FEDERAL HEALTH UPDATE
May 15, 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
Nicole Lurie, to be assistant secretary for preparedness and response, Department of Health and Human Services. Nicole Lurie is senior natural scientist and Paul O'Neil Alcoa professor of policy analysis at the RAND Corporation. She is an internationally recognized leader in health care and public health with experience working in academia and in government at the federal and state levels. As co-director of the RAND Center for Domestic and International Health Security, she leads RAND’s work in public health and preparedness. Lurie attended college and medical school at the University of Pennsylvania and completed her residency and MSPH at UCLA, where she was also a Robert Wood Johnson Foundation Clinical Scholar. Lurie also volunteers in a community clinic in Washington, DC. Dennis M. McCarthy, to be assistant
secretary of defense for reserve affairs, Department of Defense.
Dennis McCarthy is a retired Marine Corps Lt. Gen. whose 41 years of
active and reserve service were interspersed with more than 20 years
of private law practice. Since 2005, he has been executive director
of the Reserve Officers Association of the United States. Lt. Gen. McCarthy
began his military service in combat in Vietnam and remained on active
duty until 1978. He was then an active “traditional reservist” in
various infantry units and was recalled to active duty for Desert Shield/Desert
Storm and on several subsequent occasions. He also served on the Secretary
of Defense’s Reserve Forces Policy Board. From 1984 until his retirement
in 2005, he commanded eight different Marine Corps or Joint organizations,
including overall command of the Marine Corps Reserve as it undertook
its largest mobilization in history.
Specifically, the participants examined
ways to save more than $2 trillion on health care costs. The coalition
agreed to reduce the annual health care spending growth rate by 1.5
percentage points for the next 10 years, a change that could result
in savings of roughly $2,500 for American families. http://www.whitehouse.gov/the_
H1N1 Flu (Influenza A) News
Military Health Care News
This new communications tool will bring MHS information directly to e-mail subscribers and will also be available on the MHS Web site. MHS Vital Signs will highlight upcoming events and activities, the latest medical research and relevant health care news. To receive MHS Vital Signs every
month, sign up at www.health.mil/vitalsigns
Launched in March, the pilot program called “TRICARE 2 You” is a collection of videos focusing on health-care issues. Topics include basic criteria for eligibility, behavioral health resources, accessing specialty care through the TRICARE system, pharmacy options, the importance of updating personal information in the Defense Enrollment Eligibility Reporting System and newborn enrollment. Available as streaming video in TriWest’s new “TRICARE 2 You Online Library,” the videos also are provided to military treatment facilities with DVD capability so that waiting patients will have access to pertinent information. The program has been particularly well-received by the National Guard, whose benefits have been evolving and expanding over the past several years. The program has been expanded to
cover new topics and reach more beneficiaries. The next round of topics
is scheduled to roll out in May based on the feedback from the first
round, according to a TriWest spokesperson. The “TRICARE 2 You”
videos run an average of three minutes each and are in a prime-time
news format.
Researchers are looking into an inexpensive, generic drug called prazosin to help soldiers experience more restorative sleep. The study, funded by the Department of Defense, began in 2006 and recently received additional funding through 2012. Only active duty service members can participate in the study at Madigan. A separate study is being conducted at VA Puget Sound for Operation Iraqi Freedom and Operation Enduring Freedom veterans who are no longer on active duty. Col. Kris Peterson, chief of outpatient psychiatry at Madigan, and Dr. Murray Raskind, director of mental health service, VA Puget Sound, are the principal investigators of the study. Prazosin was introduced in 1973 to treat high blood pressure and is also effective in treating an enlarged prostate. But in the mid 1990s, Raskind was able to show in a study of Vietnam War veterans who had combat-related nightmares that prazosin was effective in getting rid of nightmares. The 14-week study at Madigan is coming to the same conclusion for the active duty population. There have been indications that the use of prazosin reduces alcohol and drug abuse and other symptoms of post-traumatic stress disorder. The study does not demand that soldiers
have a PTSD diagnosis, but does require that subjects have traumatic
deployment-related nightmares at least twice a week that interrupt their
sleep. It is conducted in the outpatient psychiatry clinic at Madigan.
At the end of the study, all soldiers receive medication management
as needed.
According to the notice, DoD is making no changes to the final rule, which was issued on Dec.10, 2008 DoD received approximately 300 public comments during the additional comment period, mostly following a similar pattern from or on behalf of hospitals. In the additional public comments received, there were three predominant themes: that for some hospitals, particularly some close to military installations, TRICARE OPPS would have a significant financial impact; DoD should follow the Medicare precedent in making first-year OPPS implementation cost neutral; and DoD should follow the TRICARE CHAMPUS Maximum Allowable Charge physician payment system reform precedent and limit reductions to no more than 15 percent per year during the transition period. The effective date of the final rule
is unchanged: it continues to be May 1, 2009.
As part of Mental Health Awareness Month, the Army National Guard is calling attention to this program as it proactively screens redeploying Guard members for potential health issues. The program gives Guard members a chance to identify problems three to six months after deployment. This window gives them a chance to settle into life and work, and to evaluate their health over that period. If combat-connected health problems arise, soldiers can report it during their PDHRA to become eligible for care. The program consists of three parts. First, Guard members see the “Battlemind II” training video, which shows common readjustment issues for veterans. Then they complete a questionnaire detailing their health. After that, they sit down with a trained health care provider for a 45-minute, one-on-one conversation. During that talk, qualified medical professionals ask questions about contact information, deployment location and health history. Soldiers also are informed of the types of assistance for which they are eligible, which may include health care at a Veterans Affairs hospital, and they have an opportunity to request assistance. The health care provider will then refer the soldier for follow-up care, treatment or evaluation if necessary. This proactive approach means that
even Guard members returning from their second or third tour will not
find themselves exempt. Every time they come back from a deployment,
they will be screened.
The Web page, found at http://www.tricare.mil/ Service members and family members can access behavioral health information including recent news articles, self-assessment programs and behavioral health flyers and brochures. The recently published “A TRICARE
Guide: Understanding Behavioral Health”
is also available on the page. It provides information on seven main
topics: TRICARE and Your Behavioral Health; Understanding Behavioral
Health; Covered Services, Limitations and Exclusions; Who to See for
Care; Getting Care; Your Right to Privacy; and For Information and Assistance. http://www.tricare.mil/
In this effort, the DoD has developed a sample letter that encourages college placement directors to talk to their students about pursuing a career with the DoD as a civilian employee. It is asking current and former DoD employees to personalize the letter and send it to their alma maters. Veterans Health Care News
This independent research organization evaluates and ranks federal agency reports on how transparently they report their successes and failures; how well they document the tangible public benefits they produce; and whether they demonstrate that their leadership uses performance information to devise strategies for making program improvements. The Government Accountability Project at the Mercatus Center in Arlington, Va., examined the federal agencies for its 10th Annual Performance Report Scorecard, ranking VA second highest behind the Labor Department for quality of disclosure in its annual performance and accountability reports. VA’s report was also recognized as the government’s best in the leadership category. The awards marked the 10th consecutive year that VA has been recognized by the Mercatus Center as one of the federal government’s leaders in performance reporting. VA's Fiscal Year 2008 Performance
and Accountability Report is available at http://www.va.gov/budget/
The budget emphasizes a veteran-centric commitment to expanded services with a 15.5 percent increase over 2009, the largest percentage increase for VA requested by a president in more than 30 years. The centerpiece of the $112.8 billion VA budget proposal is a dramatic increase in veteran health care funding, with an 11 percent increase over the current year's funding (excluding one-time Recovery Act funds). VA’s budget request contains four major categories of activities: creating a reliable management infrastructure; delivering ongoing services; making progress on departmental priorities; and instituting new initiatives critical to meeting the needs of veterans now and in the future. Nearly two-thirds of the increase ($9.6 billion) would go to mandatory programs (up 20 percent); the remaining third ($5.6 billion) would be discretionary funding (up 11 percent). The total budget would be almost evenly split between mandatory funding ($56.9 billion) and discretionary funding ($55.9 billion). VA's new budget request provides for an estimated 122,000 more patients to be treated over the current year. VA expects to end fiscal year 2010 with nearly 6.1 million individual patients having received care, including 419,000 veterans of the Iraq and Afghanistan war zones who separated from service. The budget supports the administration's goal to gradually expand health care eligibility to more than 500,000 new enrollees by 2013, while maintaining excellent care quality and timeliness. In 2010, the transformation of VA health care will support scheduling of 98 percent of primary care appointments within a month of the desired date. For more details on the proposed
VA budget for fiscal year 2010, please visit http://www1.va.gov/opa/
Data from the medical records of thousands of veterans will be available for researchers looking to find the most effective treatments for diseases such as post-traumatic stress disorder or an aggressive, antibiotic-resistant staph infection. Dr. Matthew Samore, professor of internal medicine at the University of Utah and chief of the Division of Clinical Epidemiology, directs Utah's part in the initiative, called the Consortium for Healthcare Informatics Research. Research teams of collaborating investigators are also located in Portland, Ore., Palo Alto, Calif., Indianapolis, Nashville, Tenn., Tampa, Fla., West Haven, Conn., Boston and Pittsburgh. The initiative looks to use state-of-the-art language processing techniques to extract information from health records that has been previously unavailable in easily searchable form. It will allow researchers to “de-identify” the information, so that individual health information is not compromised, and pool it in ways that will help doctors understand better which treatment regimens are most effective in the greatest number of patients. Medical informatics has changed in the past 20 years, creating clinical data warehouses that have transformed medical research. The consortium will take that information warehousing function to a new level, providing rich detail including outpatient pharmacy records; lab reports; notes made by nurses, physicians, physical therapists and pharmacists; radiology reports and electromagnetic images; family history; discharge summaries; physician orders; vital sign measurements; and other factors that were previously inaccessible. The $10 million, four-year initiative is an attempt to make the VA medical system records all “talk” to each other across the nation. Until now, the (available) data tends to be stored locally. Individual VA hospitals have been trying to mine such information for some time and have periodically worked with one other hospital doing the same. Once the system has been developed and tested, researchers anticipate they will be able to find “novel associations” for disease and treatment that never would have been apparent previously. Veterans have a disposition toward some types of medical problems, including PTSD, and researchers will conduct two multi-year applied studies to address both methicillin-resistant staph (known as MRSA) and PTSD. Because the research, and the initiative
itself, are designed to provide better care for vets, it's vital to
solicit opinions and priorities from veterans groups about what their
priorities are, Samore said, adding researchers will ask national veterans
groups for input. http://www.deseretnews.com/
Backed by Revolution LLC (the investment arm of AOL co-founder Steve Case), ZG Ventures and Alafi Capital, BrainScope is a health technology company that is developing a new generation of hand-held, simple-to-use, non-invasive instruments designed to aid medical professionals in rapidly, accurately, and objectively assessing brain function at the initial point of care. BrainScope’s products could eventually be used for assessment of suspected brain trauma in soldiers, athletes and accident victims. Most recently Dr. Peake served as the Secretary of Veterans Affairs and formerly as Army Surgeon General. Dr. Peake’s military and medical career also includes service as a surgeon, as a commander of several Army medical units in the U.S. and Korea, and a tour in Vietnam with the 101st Airborne Division. He is a highly decorated Army officer, having received a Silver Star, a Bronze Star with V and the Purple Heart for his service in Vietnam, as well as several other distinctions including the Distinguished Service Medal and the Legion of Merit in the course of his service. After graduating from the U.S. Military Academy at West Point in 1966, Dr. Peake was commissioned as a second lieutenant in the U.S. Army Infantry. He attended Cornell University Medical College after Vietnam and is also a 1988 graduate of the U.S. Army War College. After retiring from the Army in 2004, Dr. Peake served as executive vice president and chief operating officer of Project HOPE, a non-profit international health foundation operating in more than 30 countries. Dr. Peake became Secretary of Veterans Affairs in December 2007. BrainScope’s Board of Directors
will consist of six members: Dr. Peake; venture capitalists Miles Gilburne,
Moshe Alafi and Phil Himelstein; Steve Case; and BrainScope CEO Michael
Singer. http://www.businesswire.com/ Health Care News
According to the report, the Hospital Insurance (HI) trust fund is not adequately financed over the next 10 years. At the beginning of 2009 the assets of the HI trust fund were $321 billion and are projected to be exhausted during 2017, under the intermediate assumptions. The HI trust fund does not meet the short-range test of financial adequacy. Although the short-range financial status of the HI trust fund has not been considered satisfactory since 2003, the outlook has further deteriorated as a result of the current economic recession. In the long-term, under the intermediate assumptions the HI trust fund is projected to be exhausted in 2017, two years earlier than in last year’s report, reflecting much lower projected payroll tax income as a result of the recession. For the 75-year projection period, the actuarial deficit has increased from 3.55 to 3.88 percent of taxable payroll. The Board found that the Supplementary Medical Insurance (SMI) trust fund is adequately financed over the next 10 years and beyond because premium and general revenue income for Parts B and D are reset each year to match expected costs. However, the report cautions that further congressional overrides of scheduled physician fee reductions, together with existing “hold harmless” provision restricting premium increases for most beneficiaries, could jeopardize Part B solvency and require unusual measures to avoid asset depletion. The U.S. economy is projected to grow by 4.5 percent on average during this period, significantly more slowly than either Part B or Part D. The difference between
Medicare’s total outlays and its “dedicated financing sources”
is estimated to reach 45 percent of outlays in fiscal year 2014, the
sixth year of the projection. Based on this result, the Board of Trustees
is required to issue a determination of projected “excess general
revenue Medicare funding” in this report. This is the fourth consecutive
such finding, and it again triggers a statutory “Medicare funding
warning,” indicating that federal general revenues are becoming a
substantial share of total financing for Medicare. As required by law,
the President must submit to Congress proposed legislation to respond
to the warning within 15 days after the date of the budget submission
for the succeeding year.
GBM is a rapidly progressing cancer that invades brain tissue and can impact physical activities and mental abilities. It affects about 6,700 persons in the United States every year. Following initial treatment with surgery, radiation and/or chemotherapy, the cancer nearly always returns. Avastin, manufactured by Genentech, Inc., is a laboratory-produced molecule known as a monoclonal antibody that mimics the antibodies produced by the body’s immune system to defend against harmful substances. The medication inhibits the action of vascular endothelial growth factor that helps form new blood vessels. These vessels can feed a tumor, helping it to grow and can also provide a pathway for cancer cells to circulate in the body. The drug was first approved in 2004 to treat metastatic cancer of the colon or rectum and has since been approved for treatment of non-squamous, non-small cell lung cancer and metastatic breast cancer. In two clinical trials, about 25
percent of patients with GBM responded to Avastin with an average duration
of response of about four months.
Some experts have suggested that because 23.8 million uninsured Americans under age 65 who do not have access to employer-based health insurance have incomes above the federal poverty line, they can afford to purchase policies if they so choose. But new data show otherwise. "Wealth, Income, and The Affordability of Health Insurance," published in the May/June 2009 issue of Health Affairs, shows that measuring families' median net worth—the value of their savings plus other assets minus debt rather than just income—provides more precise estimates of the percentage who could purchase policies if they chose to do so. Until now, most studies have used income alone to estimate how many more Americans could be covered by health insurance. Using national survey data, the researchers found that the median net worth of families who purchased health insurance was $105,819—nearly 35 times greater than the median net worth of only $3,057 for families who were uninsured. Median net worth means that half the families had net worth above or below that amount. In contrast, the median income of families who purchased health insurance was $41,086—only 2.3 times greater than the median income of $17,690 for families who were uninsured. The researchers, who used 2002 and 2003 data from AHRQ's Medical Expenditure Panel Survey, also found that 4.1 percent of families with access to employer-based health insurance were poor (family income below 100 percent of the federal poverty line) and 11.1 percent were low income (family income 100-199 percent of the federal poverty line). In contrast, among families without access to employer-based health insurance, 33.8 percent were poor and 28.4 percent were low income. According to Didem Bernard, Ph.D.,
an AHRQ economist who led the research, the standard model used by economists,
which is based on income alone, works well for estimating who will enroll
in employer-based health insurance. However, it does not work well for
who will purchase non-group coverage because it overestimates health
insurance enrollment for people with low net worth and underestimates
for people with high net worth. http://www.ahrq.gov/news/
This office will spearhead the department’s efforts to pass health reform this year and coordinate closely with the White House Office of Health Reform. Both offices were created by an April 8 Executive Order to help deliver on one of President Obama's top priorities. For a list of the staff members who
have been appointed to the HHS Office of Health Reform, please visit http://www.hhs.gov/news/press/
The two new federal advisory committees were established by the American Recovery and Reinvestment Act of 2009. The first meeting of the Health IT Policy Committee was held on Monday, May 11, in Washington, D.C. The HIT Policy Committee will make recommendations to the National Coordinator for Health Information Technology on a policy framework for the development and adoption of a nationwide interoperable health information infrastructure, including standards for the secure and private exchange of patient medical information. For a list of the HHS appointees
to the Policy Committee, please visit http://www.hhs.gov/news/press/
NASPER was enacted in 2005 to provide grant support to states to establish state-administered prescription drug monitoring programs (PMP) in order to ensure that health care providers have access to the accurate, timely prescription history information. Health care providers will use such systems for the “early identification of patients at risk for addiction in order to initiate appropriate medical interventions and avert the tragic personal, family, and community consequences of untreated addiction.” The notice, published in the April 29 Federal Register, requests public comments on proposed minimum requirements for PMPs by May 29, 2009. The proposed minimum requirements relate to security, access and use of the information in the programs. SAMHSA expects that establishing minimum standard requirements will accelerate interoperability and the overall utility of such programs nationwide. At least 38 states have operating PMPs, or statutory authority to start a new program. Typically, pharmacies collect and submit information on controlled substance prescriptions to a centralized database. Physicians, pharmacists and other authorized parties access these systems to learn if patients are receiving prescriptions from multiple sources. One limitation of these systems is the lack of interoperability, as information is sometimes not currently shared among the states, or in some cases even among information systems within the same state. SAMHSA received a $2 million appropriation for FY 2009 to award formula grants to states for either implementing or improving their PMP. According to the 2007 National Survey on Drug Use and Health (NSDUH), misuse of prescription drugs currently ranks second only to marijuana. Of the 20 million Americans who reported using an illicit drug in the past month in 2007, 7 million used prescription-type drugs non-medically and approximately 14 million used marijuana. For those interested in submitting
comments, please visit http://www.dpt.samhsa.gov/pdf/
The listening session included stakeholders representing a diverse range of organizations. Health and Human Secretary Karen Sebelius, who co-chairs the group, delivered opening remarks. On March 14, 2009, President Barack Obama announced the creation of the Food Safety Working Group, chaired by the Secretaries of the Department of Health and Human Services and the Department of Agriculture. The working group
will advise President Obama on how to can upgrade our food safety laws
for the 21st century; foster coordination throughout government; and
ensure that are designing and enforcing laws that will keep the American
people safe.
At the meeting, Sebelius also released a new report, Roadblocks to Health Care: Why the Current Health Care System Does Not Work For Women. The report shows how our current system is leaving millions of women without the affordable, quality care they need and can be read at www.HealthReform.gov. Among its findings, Roadblocks to Health Care reports:
At the roundtable, Sebelius and Tchen also discussed the difficulties small businesses face when attempting to provide health benefits to their employees. Nearly three-quarters of small businesses that do not offer benefits cite high premiums as the reason. Small businesses that do offer health benefits are suffering. Forty percent of businesses that provide health care coverage say health costs have had a negative impact on other parts of their business. The roundtable discussion was held
at Stitch DC, a knitting store owned by Nora and Marie Connolly who
participated in the discussion. Other participants included Denise D’Amour
and Laurie Morin, co-owners of Capitol Hill Bikes, Erin Mara, co-owner
of Homebody, Leah Daniels, co-owner of Hill’s Kitchen and Angela Bradley,
owner of BTI Security.
Medco's drug trend, a measure of spending growth that tracks the year-over-year increases in prescription spending among its client base, faced pressure from brand-name drug price inflation that topped 8 percent in 2008. Generic drugs, however, accounted for more than 64 percent of all prescriptions dispensed last year, dampening the impact of rising brand-name prices and specialty drugs as clients and members seek lower-cost options. In 2008 Medco's overall prescription volume increased to 586 million up from 560 million the prior year. Of that total, Medco's mail-order prescription volume rose 11.6 percent to 106 million. Prescription drug utilization, which is the days of therapy per member, fell a slight 1.1 percent in 2008. This drop — the first such decrease in a decade — was primarily driven by over-the-counter availability of widely used allergy and gastrointestinal medications and safety concerns for certain medication classes. For the second consecutive year, diabetes medications were the leading driver of drug trend as the disease afflicts more patients and doctors increasingly prescribe newer and costlier drug therapies. Other key drivers of prescription growth were rheumatological, seizure, antiviral and cancer drugs. Specialty drugs, which include brand-name, high-cost biologics, accounted for 60 percent of this year’s growth. This group of drugs showed a 15.8 percent rise in drug spend. If specialty drugs were excluded, overall drug trend would have been 1.3 percent. New products and the absence of a regulatory approval process for lower cost generic versions of specialty drugs have fueled spending growth in this category. To read the summary of the findings, please visit Summary of 2009 Medco Drug Trend Report. Reserve/Guard
Reports/Policies
Legislation
Hill Hearings
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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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