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FEDERAL HEALTH UPDATE
*Click to print newsletter in pdf format Jan 2, 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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Congressional Schedule
The Wounded, Ill, and Injured Service Member campaign also received the Special Achievement award for “Best on a Limited Budget” against all other submissions. The Magellan Awards competition provides a platform for communications professionals to demonstrate the value they deliver to their organizations and clients. The awards are sponsored by the League of American Communications Professionals (LACP). Both campaigns were highly ranked in the Top 50 Communication campaigns. The Top 50 are awards given to the highest-scoring entries regardless of category. The Wounded Warrior campaign took the number eight spot and Childhood Obesity the number 24 spot out of more than 450 entries and, for the first time, TRICARE was listed in the top 10 along with recognizable commercial and government organizations such as ESPN, NASA and Coca Cola. TRICARE previously won seven Magellan Awards. Both of this year’s campaigns were enhanced by partnering with other Department of Defense and federal agencies, and made extensive use of traditional and new and social media communication techniques including video, Internet radio, “widgets” and blogs. http://www.tricare.mil/Pressroom/News.aspx?fid=488
In an interview, Granger said that too many beneficiaries of the military direct-care health system still can’t get timely appointments, reach doctors after hours or establish a close family-doctor relationship with a single military physician or group. For these reasons and more, he gave the military health system an overall grade of “C plus or B minus.” Despite the increased number of civilian providers—up 115,000 to reach 1.1 million nationwide in 2008—beneficiaries still encounter difficulties making appointments and reaching providers after hours. In addition, Granger said that improvements need to be made in electronic records, tracking health readiness and preventative care. He also wants more emphasis on disease prevention and measuring performance among health providers. Every year more beneficiaries migrate from base hospitals and clinics to networks of civilian physicians under contract to TRICARE. The migration is seen in enrollment figures for TRICARE Prime, the managed care option. Since October 2003, the number of enrollees with civilian doctors has doubled—from 600,000 to 1.2 million—while enrollees in military direct care have fallen by roughly 300,000 to just below 3 million. Patient workloads show a sharper drop. The number of inpatients in military hospitals in 2008 was 30,000 below the 2003 total, even as the beneficiary population grew, yet the number of military beneficiaries with stays in civilian hospitals rose by 80,000. Walk-in visits to military facilities in 2008 were a million down from the 30 million reported in 2003. Meanwhile, military patient visits to civilian contract doctor climbed from 24 million in 2003 to nearly 40 million in 2008. Granger suggested that more light also must be shed on how beneficiaries judge the performance of their health care system. “If you look at the [Department of Veterans Affairs], they are very transparent about their quality. We have to be more transparent about our quality and outcomes.” The Department of Defense conducts an annual Health Care Survey of DoD Beneficiaries, asking more than 200,000 users to report on the quality of their experience in the military health system. The results show the military system falls below most “benchmarks” of beneficiary satisfaction from surveys of healthcare users across America. The satisfaction gap is wider for military direct care than for users of TRICARE’s civilian networks. For example, the nationwide benchmark is 77 percent satisfaction with getting care quickly. For military beneficiaries who see military doctors, the comparable figure for quick care is 61 percent. It is 74 percent for military patients using TRICARE civilian doctors. Likewise, the nationwide benchmark is 90 percent satisfaction with how well doctors communicate. For military beneficiaries who see military providers, satisfaction with communication is 83 percent. Patients of TRICARE civilian providers give an average score 89 percent, near to the benchmark. http://www.militaryupdate.com/military_update.htm
In the past, medical and surgical residents and fellows were not deployed to combat zones for hands-on training. Concerns over issues including preparedness for this intense experience, safety, supervision and work-hour restrictions made this type of experience difficult to plan. Col. (Dr.) David Holck, Ophthalmic Plastic and Reconstructive Surgery Fellowship director and chairman of the Department of Ophthalmology at Wilford Hall, said that the best experience a military surgeon can receive is in a combat zone. "They can gain concentrated exposure to head and neck trauma and optimize their skills in the management of unique war-related injury patterns that are not routinely seen in civilian trauma centers. These include blast injuries from improvised explosive devices, burns, multisystem trauma and combinations of these injuries." Doctor Holck initiated this project by taking his fellow, Maj. (Dr.) Lisa Mihora, to the Air Force theater hospital at Joint Base Balad, Iraq, for a surgical rotation. Doctor Mihora, a board-certified ophthalmologist, is currently in her second year of a two-year fellowship at Wilford Hall as an oculofacial plastics and reconstructive fellow. This specialized division of ophthalmology involves management of deformities and abnormalities of the eye lids, tear system, orbit — the bony cavity surrounding the eye — and surrounding face and neck. Facial trauma management is an important component of this fellowship. Doctor Mihora spent six weeks at Balad, performing more than 130 procedures under the direct supervision of Doctor Holck and another oculofacial plastic surgeon, Col. (Dr.) Randal Beatty. During this six-week period, Doctor Mihora participated in more head and neck trauma surgeries than in her entire career. This included craniotomies, facial fractures, complex soft tissue facial injuries and enucleations or eye removals. Additionally, she was a member of the head and neck team, operating routinely with neurosurgeons, otolaryngologists and oral and maxillofacial surgeons. The Accreditation Council for Graduate Medical Education evaluates training programs, residents and staff using core competencies. One of these is systems-based practice, which involves understanding and successfully working in the unique medical system that they will be practicing after graduation. Wilford Hall’s program offers its fellows the chance to work with other head and neck surgeons in a team effort to help injured troops and provides the unique opportunity—available only in a military fellowship program—to improve their comfort and skill level in caring for these trauma patients. Wilford Hall is the first military facility to initiate this type of program for its surgical trainees. http://www.health.mil/Press/Release.aspx?ID=486
Established in 1983, the advisory committee makes recommendations for administrative and legislative changes. The committee members are appointed to one, two or three-year terms. The new committee members are:
Women veterans are one of the fastest growing segments of the veteran population, currently numbering approximately 1.8 million. They constitute nearly 8 percent of the total veteran population and about 5 percent of all veterans who use VA health care. VA estimates that by 2020 women veterans will make up 10 percent of the veteran population. VA has women-veterans program managers at VA medical centers and women-veterans coordinators at VA regional offices to assist women veterans with health and benefits issues. http://www1.va.gov/opa/pressrel/pressrelease.cfm?id=1631
Payments were released to the survivors on Dec. 29. The total value of the payments was about $24 million. In 1996, federal law was passed that makes a surviving spouse eligible to receive the veteran’s VA compensation or pension benefit for the month of the veteran’s death. Because the VA failed to properly implement that law in all cases, the VA formed a special task force in December to identify and pay the beneficiaries who never received the benefit or were inadvertently required to repay the money issued for the month of a veteran’s death. Most likely to have been affected by this problem are surviving spouses who never applied for VA survivors’ benefits following the death of a veteran. Eligible for the payment are surviving spouses of veterans who died after Dec. 31, 1996. The Department doesn’t have current addresses for many of them, which makes the process of contacting them difficult. VA has established a special Survivor Call Center (1-800-749-8387) for spouses who believe they may be eligible for this retroactive benefit. Inquiries may also be submitted through the Internet at http://www.vba.va.gov/survivorsbenefit.htm.
Called the Consolidation Building, the new facility will also include an education center. By co-locating medical and behavioral care, it will streamline patient care and improve patient safety. The new facility will enhance patient privacy and create a home-like environment for veterans in recovery-based treatment. http://www1.va.gov/opa/pressrel/pressrelease.cfm?id=1630
VA Secretary (Dr.) James B. Peake said all severely injured veterans of the wars in Iraq and Afghanistan will be contacted by VA’s Veterans Employment Coordination Service to determine their interest in — and qualifications for — VA jobs. So far, that office has identified 2,300 severely injured veterans of those wars, of whom 600 expressed interest in VA employment. The coordination service was established a year ago to recruit veterans into VA, especially those seriously injured in the current wars. It has nine regional coordinators working with local facility human resources offices across the country, not only to reach out to potential job candidates but also to ensure that local managers know about special authorities available to hire veterans. For example, qualified disabled veterans rated by the Defense Department or VA as having a 30 percent or more service-connected disability can be hired non-competitively. VA coordinators participate in military career fairs and transition briefings. They also partner with veterans organizations, the Department of Labor’s Veterans Employment and Training Service, as well as VA’s Vocational Rehabilitation and Employment Service, the Marine Corps’ Wounded Warrior Regiment and the Army’s Warrior Transition Units. http://www1.va.gov/opa/pressrel/pressrelease.cfm?id=1634
Degarelix is intended to treat patients with advanced prostate cancer. It belongs to a class of agents called gonadotropin releasing hormone (GnRH) receptor inhibitors. These agents slow the growth and progression of prostate cancer by suppressing testosterone, which plays an important role in the continued growth of prostate cancer. Other hormonal treatments for prostate cancer may cause an initial surge in testosterone production before lowering testosterone levels. This initial stimulation of the hormone receptors may temporarily prompt tumor growth rather than inhibiting it. Degarelix treatment did not cause the temporary increase in testosterone that is seen with some other drugs that affect GnRH receptors Prostate cancer is one of the most commonly diagnosed cancers in the United States. In 2004, the most recent year for which statistics are currently available, nearly 190,000 men were diagnosed with prostate cancer and 29,000 men died from the cancer. Several treatment options exist for different stages of prostate cancer, including observation, prostatectomy (surgical removal of the prostate gland), radiation therapy, chemotherapy, and hormone therapy with agents that affect GnRH receptors. The efficacy of degarelix was established in a clinical trial in which patients with prostate cancer received either degarelix or leuprolide, a drug currently used for hormone therapy in treating advanced prostate cancer. http://www.fda.gov/bbs/topics/NEWS/2008/NEW01935.html
The Web site, MedicalCountermeasures.gov/RequestMeeting.aspx, enables external stakeholders to request meetings with federal officials of the Public Health Emergency Medical Countermeasures Enterprise. PHEMCE enterprise comprises personnel from the National Institutes of Health, Office of Biomedical Advanced Research and Development Authority, Food and Drug Administration, and Department of Veterans Affairs. The Web site routes meeting requests to appropriate personnel; provides information on conferences, procurements and grants; and lists regulatory information and strategic plans from PHEMCE agencies. https://www.medicalcountermeasures.gov/
Over the past three decades, Congress enacted several statutes to safeguard the freedom of health care providers to practice according to their conscience. The new regulation will increase awareness of, and compliance with, these laws. Specifically, the final rule:
HHS officials are charged with working with any state or local government or entity that may be in violation of existing statutes and the regulation to encourage voluntary steps to bring that government or entity into compliance with the law. If, despite the Department’s efforts, compliance is not achieved, HHS officials will consider all legal options, including termination of funding and the return of funds paid out in violation of the nondiscrimination provisions. The rule was published on Dec. 19, 2008, in the Federal Register and takes effect Jan. 18, 2009. However, HHS components have been given discretion to phase in the written certification requirement by Oct. 1, 2009, the beginning of the 2010 federal fiscal year. Federal protection of provider conscience rights dates back to the 1970s, when Congress enacted the Church Amendments. The Amendments protect health care providers and other individuals from discrimination by recipients of HHS funds on the basis, among other things, of their refusal, due to religious belief or moral conviction, to perform or participate in any lawful health service or research activity. In 1996, Congress prohibited federal, state or local governments from discriminating against individual and institutional health care providers (including participants in medical training programs) who refused to, among other things, receive training in abortions; require or provide such training; perform abortions; or provide referrals for, or make arrangements for, such training or abortions. Provider conscience protections were expanded again as part of the Department’s fiscal year 2005 appropriations act. In that law, and in subsequent years’ appropriations acts, Congress prohibited the provision of HHS funds to any state or local government or federal agency or program that discriminates against institutional or individual health care entities on the basis that the entity does not provide, pay for, provide coverage of, or refer for abortion. http://www.hhs.gov/news/press/2008pres/12/20081218a.html
This new tool, based on a new risk-assessment model developed by researchers, may assist health care providers and their patients in making informed choices about when and how to screen for colorectal cancer and can be used in designing colorectal cancer screening and prevention trials. The risk assessment tool is available on the NCI Web site at www.cancer.gov/colorectalcancerrisk. Using easily obtainable information (e.g., personal and family medical history, lifestyle behaviors and age), the tool provides an estimate of an individual's risk of developing colorectal cancer within five years, ten years and over the course of a lifetime. This risk-assessment model is the first to provide an absolute risk estimate for colorectal cancer for the general, non-Hispanic white population age 50 or older in the United States. Approximately one in 18 Americans will develop colorectal cancer at some point during his or her lifetime. In 2008, an estimated 148,810 people were diagnosed with colorectal cancer in the United States and another 49,960 will die of the disease. There are several screening options for colorectal cancer, including fecal occult blood tests, sigmoidoscopy, colonoscopy and computerized tomographic colonography, also known as virtual colonoscopy. Having additional information about an individual's risk could aid health care providers and their patients in making decisions about which screening regimen to pursue. In addition to the standard Web tool, a mobile Web-based version for use on Internet-enabled mobile devices and the source code for the model soon will be made available to researchers. It is important that users of the online tool work with their primary health care provider to interpret the results and plan a course of action regarding colorectal cancer screening. http://www.nih.gov/news/health/dec2008/nci-29.htm
Nucleic acid is the common name for the large chemical compounds that make up the genetic material in living cells. The new FDA-approved test detects nucleic acid from HIV-2 and from HIV-1 Group O. HIV-2 infections and HIV-1 Group O infections are predominantly found on the African continent. Some cases of infection with these two types of viruses have also been detected in the United States. In addition to HIV-2 and HIV-1 Group O, the MPX test simultaneously detects nucleic acid from the most common form of HIV, HIV-1 Group M, as well as the Hepatitis C Virus and the Hepatitis B Virus. The MPX test is designed for use with plasma specimens from human donors of whole blood and blood components, but not for testing donated source plasma. Donated source plasma is considered plasma intended for further manufacturing. The test is also intended for screening tissue specimens obtained while the donor’s heart is still beating; it is not intended for use on specimens from donors whose heart no longer functions. The cobas TaqScreen MPX Test runs on the fully-automated cobas s 201 System. It is manufactured by Roche Molecular Systems Inc., Pleasanton, Calif.
The study found there were 399 hospital admissions for heart attacks in Pueblo in the 18 months before the city′s smoke-free ordinance took effect on July 1, 2003, compared to 237 heart attack hospitalizations in the similar period from 18 months to three years after this date – a decline of 41 percent. Nine published studies have reported that laws making indoor workplaces and public places smoke-free were associated with sizable, rapid reductions in hospital admissions for heart attacks. However, most of these studies looked at only a year or less of data after the implementation of smoke-free laws. This latest study, which covers three years after the Pueblo smoke-free law′s effective date, suggests that the initial reduction in heart attack hospitalizations observed after a smoke-free law takes effect is sustained over an extended period. Smoke-free laws likely reduce heart attack hospitalizations both by reducing secondhand smoke exposure among nonsmokers and by reducing smoking, with the first factor making the larger contribution. Researchers also looked at two nearby areas that had not implemented smoke-free ordinances and found no significant decline in heart attack hospitalizations during the same time periods. Long-term exposure to secondhand smoke is associated with a 25 to 30 percent increased risk of heart disease in adult nonsmokers. Secondhand smoke exposure causes an estimated 46,000 heart disease deaths each year among U.S. nonsmokers. Research shows that breathing secondhand smoke makes blood platelets stick together, in the same way as occurs in a regular smoker. Even a short time in a smoky room causes platelets to stick together. Secondhand smoke also damages the lining of blood vessels. Together, damage to coronary arteries and clots that block blood flow can cause a heart attack. Hospital admissions for heart attacks in Pueblo have declined sharply since the ordinance took effect. A previous study reported a 27 percent drop in the rate of heart attack hospitalizations 18 months after the ordinance was enacted compared to 18 months before the smoke-free policy took effect. The new study found that heart attack hospitalizations continued to fall by an additional 19 percent in the most recent 18-month study period.
The latest changes include:
The Academy also published a special article in response to concerns from parents about the safety of vaccines. It says that parents should not delay vaccinations or withhold vaccines from their children. A large study previously found no additional health risks for children who received vaccines. Children who don't receive vaccines on schedule are at an increased risk for catching infectious diseases. Young children who aren't vaccinated can also suffer severe injuries and even death. Before the pneumococcal vaccine became part of the schedule in 2000, there were an average of 200 deaths of children under 5 every year in the U.S. http://www.necn.com/Boston/Health/2008/12/29/Childhood-vaccine-schedule/1230576477.html
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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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