FEDERAL HEALTH UPDATE
Oct 30, 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
The bill includes a version of the "public option," which rates would be negotiated between providers and federal health officials, similar to the way in which private insurance operates and preferred by moderates. It also raises Medicaid eligibility levels to 150 percent of the federal poverty level for all adults, a steeper increase than in earlier drafts. Pelosi said the bill would insure 36 million more Americans—96 percent of Americans. According to the Congressional Budget Office (CBO), the bill would cut the deficit by about $30 million in the first 10 years. The main revenue sources in the House bill include a surcharge on wealthy taxpayers and changes to Medicaid and Medicare worth about $500 billion in cost savings over 10 years A previous version of the House bill carried an estimated cost of $1.04 trillion over 10 years, but House negotiators were able to lower the price tag -- in part by expanding Medicaid coverage to a broader slice of the population, the equivalent of all individuals who earn about $16,200 per year. The original House legislation had sought an increase to 133 percent of the federal poverty level, or about $14,400 per year, the same level proposed in the Senate bill. The adjustment reflects findings by congressional budget analysts that covering the poor through Medicaid -- which pays providers far less than Medicare -- is much more cost-effective than offering subsidies for private insurance policies, something the bill would provide to middle class individuals who lack access to affordable coverage through their employers. Democratic House
aides said party leaders had yet to resolve long-standing disputes over
provisions to prevent federal funds from being used to subsidize abortions
and to block illegal immigrants from receiving benefits. Democratic
leaders have committed to giving members at least 72 hours to study
the bill before a vote.
This declaration will allow the Secretary of Health and Human Services, if necessary, to temporarily waive certain standard Federal requirements in order to enable U.S. health care facilities to implement emergency operations plans to deal with the 2009 H1N1 influenza pandemic in the United States. To read the proclamation, please
read http://www.whitehouse.gov/the- Military Health Care News
On July 13, 2009, DoD awarded the South Region TRICARE program contract to the UnitedHealth Military & Veterans Services unit at UnitedHealth Group Inc., Minnetonka, Minn. Humana Military has served as a TRICARE contractor since 1996. Under its current TRICARE contract, Humana Military provides managed-care services for active-duty soldiers, their dependents and retired service members and their families in Alabama, Arkansas, Florida, Georgia, Louisiana, Mississippi, Oklahoma, South Carolina, Tennessee and Texas. That contract is set to expire March 31, 2010. Humana told the GAO that are discrepancies between the award criteria and procedures prescribed in the request for proposals issued by the Defense Department and those that appear to have been used by the department in making its contractor selection. Ralph White, assistant general counsel of the bid protest division within the GAO’s Office of the General Counsel, said the agency could recommend that TRICARE rebid the contract because it did not follow statutes and regulations related to the award. The agency also could have dismissed Humana’s claim for procedural reasons, or it could have determined that TRICARE followed the proper guidelines in awarding the contract to United Military. In rare cases, White said, the agency might recommend that the contract be given to one of the losing bidders. This is the first
time the GAO has upheld a protest concerning a TRICARE managed-care
contract. A TRICARE spokesman said DoD will review the recommendations
issued by GAO and decide how to proceed. http://twincities.bizjournals.
This year’s Distinguished Service Award recognizes all military ophthalmologists, past and present, for their persistent dedication to serving the eye-care needs of active duty, dependents and retirees. In cooperation with the Department
of Veterans Affairs, the Department of Defense (DoD) is leading the
way in providing the best possible surgical and rehabilitative eye care
available to military personnel. In August, 2009, the DoD established
the Vision
Center of Excellence to track
serious eye injuries and eye diseases, update clinical progress in a
timely and accessible manner, and jointly arrange and collaborate on
vision research studies. It is charged specifically to prevent, diagnose,
mitigate, treat and rehabilitate military eye injuries.
TRICARE eligible beneficiaries, who are entitled to Medicare Part A on the basis of age, disability, or end-stage renal disease, maintain their TRICARE eligibility when they are enrolled in the supplementary medical insurance program under Part B of Medicare. In general, in the case of medical or dental care provided to these individuals for which payment may be made under both Medicare and TRICARE, Medicare is the primary payer and TRICARE will normally pay the actual out-of-pocket costs incurred by the person. This final rule prescribes double coverage payment procedures and makes revisions to TRICARE rules to accommodate beneficiaries who are eligible under both Medicare and TRICARE, and who participate in Medicare's outpatient prescription drug program under Medicare Part D. These revisions are necessary because of the requirements contained in the Centers for Medicare and Medicaid Services (CMS) final rule for the Medicare Prescription Drug Benefit, Part D plans with other prescription drug coverage. This final rule also establishes requirements and procedures for implementation of the improvements to the TRICARE Pharmacy Benefits Program directed by section 714 of the Ronald W. Reagan National Defense Authorization Act (NDAA) for Fiscal Year (FY) 2005 (NDAA FY 05) (Pub. L.108-365). It clarifies that the cost-sharing requirements for Medicare-eligible beneficiaries may not be in excess of the cost-sharing requirements applicable to other retirees, their dependents, former spouses and survivors. Additionally, the rule authorizes the Department of Defense (DoD) Pharmacy and Therapeutics committee (P&T) to make a separate and additional determination of the relative clinical and cost effectiveness of pharmaceutical agents that provide greater value than other uniform formulary agents in that therapeutic class. This rule also describes the transition process that will occur as the uniform formulary is developed and uniform service facilities move to a uniform formulary, consistent with their scope of practice. This final rule is effective Nov.
30, 2009.
The task orders,
awarded under the MHS D/SIDDOMS 3 Contract, include Phase II of the
Healthcare Artifact and Image Management Solution (HAIMS) program to
expand upon the earlier HAIMS development effort by the Evolvent Team;
the Clinical Data Repository (CDR) Stabilization program to stabilize
the performance and correct the problems reported by the healthcare
community; and the Knowledge Support Center/Survey Data Repository (KSC/SDR)
program for a web-based business intelligence capability and a consolidated
survey data repository.
The task order has a 12-month base period of performance, two one-year options, and a total value of $8.3 million if all options are exercised. AHLTA-T maintains a comprehensive,
computer-based patient record for every soldier, sailor, airman, marine,
and beneficiary entitled to DoD military healthcare in theater of operations.
Under this task order, PSI and its team members, Evolvent and ASM Research,
will provide maintenance, sustainment and support services, which will
improve system speed, reliability, data quality, and usability of currently
existing AHLTA-T products. The new functionalities will improve patient
safety and quality of care for approximately 9.4 million beneficiaries
of the Military Health System (MHS) TRICARE Program.
The Hawai'i Island Family Health Center is the culmination of several years of effort by island residents and federal, state and local governments to address a critical shortage in health professionals available to the Big Island's citizens. Along with the Hawai'i Health Systems Corporation's Hilo Medical Center, the staff will serve patients in the community, while also training future medical professionals to serve in a rural health setting. Dr. Lucy Bucci, MD, MPH, director JABSOM Department of Family Medicine and Community Health, leads a staff of two physicians, a nurse practitioner and a pharmacist. They already are seeing about 40 patients a day. Officials believe the interdisciplinary training center will make it easier to recruit needed health care workers from all four health care professions to practice on the Big Island. Individuals and community organizations came together on the Big Island after state funding for a Hilo residency training program lagged. The Hilo Medical Center Foundation worked to increase awareness and funds for the program. HMSA, TriWest Health Care Alliance and the Centers for Medicare and Medicaid Services contributed key financing to establish the clinic/training center. TriWest provides managed-care services for active-duty soldiers, their dependents and retired service members and their families in the TRICARE West Region, which includes Hawaii. TriWest hopes to establish a training model which can be replicated in communities throughout the Pacific, where many military personnel are stationed. The Hawai'i Island Family Health Center is located at 45 Mohouli Street in Hilo. The clinic features nine examination rooms in 4,350 square feet of medical clinic and education space. Veterans Health Care News
The summit, held in Washington, D.C., invited mental health experts from both departments, Congress, the president’s cabinet and more than 57 non-government organizations to discuss an innovative, wide-ranging public health model for enhancing mental health for returning service members, veterans and their families. Striking down the stigma associated with the mental health risks of service in a combat zone is among the priorities of the joint VA-DoD campaign on mental health for service members, veterans and families. Various studies show a large incidence of post-traumatic stress disorder occurs during the lifetime of many combat veterans. A final report following the summit
will summarize policies, programs and practices that show promise for
enhancing the well-being and care for individual service members, veterans
and their families. VA and DoD view mental health in returning service
members and veterans as a matter of public health and an opportunity
to engage in a broad response throughout America. http://www1.va.gov/opa/
In surveys of 308 veterans, researchers found that those who had suffered combat injuries were at greater risk of developing migraine headaches. Meanwhile, those who screened positive for post-traumatic stress disorder (PTSD) had elevated rates of both migraine and tension-type headaches. The findings, published in the journal Headache, suggest that veterans with either physical injuries or PTSD should also be asked about chronic headaches. A few past studies have suggested that PTSD may be associated with higher headache risks. But because PTSD often arises after a physical injury, it has not been clear whether the stress disorder itself is linked to headache risk. In the new study, physical injury and PTSD were each independently associated with higher headache risks. Of the veterans assessed, 40 percent screened positive for PTSD, while 17.5 percent had combat-related physical injuries only. When it came to headache, 10 percent said they had been diagnosed with migraine, 10 percent reported a diagnosis of tension- type headache and six percent said they had been diagnosed with both. Overall, vets with physical injuries only had more than twice the risk of recurrent headaches as those without such injuries. The risk was four times higher among veterans with PTSD versus those without the disorder. When the researchers looked at headache type, they found that physical injuries were related to migraines only, while PTSD was linked to migraines and tension headaches. PTSD could raise headache risk for a number of reasons, according to the researchers. Health Care News
Arzerra, manufactured by GlaxoSmithKline, is approved for patients with CLL whose cancer is no longer being controlled by other forms of chemotherapy. CLL primarily affects people older than 50 and arises from a group of white blood cells known as B-cells that are part of the body’s immune system. Each year, about 16,000 people are diagnosed with CLL and about 4,400 people die from the disease. Arzerra is a monoclonal antibody, a type of biotechnology product. Antibodies that occur in nature are produced by the immune system in response to invaders. Arzerra binds to a specific protein found on the surface of both normal and malignant B cells, making the cells more susceptible to immune system attack. The product was approved under the FDA’s accelerated approval process, which allows earlier approval of drugs that meet unmet medical needs. Products may receive accelerated approval based on a surrogate endpoint, such as a reduction in the size of the tumor or decrease in the number of cancerous white cells or in an enlarged spleen or lymph nodes. These indirect measures for clinical outcomes are considered reasonably likely to predict that the drug will allow patients to live longer or with fewer side effects of a disease. The accelerated approval process
requires further study of the drug. The manufacturer is currently conducting
a clinical trial in CLL patients to confirm that the addition of Arzerra
to standard chemotherapy delays the progression of the disease.
HAIs are one of the most common complications
of hospital care. Nearly 2 million patients develop HAIs, which contribute
to 99,000 deaths each year and $28 billion to $33 billion in health
care costs. HAIs are caused by different types of bacteria that infect
patients being treated in a hospital or health care setting for other
conditions. The most common HAI-causing bacteria is methicillin-resistant Staphylo Of the $17 million, $8 million will fund a national expansion of the Keystone Project, which within 18 months successfully reduced the rate of central-line blood stream infections in more than 100 Michigan intensive care units and saved 1,500 lives and $200 million. The project was originally started by the Johns Hopkins University in Baltimore and the Michigan Health & Hospital Association to implement a comprehensive unit-based safety program. The program involves using a checklist of evidence-based safety practices; staff training and other tools for preventing infections that can be implemented in hospital units; standard and consistent measurement of infection rates; and tools to improve teamwork among doctors, nurses and hospital leaders. Last year, AHRQ funded an expansion of this project to 10 states. With additional funding from AHRQ and a private foundation, the Keystone Project is now operating in all 50 states, Puerto Rico and the District of Columbia. The new funding announced today will expand the effort to more hospitals, extend it to other settings in addition to ICUs, and broaden the focus to address other types of infections. Specifically, the new $8 million in funding will provide:
AHRQ, in collaboration with the Centers for Disease Control and Prevention (CDC), also identified several high-priority areas to apply the remaining $9 million toward reducing MRSA and other types of HAIs. A complete list of institutions funded
by the $17 million in resources awarded today is available at http://www.ahrq.gov/qual/
The report outlines the many ways health insurance reform will lower health care costs for small businesses. The report notes:
Health insurance reform will bring down costs for small businesses by creating a health insurance exchange, providing a small business tax credit, ending the “hidden tax” on small businesses that provide health insurance and preventing arbitrary premium hikes. Reform will also ensure Americans have stable, secure insurance coverage, limit out-of-pocket spending and eliminate caps on benefits. To learn more about how health insurance
reform will benefit small businesses and read the complete report, visit www.HealthReform.gov.
This second phase of the partnership includes expanded content and multimedia tools at www.webmd.com/fda. WebMD is personalizing FDA health information for consumers with five new online FDA sections that will initially focus on allergies and asthma, children’s health, diabetes, heart health and vitamins and supplements. Launched in December 2008, this joint effort has already proven effective in reaching consumers with important safety information. The FDA’s information is also located within WebMD's homepage, www.webmd.com, WebMD Health News, WebMD Health Search, RSS feeds, and targeted WebMD Newsletters and Special Reports. Since the launch, over 150,000 consumers have accessed the FDA destination on WebMD for health and wellness information on issues ranging from egg safety to contact lens safety to medicine safety. The FDA’s consumer information is also available through WebMD the Magazine, distributed ten times a year and reaching an additional 11 million consumers with each issue. In May, the FDA’s
joint partnership center on WebMD’s site increased the reach of the
agency’s warning to stop using an over-the-counter weight loss product
after reports of serious health problems associated with the product.
A special WebMD email alert with the warning reached almost 3 million
consumers interested in weight, fitness and health issues—providing
the right audience with the right information at the right time.
Called the Systolic Blood Pressure Intervention Trial (SPRINT), the nine-year, $114 million study will be conducted in more than 80 clinical sites across the United States. Current clinical guidelines recommend systolic pressure (the top number in a blood pressure reading) of less than 140 millimeters of mercury (mm Hg) for healthy adults, and 130 mm Hg for adults with kidney disease or diabetes. SPRINT will evaluate the potential benefits of maintaining systolic blood pressure at less than 120 mm Hg for adults who are at risk for heart disease or kidney disease. The study will also assess possible risks of this therapeutic strategy. Beginning in the fall of 2010, SPRINT will enroll approximately 7,500 participants age 55 years or older with systolic blood pressure of 130 mm Hg or higher. Study participants will be treated with commonly available blood pressure medications to achieve one of two different levels of blood pressure control — either less than 140 mm Hg (standard group) or less than 120 mm Hg (treatment group). Those in the treatment group will take an average of three to four medications; those in the standard group will take about two medications. SPRINT participants will be seen in clinics every few months at the beginning of the study and less frequently as their blood pressure is controlled. The study will include standard tests for determining the health of the heart, kidneys and brain. The clinical trial is based in large part on observational studies that suggest that maintaining a lower blood pressure level than is currently recommended reduces the risk of cardiovascular diseases. SPRINT will test the effectiveness of a medical strategy to reach specific blood pressure goals and does not compare specific drugs to each other. Study participants will be given specific blood-pressure lowering medications as determined by their research clinicians; medications may differ among participants in each treatment group. High blood pressure is one of the most common conditions among middle-aged and older adults, and is a leading risk factor for stroke, heart disease, kidney failure, and other conditions. High blood pressure is also a key contributor to the development and progression of chronic kidney disease. Nearly 1 in 3 adult Americans has high blood pressure. Worldwide estimates suggest that over 900 million adults have high blood pressure. For more information, please visit http://www.nih.gov/news/
The 18-month initiative, called the Mississippi Health First Collaborative, will give patients diabetes self-management training in their home communities, in locations such as community centers or senior centers, instead of in hospitals or other traditional health care settings, such as doctors’ offices or outpatient clinics. The members of this Collaborative will help motivate and educate diabetes patients across the state to take preventive action against some of the complications of diabetes. Other federal agencies participating in the Mississippi Health First Collaborative include the Centers for Disease Control and Prevention (CDC), Administration on Aging (AOA), Health Resources and Services Administration (HRSA), National Institutes of Health (NIH), Housing and Urban Development (HUD) and the Department of Health and Human Services’ Office of Minority Health. National non-profit and state entities working with the collaborative include the American Association of Diabetes Educators, American Diabetes Association, National Academy for State Health Policy and Mississippi’s Department of Health. Mississippi has one of the nation’s highest obesity rates; along with high rates of diabetes, poverty and medical need. In Mississippi, approximately 1 in 7 African Americans have been diagnosed with diabetes, compared to 1 in 10 whites. CDC data show that African Americans are at greater risk of diabetes and are more likely to experience disease and life-threatening complications, such as blindness and kidney failure. Many individuals in the state are designated as being a part of a “medically underserved group,” which is a population group that faces face economic, cultural or linguistic barriers to health care; or live in “medically underserved areas,” or areas with shortages in the availability of personal health services. This project borrows from the success of other projects Medicare has undertaken to improve care for patients with diabetes. Since August 2008, Medicare’s Quality Improvement Organizations (QIOs) have worked with local organizations and groups in select parts of the country to bring diabetes self-management training to their communities. This Collaborative is intended to provide similar services. QIOs work in every state and territory of the United States to improve the quality of healthcare available to local Medicare beneficiaries. QIOs for the states/territories of New York, Maryland, the District of Columbia, Georgia, Louisiana, and the U.S. Virgin Islands have worked with hundreds of doctors’ offices to find Medicare patients who could benefit from diabetes self-management training. To date, these efforts have helped more than 2,700 Medicare beneficiaries. Through the summer of 2011, Medicare hopes to train at least 7,000 more beneficiaries in these states and territories. For more information on how patients, caregivers, healthcare providers, and community leaders can get involved in the Mississippi Health First Collaborative, please visit http://www.cmspulse.org. 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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