FEDERAL HEALTH UPDATE
Feb 27, 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
Miller is senior vice president and director of studies at the Center for a New American Security (CNAS). He has served as an advisor to the Defense Science Board, as senior associate at the Center for Strategic and International Studies; and as senior associate member at St. Antony’s College, Oxford. In 2000, he received the Department of Defense Medal for Outstanding Public Service. Dr. Miller received a B.A. degree with honors in economics from Stanford University, and Master’s and Ph.D. degrees in public policy from the John F. Kennedy School of Government at Harvard University. Since 2006, retired Marine Corps Lt. Gen. Gregson has been a foreign policy and military affairs consultant for WCG & Associates International. Previously he served as chief operating officer for the United States Olympic Committee. From 2003 to 2005 he was commanding general of the Marine Forces Central Command in the Pacific, where he led and managed more than 70,000 Marines and sailors in the Middle East, Afghanistan, East Africa, Asia and the United States. He served in the Marine Corps since his graduation from the Naval Academy and the US Naval War College. The White House also announced that the following individuals will remain serving in their current posts at the Department of Defense: Mike Donley, secretary of the Air Force; Lt. Gen. James R. Clapper (USAF, Ret), undersecretary of defense for intelligence; and Michael G. Vickers, assistant secretary of defense for special operations/low intensity conflict and interdependent capabilities (SO/LIC&IC).
A TMS Therapy device was approved by the FDA last October to treat depressed patients who had not adequately benefited from prior antidepressant medication. TMS treatment does not require medication, surgery, sedation or anesthesia. During use, a patient is seated in what resembles a dental chair. The treating psychiatrist places a treatment coil on the patient's head from which short pulses of MRI-strength magnetic fields are aimed at the structures in the brain involved in mood regulation. A treatment session lasts about 40 minutes, and patients usually receive 20 to 30 sessions over a 4 to 6 week period. Patients are awake and alert, and return to normal activities after each session. http://news.prnewswire.com/DisplayReleaseContent.aspx?ACCT=104&STORY=/www/story/02-24-2009/0004977878&EDATE=
As a result of these changes, veterans seriously wounded in combat and identified as “catastrophically wounded” go through an expedited disability evaluation process that lasts about 100 days to begin receiving benefits. If veterans are recognized as fitting into that category, they will forego the redundancy of separate Defense and VA medical evaluations and go through the VA process only. The expedited process applies to service members whose conditions are designated catastrophic and whose injuries were incurred in the line of duty as a direct result of armed conflict. A catastrophic injury or illness is a permanent, severely disabling injury, disorder or disease to such a degree that a service member or veteran requires personal or mechanical assistance to leave home or bed, or requires constant supervision to avoid physical harm to themselves or others. Until recently, it took two years for military members to reach 100-percent-disabled status in terms of their disability compensation and medical benefits through the departments of Defense and Veterans Affairs. Regardless of the severity of the injuries, each service member went through multiple medical evaluations and screenings first with the military, only to go through the same process again with VA. Eventually, all servicemembers transitioning to veteran status may benefit from the changes the expedited disability evaluation system offers. The current system may be completely reformed to a one-year process by cutting out the military evaluation altogether, much like the expedient version. The pilot program for such a process is under way, but no decisions have been made yet. http://www.health.mil/Press/Release.aspx?ID=554
DoD evaluated leading patient safety reporting software from suppliers in the US and other countries. A rigorous competitive selection process resulted in the DoD’s choosing Datix software because it best met core requirements for a web-based solution and a complete patient safety taxonomy. Another factor in the DoD’s choice of Datix was the company’s prior experience in implementing large-scale patient safety reporting solutions. As well as covering 75 percent of the National Health Service in the United Kingdom, a single Datix system meets the needs of the Patient Safety Learning System for the Canadian Province of British Columbia. This experience demonstrated Datix’s ability to meet DoD’s requirements for a large number of users and also provides an opportunity for the DoD to learn from the experiences of another similarly sized implementation. A limited deployment of Datix software will take place at nine Military Treatment Facilities in late 2009, followed by a decision to proceed to full deployment in 2010. Systems integration and training will be carried out by Northrop Grumman Corporation under a separate contract. http://www.sourcewire.com/releases/rel_display.php?relid=45879
The contest, open to all servicemembers, their families and MHS personnel, is the first of its kind for MHS, using the social media Web site, YouTube, to manage and collect submissions. Winners will receive a special coin from the Assistant Secretary of Defense, Dr. S. Ward Casscells, and have their videos featured on www.health.mil. Videos will be accepted on a range of military health topics, such as outstanding employees and medical providers, rehabilitation experiences or volunteer efforts. Videos should fall into at least one of five categories: humor, poignancy, history, artistic beauty (highlighting place of work and surrounding area) and/or song. Members of the YouTube community will vote on their favorite videos, selecting the top five as winners. Full contest rules and instructions are available at http://www.youtube.com/group/ShareYourCare.
Claims are now being accepted from Filipino veterans eligible for one-time payments of $9,000 for non-U.S. citizens and $15,000 for Filipino veterans with U.S. citizenship. The Department of Veterans Affairs (VA) is working to begin making payments as soon as possible. VA and the Embassy of the United States in Manila have announced locations in the Philippines where veterans can apply immediately. The list has been posted at http://manila.usembassy.gov. The VA Regional Office in Manila will process all claims for this benefit. Extensive outreach is planned to alert World War II Veterans throughout the Philippines. Claims must be submitted by Feb. 16, 2010, a year after the bill’s signing. The payments do not affect other benefits veterans may be receiving. The VA regional office in Manila currently provides approximately $15 million monthly in monetary benefits to veterans residing in the Philippines. About $8 million of this goes to Filipino World War II veterans or their survivors each month. http://www1.va.gov/opa/pressrel/pressrelease.cfm?id=1654
The 2010 budget request is a significant step toward realizing a vision shared by the President and Secretary of Veterans Affairs Eric K. Shinseki to transform VA into an organization that is people-centric, results-driven and forward-looking. If accepted by Congress, the President’s budget proposal would increase VA’s budget from $97.7 billion this fiscal year to $112.8 billion for the fiscal year beginning Oct. 1, 2009. This is in addition to the $1.4 billion provided for VA projects in the American Recovery and Reinvestment Act of 2009. The 2010 budget represents the first step toward increasing discretionary funding for VA efforts by $25 billion over the next five years. The gradual expansion in health care enrollment that this would support will open hospital and clinic doors by 2013 to more than 500,000 veterans who have been excluded from VA medical care benefits since 2003. The 2010 budget request provides the resources to achieve this level of service while maintaining care for lower-income and service-disabled veterans who currently rely on VA medical care. The new budget provides greater benefits for veterans who are medically retired from active duty, for the first time allowing all military retirees to keep their full VA disability compensation along with their retired pay. The President’s budget request also provides the resources for effective implementation of the post-9/11 GI Bill — providing unprecedented levels of educational support to those who have been in active duty. The new budget will support additional specialty care in such areas as prosthetics, vision and spinal cord injury, aging, and women's health. New VA Centers of Excellence will focus on improving these critical services. The proposed fiscal year 2010 budget also addresses homelessness among veterans. It expands VA's current services through a collaborative pilot program with non-profit organizations that is aimed at maintaining stable housing for vulnerable veterans at risk of homelessness, while providing them with supportive services to help them get back on their feet through job training, preventive care and other critical services. The President’s budget request also provides investments to carry VA services to rural communities that often are unable to access VA care. The budget expands VA mental health screening and treatment with a focus on reaching veterans in rural areas in part through an increase in Vet Centers and mobile health clinics. New outreach funding will help rural veterans and their families stay informed of these resources and encourage them to pursue needed care. https://connect.limra.com/opa/pressrel/,DanaInfo=www1.va.gov+pressrelease.cfm?id=1655
The "reserve fund" in the budget proposal represents President Obama's attempt to demonstrate how the country could extend health insurance to millions more Americans and at the same time begin to control escalating medical bills that threaten the solvency of families, businesses and the government. Obama aims to make a "very substantial down payment" toward universal coverage by trimming tax breaks for the wealthy and squeezing payments to insurers, hospitals, doctors and drug manufacturers. Embedded in the budget figures are key policy changes that the administration argues would improve the quality of care and bring efficiency to a health system that costs $2.3 trillion a year. About half the money for the new fund would come by capping itemized tax deductions for Americans in the top income bracket. The proposal, which administration officials characterize as a "shared-responsibility issue," would reduce the value of tax deductions for families earning more than $250,000 by about 20 percent. Nearly one-third of the money would be generated by eliminating subsidies that the government pays insurers that sell Medicare managed-care plans. Instead, the Medicare Advantage plans would be put under a competitive bidding process, for a savings of $175 billion over the next decade. If the budget is approved by Congress, drug companies will be required to increase the rebate they pay on medications sold to Medicaid patients from 15 percent to 21 percent. The proposal, which would raise $19.5 billion over 10 years, is seen as prompting strong opposition from industry, which has argued that the current rebate cuts into profits. Wealthy senior citizens would also be asked to pay higher premiums for Medicare drug coverage, similar to the higher premiums they now pay for physician visits. The budget figures also represent significant shifts in how the United States will pay for medical care. For example, experts have identified hospital readmissions — especially for elderly patients — as a sign of poor care and unnecessary expense. About 18 percent of Medicare patients are readmitted to the hospital within 30 days of an original visit. The new approach would establish flat fees for the first hospitalization and 30 days of follow-up, sometimes done by separate facilities. Hospitals or clinics with high readmission rates could be paid less. In addition, Medicare and Medicaid currently consume 5 percent of the gross domestic product, or $660 billion a year. At their current growth rates, absent restructuring, the two programs will equal 12 percent of the GDP by 2050. President Obama aims to curb the growth rates with his proposal. https://connect.limra.com/wp-dyn/content/article/2009/02/25/,DanaInfo=www.washingtonpost.com+AR2009022502587_pf.html
The Infectious Diseases Society of America (IDSA) and the Centers for Disease Control and Prevention (CDC) have written to supermarkets that offer free-antibiotics promotions asking them to join “Get Smart: Know When Antibiotics Work,” a campaign from CDC to educate consumers about the importance of using antibiotics appropriately. Several grocery store chains nationwide began offering free antibiotics this winter. Some are linking the promotion to cold and flu season, despite the fact that antibiotics do not work against these viral illnesses. Furthermore, antibiotics can have serious side effects, and their misuse is contributing to the increase in antibiotic-resistant infections such as methicillin-resistant Staphylococcus aureus (MRSA). Studies show many people believe that antibiotics can cure a cold or the flu, and tend to ask or pressure their clinicians to provide them. Every year, tens of thousands of people are prescribed antibiotics for these conditions, even though they will do no good and can be harmful. A recent study in Clinical Infectious Diseases estimates that antibiotics are responsible for 142,000 emergency department visits each year, mostly because of allergic reactions. In letters to Wegmans, ShopRite, Stop and Shop, and Giant, IDSA and CDC suggest that supermarkets could begin with CDC’s easy-to-understand posters, brochures, and other educational materials. IDSA suggests supermarkets offer free flu shots rather than free antibiotics as a way to save customers money while protecting their health.
Under her leadership, HRSA will expand and improve care provided at the Community Health Centers, which serve millions of uninsured Americans and address severe provider shortages across the country In addition to the Community Health, HRSA oversees many programs that the federal government runs to bring health care providers to underserved areas throughout the nation. HRSA also will administer $2.5 billion allocated in the Recovery Act to invest in health care infrastructure and train health care professionals. Dr. Wakefield previously served as director of the Center for Health Policy, Research and Ethics at George Mason University in Fairfax, Va. She also served as the chief of staff for United States Senator Kent Conrad (D-ND) from January 1993 to January 1996 and as legislative assistant and chief of staff to Senator Quentin Burdick (D-ND). Dr. Wakefield has served as a member of the Medicare Payment Advisory Commission and the Department of Veterans Affairs’ Special Medical Advisory Group. She served as chair of the Institute of Medicine (IOM) Committee on Health Care Quality for Rural America and of the Catholic Health Initiatives Board of Trustees, and was a subcommittee chair for President Clinton’s Advisory Commission on Consumer Protection and Quality in the Health Care Industry. Dr. Wakefield received her M.S. in nursing and her Doctor of Philosophy from the University of Texas at Austin and her B.S. in nursing from the University of Mary at Bismarck, N.D. She is a fellow in the American Academy of Nursing, and is a recipient of numerous awards including the American Organization of Nurse Executives (AONE) 2006 Nurse Research Award and the 2008 Nursing Economics Margaret D. Sovie Writer's Award. http://www.hhs.gov/news/press/2009pres/02/20090220a.html
Due to lack of resources, depression in individuals with HIV/AIDS has been largely ignored in sub-Saharan Africa, even though 67 percent of the world's cases are there. Research has shown that depression is associated with failure to adopt healthy protective behaviors and that people with less depression are more likely to engage in healthy behaviors such as using precautions if engaging in sex. Despite a culture which prizes stoicism in the face of adversity, researchers found Kenyans had a high degree of openness and willingness to talk about depression and hopelessness. Thirteen percent incidence of major depression disorder and a 21 percent incidence of other depressive disorder in the 345 HIV/AIDS Kenyan patients were identified. The PHQ-9 was developed in a 1999 study to screen primary care patients for depression. It is now increasingly used by psychiatrists. Although the PHQ-9 has been extensively tested, validated and utilized in the United States and West Europe, only one previous study has evaluated use of the PHQ-9 with an HIV-positive population, and that was in the United States, not in Africa. Only three previous studies have looked at the feasibility of administering the PHQ-9 in Africa, none to patients with HIV/AIDS.
The Office of National AIDS Policy (ONAP) is the White House Office tasked with coordinating the continuing efforts of the government to reduce the number of HIV infections across the United States. The office emphasizes prevention through wide-ranging education initiatives and also helps to coordinate the care and treatment of citizens with HIV/AIDS. The President has made a strong commitment to developing a national AIDS strategy, which will be a top priority for the Office of National AIDS Policy. In addition, ONAP coordinates with international bodies to ensure that the fight against HIV/AIDS is fully integrated around the world. The ONAP is part of the Executive Office of the President’s Domestic Policy Council (DPC). Crowley previously served as the deputy executive director for programs at the National Association of People with AIDS (NAPWA). While at NAPWA, he helped implement several key initiatives including the National HIV Testing Day Campaign and the Ryan White National Youth Conference. Crowley received his Master of Public Health from the Johns Hopkins University School of Hygiene and Public Health, and his Bachelor of Arts in Chemistry from Kalamazoo College. He is also an alumnus of the United States Peace Corps, where he served as a volunteer/high school science teacher at the Nsongweni High School in Swaziland.
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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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