FEDERAL HEALTH UPDATE
May 8, 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
Kathy Greenlee has served as secretary
of aging for the state of Kansas since January 2006. In that capacity,
she has led a cabinet-level agency with 192 full-time staff members
and a total budget of $495 million. Her department oversees the state’s
Older Americans Act programs, the distribution of Medicaid long-term
care payments and regulation of nursing home licensure and survey processes.
Greenlee also served as chief of staff and chief of operations for Gov.
Kathleen Sebelius. She is a graduate of the University of Kansas with
degrees in business administration and law.
Carmen Nazario is an assistant professor at the Inter American University of Puerto Rico, where she teaches social policy and coordinates the social work practicum at the School of Social Work. Nazario has vast experience in public service with a focus on improving services to children and families within the United States and around the world, dating back to 1968. Most recently, she served as administrator of the Administration for Children and Families for the Commonwealth of Puerto Rico, where she led an agency of 4,000 staff with a budget of over $220 million. Nazario is from Bayamon, Puerto Rico.
She received a Bachelor of Arts with honors in sociology from the University
of Puerto Rico in 1967, and was awarded her Master of Social Work degree
from Virginia Commonwealth University School of Social Work in 1973.
Corr most recently was executive
director of the Campaign for Tobacco-free Kids. Dr. Roubideaux has conducted
extensive research on American Indian health issues, with a focus on
diabetes.
H1N1 Flu (Influenza A) News
Military Health Care News
The Wilson Rx Survey, conducted annually by Wilson Health Information, LLC, reported that TRICARE beneficiaries scored TRICARE high enough to rank it number one in satisfaction in nearly 40 categories, including overall health plan satisfaction, plan coverage, costs, service delivery, quality and prescription drug coverage. The survey was self-administered, with respondents rating various aspects of their health care and prescription plans on a scale of one to four. Conducted by U.S. mail, more than 71,000 surveys were sent to household healthcare shoppers or decision makers. Of the 34,454 people completing the survey, 835 were TRICARE beneficiaries. TRICARE officials note that external surveys differ from Department of Defense and TRICARE-conducted surveys. Survey methods, questions, scales of measurements and weighting of responses may not be comparable. In addition, demographics may not reflect the entire TRICARE beneficiary population. For instance, the Wilson Rx survey did not include overseas, Alaska and Hawaii and some other locations with high TRICARE beneficiary populations. TMA administers the TRICARE health care plan for the uniformed services, retirees and their families, serving more than 9.4 million eligible beneficiaries worldwide. Details on the Wilson Rx survey can
be found at the TRICARE transparency Web page at http://www.tricare.mil/
After two years as an ACPE diplomate, Smith was inducted into the organization’s prestigious fellowship, a recognition that comes in the wake of his leadership on a broad range of health policy, clinical quality and patient safety issues. This award adds to his growing list of accomplishments in the medical community, including two highly esteemed fellowships with the American College of Health Care Executives and the American Academy of Family Physicians. Smith graduated from the University
of Virginia School of Medicine and holds a Master’s degree in medical
management from Tulane University. He is a board certified family physician
and served in the U.S. Navy for more than 30 years before retiring in
2005. In addition to his current duties, Smith also serves as the acting
chief medical officer for TRICARE Management Activity.
First opened as an 80-bed hospital, the 247-bed center is one of the world's premier medical facilities with 60 outpatient clinics and 16 operating rooms — combining patient care, teaching and research. The facility has treated hundreds of thousands of people throughout the century. WRAMC now includes the Military Advanced Training Center. The 31,000-square-foot rehabilitation center opened in September 2007. It has cutting-edge technologies such as computer and video monitoring systems and simulation rooms. Service members injured before the days of infrared camera-assisted motion analysis and treadmills that mimic uneven ground went through different methods of physical therapy. Recently WRAMC opened the Warrior
Clinic, with its Americans with Disabilities Act-compliant restrooms,
double- wide doors, lower examining room tables. It was specifically
designed for wounded warriors and their families. Its comfortable seating,
warm amber lighting, and 50-inch flat screen televisions invite relaxation.
The council co-chairmen met with Gen. George W. Casey Jr. to report the top retiree issues April 29, after the council's 49th meeting, held April 20-24 in the Pentagon. The council, chaired by retired Lt. Gen. Frederick Vollrath and retired Sgt. Maj. of the Army Jack Tilley, is made up of seven retired officers and seven retired noncommissioned officers. At their annual meeting, they reviewed 30 issues submitted by installation retiree councils, 13 of them dealing with health care. In its report to the chief of staff, the council warned that recruiting and retention would be affected if health care policy were determined by budgetary constraints alone, without considering the sacrifices asked of the current force. The Council made the following recommendations:
http://www.army.mil/-news/
Developed with support from the U.S. Army’s Telemedicine Advanced Technology Research Center, the software application is designed to allow emergency responders at federal, state and local levels to communicate and collaborate during crises. The platform began as a clinical decision support system for the treatment of chemical weapons, biological weapons and blast injuries and has been expanded to include mapping, credentialing and more knowledge bases (19 at last count). Aside from real-time credentialing and decision support, EFR MedCom is also designed to facilitate communication of casualty data to a command center, facilitate information exchange through the Nationwide Health Information Network and develop information databases through the Google Health platform. At the conference, the CEO and founder of MedRed, William K. Smith, highlighted the real-time communication and accurate information that the software provides to first responders. MedRed’s success in recent years has been tied to its military projects. After acquiring the rights to the Special Operations Medical Diagnostic System in 2004, the company developed an online PHR manager in 2005 and created the DiagnosTX clinical decision support system in 2006. The company partnered with Walter Reed Army Medical Center and the Defense and Veterans Brain Injury Center last year to develop decision support for soldiers with traumatic brain injury, then installed its DiagnosTX system at Walter Reed. Smith said MedRed will make EFR MedCom
available for purchase by national, state and local first responder
organizations on June 1. The company is also looking to create a pilot
project for the system in Washington and one or two other major urban
areas. http://www.healthcareitnews.
Military medical authorities also advise that troops slated for deployment to combat zones should cease taking aspirin at least 10 days before departure. Aspirin is “a platelet-inhibitor,” which can prevent the ability to form of blood clots. Low amounts of blood platelets can lead to excessive bleeding aspirin use by troops deployed in contingency areas could contribute to excessive bleeding in the event of wounding or injury. Blood loss is the most common cause of preventable death associated with combat injuries. The memorandum also directed the cessation of “over-the-counter access” to aspirin through Army and Air Force Exchange Service outlets or morale, welfare and recreation activities in war zones. AAFES has jurisdiction over Army post exchanges and Air Force base exchanges. The intent of the new policy is to “discourage the inadvertent use of aspirin” in combat zones. People who routinely take small doses of aspirin per doctor’s orders to maintain vascular health should be all right but they should consult their physician. Service members and civilians could
substitute over-the-counter, non-aspirin-based medications – such
as Tylenol or Motrin -- for treatment of colds, fever, muscle aches
and other maladies.
The claims court vacated the government's TRICARE contract with Lockheed Martin Federal Healthcare after finding that the contracting officer failed to analyze potential conflicts of interest. The claims court suggested having an independent auditor monitor the enforcement of Lockheed's mitigation plan, but the government rejected this idea. Because the government refused the proposed oversight, the claims court enjoined it from renewing Lockheed's contract. In its decision, the lower court relied extensively on affidavits filed by losing bidder Axiom Resource Management. Lockheed and the government appealed. The Federal Circuit found that the claims court violated administrative law by allowing Axiom to supplement the record with affidavits and then relying extensively on those affidavits to support its decision. The federal appeals court also agreed
with the government that the claims court failed to properly review
the record under the "arbitrary and capricious" standard. http://www.courthousenews.com/ Veterans Health Care News
Veterans, service members, reservists and National Guard members with active duty since Sept. 10, 2001, may be eligible for this benefit. Veterans will remain eligible for benefits for 15 years from the date of last discharge or release from a period of active duty of at least 90 continuous days. Eligible applicants must have served for an aggregate period of at least 90 days since Sept. 10, 2001, or served at least 30 continuous days on active duty since Sept. 10, 2001, and received a discharge for disability. Benefit payment rates range from 40 percent of the maximum benefit for an person with at least 90 days, but less than 6 months, of aggregate service and up to 100 percent of the benefit for people with at least 36 months of aggregate service or 30 continuous days and a discharge due to a service connected disability. Prospective beneficiaries may apply on-line through the GI Bill Web site at www.GIBILL.VA.gov. Qualified Veterans will receive a “Certification of Eligibility” as well as additional information regarding benefits they may qualify for under the Post-9/11 GI Bill, which will become effective on Aug. 1, 2009. The Post-9/11 GI Bill, passed by Congress last year, is the most extensive educational assistance program authorized since the original GI Bill was signed into law in 1944. It provides eligible applicants with tuition payments to assist them in getting a college education. For many participants, it also provides a housing allowance and a stipend for books and supplies. Information about the new program
and VA’s other educational benefits can be obtained through www.GIBILL.VA.gov or by calling 1-888-GIBILL1 (1-888-442-4551).
Running Start is a non-profit organization dedicated to inspiring young women to run for political office. It offers high school and college women the unique opportunity to hear from today’s leaders. By educating young women about the importance of politics and giving them the skills they need to become leaders, they give them the running start they need to reach their aspirations. Assistant Secretary Duckworth was recognized as a “Woman to Watch” by Running Start along with Erin Issabelle Burnett, CNBC television anchor; Betsy Fischer, executive producer of Meet the Press; Julie Gilbert, founder and CEO of Wolf Means Business; and Mona Sutphen, deputy chief of staff for the Obama Administration. Duckworth spoke to a crowd of 300
young women at a ceremony at the National Press Club.
The VA software is open-source software—its code is freely available to the public and is constantly being improved by users—and it includes important features, such as a bar-coding system to track drug dispensing, to help improve patient safety. But very few US hospitals have taken advantage of it. Wealthier hospitals have opted to buy more expensive, custom systems from private vendors, while smaller and more rural hospitals often stick with paper records. Technology experts cite a number of reasons: The software itself is free, but still costs millions to install and maintain, so money remains a barrier. In addition, installing and running VistA requires skilled technology workers, a resource lacking in many hospitals, particularly smaller and more rural institutions. Some policy makers are working to change that. Senator Jay Rockefeller (D-W.Va.), chair of the Finance Committee's health subcommittee, is introducing legislation that would promote the widespread adoption of VistA and other open-source systems among hospitals serving the poor. He also successfully pushed to include provisions in the stimulus bill to make VistA more accessible. VistA was designed mainly for clinical use, not for billing, since the VA gets most of its money from the government, not from insurance reimbursements. But billing components can be added. The system also is less honed for medical specialties that the Veterans Affairs Department has not traditionally offered or focused on, such as obstetrics. But experts say VistA is highly adaptable and those capabilities can be built. Senator Rockefeller said he hopes to fully underwrite the roughly $10 billion cost of installing and maintaining open-source electronic records systems in all of the country's safety-net hospitals, removing a barrier that he fears could lead to a deepening divide between health information haves and have-nots. Even with generous subsidies from the Obama administration's $19 billion health technology investment in the stimulus bill, many hospitals still can't afford an electronic records system. Rockefeller's legislation would also
create a federal public utility board to coordinate upgrades to a national
open-source system and build a standard child-specific electronic health
record for the Medicaid program. http://www.boston.com/news/
One of several projects under way at the VA’s Center of Excellence involves getting civilian emergency departments to work with VA hospitals and clinics to ensure no veteran falls through the cracks. Called Safe Vet, the project entails hiring and training coordinators to work at selected VA facilities. So far, Safe Vet programs are being started in Denver and Philadelphia. Here is a possible scenario: A veteran is brought to an emergency department by family members concerned because the veteran has taken an unknown substance and is exhibiting bizarre behavior. The emergency staff evaluates the vet and determines the patient is not an immediate threat to himself or others. Instead of the veteran’s just going on home, he or she is then referred to the coordinator for the Safe Vet program. That coordinator does a separate evaluation specific to behavioral health, which includes developing a plan of care catered to that veteran’s need and providing the veteran and family with the VA’s suicide-prevention hotline information. The program is being developed and coordinated at the Canandaigua VA. It involves creating a training program for the Safe Vet coordinator, who will be an employee of the selected VA and must be a psychologist or social worker. Though the coordinators are hired by the selected VA facilities, the duties and other details of the position are determined by the program developed in Canandaigua. All Safe Vet coordinators, no matter where they work, will fulfill the same requirements. Canandaigua will also be the VA where all the data will be recorded, managed and analyzed. VA sites are selected based on the number of veterans living in an area and other factors with at least three more communities to be selected this year. A VA coordinator and emergency personnel work together to share information and make sure veterans receive care through the VA, care they might not otherwise have sought or known about. The program also guarantees “intensive follow-up” from the VA for up to a year. Though a Safe Vet program is not yet designed for a specific VA in upstate New York, it is likely one will eventually be at a site in the region encompassing VA facilities in Canandaigua, Buffalo and Syracuse. Those working on the Safe Vet program involve others affiliated with the University of Rochester, including psychiatrist Glenn Currier, the center’s chief of medical affairs and associate professor of psychiatry at the university. The rise in calls to the national suicide-prevention hotline operated out of the VA on Fort Hill Avenue is a sign of the dire need to help veterans. Since launched in July 2007, dispatchers had fielded 128,974 calls as of March 31, including 3,305 rescues. The hotline received 67,350 calls in fiscal 2008. In the first six months of fiscal 2009, the number of calls was already at 52,245. The number of employees at the Center of Excellence has remained at about 45 since it opened in 2007, though the amount of work has increased with many part-time positions having become full-time. Health Care News
The study, published in the journal Health Affairs, found that mental-health drug prescriptions for U.S. adults increased 73 percent and those for children rose 50 percent over a 10-year period. In 2006, one in 10 adults and one in 20 children reported having a prescription for a mental-health drug. A separate study, also reported in the journal, found the per-capital spending for mental-health care has grown more than 30 percent over the 10 years ended in 2006, with almost all the increase due to psychiatric drug costs. The increase in mental-health spending and the number of patients using these drugs largely indicate better access to care but the increase has been more towards medicating rather than therapy. For about 30 years ending in 2000, the growth of mental-health costs remained relatively flat, consistently staying at around 1 percent of the gross domestic product, and growing at about half the rate of all other health-care spending. But starting around 2000, mental-health-care costs began to climb more sharply. Cost growth in general health care is related to a variety of factors, such as spending for diagnostic imaging and hospital care. In 2006, drug costs accounted for 51 percent of mental-health-care costs, while drugs accounted for just 26 percent of spending for all other health-care costs, according to data from a national household survey of health-care spending focusing on outpatient care. Per-capita spending for mental-health care between 1996 and 2006 grew about $40 to $148.56. The studies were funded by a combination
of the John D. and Catherine T. MacArthur Foundation and the National
Institutes of Mental Health.
The report was developed by HHS staff from across the department and is available at www.HealthReform.gov. Hard Times in the Heartland indicates that nearly 50 million people in rural America face challenges accessing health care. Not only do these Americans face higher rates of poverty, they report more health problems, are more likely to be uninsured, and have less access to primary health care providers than do Americans living in urban areas. The report notes:
In addition to the Hard Times
in the Heartland report, visitors to the Web site are also encouraged
to take a new Health Reform quiz, a new feature on www.HealthReform.gov.
The study published in the May issue of the Journal of Allergy and Clinical Immunology showed that obese children and adolescents are at increased risk of having some kind of allergy, especially to a food. The study was funded by the National Institute of Environmental Health Sciences (NIEHS) and the National Institute of Allergy and Infectious Diseases (NIAID), both parts of the National Institutes of Health. The study is the first to be published using new data from the National Health and Nutrition Examination Survey (NHANES). NHANES is a large nationally representative survey conducted by the National Center for Health Statistics, a part of the Centers for Disease Control and Prevention. NHANES is designed to assess the health and nutritional status of adults and children in the United States. An allergy/asthma component was supported by NIEHS and added to the 2005–2006 NHANES study, making it the largest nationally representative dataset of allergy and asthma information ever assembled in the United States. In this study, the researchers analyzed data from 4,111 children and young adults aged 2-19 years of age. They looked at total and allergen-specific immunoglobulin E (IgE) or antibody levels to a large panel of indoor, outdoor and food allergens, body weight, and responses to a questionnaire about diagnoses of hay fever, eczema, and allergies. Obesity was defined as being in the 95th percentile of the body mass index for the child’s age. Researchers found the IgE levels were higher among children who were obese or overweight. Obese children were about 26 percent more likely to have allergies than children of normal weight. In addition, the rate of having a food allergy was 59 percent higher for obese children. "Given that the prevalence of
both obesity and allergic disease has increased among children over
the last several decades, it is important to understand and, if possible,
prevent these epidemics," said Cynthia M. Visness, Ph.D., lead
author on the paper and a scientist at Rho Federal Systems Division,
Inc. in Chapel Hill, N.C.
Fogarty International Research Collaboration Award (FIRCA) grants are given jointly to an NIH-supported investigator and an overseas collaborator in a low- and middle-income country, with the financial support going to the foreign collaborator. The FIRCA program is intended to benefit the research interests of both collaborators while increasing research capacity at the foreign site. Each institution will receive between $33,000 and $41,000 annually over three years. The new grants aim to increase access to emerging research techniques and capabilities, and unique populations and environments. The five new grants will support research on a wide range of public health issues including obesity, chronic mountain sickness, dengue fever and central nervous system injuries. 2009 Fogarty International Research Collaboration Award Grantees:
For details about each award or more
information, for the FIRCA Program, please visit http://www.fic.nih.gov/
Some Hydroxycut products are associated with a number of serious liver injuries. The FDA has received 23 reports of serious health problems ranging from jaundice and elevated liver enzymes, an indicator of potential liver injury, to liver damage requiring liver transplant. One death due to liver failure has been reported to the FDA. Other health problems reported include seizures; cardiovascular disorders; and rhabdomyolysis, a type of muscle damage that can lead to other serious health problems such as kidney failure. Liver injury, although rare, was
reported by patients at the doses of Hydroxycut recommended on the bottle.
Symptoms of liver injury include jaundice (yellowing of the skin or
whites of the eyes) and brown urine. Other symptoms include nausea,
vomiting, light-colored stools, excessive fatigue, weakness, stomach
or abdominal pain, itching, and loss of appetite. Although the FDA has not received reports of serious liver-related adverse reactions for all Hydroxycut products, Iovate has agreed to recall all its Hydroxycut products. Hydroxycut Cleanse and Hoodia products are not affected by the recall. Consumers who have any of the products involved in the recall are advised to stop using them and to return them to the place of purchase. The agency has not yet determined which ingredients, dosages or other health-related factors may be associated with risks related to these Hydroxycut products. The products contain a variety of ingredients and herbal extracts. The FDA continues to investigate the potential relationship between Hydroxycut dietary supplements and liver injury or other potentially serious side effects. For more information: Hydroxycut Products
The research studies are designed to create a better understanding of the biology of lung cancer and to develop a test to detect early-stage lung cancer in lifetime nonsmokers. The two organizations are sponsoring this multi-institutional effort. NCI's Early Detection Research Network (EDRN) and the Canary Foundation will provide initial funding of $1 million each. Research has shown that lung cancer in people who have never smoked differs in many ways from the disease in smokers. For example, non-smokers with lung cancer have different tumor tissue structure, gene mutations and demographic profiles than smokers with lung cancer. Global estimates suggest that as many as 25 percent of all lung cancers worldwide — 15 percent of those in men and 50 percent of those in women — are not attributable to smoking. If lung cancer in non-smokers is viewed as a separate category, it ranks as the seventh most common cause of cancer deaths worldwide, even before cancers of the cervix, pancreas and prostate. Using lung cancer cell lines, tissue, and blood specimens, researchers at five of the nation's leading research institutions will undertake a coordinated approach to biomarker discovery using their expertise to study the same sets of specimens by different methods. The researchers will deposit the data in a single repository, and integrate the results to find the most promising biomarkers. Because of this design, this project will also serve as a pilot study to demonstrate the feasibility of the approach and the ability to integrate the data across different platforms. If it is successful, the researchers plan to open the project to additional collaborators from the EDRN. The NCI-EDRN will fund most of the
tumor studies, and the Canary Foundation will provide funding for the
cell culture studies. http://www.nih.gov/news/
The facility is approved for seasonal influenza vaccine production and could be used for the production of vaccine against the new 2009 H1N1 influenza strain. As part of its overall pandemic influenza preparedness efforts, the FDA meets with vaccine manufacturers to guide the efficient establishment of influenza vaccine facilities that comply with agency requirements. The agency promptly reviews applications and manufacturing supplements that could increase both the number of manufacturers and the overall supply of vaccine. The facility, located in the United States, is owned and operated by sanofi pasteur, which manufactures Fluzone influenza virus vaccine. This new facility will greatly increase sanofi pasteur’s production capability. The FDA has interacted with the company throughout the regulatory process to help ensure compliance with applicable requirements. The bulk manufacturing facility will be used for the production of Fluzone, sanofi pasteur’s egg-based influenza vaccine. The FDA’s Pandemic Influenza Preparedness
Strategic Plan may be found on the FDA’s Web site at http://www.fda.gov/oc/op/ Reserve/Guard
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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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