FEDERAL HEALTH UPDATE
Jan 8, 2010Produced 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
Pelosi added the House and Senate “are very close to reconciliation” on the two versions of the bill. But when asked if the bill would pass this month, Democratic lawmakers seemed unsure, and there was a lengthy pause before Pelosi said, “It’s possible.” Other Democrats attending the meeting included Reps. Charles Rangel (N.Y.), George Miller (Calif.), Louise Slaughter (N.Y.) and Henry Waxman (Calif.). Pelosi described the series of meetings as “an intense couple of days." When asked what the president’s message was, Waxman, the chairman of the House Energy and Commerce Committee, said: “Get it done.” Military Health Care News
TRICARE received the “Best Campaign on a Limited Budget” award; a gold award in the Community Relations category; and was selected for third place in the top 50 campaigns worldwide. The 2009 Magellan awards included nearly 400 government agencies, major corporations and public relations firms worldwide. The LACP was established to facilitate discussion of best-in-class practices in communications within the public relations industry and recognize those who demonstrate exemplary communications. TMA’s Mental/Behavioral Health campaign placed third among the top 50 campaigns with a score of 98 out of a possible 100. TMA 2009 award winning mental and
behavioral health communication products included the development and
distribution of the comprehensive TRICARE behavioral health guide and
the development of a Mental Health Resource Center on the TRICARE website
at www.tricare.mil/mentalhealth.
"Theater of War" is an innovative new project that presents readings of ancient Greek plays as a catalyst for town hall discussions about the challenges faced by combat veterans and their families today. "Theater of War" is funded by the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, which recognized the project's ability to help service members, veterans, caregivers, and family members confront and discuss the emotional and psychological effects of combat and war, and the challenges of homecoming. Goals of the project are to:
Those interested in attending the
event should RSVP by e-mail to Monica.valdiviezwiley@us.army.
There are measurable decrements by which physical and cognitive performance can be gauged as an environment increases in elevation, related to reduced air and oxygen pressures that decrease the availability of oxygen. The result is hypoxia, an inadequate oxygenation of the blood. At 4,000 ft. above sea level, the first signs appear of a lack of physical performance. When a human reaches 8,000 ft. above sea level, certain altitude sicknesses are evident. Acute mountain sickness (AMS), in particular, is characterized by headache, nausea, dizziness, and shortness of breath. AMS is common, but recovery is quick with descent and rest. Two more serious but rare altitude sicknesses require medical treatment and can be very dangerous for troops in combat. Training for high-altitude deployment is conducted at military installations in CONUS including Fort Carson, Colo., the Marine Mountain Warfare Training Center, Calif., and at Hawthorne Army Proving Ground, Nev. High altitude research is simulated in a controlled environment with hypobaric chambers. At USARIEM these decompression chambers are used by researchers to control the barometric pressure and oxygen concentration in an enclosed environment to simulate high altitude conditions. The simulation gives researchers the data they need to draw conclusions about acclimatization, acute mountain sickness, hypoxia, and human performance metrics. USARIEM is also studying the effectiveness of hypoxic chambers used by athletes across the world to help their bodies perform better at higher altitudes. As a result of the research conducted at USARIEM, several products have been developed. Because there is relatively little data accumulated in regards to altitude sickness, several models are being created to be used as tools for the military. The research team at USARIEM is working on several predictive models which will pivot around the results and findings of three main topics of research: altitude sickness, work performance and altitude acclimatization. For more information about the findings,
please visit www.usariem.army.mil.
Health Net Federal Services is responsible for verifying and updating registration information in the appointment system, making and canceling patient appointments with military treatment facility providers, and providing performance and management reports on the appointing process for eligible beneficiaries. Health Net Federal
Services currently provides Patient Appointing Services for the seven
military treatment facilities in the Puget Sound, Wash., the Naval Health
Clinic in Great Lakes, Ill., and Weed Army Community Hospital in Fort
Irwin, Calif.
One in five service members returning from Iraq and Afghanistan suffers from major depression or post traumatic stress disorder (PTSD), according to the Department of Veterans Affairs National Center for Posttraumatic Stress Disorder. The Toolkit, located at www.tricare.mil/wii, is a resource for wounded service members seeking information about health care. In the Toolkit, service members can find information explaining Medicare eligibility for wounded service members and an explanation of how TRICARE and Medicare work together to reduce a service member’s out-of-pocket costs. There are also news releases with the latest information on new programs and changes in care. It also provides a link to the Mental Health Resource Center, which offers confidential access to mental health resources for service members and their loved ones. The Toolkit features a widget — an embeddable link directing people back to the Toolkit Web site. Visitors can download the widget and install it on their own Web site, to help spread the word about the Wounded, Ill and Injured Toolkit to others who can benefit from its resources. For more information about TRICARE’s behavioral health care resources, go to www.tricare.mil/mentalhealth. Veterans Health Care News
Under current regulations, the copayment amount must be increased based on the prescription drug component of the Medical Consumer Price Index, and the maximum annual copayment amount must be increased when the copayment is increased. Under the amendments, the VA will
freeze copayments at the current rate for the next six months, and thereafter
resume increasing copayments in accordance with any change in the prescription
drug component of the Medical Consumer Price Index.
The program will take place within the VA Capitol Health Care Network (VISN 5), which currently provides health care for eligible veterans in Maryland and portions of Virginia, West Virginia and Pennsylvania, as well as the District of Columbia. The pilot allows each of the medical centers within the VISN 5 region, both inpatient and outpatient, to provide the Sharps Disposal By Mail System(R) and the RxTakeAway(TM) solutions to their patients. Sharps Disposal By Mail System(R) is a comprehensive solution for the containment, transportation, destruction and tracking of medical waste generated outside the hospital and large healthcare facility settings, while the RxTakeAway(TM) is a comprehensive solution that facilitates the proper disposal of unused medications. In conjunction with the pilot program, each participating veteran will receive a survey so VISN 5 administrators can gauge their perception of the program and ease of use. For more information, please visit http://www.sharpsinc.com/
The VA Network Telecare Center is staffed by professionally trained nurses, who are ready to help answer veteran health care questions 24 hours a day, seven days a week. The South Central VA Health Care Network created its Telecare Center as part of its on-going efforts to provide veterans with timely health care information. All telephone calls are answered by a staff of professionals who are experienced in telephone assessment of medical situations and crisis intervention. To help veterans who call, nurses use their training and experience as well as other readily available resources. Telecare nurses provide both medical and emotional support. They are trained to provide symptom analysis, instruct on first aid procedures, help with stress and anxiety, answer medication questions, explain laboratory test results, educate patients about specific diseases, and check appointments. URAC’s Health Call Center Accreditation
standards address approaches to ensuring appropriate patient protections
have been established, such as policies for confidentiality of patient
information, informed consent, dispute resolution, and other issues.
The standards cover staff structure and qualifications, quality improvement,
information management, oversight of delegated functions, ethics, complaints,
and the case management process.
According to VA officials, this ground-breaking program will expand over time and could be a catalyst for a national health records system. In coming months, the U.S. Department of Defense is set to join the program. The partnership may also spur similar medical collaborations on the local and state level as it develops. The San Diego Union-Tribune reports that the pilot program will provide health-care providers with instant electronic access to medical records for about 1,000 patients. In the beginning, these records will include personal identification information, lists of allergies and medical conditions and histories. Eventually the program will expand to include x-rays, files with doctors' examination notes and lab test results. Although it's too early to gauge the success of the program, the partnership illustrates that public and private groups can bypass the barriers that have previously blocked the formation of an electronic medical information network. In the past, the cost of computers and software, the lack of any official sharing standard, debates about patient privacy and competition between private organizations have stifled efforts for such electronic medical-records exchanges. The success of this pilot program
could spark a new movement of partnerships between public and private
health organizations, especially as the efforts align with President
Barack Obama's push for all Americans to have electronic medical records.
The task order from the Office of Enterprise Development in VA’s Office of Information and Technology calls for SAIC to provide technical assistance to the Blood Bank Program managed by the VA’s Health Provider Systems Program Office. SAIC will support all development activities and resolve customers’ technical issues concerning software and associated interfaces. SAIC also will provide IT product development, quality management, testing and system administration, among other services. The Blood Bank Program supports clinicians in delivering patient care, and helps laboratory staff provide safe blood transfusions, meeting blood bank regulatory agency requirements and required hospital reporting services. The program also is responsible for maintaining and enhancing legacy software, including the Veterans Health Information Systems and Technology Architecture Blood Bank, the VistA Blood Establishment Computer Software, and vendor interface applications. The work will be performed primarily
in Chicago at the Hines VA Field Office.
As a federal agency, VA is required to have 15 percent of buildings incorporate sustainable practices by 2015 in accordance with Executive Order 13423. The recent Green Globe certifications raise VA’s sustainable building inventory and contribute toward reaching the department’s goals. The Green Globes system is an independent ratings based on environmental assessments. The ratings criteria include building energy efficiency, low greenhouse gas emissions, conservation and protection of water, comprehensive recycling of waste, high indoor air quality, reduced environmental impact of products and materials, employee use of public transportation and many other factors. Green Globes and Leadership in Energy and Environmental Design (LEED) are the only two environmental building rating systems developed by organizations that are accredited by the American National Standards Institute. The top rating under the Green Globes system is four green globes. For a list of the medical centers
that were recognized, please visit http://www1.va.gov/opa/ Health Care News
This was the slowest rate of growth since 1960. Despite slower growth, however, health care spending continued to outpace overall nominal economic growth, which grew by 2.6 percent in 2008 as measured by the Gross Domestic Product (GDP). The findings are included in a report by CMS’ Office of the Actuary, released in the health policy journal Health Affairs. The 4.4 percent growth in 2008 was down from 6.0 percent in 2007, as spending slowed for nearly all health care goods and services, particularly for hospitals. However, health spending as a share of the nation’s GDP continued to climb, reaching 16.2 percent in 2008, up 0.3 percentage points from 2007. Larger increases in the health spending share of GDP generally occur during or just after periods of economic recession. The economic downturn significantly impacted health spending as more Americans could not afford to spend their limited resources on health care and instead went without care. This led to slower growth in personal health care paid by private sources of funds, which increased only 2.8 percent in 2008. The recession also made it difficult for many Americans to afford private health insurance, coverage, leading to lower growth in private health insurance benefit spending, which slowed to 3.9 percent in 2008. Health spending was also affected by the American Recovery and Reinvestment Act of 2009 (ARRA), which provided a temporary 27-month increase in Federal Medical Assistance Percentages (FMAP) used to determine the federal Medicaid payments to states. The legislation led to approximately $7 billion of Medicaid spending shifting from states to the federal government for the last quarter of 2008. Other statistics on the growth of health care spending in the new report include:
To read the complete report, visit http://www.cms.hhs.gov/
Funding will be provided by the Biomedical Advanced Research and Development Authority (BARDA), within HHS’ Office of the Assistant Secretary for Preparedness and Response. The first contract year provides $16.8 million of funding with options for additional funding over the following four years. If it is licensed by the U.S. Food and Drug Administration (FDA), the federal government could buy Anthim for the Strategic National Stockpile under Project Bioshield. Project Bioshield is designed to accelerate the research, development, purchase and availability of effective medical countermeasures for the Strategic National Stockpile. Anthim is being developed by Elusys to treat people stricken by inhaled anthrax and to prevent illness from anthrax. The new contract, one of the largest awarded by BARDA for advanced product development, will support the Elusys’ clinical and commercial strategy, including scaling up manufacturing, expanded human safety trials and pivotal, non-clinical effectiveness studies in animals, through FDA licensure. Anthim has been granted Fast-Track status and Orphan Drug Designation by the FDA. Anthim has been developed under a National Institutes of Health (NIH) contract, using the BARDA Biodefense Medical Countermeasures Development Fund, as well as funding from the Department of Defense and the private sector. Elusys has completed two safety studies in humans, as well as numerous studies demonstrating safety and efficacy in animal models. Using an established non-human primate treatment model, up to 79 percent of animals treated with a single, intravenous dose of Anthim at the onset of symptoms survived a lethal inhalational challenge with anthrax spores. All animals in this study had confirmed levels of anthrax in their blood at the time of Anthim treatment. Elusys also reported results from an animal study that demonstrated that a single dose of Anthim provided up to 94 percent survival when administered to study subjects after symptoms of disease were present. The results of these studies are consistent with previously conducted animal studies using Anthim and continue to show the dramatic increase in survival that Anthim can provide. Anthim, given either by intravenous or intramuscular administration, also provides a high level of survival when given immediately after anthrax exposure in animal models. In two dose-escalating human clinical safety studies, results show Anthim to be safe and well-tolerated at doses at or above the anticipated efficacious dose in humans. Elusys has received a total of $34
million in government funding for advanced development of Anthim. Funding
has been received from HHS, BARDA, NIAID and the Department of Defense.
Only people with very severe depression receive benefits from drugs, according to the senior author of the study, Robert J. DeRubeis, a University of Pennsylvania psychology professor. Hundreds of studies have attested to the benefits of antidepressants over placebos but many studies involve only participants with severe depression. There is a tendency to generalize the findings to mean that all depressed people benefit from medications, which this study proves incorrect. The current analysis attempted to quantify how much of antidepressants' benefit is attributable to chemical effects on the brain and how much can be explained by other factors, such as visiting a doctor, taking action to feel better or merely the passage of time. The study found that the magnitude of the drugs' benefit increased with the baseline level of depression. The effect of treatment was similar in people with mild, moderate and severe symptoms, regardless of whether they took an antidepressant or placebo. Only the people who rated very severe on the depression scale at the start of the study showed measurable improvement on antidepressants. Researcher suggested that better antidepressants are needed for people with mild to moderate depression as is research on how to diagnose depression with tools, such as biomarkers, that could help personalize treatment. Of the six studies in the current analysis, three involved selective serotonin reuptake inhibitors, or SSRIs, the most commonly used antidepressants, and three involved an older class of medications called tricyclics. Both classes are thought to be equally effective, although SSRIs are associated with fewer side effects. One exception to the study findings
was people with dysthymia, or chronic, low-level depression. The analysis
assessed severity of symptoms, not chronicity. Other studies have established
that people with chronic depression, no matter how severe, tend to respond
well to antidepressants while other treatment may be ineffective.
In a study published in Jan. 7, 2010 issue of The New England Journal of Medicine, researchers from four Department of Veterans Affairs (VA) medical centers and two non-VA hospitals found preoperative cleansing of patients’ skin with chlorhexidine-alcohol is superior to cleansing with povidone-iodine for preventing surgical-site infection. Researchers found that the overall rate of surgical-site infection using chlorhexidine-alcohol was 9.5 percent, compared to 16.1 percent with povidone-iodine. These findings indicate only 17 patients need to receive an optimal skin antiseptic preparation in order to prevent one infection. The results of this study are considered extremely significant, since two-thirds of surgical-site infections are confined to the incision. A clinical trial involving 847 evaluable patients was conducted between April 2004 and May 2008 at the Michael E. DeBakey VA Medical Center, Houston; the VA Boston Healthcare System; the Milwaukee VA Medical Center; the Atlanta VA Medical Center; the Medical College of Wisconsin, Milwaukee; and Ben Taub General Hospital, Houston. Approximately 27 million operations are performed each year in the United States. Despite the implementation of preoperative preventive measures, which include skin cleansing with povidone-iodine (the current standard of care practice for surgical-site antisepsis), surgical-site infection occurs in 300,000 to 500,000 surgery patients each year in the United States. The Centers for Disease Control and Prevention has recommended the use of chlorhexidine-based preparations, but it has not made a recommendation as to the type of antiseptics that should be used for pre-operative prevention of surgical-site infection. The two antiseptics
studied are manufactured by CareFusion, a company formed by Cardinal
Health, which funded the research. One author is from Cardinal Health
and substantially contributed to the design and conception of the study
and critically revised the manuscript. However, this author played no
role in data collection or analysis.
The National Health Security Strategy is a call to action so that every community becomes fully prepared and ready to recover quickly after an emergency. The strategy sets priorities for government and non-government activities over the next four years. It provides a framework for actions that will build community resilience, strengthen and sustain health emergency response systems and fill current gaps. The National Health Security Strategy and the accompanying interim implementation guide outline 10 objectives to achieve health security:
The National Health Security Strategy also highlights specific actions that the nation — including individuals, communities, non-government organizations and government agencies — should take to prevent, protect against, respond to and recover from health threats. Among the initial actions for the federal government are conducting a review to improve the system for developing and delivering countermeasures — medications, vaccines, supplies and equipment for health emergencies; coordinating across government and with communities to identify and prioritize the capabilities, research, and investments needed to achieve national health security; and evaluating the impact of these investments. Federal, state, local, tribal and territorial government agencies, as well as medical, public health and community-based organizations, collaborated to develop the strategy and interim implementation guide. To determine any additional issues and themes the strategy should address, the HHS solicited direct input from non-federal participants during six regional workshops. HHS also worked with the Institute of Medicine to engage the medical community. The Pandemic and All Hazards Preparedness Act directed the HHS Secretary to develop the National Health Security Strategy with an accompanying implementation plan by 2009 and to revise the documents every four years. HHS, however, will update the implementation plan every two years to reflect advances in public health and medicine. To obtain a copy of the strategy and implementation guide, visit www.hhs.gov/disasters. 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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