FEDERAL HEALTH UPDATE
June 12, 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
Senator Edward Kennedy, chair of the Senate Health, Education, Labor and Pensions Committee, introduced a bill, which would require all Americans to have health insurance, prohibit insurers from refusing to cover pre-existing conditions and place other restrictions on the industry. It also would establish online exchanges where the uninsured and employees of small companies could shop for affordable insurance policies. Kennedy omitted two provisions he favors that are being negotiated with Republicans -- creation of a government-run program to compete with private insurers and a mandate that employers provide benefits to workers. On the same day, House Democrats released an outline of their plan, which would require employers to provide insurance to workers and would require individuals to carry insurance. The outline, put together by the House Ways and Means, Energy and Commerce, and Education and Labor Committees, includes a "play or pay" provision that would require businesses to provide health insurance or make a contribution to the federal government "on behalf of their uncovered workers." But the outline also states that "small low-wage firms" would be exempted from the requirement and that a new small business tax credit would be put in place for employers offered health coverage. Congressional hearings are scheduled
over the next few weeks.
Joan Evans recently served as chief
of staff to Congresswoman Darlene Hooley (OR-5) from 1997-2009, who
was the first Oregon Democrat to serve on the House Veterans Affairs
Committee. Prior to that, Ms. Evans was the American Academy of Ophthalmology’s
Washington representative for policies affecting Department of Defense
and Department of Veterans Affairs manpower, health care and research.
H1N1 Flu (Influenza A) News
This is the first global flu epidemic in 41 years as infections in the United States, Europe, Australia, South America and elsewhere climbed to nearly 30,000 cases. WHO Director Dr. Margaret Chan made the announcement after the U.N. agency held an emergency meeting with flu experts. The long-awaited pandemic announcement is scientific confirmation that a new flu virus has emerged and is quickly circling the globe. On June 10, 2009, the WHO said 74 countries had reported nearly 27,737 cases of swine flu, including 141 deaths. According to WHO officials, a Phase Six alert doesn't mean anything concerning severity but has to do with geographic spread. Chan described the virus as "moderate." The WHO's pandemic criteria is when a new flu virus begins spreading in two world regions. The agency has stressed that most cases are mild and require no treatment, but the fear is that a rash of new infections could overwhelm hospitals and health authorities—especially in poorer countries. Still, about half of the people who have died from swine flu were previously young and healthy—people who are not usually susceptible to flu. Swine flu is also crowding out regular flu viruses. Both features are typical of pandemic flu viruses. The last pandemic was the Hong Kong flu of 1968, which killed about 1 million people. Ordinary flu kills about 250,000 to 500,000 people each year. Swine flu is also continuing to spread during the start of summer in the northern hemisphere. Normally, flu viruses disappear with warm weather, but swine flu is proving to be resilient. WHO is now recommending that flu vaccine makers start making swine flu vaccine. Drug giant GlaxoSmithKline PLC said they could start large-scale production of pandemic vaccine in July but that it would take several months before large quantities would be available. The U.S. government has already taken steps like increasing availability of flu-fighting medicines and authorizing $1 billion for the development of a new vaccine against the novel virus. In addition, new cases seem to be declining in many parts of the country. According to the Centers for Disease Control and Prevention (CDC), swine flu has infected more than 13,000 people in all 50 states and caused at least 27 deaths. But CDC officials said the WHO's Phase Six declaration would not change their approach to the disease. They said the CDC has acted for the past month as if a pandemic already existed in the United States. In Mexico, where the epidemic was first detected, the outbreak peaked in April. Mexico now has less than 30 cases reported a day, down from an average of 300. Mexico has confirmed 6,337 cases, including 108 deaths. http://www.who.int/en/ Military Health Care News
As a corporate service provider for TRICARE and Health Net, the EIC can now bill TRICARE insurance for the one-on-one Applied Behavioral Analysis (ABA) therapy for children of military families who are enrolled in the Extended Care Health Option (ECHO) program. Recently the Department of Defense
expanded its Enhanced Access to Autism Services Demonstration Project
to include services delivered by the EIC up to $36,000 per fiscal year.
This gives 100 percent coverage, not counting the families’ deductibles,
to children enrolled in part-time sessions that last 2.5 hours per day
on Monday-Friday. Autism impacts the normal development of the brain, primarily in the areas of social interaction and communication skills. Children and adults with autism typically have difficulties in communication, social interactions and leisure or play activities. More than one and a half million
people in the U.S. today have autism or some form of pervasive developmental
disorder. Autism is the most common of the pervasive developmental disorders.
For more information, visit http://www.
The Commander in
Chief paid bedside visits with U.S. and coalition service members, as
well as joining an enthusiastic crowd of outpatients at the USO Warrior
Center. Along the way he pinned on six Purple Hearts honoring service
members injured in Afghanistan and Iraq.
In the April report, the Army reported seven active duty potential suicides. Since that time, an additional suicide was reported. Of the eight, three have been confirmed as suicides and five remain under investigation. There have been 82 reported active duty suicides in the Army during calendar year 2009. Of these, 45 have been confirmed as suicides and 37 are pending final determination of manner death. For the same period in 2008, there were 51 suicides among active duty soldiers. During May 2009, among reserve component soldiers who are not on active duty, there was one confirmed suicide and seven potential suicides. To date in 2009, among that same group, there have been 16 confirmed suicides and 21 potential suicides that are currently under investigation. For the same period in 2008, there were 23 suicides among reserve soldiers who were not on active duty. In January, the Army implemented a plan to combat the rise of suicide in its ranks. The Army mandated a suicide prevention stand-down that involved all 1.1 million soldiers; established a Suicide Prevention Task Force; made dozens of improvements to Army policies, procedures and resources; and recruited additional psychological and behavioral health counselors. The Army’s Suicide Prevention Task Force is focused on rapid improvements across the spectrum of health promotion, risk reduction and suicide prevention to ensure the Army’s programs in these areas are coordinated, fully-resourced, and effective. The Army has identified additional crisis intervention resources available to the Army community. Soldiers and families in need of crisis assistance are strongly encouraged to contact Military OneSource or the Defense Center of Excellence for Psychological Health and Traumatic Brain Injury Outreach Center (DCoE). Trained consultants are available from both organizations 24 hours a day, seven days a week, 365 days a year. The Military OneSource toll-free
number for those residing in the continental United States is 1-800-342-9647,
the Military One Source Web site can be found at http://www.militaryonesource. The DCoE Outreach Center can be contacted
at 1-866-966-1020, or at http://www.dcoe.health.mil/ The Army’s suicide prevention information
is located at http://www.armyg1.army.mil/hr/
Maj. (Dr) Vikhyat Bebarta, chief of medical toxicology and a staff emergency physician at Wilford Hall at Lackland Air Force Base, Texas, is the recipient of the Best Basic Science Research Award. The award was presented by the Society of Academic Emergency Medicine (SAEM), for Bebarta’s research on evaluating treatments for cyanide poisoning. SAEM is the premier organization for emergency medicine research and is dedicated to the improvement of care for the acutely ill and injured patient by improving research and education. The year-long research involved the comparison of two antidotes to determine the most effective treatment for cases of cyanide poisoning resulting in cardiac arrest or death. The study advances efforts to provide better treatment for service members exposed to cyanide. Service members can be exposed to cyanide in building fires in the U.S. and in combat. It is a high-level terrorist threat and has been used as a weapon by terrorists. Dr. Bebarta, with the help of the 59th Medical Wing's clinical research department, found that a newer antidote caused a faster and higher rise in blood pressure in subjects critically ill with low pressure due to the cyanide toxicity. It also removed all cyanide from the blood, while an older antidote did not. A staff member of the WHMC Emergency
Department now for five years, Bebarta has served two deployments at
the Air Force Theater Hospital at Joint Base Balad, Iraq, where he made
contributions to the advancement of care for wounded warriors. http://www.health.mil/Press/
The services include group level briefings for pre- and post-deployment military and family, individual consultations, skill-building sessions for families and multi-session family interventions. The services also include consulting military staff, schools, family and community on parenting and combating stress, traumatic grief and other deployment-related stresses. Work will be performed at the following military locations: Headquarters Marine Corps and the Wounded Warrior Regiment in Quantico, Va.; Marine Corps Bases in Hawaii, Okinawa, Twenty-Nine Palms, Calif., Camp Pendleton, Calif., and Camp Lejeune, N.C., as well as the WW Battalion’s in Camp Pendleton and Camp Lejeune; Naval Stations Norfolk, Va. and San Diego, Calif.; the Naval Special Warfare sites in Coronado, Calif. and Little Creek/Dam Neck, Va.; Naval Air Station Whidbey Island, Wash.; and the Naval Construction Battalion Commands in Gulfport, Miss., and Port Hueneme, Calif. Work is expected to be completed
in June 2010.
In a joint project with Northwestern University’s Medill School of Journalism, the Center examined 22,000 travel disclosure forms filed by DoD personnel. Researchers found that the medical industry was by far the biggest sponsor of free travel, accounting for about 40 percent of all trips. The sponsors included not only drug and device makers but also health foundations, as well as trade groups often funded by those companies. Of special interest to the industry were DoD employees who prescribe, purchase or recommend the use of drugs or medical equipment. Drug companies and device manufacturers spent about $1.7 million for more than 1,400 trips taken by DoD doctors, medical researchers, pharmacists and other health care employees over the decade, creating relationships that pose serious conflict of interest issues, according to medical ethics experts. Among the top medical device manufacturers or pharmaceutical company sponsors of trips for DOD personnel are:
Representatives of these companies say they follow the law and government regulations closely, paying only for reasonable expenses tied to professional trips or third-party meetings. But industry-sponsored travel has become a hot topic in the medical community, prompting criticism by bio-ethicists, elected officials, and professional organizations. Studies in the Journal of the American
Medical Association and CHEST, a medical specialty journal, have found
a link between perks bestowed on doctors and an increased likelihood
that physicians, usually unknowingly, would prescribe a company’s
drugs. Academic studies like these spurred a recent movement to regulate
industry gifts to medical professionals. Since 2003, the American Medical
Association’s guidelines have prohibited physicians from accepting
subsidies from industry “directly or indirectly to pay for the costs
of travel, lodging or other personal expenses of physicians attending
conferences or meetings.”
Among the awards were three Blue Pencil & Gold Screen Awards from the 2009 National Association of Government Communicators (NAGC) competition. TRICARE’s “That Guy” award-winning alcohol abuse campaign was also recognized with honors from the Public Relations Society of America (PRSA) and the International Academy of the Visual Arts. In NAGC’s news release category, TRICARE won a first place Blue Pencil award for “TRICARE Beneficiaries Stay Alert…New Electronic Delivery Service.” The TRICARE team also won two awards of excellence in NAGC’s Gold Screen division: one for a Web article dealing with TRICARE beneficiaries and National Cancer Institute; and the second for the Military Health System’s “Dot-Mil-Docs” podcast on Blogtalkradio.com. The Blue Pencil & Gold Screen Awards competition salutes superior communications efforts of government agencies and recognizes the people that create them. Blue Pencil Award categories are designed for writing, editing and other related materials. Gold Screen Award categories recognize audio-visual and multimedia products, including broadcast and Internet-based products. PRSA awarded TRICARE’s
“That Guy” campaign a Bronze Anvil in the Research/Evaluation category.
In addition, three awards of excellence in the visual appeal, gaming
or gaming related and animation categories were bestowed from the International
Academy of the Visual Arts for That Guy’s “Buzz Kill” section. The
awards honor creative excellence in interactive media by seeking out
the best in Web sites, online advertising and marketing, and online
audio and video media. http://www.tricare.mil/ Veterans Health Care News
The estimated cost the project at the state veterans’ home in Tilton is $5.7 million, with VA’s grant covering 65 percent of the total. The New Hampshire Veterans Home agreed to enter into a contract for the improvements within 90 days of an agreement with VA. Last year, VA spent more than $336 million in New Hampshire on behalf of the state's 131,000 veterans. VA operates a major medical center in Manchester and five outpatient clinics. The VA’s facilities provided care last year during 189,000 outpatient visits. The state-run veterans’ home in
Tilton supplements these federal services. For more information about
the New Hampshire Veterans Home and other New Hampshire services for
veterans, visit www.nh.gov/nhveterans/bene.
Dr. Janet Kemp, national director of VA’s suicide prevention program, is a finalist for the Citizen Services Medal. She established a national suicide prevention hotline for veterans, which has resulted in more than 3,000 immediate rescues. Dr. Audrey Nelson, director of the Patient Safety Center in Tampa, Fla., is a finalist for the Career Achievement Medal. Dr. Nelson explored ways to help nurses and medical practitioners avoid back injuries, which resulted in a $200 million program across the VA to use mechanical lifts and transfer devices when moving patients. Sponsored by the Partnership for Public Service, the Service to America Medals (“Sammies”) pay tribute to America’s federal workforce, highlighting those who have made significant contributions to our country. The 2009 finalists come from more
than 20 federal agencies, including the departments of Commerce, Defense,
Health and Human Services, Housing and Urban Development, Interior,
Justice, Treasury and Veteran Affairs; the Central Intelligence Agency,
Government Accountability Office, Environmental Protection Agency, Federal
Deposit Insurance Corporation, General Services Administration, Social
Security Administration, U.S. Agency for International Development and
NASA. http://www1.va.gov/opa/
The new location
has about 100,000 square feet of office space with offices for VA Regional
Counsel and training rooms for the Dorn VA Medical Center. The facility
replaces the downtown office where South Carolina veterans have sought
benefits for about 60 years. http://www.thestate.com/
The university has agreed to use the land solely for the purpose of educating students in the health sciences, a significant part of VA's mission. Since 2002, the university has been using the property under an enhanced-use lease agreement with VA. The Secretary of Veterans Affairs recently determined that the majority of the land leased to the university would not be needed by VA in the future. The transfer agreement also facilitates the use of 8.5 acres to be used for the planned Joint Federal Health Care Facility to be shared by VA and the Navy. The transfer will save VA the cost of maintaining property it no longer needs. The property has been most recently
used as a staging area for construction of the Captain James A. Lovell
Federal Health Care Center, a joint VA and Department of Defense medical
facility scheduled to open in late 2010. http://www1.va.gov/opa/ Health Care News
The new report Health Disparities: A Case for Closing the Gap is available at www.HealthReform.gov and highlights some of the glaring disparities that exist in the current health system, including:
The report also notes that 40 percent of low-income Americans do not have health insurance. About one-third of the uninsured have a chronic disease and are six times less likely to receive care for a health problem than the insured. In contrast, only six percent of high-income Americans lack insurance. Secretary Sebelius co-hosted a White
House Health Care Stakeholder Discussion on health disparities with
Nancy-Ann DeParle, director of the White House Office of Health Reform,
and Tina Tchen, director of the White House Office of Public Engagement
and executive director of the White House Council on Women and Girls.
The Call to Action looks at the ways housing can affect health. The surgeon general hopes its release will initiate a national dialogue about the importance of healthy homes. Some examples outlined in the Call to Action include preventing falls by taking measures such as installing grab bars in showers and preparing a fire escape plan. Falls are the leading cause of injury deaths among older adults. The Call to Action outlines the next steps of a society-wide approach to healthy homes that will result in the greatest possible public health impact and reduction of disparities in the availability of healthy, safe, affordable, accessible and environmentally friendly homes.
The Call to Action also highlights
the need for research that links housing conditions with specific health
outcomes and that highlights the impact of disparate access to safe,
healthy, affordable and accessible homes. The outcomes of this research
should result in tangible improvements to people’s lives by translating
practice into policy.
The guidance, entitled “Good Laboratory Practices for Molecular Genetic Testing for Heritable Diseases and Conditions,” addresses considerations for clinical and laboratory professionals that are important for achieving patient benefits and avoiding medical mistakes when molecular genetic tests are used. These include ensuring proper test method selection and test performance, as well as appropriate test result reporting, interpretation and use. The guidance also covers factors to consider before introducing new tests and what qualifications laboratory personnel should have to perform testing. The recommendations are intended for use by clinical and public health professionals and those evaluating laboratory practices and policies. Molecular genetic testing is one of the most rapidly growing areas of laboratory testing in the United States. The number of genetic diseases and conditions for which tests are available has more than tripled from 423 in the past eight years to more than 1,300 today. The growth of direct-to-consumer testing – which is permitted in 37 states and often done without oversight – has raised additional concern about the potential misuse of genetic tests. DNA-based genetic tests are used to help make decisions about patient care, such as whether patients have or may be at risk for a genetic disease such as cystic fibrosis or whether they may be prone to chronic diseases including cancer, diabetes and blood clotting disorders. Getting an accurate diagnosis influences a patient’s course of treatment and how they deal with a disease or disease threat. Implementation of the genetic testing guidance can improve accurate diagnoses and ultimately ensure that patients and their doctors can make the best decisions for their health. The new recommendations are available
through the CDC’s MMWR Web site at http://www.cdc.gov/mmwr/PDF/
In exchange for the loan repayments, clinicians serve for two years with the Corps. The new funds are expected to double the number of Corps clinicians and make 3,300 awards to clinicians that serve in health centers, rural health clinics and other health care facilities that care for uninsured and underserved people. Since its inception nearly 40 years ago, the NHSC has provided scholarships and loan repayments for more than 30,000 doctors, dentists and other health professionals who provide health care in the most geographically isolated and economically distressed regions of the country. In addition to $50,000 for loan repayment, each clinician receives a competitive salary and a chance to have a significant impact on a community. Primary care practitioners interested in applying for loan repayments should visit http://nhsc.hrsa.gov. To see a list of opportunities available
by state, go to http://www.hhs.gov/recovery/
The findings show how a genetic variant, located in the SOD2 gene, may affect how a person responds to the chemotherapy drug cyclophosphamide. Cyclophosphamide is used in the treatment of breast and other cancers. The SOD2 gene produces a key protein that protects cells from damage by molecules known as reactive oxygen species, or free radicals. Reactive oxygen species are produced by normal cellular processes and the action of some chemotherapy drugs. The findings represent the first preliminary evidence pointing toward a mechanism and a potential biomarker for cyclophosphamide resistance in breast cancer patients. The study appeared online June 9, 2009, in Clinical Cancer Research. In the new study, the research team investigated whether the variation affected survival in two separate groups of women with breast cancer: 248 women in the United States and 340 women in Norway. Some of the women received chemotherapy, and some did not receive chemotherapy. The team first analyzed DNA from the women to determine their genotype, meaning which types of the SOD2 gene they had. The researchers found that, among patients who received chemotherapy, those who had one form had decreased survival and those with another form had the poorest survival. In contrast, the genotype of SOD2 did not affect survival among those who did not receive chemotherapy. Researchers believe that, with the
progress of individualized medicine, a diagnostic test may be developed
that determines whether a patient has certain genetic variations that
may modify the effect of certain chemotherapies. This would ensure patients
with cyclophosphamide resistance would receive a more effective therapy. http://www.nih.gov/news/
In the poll, conducted by Greenberg Quinlan Rosner Research and Public Opinion Strategies, 70 percent of Americans surveyed ranked investing in prevention between an eight and 10 on a scale of zero to ten, where zero means not at all an important health care priority and 10 means very important. Forty-six percent rated prevention as a 10. Overall, prevention was rated higher than all other proposals, including providing tax credits to small businesses and prohibiting health insurers from denying coverage based on health status. More than three-quarters of Americans (76 percent) support increasing funding for prevention programs that provide people with information and resources and creating policies that help people make healthier choices. Investing in prevention is popular across the political spectrum, with 86 percent of Democrats, 71 percent of Republicans and 70 percent of Independents supporting investing more in prevention. While Americans believe that prevention will save money (77 percent), they strongly support prevention regardless of its impact on costs. Rather, they point clearly to keeping people healthy as the best reason to invest in prevention, with 72 percent agreeing with the statement that "investing in prevention is worth it even if it doesn't save us money, because it will prevent disease and save lives." Additionally, 57 percent agree more with the statement "we should invest in prevention to keep people healthier and improve quality of life" than the statement "we should invest in prevention to lower health care costs" (21 percent). Americans believe the U.S. needs to put more emphasis on prevention (59 percent) rather than thinking there needs to be more emphasis on treatment (15 percent), by nearly a four to one ratio. This represents a significant shift toward prevention over the last two decades -- in 1987, only 45 thought there should be greater emphasis on prevention.
The results from the poll are available at www.healthyamericans.org Reserve/Guard
Reports/Policies
Legislation
Hill Hearings
Meetings / Conferences
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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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