In addition, the drug facts boxes quantified the benefits of the medications over a placebo and older treatments. The drug facts boxes also included the year that the medications received FDA approval and alternative treatments that do not involve medication.

    According to the study, about 72 percent of individuals who viewed drug facts boxes for the heart disease medications correctly said that the statin provides a larger benefit, compared with 9 percent of people who viewed the brief summaries currently used. About 70 percent of individuals who viewed drug facts boxes for the heartburn medications correctly said that the protein pump inhibitor provides a larger benefit, compared with 8 percent who viewed the brief summaries currently used, the study found.

  • Dale Birkle Dreer, Ph.D., was recently appointed chief of the Office of Scientific Review (OSR) at the National Center for Complementary and Alternative Medicine (NCCAM), a component of the National Institutes of Health (NIH). The Office is responsible for the peer review of all grant applications assigned to NCCAM.

    In her new role, Dr. Dreer will oversee the activities of scientists and technical support personnel within OSR to ensure continued quality in the grants and contracts peer review process. She will also direct and coordinate activities to evaluate the overall performance of NCCAM's grant review processes and allocation of resources.

    Dr. Dreer's scientific expertise focuses on the impact of the physical and psychological environment on brain structure and function, the effects of drugs on the brain and cardiovascular system, biochemical responses to environmental insults, and mechanisms for adaptation. She has authored more than 40 research papers and eight book chapters and scientific reviews.

    Dr. Dreer began her NIH career in NCCAM's OSR in 2001 as a scientific review officer. Prior to joining NIH, she was a professor in the Department of Pharmacology and Toxicology at West Virginia University. Dr. Dreer received her bachelor's degree in general sciences from Bridgewater College in Bridgewater, Va., and earned her doctorate degree in pharmacology from the Medical College of Virginia-Virginia Commonwealth University Richmond, Va.

    Dr. Dreer officially assumed her position on Feb. 2, 2009.

  • According to the New York Times, Zagat guides, known for an assortment of mostly leisure-related topics including hotels, spas, golf courses, movies and nightlife, will expand to review doctors and rate them in categories like trust and communication.

    As in other Zagat guides, the responses are summarized and presented as scores that, in this case, are edited by the insurance company WellPoint. They can be viewed only by WellPoint customers. The reviews are being introduced online to millions of WellPoint’s Blue Cross plan members across the country.

    Many doctors, including those in California, Connecticut and North Carolina, where the Zagat-WellPoint venture was first introduced, have given the idea low marks.

    Under a deal announced in January 2008, WellPoint was licensed to use the Zagat name and brand. Zagat also has alliances with Google, Priceline.com and the liquor distributor Diageo.

    Nina Zagat, who founded the Zagat Survey company, said the reviews were not meant to be the main factor in the choice of a doctor. Rather, they could help a patient choose among specialists recommended by her primary physician.

    Eric Fennel, a WellPoint vice president who oversees the online review program, said most comments by patients so far have been positive. He said more than 75 percent of patients were posting comments and 88 percent of them recommended their doctor.

    The Zagat reviews are currently available to about two million WellPoint and Anthem members, in Los Angeles and Ventura Counties in California, Cincinnati and Dayton in Ohio, Connecticut, and 3.7 million at Blue Cross and Blue Shield of North Carolina, which is not affiliated with WellPoint. The company said it planned to offer the feature in San Francisco, San Diego and Sacramento this year and eventually at other WellPoint and independent Blue Cross plans. http://www.nytimes.com/2009/02/16/business/media/16zagat.html?8dpc=&_r=1&pagewanted=print

  • The Internal Revenue Service (IRS) issued its final report on the results of the Exempt Organization Hospital Study.

    The study, which began in 2006, is based on responses to questionnaires sent to a sampling of 500 nonprofit hospitals regarding community benefit and executive compensation practices. Twenty hospitals were selected for the review of executive compensation.

    On average, nonprofit hospitals reported spending 9 percent of their total revenue on community benefit, with uncompensated care representing the single largest expenditure for a majority of the hospitals surveyed, at 56 percent. Medical education and training followed, accounting for 23 percent of community benefit expenditures, and research and community service trailed with 15 percent and 6 percent, respectively.

    For executive compensation, the IRS found that the average total compensation paid to top management was $490,000; $377,000 was the median. The 20 hospitals in the executive compensation study reported an average and median compensation of $1.4 million and $1.3 million, respectively.

  • According to Reuters, a new study found that an oral vaccine protected mice from the anthrax bacteria, suggesting a pill could replace injections for humans.

    Normally, vaccines won’t work if ingested because they are destroyed by the digestive process in the tomach. Consequently, vaccines generally are administered by injection.  Researchers said that using 'food grade' lactic acid bacteria as a vehicle provides a safe way of getting the vaccine into the small intestine without losing any of the drug's efficacy.

    Anthrax is a fairly common bacteria whose spores can be used as a biological weapon. Usually it causes an easily treated skin lesion. But if inhaled, it can take hold quickly and by the time a person starts showing symptoms, it is usually too late for successful treatment with antibiotics.

    Because most vaccines are proteins, they lose effect when the passing through the stomach. This means they require multiple injections to work.  The study showed that once the vaccine was through the stomach and in the small intestine, it was able to bind to immune cells needed to trigger a response to protect against anthrax.  The findings showed the oral vaccine worked about as well as a vaccine delivered by needle.

  • The U.S. Food and Drug Administration approved a humanitarian device exemption for the first implantable device that delivers intermittent electrical therapy deep within the brain to suppress the symptoms associated with severe obsessive-compulsive disorder (OCD).

    The Reclaim system uses a small electrical generator known as a pulse generator to create electrical stimulation that blocks abnormal nerve signals in the brain. This small battery-powered device is implanted near the abdomen or the collar bone and connected to four electrodes implanted in the brain through an insulated electric wire known as the lead. Two device systems may be implanted to stimulate both sides of the brain or one device may be implanted with two lead outputs.

    Human device exemptions facilitate the development of medical devices intended to treat or diagnose a disease or condition affecting fewer than 4,000 people per year in the United States. To receive approval, a company must demonstrate the safety and probable benefit of the device.

    OCD is an anxiety disorder and is characterized by recurrent, unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions). Repetitive behaviors such as hand-washing, counting, checking or cleaning are often performed with the hope of preventing obsessive thoughts or making them go away. Performing these actions provides only temporary relief, but not performing them markedly increases anxiety.

    The approval of the human device exemption was based on a review of data from 26 patients with severe treatment resistant OCD who were treated with the device at four sites. On average, patients had a 40 percent reduction in their symptoms after 12 months of therapy. While all patients reported adverse events, the majority of these events ended after an adjustment was made in the amount of electrical stimulation.

    Patients who require electroconvulsive shock therapy should not be implanted with the Reclaim device. Other patients who should not use the device include persons who will undergo magnetic resonance imaging (MRI) or deep tissue heat treatment known as diathermy. http://www.fda.gov/bbs/topics/NEWS/2009/NEW01959.html

      
Reserve/Guard
  • As of Feb. 17, 2009, the total number of Guard and Reserve currently on active duty has increased by 4,079 to 125,806.  The totals for each service are Army National Guard and Army Reserve 96,184; Navy Reserve, 6,259; Air National Guard and Air Force Reserve, 15,298; Marine Corps Reserve, 7,332; and the Coast Guard Reserve, 733.  www.defenselink.mil

Reports/Policies

  • The GAO published “Veterinarian Workforce: Actions Are Needed to Ensure Sufficient Capacity for Protecting Public and Animal Health,” (GAO-09-178) on Feb. 18, 2009.  In this report, the GAO determined the extent to which the federal government has assessed the sufficiency of its veterinarian workforce for routine activities; the federal government has identified the veterinarian workforce needed during a catastrophic event; and federal and state agencies encountered veterinarian workforce challenges during four recent zoonotic outbreaks. http://www.gao.gov/new.items/d09178.pdf

Legislation

  • No legislation was proposed this week.

Hill Hearings

  • The House and Senate Veterans Affairs Committees will hold a joint hearing on Feb. 24, 2009, to hear the legislative presentation of the Disabled American Veterans.
  • The House Armed Services Subcommittee on Military Personnel will hold a hearing on Feb. 25, 2009, to receive testimony on beneficiary and advocacy view.
  • The House Veterans Affairs Committee will hold a hearing on Feb. 25, 2009, to examine document tampering and mishandling at the U.S. Department of Veterans Affairs.
  • The House Veterans Affairs Committee will hold a hearing on Feb. 26, 2009, to hear VA’s update on short and long-term strategies for implementing new G.I. bill requirements.
  • The House Veterans Affairs Committee will hold a hearing on March 5 and 12, 2009, to hear the legislative presentation of veterans’ service organizations.
  • The Senate Veterans Affairs Committee will hold a hearing on March 10, 2009, to examine budget for veterans programs for fiscal year 2010.
  • The House Veterans Affairs Committee will hold a hearing on March 18, 2009, to hear the legislative presentation of the Veterans of Foreign Wars.
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 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.

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