FEDERAL HEALTH UPDATE
Feb 19, 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
Ellen Murray has served as staff director for the Senate Appropriations Subcommittee on Labor, Health and Human Services, Education and related agencies since 1999. In that capacity, she oversaw the annual $150 billion Labor Health and Human Services appropriations bill. Murray has extensive knowledge of the HHS budget. Prior to her tenure with the Senate, she served in both the budget office and the Office of the General Counsel at HHS. Previously, Murray served as an economist at the Social Security Administration. Bryan H. Samuels has spent his career formulating service delivery innovations and streamlining operations in large government organizations on behalf of children, youth and families. As chief of staff for Chicago Public Schools (CPS), Samuels played a leadership role in managing the day-to-day operations of the third largest school system in the nation with 420,000 students, 623 schools, 44,000 employees, and a $5 billion budget. From 2003 to 2007, Samuels served as the director of the Illinois Department of Children and Family Services (DCFS), the nation’s third largest child welfare agency. Prior to 2003, Samuels taught at the University of Chicago’s School of Social Service Administration, while also providing technical assistance to state and local governments to improve human service delivery to vulnerable populations. Military Health Care News
Mayer served as the ASDHA from Nov. 18, 1983, to Apr. 21, 1989. He was recruited by former Defense Secretary Caspar W. Weinberger to improve the military’s medical system and redirect the mission to focus on medical readiness for combat operations. Mayer shifted the responsibility of military family care and peacetime burden to civilian facilities and doctors. This initiative inevitably resulted in a complete revamping of what was formerly known as the CHAMPUS program into today’s military managed health care program, TRICARE. Mayer’s earliest contribution to
military medicine took place during the Korean War when, as a young
major attached to Brooke Army Medical Center, he studied the records
of more than 4,000 returning prisoners of war to analyze Russia’s
“new weapon of control” – brainwashing. His groundbreaking lecture,
delivered in October 1956 to a group of his peers and supervisors at
the Naval Radiological Defense Laboratory in San Francisco, began his
career in military medicine.
VCE was formed after the fiscal year 2008 National Defense Authorization Act directed DoD and VA to establish a center of excellence in the prevention, diagnosis, mitigation, treatment and rehabilitation of military eye injuries. Congress also mandated that the departments better coordinate visual rehabilitative care and benefits for service members’ continuum of care between the agencies. The need for the VCE is evidenced in the variety of injuries that impact soldiers’ vision, from traumatic eye injury as a result of explosive devices and projectiles, to vision disorders associated with TBI, and eye injury caused by exposure to chemicals, biohazards, lasers or extreme environmental conditions. VCE is facilitating collaborative efforts that support optimal DoD/VA vision care transition, such as a process developed at Walter Reed Army Medical Center for blind rehabilitation care. There are increasing numbers of eye injuries occurring among service members from OEF/OIF compared with previous conflicts. According to the November 2008 Medical Surveillance Monthly Report of the Armed Forces Health Surveillance Center, more than 1,000 ocular injuries caused by war, guns and explosives were treated in fixed hospitals from 2003 to 2007. About 60-70 percent of severe and moderate TBI cases and 40 percent of mild TBI cases include some form of visual impairment, such as nerve damage from concussive events. VCE intends to capture reports from the Defense and Veterans Brain Injury Center, which collects intake information on visual issues caused by mild TBI. VCE is spearheading development of a new database to track eye injuries across the DoD and VA systems of care and to integrate pertinent information from all of the services. The new Defense and Veterans Eye Injury Registry (DVEIR) will record and follow the occurrence, treatment and outcomes of all eye injuries experienced by active duty service members since 9/11. A key goal for the database is to develop a common documentation strategy for vision care among DoD’s and VA’s varying health records. VA and DoD also are working on ways to share more patient information, and DoD is looking at redesigning an electronic health record to make its records more user friendly. The joint registry will also provide synergy with other centers of excellence being developed for service members exposed to blasts, such as one on hearing issues. Blast injuries can cause hearing and vision problems, as well as limited sense of smell and taste. For more information, please visit www.visioncenterofexcellence.
Transition to new regional contracts, known as “T-3,” was initially slated for completion by April 1, 2010, but formal protests filed with the Government Accountability Office (GAO) by two of the current contractors (Health Net Federal Services in the North, Humana Military Healthcare Services in the South) put transition activities on hold. Both protests were subsequently sustained by the GAO, and TMA is reevaluating the awards and considering options as recommended by the GAO. The T-3 contracts announced in July of 2009 are worth an estimated $55.5 billion over the base and five option periods. Aetna Government Health Plans, Hartford, Conn., was the contractor selected for the North Region, and UnitedHealth Military & Veterans Services, Minnetonka, Minn., was selected in the South Region, while TriWest was retained in the West Region. In addition to the sustained protests filed by Humana and Health Net, UnitedHealth filed an agency-level protest regarding the West Region award to TriWest, delaying transition for the entire United States. T-3 contract information and updates
can be found on a special TRICARE Web page at www.tricare.mil/T3contracts.
Under terms of the new contract, General Dynamics will continue to support digital medical records systems for use in combat areas. It includes operations in both Iraq and Afghanistan. There are currently 35,000 systems in place at hospitals and mobile battlefield medical operations in 14 countries. General Dynamics'
information technology division has been an MC4 contractor since 2005.
Its information technology division accounted for $2.7 billion of General
Dynamics $7.9 billion in fourth quarter revenue.
Among active-duty soldiers, there were 12 potential suicides: one has been confirmed as suicide, and 11 remain under investigation. For December, the Army reported ten potential suicides among active-duty soldiers. Since the release of that report, three have been confirmed as suicides, and seven remain under investigation. During January 2010, among reserve component soldiers who were not on active duty, there were 15 potential suicides. For December, among that same group, there were seven total suicides. Of those, five were confirmed as suicides and two are pending determination of the manner of death. In January, the Suicide Prevention Resource Council and the American Foundation for Suicide Prevention selected the Army’s “Ask, Care, Escort” model for inclusion in their national registry of programs reflecting “best practices” in suicide prevention. The Army’s model is one of only thirteen suicide prevention programs, nationwide, included in the registry. Army leaders can access current health
promotion guidance in newly revised Army Regulation 600-63, Health Promotion
at: http://www.army.mil/usapa/ The Army's comprehensive list of
Suicide Prevention Program information is located at http://www.armyg1.army.mil/hr/ Veterans Health Care News
VA wants to be able to track when and how its physicians respond to medical alerts sent to them via the CPRS, which currently can monitor only whether providers click to acknowledge receipt of an abnormal diagnostic test result alert. VA is seeking a vendor to update its CPRS interface and workflow to enable the tracking and reporting of critical diagnostic test alerts and actions taken by the physicians. VA wants the vendor to provide source code for three functional and documented prototypes over 16 months. The alerts re-engineering project is part of the Veterans Health Administration Innovation Program, a VHA project to encourage and test innovative ideas from the field. The VA’s notice about the alert
project is online.
In an e-mail to the hospital staff and a separate note to local members of Congress and other officials in Washington, Citron, 63, of Wilmington, praised the professionalism of the medical center's staff and its support of him "during a time of rapid growth and change." He noted programs such as behavioral and women's health that were added or strengthened during his 21/2 years at the hospital. He also acknowledged "some challenging situations," including the troubled prostate-cancer program that, over a six-year period, was marked by incorrect doses of radiation. Citron worked for the VA for 38 years after serving in the military for four years, which included a year at a MASH unit in Vietnam. The VA will conduct a national search
for a replacement.
Petzel had been acting principal deputy under secretary for health since May 2009. Previously, he directed one of VA's 21 geographic health care networks covering eight medical centers and 42 community based outpatient clinics serving veterans in Iowa, Minnesota, Nebraska, North Dakota, South Dakota, western Illinois and western Wisconsin. During his decades of service to veterans in VA, he has served on numerous advisory committees that guided development of new and improved health care programs. Board certified in internal medicine, Petzel also has served previously as chief of staff for the Minneapolis VA Medical Center. He graduated from
Northwestern University Medical School in 1969 and has served on the
faculty of the University of Minnesota Medical School.
From now until Feb. 28, Veterans Health Administration (VHA) and Office of Information & Technology (OI&T) government and contract employees can submit their innovative ideas, comment on ideas, and vote on ideas. One hundred of the ideas will be selected and employees will be invited to submit full proposals. The Innovation Initiative will allow employees to enter health information technology ideas in a variety of categories, such as engaging veterans in their care, helping medical providers, increasing transparency, and improving workflow. A series of screening panels will review the suggestions. VA Assistant Secretary for Information and Technology Roger Baker and Dr. Gerald Cross, VA’s acting deputy under secretary for health, will select the top 25 ideas. In September 2009, Shinseki announced a similar competition for the Veterans Benefits Administration (VBA), encouraging employees to submit ideas on everything from speeding the processing times for disability claims to improving transparency. The winning ideas for the VBA innovation competition will be announced in February. The final selections will receive full funding for project development and execution at the regional offices submitting the idea. Health Care News
As described in media reports, the stimulus package resulted in $3.2 billion in economic activity as federally funded safety-net providers undertook expenditures to expand and improve their facilities, beef up their information technology systems and hire and hold onto medical personnel and staff. The findings are contained in a report issued by the Geiger Gibson/RCHN Community Health Foundation Research Collaborative at the George Washington University School of Public Health and Health Services' department of health policy and funded by the United Health Foundation and the RCHN Community Health Foundation. The practical result will be that nearly 3 million additional patients will be able to obtain medical care at community health centers by 2011, bringing the total number of people served to 21 million each year. The report emphasizes that these facilities cater to the needs of the poor and those living in areas underserved by other types of medical providers, making their value even higher to such communities during the recession. Areas with the worst economic conditions received a greater share of the new health centers funding from the American Recovery and Reinvestment Act (ARRA). The money would have gone twice as
far, however, were the economy in better shape, the report notes: "The
returns are lower now since most of the gains in estimated economic
activity are offset by higher unemployment levels and other effects
of the recession." So far, $1.85 billion of the funding has already
been distributed. http://thehill.com/blogs/blog-
The awards are expected to help make health IT available to more than 100,000 hospitals and primary care physicians by 2014 and train thousands of individuals for careers in health care and information technology. This Recovery Act investment will help grow the emerging health IT industry, which is expected to support tens of thousands of jobs ranging from nurses and pharmacy techs to IT technicians and trainers. The HHS grant awards are part of a federal initiative to build capacity to enable widespread meaningful use of health IT. This assistance at the state and regional level will facilitate health care providers' efforts to adopt and use electronic health records (EHRs) in a meaningful manner that has the potential to improve the quality and efficiency of health care for all Americans. Of the over $750 million investment, $386 million will go to 40 states and qualified State Designated Entities (SDEs) to facilitate health information exchange (HIE) at the state level, while $375 million will go to an initial 32 non-profit organizations to support the development of regional extension centers (RECs) that will aid health professionals as they work to implement and use health information technology. The more than $225 million in DOL grant awards will be used to train 15,000 people in job skills needed to access careers in health care, IT and other high growth fields. The grants will fund 55 separate training programs in 30 states to help train people for secure, well-paid health jobs and meet the growing employment demand for health workers. Employment services will be available via the Department of Labor's local One Stop Career Centers, and training will be offered at community colleges and other local education providers. The HHS and DOL awards are part of an overall $100 billion investment in science, innovation and technology the Obama administration is making through the Recovery Act to spur domestic job creation in growing industries and lay a foundation for economic growth. In addition to the 10,000 jobs the DOL grantees expect to fill with freshly trained workers, the health IT extension centers are expected to hire more than 3,000 technology workers nationwide in the months ahead. A complete listing of the state HIE,
REC and job training grant recipients can be view at http://www.hhs.gov/news/press/
For patients with cancer, the program is also designed to help ensure the appropriate administration of these drugs, which they receive to treat anemia that can occur as a result of chemotherapy. ESAs, manufactured by Amgen Inc., are forms of the human protein erythropoietin, which stimulates bone marrow to make red blood cells. In April 2008, FDA required Amgen Inc. to establish this risk management program based on studies that found that ESAs caused tumors to grow faster and resulted in earlier deaths in some cancer patients. Amgen’s risk management program, Risk Evaluation and Mitigation Strategy (REMS), requires health care professionals to provide their patients receiving an ESA with a Medication Guide that contains information for patients on how to safely use a drug. In addition, the company’s APPRISE (Assisting Providers and Cancer Patients with Risk Information for the Safe Use of ESAs) program requires specific training and certification of health care professionals who administer chemotherapy to patients with cancer and counseling of their patients. It does not apply to patients being treated with an ESA for anemia due to other circumstances. Through the risk management program, Amgen must ensure that health care professionals who treat patients with cancer do the following:
Amgen is also required to oversee and monitor health care professionals and hospitals that use ESAs for patients with cancer to ensure that these caregivers are fully compliant with all aspects of the overall risk management program. ESAs are approved for the treatment of anemia that may occur as a result of kidney failure, from certain kinds of chemotherapy, from the drug AZT, which can be used for the treatment of HIV infection, and for the treatment of anemia among certain patients undergoing surgery. For more information,
please visit http://www.fda.gov/AboutFDA/
The report was prepared by the Centers for Disease Control and Prevention’s National Center for Health Statistics from data gathered by state and federal health agencies and through ongoing national surveys. This year's edition features a special section on medical technology, and finds that the rate of magnetic resonance imaging, known as MRI, and computed and positron emission tomography or CT/PET scans, ordered or provided, tripled between 1996 and 2007. Highlights of the special section include:
The full report contains 150 data tables in addition to the special feature on medical technology. The tables cover the spectrum of health topics, serving as a comprehensive snapshot of the nation's health. The full report is available at http://www.cdc.gov/nchs/hus.
CDC is encouraging healthcare facilities across the country to enroll in this new surveillance system, which was designed to improve patient safety. By having a coordinated national network, CDC can summarize national data to understand better how to prevent adverse transfusion events such as reactions to blood products, medical errors, and process problems. The system, called the Hemovigilance Module, is part of CDC’s National Healthcare Safety Network (NHSN). NHSN is an Internet-based surveillance system that allows healthcare-associated infection data to be tracked and analyzed to allow CDC and healthcare facilities to maximize prevention efforts. Hospitals will submit data confidentially to CDC through the Hemovigilance Module. CDC will review the national data to help identify ways to improve the safety of blood transfusion. Previously, transfusion-related events were monitored by facilities on their own. Now, hospitals that join the Hemovigilance Module will have access to standardized data analysis tools, as well as an opportunity to see how their data compare to other hospitals throughout the United States. CDC provides the module at no cost to hospitals and healthcare facilities. The agency also provides participating facilities with training and ongoing user support at no cost to the facilities. For more information, please visit www.cdc.gov/nhsn/. 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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