FEDERAL HEALTH UPDATE
Apr 10, 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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Executive and Congressional News
Currently, there is no comprehensive system in place that allows for a streamlined transition of health care records between DoD and the VA. Under the initiative, both departments will work together to define and build a system that will ultimately contain administrative and medical information from the day an individual enters military service throughout his or her military career, and he or she leaves the military. Access to electronic
records is considered essential to modern health care delivery and the
paperless administration of benefits. It provides a framework to ensure
that all health care providers have all the information they need to
deliver high-quality health care while reducing medical errors. The
creation of this Joint Virtual Lifetime Record by the two organizations
would take the next step to delivering seamless, high-quality care and
and is designed to serve as a model for the nation. http://www.whitehouse.gov/the_
States will receive $2 billion in Recovery Act funding to support child care for working families. The administration also plans to make $300 million in vaccines and grants available to ensure more underserved Americans receive the vaccines they need. The $2 billion in Recovery Act funds for the Child Care and Development Fund will allow states across the country to support child care services for more families whose children require care while they are working, seeking employment or receiving job training or education. In addition to funding for child care programs, $300 million in Recovery Act funding and grants will be used to increase access to vaccines for underserved Americans. Funded by the American Recovery and Reinvestment Act, the majority of these new resources will be used to purchase vaccines, which will be distributed through the Centers for Disease Control and Prevention’s Section 317 immunization program to all 50 states, several large cities, and U.S. territories. Funding will also be used to support national public information campaigns regarding vaccines and support grants to states that demonstrate innovative new ways to ensure more Americans receive the vaccines they need. To see a list of state by state funding
for child care programs, visit http://transparency.cit.nih. Military Health Care News
In the release, TRICARE officials remind beneficiaries that their managed care support contractor (MCSC) can assist them with setting up electronic enrollment fee payments. The contractor is responsible for verifying the information necessary to initiate allotments and EFTs. Depending on a beneficiary’s MCSC, options range from a retirement pay allotment to Electronic Funds Transfer (EFTs) from the enrollee’s designated financial institution, or by credit card. A check for the first quarter is required initially to cover the period of time it takes to process and begin any electronic option. The most convenient, reliable and secure form of enrollment fee payment is through allotment. With allotments, beneficiaries don’t have to worry about credit card expiration or a change in financial institutions. A simple allotment authorization form is available on the MCSC Web sites. If electronic options become a requirement in the future, the only time payments by check will be accepted is for the first payment to cover the next quarterly period while an allotment or other electronic means of payment is being processed. More information is available on the Web site of each TRICARE regional MCSC:
The Civilian Provider Training Portal, a pilot web portal developed by a team of PSI specialists for TRICARE Management Activity (TMA), provides training to civilian health care providers who care for service members and veterans with PTSD and TBI. With PSI's assistance, MHS Learn delivers this training through a new front-end portal, which includes continuing medical education certificates, custom reports and a refined self-registration process. At the end of the six-month pilot,
the program will be evaluated to determine if additional education courses
are needed to help providers treat patients suffering from disorders
related to military experiences. The Civilian Provider Training Portal
is also supported by Oracle Corporation's iLearning software and On
Demand services and can be accessed at www.health.mil/ PSI's Telehealth Team is providing training and sensitizing services to the Air Force Medical Service to deliver critical care for soldiers suffering from PTSD and TBI. As part of the program, the PSI Team specialists are overseeing Virtual Reality Technology to provide mental health services to active duty and veteran beneficiary populations. One method of treatment is “Virtual Iraq,” which involves exposing the patient to a virtual world that simulates the sources of combat stress. By gradually re-introducing the patient to the experiences that triggered the trauma, the memory becomes tolerable. Like the Civilian Provider Training Portal, this “Virtual Iraq” platform also can improve critical care to inflicted soldiers by better preparing and sensitizing clinicians charged with their care. PSI is also involved in the development of a Clinical Case Management and Disability Evaluation, under the management of the Defense Health Information Management System – TRICARE Management Activity solution, an information technology solution that will help service members and veterans suffering from PTSD and TBI. The Clinical Case Management and
Disability Evaluation initiative will provide essential clinical case
management information for the physician to ensure the patient gets
“the right care at the right time at the right place.” This initiative
will also provide the capability to standardize Department of Defense
and Veterans Affairs disability evaluation workflow processes across
the two agencies, which will ensure our service members and veterans
receive the health care and benefits to which they are entitled. http://www.defencetalk.com/
The initial pilot was at Madigan Army Medical Center in Tacoma, Wash. The new projects, in Bethesda, Md., and Hampton Roads, Va., will focus on using the Micare PHR as a tool for care coordination as well as a mechanism for patients to share health records across a mix of military and commercial providers and payer organization. In the first project, MHS will partner with the National Naval Medical Center in Bethesda, Md., to test the ability of the Micare PHR to support a medical home of more than 10,000 patients in a primary care setting. In a medical home care model, a patient’s health care services and specialists are coordinated through a single physician or provider team. MHS hopes to launch the Bethesda project in the next three months. The test will also give MHS experience developing a patient-provider portal necessary for the kind of health information sharing necessary in the medical home setting. In the second project, MHS will begin working with the Riverside Health System, a 350-physician integrated medical facility in Hampton Roads, Va., an area with the highest concentration of military families in the country. The region is home to an array of military hospitals and health care organizations, including a VA hospital and an Air Force care facility. At Riverside, MHS wants to test the experience of PHR users who cross back and forth between DoD, VA and private health care providers and purchasing organizations in pursuing health care services. Eventually, plans call for the addition
of an e-benefits feature to be added to the Riverside project.
Through this program, which includes manufacturer contributions of clean, synchronized data, the DoD and VA have been able to save more than $32 million to date through product price reductions, including $11 million in 2008. The manufacturers will receive the 2008 DoD/VA Award for Healthcare Product Data Quality in two categories:
The 2008 Champions are BD and Sage Products, Inc.
The 2008 Leaders are: Cardinal Health, Medegen, Propper Manufacturing Company, Retractable Technologies, Inc., and 3M. Winners were selected based on multiple
criteria that measure the breadth, quality and frequency of product
data submitted in support of the DoD/VA internal data synchronization
program and pilot DoD/VA Product Data Utility — a single source of
true, synchronized product information in the federal healthcare supply
chain. Data fields evaluated included those that are most needed for
efficient supply chain interactions, such as packaging levels and product
descriptions. http://www.health.mil/Press/ Veterans Health Care News
During his 37-year government career, Dr. Kussman attained the rank of brigadier general while in the U.S. Army, and has been with VA since 2000. Since 2007, Dr. Kussman has served as under secretary for health and in this role has directed a health care system with an annual budget of approximately $40.2 billion, overseeing the delivery of care to more than 5.6 million veterans. VA, the nation’s largest health care system, employs more than 231,000 health care professionals and support staff at more than 1,400 sites of care, including hospitals, community and facility-based clinics, nursing homes, domiciliaries, readjustment counseling centers, and various other facilities. A native of Troy, N.Y., Kussman earned
his undergraduate and medical degrees from Boston University, receiving
his medical degree in 1968. In 1994, he earned a master’s degree in
management from Salve Regina University. He is also a graduate of the
Army War College and an honor graduate of the Command and General Staff
College. He is board-certified in internal medicine and serves on the
faculty of the Uniformed Services University of Health Sciences. http://www1.va.gov/opa/
The study’s authors, led by Dr. Ashish K. Jha of Harvard University, noted that VA’s use of electronic health records has significantly enhanced the quality of patient care. They also found that only 1.5 percent of U.S. hospitals have comprehensive electronic health records; adding VA hospitals to the analyses doubled that number. VA clinicians began using computerized patient records in the mid-1990s for everything from recording examinations by doctors to displaying results of lab tests and x-rays. Patient records are available 100 percent of the time to VA health care workers, compared to 60 percent when VA relied on paper records. The authors of the NEJM article
are the latest to praise VA for its technology and commitment to patient
safety. In 2006, VA received the prestigious “Innovations in American
Government” Award from Harvard’s Kennedy School of Government for
its advanced electronic health records and performance measurement system.
The contract is for one base year and three option years to help ensure financial adherence to federal mandates through enhanced portfolio programming and management of the VA's information. CACI is expected to improve the VA’s ability to use its IT portfolio management process to make the possible selection of IT projects to execute and ensure those projects are properly managed in support of program priorities. This objective is in line with the VA's objectives of enhancing financial efficiency, complying with Office of Management and Budget mandates and standardizing the management of information technology projects across the agency. CACI will support all operational
and technical requirements associated with the systematic analysis planning,
budgeting and execution of IT investments. The company's functional
core competency of program management and system engineering and technical
assistance support services will be a principal resource in fulfilling
the contract. http://itservices.cbronline.
Health Net has partnered with the Martinsburg VAMC, which serves veterans residing primarily in the counties of Rockingham, Albemarle, Augusta and Greene, to deliver primary care and mental health services in Harrisonburg since 1999. The Harrisonburg VA clinic offers chronic disease management, as well as health promotion programs, on a wide range of health issues such as smoking, hypertension, diabetes, obesity and heart disease. Veterans are screened and treated for conditions such as alcohol and substance abuse, military sexual trauma and post-traumatic stress disorder (PTSD). The Harrisonburg clinic also offers
a full range of well-woman services, including education, family planning,
breast cancer screening, and cervical cancer screening.
With these new partnerships, the VA Nursing Academy will expand the number of collaborations between the department and nursing schools from 10 to 15. The VA Nursing Academy is a virtual five-year pilot program with central administration in Washington. It expands learning opportunities for nursing students at VA facilities, funds faculty development of VA staff for additional faculty positions to competitively selected school partners. The five-year, $59 million program began in 2007. Five nursing schools will form new partnerships with five VA medical centers and join the VA Nursing Academy this year. They are:
The American Association of Colleges of Nursing has reported that in 2007 more than 36,000 qualified applicants were turned away from entry-level baccalaureate degree programs in nursing schools because of insufficient numbers of faculty, clinical sites, classroom space and clinical mentors. VA currently provides clinical education for approximately 100,000 health professional trainees annually, including students from more than 600 schools of nursing. VA Nursing Academy enables competitively selected VA-nursing school partnerships to expand the number of nursing faculty, enhance the professional and scholarly development of nurses, increase student enrollment by about 1,000 students and promote innovations in nursing education. Further information about the program
can be obtained from VA’s Office of Academic Affiliations web site
at www.va.gov/oaa.
As the number-two executive in the VA, Gould will oversee the day-to-day operation of the federal government's second-largest cabinet department, which provides health care to more than 1 million patients per week and benefits checks to about 3.7 million people monthly. As a naval reservist, Gould served at sea aboard the guided missile destroyer Richard E. Byrd and was 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 officer. Gould recently served as vice president for public-sector strategy at IBM Global Business Services, where he also founded and led IBM's Global Leadership Initiative. Prior to 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. Gould's previous service in the federal government includes positions as the chief financial officer and assistant secretary for administration at the Commerce Department and, later, as deputy assistant secretary for finance and management at the Treasury Department. 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. 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. Health Care News
The Federal Health Architecture, an E-Gov initiative led by the Office of the National Coordinator for Health Information Technology (ONC), is making this free software, called CONNECT, and supporting documentation available at www.connectopensource.org. The ONC has facilitated development of the NHIN, which will tie together health information exchanges, integrated delivery networks, pharmacies, government health facilities and payors, labs, providers, private payors and other stakeholders into a “network of networks.” The NHIN uses interoperability standards recognized by the Secretary of Health and Human Services, as well as public and private sector specifications, participation agreements and policies. To enable health information exchanges over the NHIN, the ONC is working to develop the necessary governance processes and legal framework for participation in the network. The CONNECT software was developed with the input of more than 20 federal agencies to connect their health IT systems to the NHIN. This shared software solution can be used by each agency within its own environment. CONNECT implements the core services defined by the NHIN including standards for security to protect health information when it is exchanged with other trusted health organizations. The agencies built CONNECT using open source components and will make it available under an open source license in order to encourage innovation and to keep costs low. CONNECT will be available to the entire health care industry, which is expected to speed NHIN adoption among health care organizations. The Department of Defense, the Department of Veterans Affairs, the Social Security Administration (SSA), the Centers for Disease Control and Prevention, the Indian Health Service, and the National Cancer Institute have tested and demonstrated CONNECT’s ability to share data among one another and with private sector organizations. In February 2009, the CONNECT software gateway was used for the first time in a limited production environment when the SSA began receiving live patient data from MedVirginia through the NHIN. Private and public sector organizations can download CONNECT and use it for their connectivity needs. As with other open source solutions, organizations are encouraged to modify and expand the capabilities of the software. Although the download is free, an organization opting to use the solution should be aware it will be responsible for costs associated with its implementation and maintenance within its own environment. More information about HHS health
information technology activities is available at http://www.hhs.gov/healthit.
The two companies
expect this field, already a multibillion-dollar market, to grow rapidly
as populations grow older in the United States and abroad. This type
of remote technology—which is referred to as telehealth and home health
monitoring—is a $3 billion market in North America and Europe, and
it's projected to reach $7.7 billion by 2012.
Loonsk, who served as director of interoperability and standards in the Office of the National Coordinator (ONC), will lead the healthcare strategy direction as the company expands its healthcare practice. CGI Federal is a wholly owned, U.S.-operating subsidiary of CGI Group, Inc. CGI is a healthcare systems integrator experienced in working with complex, large-scale, multi-stakeholder health information projects. Its practice spans all levels of government as well as commercial payers and providers. Loonsk served at the ONC, which is
under the umbrella of the Department of Health and Human Services, since
2005. In this role, he worked with leadership in both the government
and commercial healthcare sectors to help create a standards-based,
deployable healthcare IT strategy. Prior to HHS, he served as the associate
director for informatics and director of the Information Resources Management
office for the Centers for Disease Control and Prevention.
The report focuses on three main topics: escalating health care costs, diminishing access to care, and persistent gaps in quality. According to the report, health care costs have doubled from 1996 to 2006, with employer-based family insurance policies now costing about $12,680, the annual salary for a minimum wage worker. Some other key findings were that at least 80 percent of Americans who are uninsured or don't have access to care are from working families. In addition, the report found that even those with insurance forgo medical attention because they can't afford copayments or deductibles. The report also examines the disparities in care and health care quality in America. The HHS report points out that up
to 98,000 people die each year from medical errors alone. To view the
report, please visit http://www.healthreform.gov/
By law, CMS annually updates the Medicare Advantage capitation rates by a growth percentage that reflects growth in all Medicare expenditures, including expenditures under Part A and Part B payment rules. This growth percentage thus reflects the projected reduction in 2010 physician payments provided for under Part B payment rules. CMS announced that the 2010 payment rates will be 0.81 percent. For prescription drug program enrollees, the announcement includes important information about the 2010 Part D deductible, initial coverage limit, out-of-pocket threshold and related parameters for the standard benefit. The annual percentage increase in average per capita Part D spending – used to update the deductible, initial coverage limit and out-of-pocket threshold for the defined standard benefit for 2010 – is 4.66 percent. For the first time, for plan year 2010, CMS will make a “coding pattern differences adjustment” to Medicare Advantage risk scores, reducing Medicare Advantage payment rates to account for differences in disease coding patterns between Medicare Advantage organizations under Part C and the Original Medicare program (Parts A and B). The adjustment will be applied as a uniform 3.41 percentage reduction to all Medicare Advantage plans’ Part C risk scores in 2010. In addition, the 2010 rates announced reflect a provision in recently enacted legislation requiring a multi-year phase-out of the inclusion of costs of indirect medical education in Medicare Advantage rates. The maximum reduction as part of this phase-out is approximately 0.60 percent per year. The changes announced update and make final provisions of the Advance Notice that CMS released on February 20, 2009. The Announcement of Calendar Year
(CY) 2010 Medicare Advantage Capitation Rates and Medicare Advantage
and Part D Payment Policies may be viewed at http://www.cms.hhs.gov/
Coartem is not approved for the treatment of severe malaria nor to prevent malaria. Severe malaria is different than acute, uncomplicated malaria in that patients with severe malaria have altered consciousness and other metabolic and end-organ complications. These patients are not candidates for oral drugs and should be given intravenous anti-malarial therapy. Coartem has been shown to be effective in geographical regions with reported resistance to chloroquine, a drug that prevents and treats malaria. Symptoms of malaria include fever, chills, and flu-like illness. Left untreated, the disease can cause severe complications, including death. About 90 percent of malaria deaths occur in Sub-Saharan Africa, but the disease is also prevalent in parts of Asia and Latin America. It is estimated that 350 to 500 million new cases develop worldwide annually and 1 million patients, primarily young children, die of the disease. Artemether, one of the active ingredients
in Coartem tablets, is the first artemesinin class drug approved in
the United States. The artemesinins are derived from the leaves of the
Artemisia annua plant that are used to treat malaria.
These 25 device types, which are listed in the Federal Register announcement posted on April 9, 2009, were marketed in the U.S. prior to the Medical Device Amendments to the Food, Drug, and Cosmetic Act of 1976. That law authorized the FDA to review new medical devices. Devices found by the FDA to be of high risk to consumers will be required to undergo the agency’s most stringent premarket review process. The FDA classifies medical devices into three categories according to their level of risk. Class III devices represent the highest level of risk and generally require a showing of safety and effectiveness before they may be marketed. Class III devices include heart valves and intraocular lenses. Class I and Class II devices pose lower risks and include devices such as adhesive bandages and wheelchairs. Most Class II devices and some Class I devices are marketed after submission of premarket notifications establishing their substantial equivalence to legally marketed devices that do not require premarket approval. After Congress enacted the medical device law in 1976, the FDA classified these 25 devices types into Class III (premarket approval). Under the law, these devices were not immediately required to undergo the premarket approval process. The law required the FDA to issue a rule subjecting the devices to that requirement. As of 1994, there were approximately 149 Class III, pre-1976 types of medical devices that had not yet been subject to premarket approval. Since then, the FDA has made significant progress in reviewing and issuing new regulations for all but 27 of those device types, including the review of 55 types since January 2000. (The FDA has already initiated this process for two device types, which will be completed separately.) Manufacturers of the 25 remaining device types must submit the requested information within 120 days. The FDA will review the submitted data and, based on the risk level, issue regulations for each device type that either will require manufacturers to submit premarket approval applications or will re-classify the devices into Class I or Class II. For more information, please visit
FDA’s Center for Devices and Radiological Health Web site http://www.fda.gov/cdrh/
In the preliminary report, researchers found that nearly 40 percent of babies born in the United States in 2007 were delivered by unwed mothers. The 1.7 million out-of-wedlock births, of 4.3 million total births, marked a more than 25 percent jump from five years before. The new numbers indicate the nation is experiencing a baby boomlet with fertility rates higher in every racial group. On average, a U.S. woman has 2.1 babies in her lifetime. The highest fertility rates were among Hispanics. But it's not clear the boomlet will last. Some experts think birth rates are already declining because of the economic recession that began in late 2007. The 2007 statistical snapshot reflected a relatively good economy coupled with cultural trends that promoted childbirth. Meanwhile, U.S. abortions have been dropping to their lowest levels in decades, according to other reports. Some have attributed the abortion decline to better use of contraceptives, but other experts have wondered if the rise in births might indicate a failure in proper use of contraceptives. Some earlier studies have shown declining availability of abortions. The statistics are based on a review of most 2007 birth certificates by the National Center for Health Statistics, part of the Centers for Disease Control and Prevention. The numbers also showed:
To read the preliminary report, please
visit http://www.cdc.gov/nchs/data/ Reserve/Guard
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