FEDERAL HEALTH UPDATE
Sep 18, 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
Baucus maintains his proposal, known as the “Chairman’s Mark,” will make it easier for families and small businesses to buy health care coverage while ensuring those who want to keep their current health care coverage can. It will block insurance companies from denying coverage because of pre-existing conditions or imposing annual caps or lifetime limits on the amount of coverage they will provide. In addition, the bill would improve the way the health care system delivers care by improving efficiency, quality and coordination. This plan is expected will slow health care costs over time. In The Congressional Budget Office’s (CBO) analysis, the CBO estimates the Baucus plan would make an $856 billion investment in the health care system over ten years. That investment would not add to the federal deficit. Instead, the plan would be fully paid for through increased focus on quality, efficiency, prevention and adjustments in federal health program payments. Provisions in Baucus' America's Healthy Future Act include:
The Senate Finance Committee
will meet to begin voting on the legislation next week.
The United States is joining Australia,
Brazil, France, Italy, New Zealand, Norway, Switzerland and the United
Kingdom in making the H1N1 vaccine available to WHO on a rolling basis
as vaccine supplies become available, in order to assist countries that
would not otherwise have direct access to the vaccine.
During his address to a joint session of Congress on Sept. 9, 2009, President Obama outlined his proposals for health insurance reform, which included investing in new ways to manage medical liability claims. The goals of this new initiative are to put patient safety first and work to reduce preventable injuries; foster better communication between doctors and their patients; ensure that patients are compensated in a fair and timely manner for medical injuries, while also reducing the incidence of frivolous lawsuits; and reduce liability premiums. This competitive three-pronged initiative will support the following:
The funding opportunity announcement will be available on grants.gov within 30 days of the Sept. 17, 2009, Presidential Memorandum. Potential grantees will have two months to complete and submit their applications. AHRQ will review applications and make award decisions in early 2010. The funding will support grants that will vary depending on the size and complexity of the proposal. The "Review of What Works" and overall program evaluation will be conducted by contracts with existing AHRQ funding. More information
can be found at http://www.ahrq.gov/fund/ Military Health Care News
Both accolades recognize MC4’s role in expanding and supporting the electronic medical recording (EMR) mission on the battlefield, and most recently expanding MC4 use to garrison battalion aid stations. MC4 was one of 10 agencies to earn the 22nd Annual GCN Agency Award for Outstanding Information Technology Achievement in Government. This year's winners were selected from nearly 100 nominations. Louis Carrion, MC4 systems administrator and trainer, will be one of 28 individuals to receive a 2009 Rising Star Award. The award, in its fourth year, honors up-and-coming employees in the public and private sectors who have made an early — and substantive — contribution to the government information technology community. This year’s judges considered 160 nominations. MC4 integrates, fields and supports
a comprehensive medical information system. It has enabled the capture
of more than 11.5 million electronic patient encounters in the combat
zone since 2003. MC4 has also trained 40,000 deployable medical professionals
and fielded 30,000 systems to 750 units with medical personnel, to include
Stryker Brigades, Army National Guard and Reserve and all active divisional
units throughout 14 countries.
The study was published in the September issue of Injury, the International Journal of the Care of the Injured. The research was led by Lt. Cmdr. Andrew J. MacGregor of the Department of Medical Modeling, Simulation and Mission Support at NHRC. Researchers analyzed the injuries and physiologic characteristics of 831 American military personnel injured during combat between September 2004 and February 2005. The patients were then followed through November 2006 for diagnosis of PTSD or other mental health outcomes. The results show that 17 percent of the patients received a diagnosis of PTSD during the follow-up period. In total, 31.3 percent of the patients received a mental health-related diagnosis. The study also looked at the relationship between injury severity and PTSD. The evidence in the general population of a link is mixed. The research team found a positive association between the severity of an injury and a later diagnosis of PTSD or other mental health diagnosis. Blood pressure and injuries associated with battle-related gunshots predicted mental health outcomes but not PTSD. Somewhat unexpectedly, no association was found between post-injury heart rate and subsequent mental health outcomes once the severity of the injury was considered. This may be due to the nature of the study population, however, as this association has been identified only in non-military samples. The study is one of the few studies focused on the military population. It uses pre-existing baseline data and diagnoses by credentialed professionals, rather than relying on self-reporting. Researchers concluded that future
studies should attempt to quantify combat exposure and incorporate data
from the Department of Veterans Affairs in order to track those discharged
because of their injury. MacGregor and his team have already embarked
on additional research into specific injuries and how they affect the
results.
This online, interactive Web page, located at www.health.mil/profiles, combines social and traditional media to revolutionize the way the MHS communicates with its staff and the general public. The profiles share compelling personal stories of individuals who work to advance military health. The first issue of MHS Profiles tells the story of Lt. Cmdr. Patrick Blair, a Navy immunologist who works on H1N1 influenza research with the Naval Health Research Center in San Diego. His career as a “virus hunter” has taken him to the Andes mountains in Peru, where he identified and tracked three diseases not previously known to be in the region. They were able to determine an appropriate treatment and help heal the infected local villagers. Blair was later stationed in Indonesia, working towards preventing the outbreak of infectious diseases following the 2004 tsunami that devastated the region. His current team in San Diego was the first to catalog and identify H1N1 influenza cases in the United States. The series of personalized
articles will focus on the people who work on innovative and progressive
programs designed to meet the needs of our service members, veterans
and their families. New issues are slated to appear monthly.
The program was evaluated by the ACGME, the governing body for all United States physician medical training programs in April 2009. The surgical residency received full accreditation from the ACGME to proceed with training four general surgeons each year for five years of general surgery residency. The surgical residency was electively closed following Hurricane Katrina in 2005 and re-established in July 2007. The program was restructured in 2008 to include integration with the Naval Hospital in Pensacola, Fla., 96th Medical Group at Eglin AFB, Fla., and the Biloxi Veterans Affairs Medical Center, Miss. The surgical residents also perform
specialty rotations at the University of Mississippi Medical Center
in Jackson, Brooke Army Medical Center Burn Unit in San Antonio and
Landstuhl Regional Medical Center in Germany. This training platform
enforces and sets a clear understanding of the functioning of the joint
service environment and reflects the current operational environment.
The H1N1 vaccine, approved by the Food and Drug Administration on Sept.15, is scheduled to be available in October. Vaccine for active duty members will be provided by the DoD through supply chains similar to seasonal flu vaccine. 2009 H1N1 vaccine for dependents and retirees who normally get their flu vaccine at DoD facilities will be provided through a Department of Health and Human Services allocation to each state. To receive, each facility must register as a vaccine provider with the state(s) in which its population resides. Each state has an online registration form. All forms can be found at the following
Web site: http://www.cdc.gov/h1n1flu/ Veterans Health Care News
This is the first of several contracts that will provide a new state-of-the-art VA medical center consisting of inpatient hospital beds, a community living center, a spinal cord injury center and outpatient services. The total cost of the new facility is $800 million, with completion projected in 2012. GSA-JV of Bellevue, Wash., a service-disabled,
veteran-owned business, was awarded the contract, which calls for building
demolition, site surfacing and hazardous materials abatement at the
location of the former Fitzsimons Army Medical Center.
The National Vietnam Veterans Longitudinal Study (NVVLS) will study the Vietnam generation’s physical and psychological health. The new study will supplement research already underway at VA, including studies on PTSD and on the health of women Vietnam veterans. This is a follow-up study to a previous one that concluded in 1988. VA has begun work to solicit bids
to conduct the study, which is expected to run from 2011 through 2013.
The contract provides more than $19.6
million to River City Construction LLC of East Peoria, Ill., to construct
a 27,000-square-foot surgical suite and renovate 10,000 square feet
of existing space for surgical support. The contractor has three years
to complete the work.
Kevin Secor, a Veterans Service Organizations liaison with the Office of the Secretary of Veterans Affairs, recently sent an e-mail that outlined the scam. “I have received many reports that veterans are being contacted by ‘Patient Care Group’ representing that they are helping administer VA prescriptions and stating that the pharmacy billing procedures have changed and they are therefore requesting veteran credit card numbers for prescription payments in advance of filling their prescriptions,” Secor wrote. “This is false. “VA does not call veterans asking to disclose personal financial information over the phone. VA has not changed its processes for dispensing prescription medicines.” Anyone who receives a call from someone who claims to work for the Patient Care Group and asks for a credit card number should simply hang up. Veterans with questions about VA
services should contact the nearest VA medical center or call toll-free
877-222-8387.
Research psychologist Dr. Gregory Goodrich and Chief of Ophthalmology Dr. Glenn Cockerham received the 2009 Olin E. Teague Award at a special ceremony in Washington, D.C. In 2004, the doctors began noticing that soldiers and Marines who had lived through improvised explosive device, or IED, blasts and other explosions in Iraq and Afghanistan suffered from eye injuries and visual disorders that often went undiagnosed, according to the statement. The doctors' research
led to the adoption of standard eye examination techniques at all Veterans
Affairs' trauma centers to detect such issues before serious vision
loss occurs. http://www.mercurynews.com/
Supported by a five-year $6 million grant, this network will consist of four to six epilepsy centers linked to existing polytrauma and academic research centers where research and education about epilepsy can be fostered. Congressionally mandated to enhance epilepsy care for veterans with the disorder, the network will build current resources to serve veterans who may develop epilepsy as a result of traumatic brain injury. Epilepsy, a brain disorder, is characterized by repeated, spontaneous seizures of any type. Caused by abnormally excited electrical signals in the brain, seizures are episodes of disturbed brain function that trigger changes in attention or behavior. The VA Maryland Health Care System has started developing connections with other VA medical centers to form a Regional Epilepsy Center, establishing and implementing strategies that would provide epileptic veterans with the highest level of care. Through the network, clinicians plan to establish an innovative program based on health informatics — monitoring the size, distribution and outcomes among veterans with epilepsy and trauma, who are at risk for seizures. The use of advances in informatics — for example the VA’s computerized patient record system — will enable the network to provide both patient and caregivers with pertinent educational materials at the time of the patients’ visits. The network has begun recruiting staff and developing administrative structures, with the expectation that basic administration and services will be in operation by the end of the first year. Expansions of facilities and services will be phased in as resources allow. The Northeast network includes VA
medical centers in Baltimore, Richmond, Va., and West Haven, Ct. The
VA currently treats more than 9,000 veterans with epilepsy, a long-term
complication of head trauma.
The pilot areas include the Bethel, Wade Hampton, and Dillingham census areas as well as the Bristol Bay Borough, Northwest Arctic Borough and the city of Cordova. The pilot project is designed to demonstrate improved health care access to currently enrolled veterans living in the designated pilot areas. Letters were mailed in mid-August to veterans who live in the designated areas and are currently enrolled in the Alaska VA health care system. Veterans who have served after Sept. 11, 2001, will be eligible to enroll in the Alaska VA health care system and the pilot at any time during the one-year pilot project. Veterans will be asked to “opt-in” to the program by Sept. 30 in order to track authorizations and costs associated with the pilot project. The Rural Health Pilot represents
potential revenue in excess of $676,000 to the Alaska Native Health
Care System and Community Health Clinics. Success of the program will
be determined by the number of authorizations issued and the number
of veterans who choose to participate in the pilot. In addition, feedback
will be solicited from providers and focus groups conducted with veterans
in the pilot areas. http://www.thetundradrums.com/
VA Boston Healthcare System will work in coordination with MGH and Spaulding Rehabilitation Hospital to provide high quality, patient-centered care and implement a fully integrated system to enhance a comprehensive communication system between program components. They will work with MGH to establish an outreach clinic on the campus of MGH to assist in the coordination of care of OEF/OIF veterans seen at the MGH. The program will work to:
PTSD is a recognized anxiety disorder that can follow seeing or experiencing an event that involves actual or threatened death or serious injury to which a person responds with intense fear, helplessness or horror, and is not uncommon in war. Feelings of fear, confusion or anger often subside, but if the feelings don't go away or get worse, a veteran may have PTSD. Health Care News
The funds are part of the $500 million allotted to HHS’ Health Resources and Services Administration (HRSA) to address workforce shortages under the American Recovery and Reinvestment Act (ARRA). The grants announced are distributed through six HRSA programs:
To date, HHS has announced the availability of nearly $200 million in ARRA workforce funds, of a total $300 million, to expand HRSA’s National Health Service Corps. The funds will pay for student loan repayments for primary care medical dental and mental health clinicians who wish to practice, for a minimum of two years, in NHSC sites that treat underserved and uninsured people. In addition, HRSA received $2 billion through ARRA to expand health care services to low-income and uninsured individuals through its health center program. More than $1.3 billion of these funds have already been awarded to community-based organizations across the country. HRSA-supported health centers treated 17 million patients in 2008, 40 percent of whom have no health insurance. Health Professions Awards by Program
are located at http://www.hhs.gov/recovery/ Health Professions Awards by State
are located at http://www.hhs.gov/recovery/
The Adoption Incentives program was created as part of the Adoption and Safe Families Act of 1997. The original program authorized incentive funds to states that increased the number of children adopted from foster care. In order to get payments, states had to increase the number of children adopted relative to baseline data. States use the funds from the adoption incentive award to enhance their programs for abused and neglected children. Under the Fostering Connections to Success and Increasing Adoptions Act of 2008 (P.L. 110-351), the adoption incentives were revamped to provide stronger incentives for states to redouble their efforts to find children — particularly older children and children with special needs — loving adoptive homes. In addition, the law introduced the concept of an adoption rate, which is derived from comparing current year adoptions to the number of children in care at the end of the previous year. A list of each state’s adoption
incentive award amount can be found at http://www.acf.hhs.gov/news/
The test, called OVA1, helps patients and health care professionals decide what type of surgery should be done and by whom. OVA1 identifies some women who will benefit from referral to a gynecological oncologist for their surgery, despite negative results from other clinical and radiographic tests for ovarian cancer. If other test results suggest cancer, referral to an oncologist is appropriate even with a negative OVA1 result. OVA1 should be used by primary care physicians or gynecologists as an adjunctive test to complement, not replace, other diagnostic and clinical procedures. It uses a blood sample to test for levels of five proteins that change due to ovarian cancer. The test combines the five separate results into a single numerical score between 0 and 10 to indicate the likelihood that the pelvic mass is benign or malignant. OVA1, developed by Vermillion Inc.,
headquartered in Fremont, Calif., in conjunction with researchers at
The Johns Hopkins University in Baltimore, is intended only for women,
18 years and older, who are already selected for surgery because of
their pelvic mass. It is not intended for ovarian cancer screening or
for a definitive diagnosis of ovarian cancer. Interpreting the test
result requires knowledge of whether the woman is pre- or post-menopausal. http://www.fda.gov/NewsEvents/
The vaccines, made by CSL Limited, MedImmune LLC, Novartis Vaccines and Diagnostics Limited, and sanofi pasteur Inc., will be distributed nationally after the initial lots become available, which is expected within the next four weeks. All four firms manufacture the H1N1 vaccines using the same processes, which have a long record of producing safe seasonal influenza vaccines. Based on preliminary data from adults participating in multiple clinical studies, the 2009 H1N1 vaccines induce a robust immune response in most healthy adults 8 to 10 days after a single dose, as occurs with the seasonal influenza vaccine. Clinical studies under way will provide additional information about the optimal dose in children. The recommendations for dosing will be updated if indicated by findings from those studies. The findings are expected in the near future. As with the seasonal influenza vaccines, the 2009 H1N1 vaccines are being produced in formulations with and without thimerosal, a mercury-containing preservative. People with severe or life-threatening allergies to chicken eggs, or to any other substance in the vaccine, should not be vaccinated. In the ongoing clinical studies, the vaccines have been well tolerated. Potential side effects of the H1N1 vaccines are expected to be similar to those of seasonal flu vaccines. As with any medical product, unexpected or rare serious adverse events may occur. The FDA is working closely with governmental and nongovernmental organizations to enhance the capacity for adverse event monitoring, information sharing and analysis during and after the 2009 H1N1 vaccination program. In the U.S. Department of Health and Human Services, these agencies include the Centers for Disease Control and Prevention. Vaccines against three seasonal virus
strains are already available and should be used (see information on the seasonal
flu). However, they do not
protect against the 2009 H1N1 virus (see information
on H1N1 flu).
The new Web site was created in collaboration with the Office of the National Coordinator for Health Information Technology, the Health Resources and Services Administration and the Centers for Disease Control and Prevention, as well as a number of professional organizations, to enable more effective use of newborn screening test results in assessing child health and improving lifelong health care. Newborn screening is an important part of public health, but use of test results is complicated by wide variations among states in the ways tests are conducted and results recorded and by inefficient, paper-based communications. The current situation can delay rapid attention to a child's health problems and it creates frustration and extra work for parents, health care providers and public health authorities. The new Web site is a translator, to help deal with current complexity and to promote more efficient electronic exchange of newborn screening information in the future. The Web site is designed to help states move toward the use of common terminology and coding standards, a key step in enabling electronic exchange of laboratory test information as well as readying newborn screening information for inclusion in electronic health records (EHRs). The site covers more than 100 conditions and lists the terminologies and codes used for each. It also identifies the tests that may be used in screening for each condition. For all the conditions and tests included, the preferred standard terminology and codes are indicated. Users of the Web site can view the information interactively or download electronic datasets of standard names and identifiers for use in their systems. The goal of the Newborn Screening
Codes and Terminology Guide is to provide a standard framework for reporting
the results of newborn screening tests whose contents can be accurately
interpreted by recipient electronic systems for use in care, follow-up
and analysis. This standard framework will also enable the use and comparison
of data from different laboratories.
The drug treats adults with complicated skin and skin structure infections caused by methicillin-resistant Staphylococcus aureus — commonly known as the superbug MRSA — and other gram-positive bacteria. The once-a-day injectable drug will be marketed for three years with Japan-based Astellas’ U.S. unit under the brand name Vibativ. The Food and Drug Administration’s approval of the drug, with side effects on the kidney and a “black box” warning for pregnant women, caps a three-year journey through the approval process for telavancin. The drug is the first approved specifically to target MRSA, which currently is treated largely with the antibiotic vancomycin. The superbug has become increasingly resistant to generic vancomycin. At the same time, MRSA has spread from hospitals to locker rooms and other general community settings, where the skin infections largely occur. Theravance hopes that this initial
FDA approval of telavancin to treat MRSA will facilitate its approval
to use the drug against hospital-acquired pneumonia in November 2009. http://sanfrancisco.
CCHIT will offer an updated comprehensive electronic health record certification program, called CCHIT Certified 2011, as well as a modular certification program — called Preliminary ARRA 2011 — that is limited to the standards for qualifying EHR technology under the American Recovery and Reinvestment Act (ARRA). The goal of the new programs is to help providers achieve meaningful use to qualify for the ARRA incentives in 2011 and 2012, which may not occur if they wait until late 2010 to implement certified EHR systems and technologies. The CCHIT commission followed the recommendations of the health information technology advisory committees to the Office of the National Coordinator (ONC) and believes there is sufficient information to offer preliminary ARRA certification. HHS criteria and standards are slated for publication by the end of 2009. Final rules on meaningful use are expected in the spring of 2010. If that process results in the introduction of new requirements, the commission will offer vendors with preliminary certifications an incremental inspection at no additional fee to bring their certifications into alignment with the final rules. The commission's certification materials, including criteria, test scripts and certification policies for both programs, will be published Sept. 24 on the CCHIT Web site. Applications for certification will open online on Oct. 7. To help HIT companies and developers
to make 2011-certified EHR technology available to providers, the commission
is offering a workshop in the Chicago area on Oct. 1. The workshop,
Get Certified 2011, is designed to orient companies and developers to
the new certification process and help them use the new certification
program tools effectively.
Weems’ 28-year career in the federal government culminated with his appointment as acting administrator of CMS. In this role, Weems led the launch of Medicare’s e-prescribing program and personal health record pilot programs, as well as payment reforms that included non-payment for some medical errors. Earlier he had been deputy chief of staff and chief financial officer of HHS. He was also vice chairman of the American Health Information Community, where he helped lead the team advising Bush administration Health and Human Services secretary Michael Leavitt on strategies for promoting the use health IT. Vangent specializes in business process
outsourcing, human capital management and systems integration. In February
it won a $14 million task order contract from the Military Health System
to support the military’s efforts to track traumatic brain injuries
and behavioral health.
The new report shows that nationwide, the number of uninsured has increased from 39.8 million in 2001 to 46.3 million in 2008.
To learn more and view state by state
data, visit http://www.healthreform.gov/
The new demonstration will build on a model being tested in Vermont. Under the Vermont model, private insurers work in cooperation with Medicaid to set uniform standards for “Advanced Primary Care (APC) models,” also known as medical homes. These models provide incentives for doctors to spend more time with their patients and offer better coordinated higher-quality medical care. In Advanced Primary Care models, physicians are given supplemental payments for achieving nationally recognized quality standards, coordinating care across a multidisciplinary team and monitoring patients’ care outside the physician’s office or hospital using health information technology. This demonstration will mark the first time Medicare will be a full partner in these experiments, and the practice model would align compensation offered by all insurers to primary care physicians. Instead of each third party payer and public program adopting different approaches, using different ways of measuring performance and creating different payment incentives, multi-payer programs will join together to work toward common goals to improve the delivery of care. States wishing to participate in the new demonstration must:
The demonstration’s design will include mechanisms to assure it generates savings for the Medicare trust funds and the federal government overall. The Centers for Medicare & Medicaid Services will develop application materials later this fall with the expectation that the demonstration programs begin next year. To read a fact sheet on this initiative,
visit http://healthreform.gov/
The National Immunization Survey (NIS) estimates the proportion of teens aged 13 through 17 years who have received six recommended vaccines by the time they are surveyed. Three of these are recommended to be given at age 11 or 12 years: the tetanus-diphtheria-acellular pertussis vaccine (Tdap), the meningococcal conjugate vaccine (MCV4), and, for girls, the human papillomavirus vaccine (HPV4). If missed at this age, the vaccines can be given in the teen years. The survey also covers three other vaccines, which are recommended to be given earlier in life: measles, mumps and rubella vaccine (MMR), hepatitis B vaccine (HepB), and varicella (chickenpox) vaccine. Preteens and teens should get all recommended doses of these vaccines if they missed them when they were younger. All doses are counted, no matter when they were received. The survey found that, compared to 2007, there was a substantial increase in the percentage of teens who had received the recommended vaccines. CDC has conducted the National Immunization Survey for teens since 2006. It is similar to the standard NIS, which began in 1994, that collects immunization information among children 19 through 35 months old. It is a random digit-dialed telephone survey of parents or care-givers, followed by verification of records with healthcare providers. For more information, visit www.cdc.gov/vaccines/default. 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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