Health Reform Needs Enforceable National Workforce Strategy

/PRNewswire/ -- Congressional leaders must ensure that health reform includes a health workforce planning body with sufficient authority to ensure implementation of an integrated, coordinated national health workforce policy, according to Dr. Steven A Wartman, president and CEO of the Association of Academic Health Centers (AAHC). "With each step in the legislative process, the Congress has progressed toward a more effective health workforce planning process," Wartman said. "Still missing from both House and Senate bills is a mechanism -- such as national health workforce commission recommendations that automatically go into effect unless overridden by Congress -- to ensure timely implementation of the recommendations," added Wartman, urging Congress to address this concern before finalizing the legislation.

An updated analysis of the current House and Senate bills released today by the AAHC identifies additional strengths and weaknesses in the bills when measured against the AAHC's own health workforce recommendations:

-- The AAHC recommends that development and implementation of an
integrated, coordinated, strategic national health workforce policy be
the primary objective of any advisory committee or national
commission. The House bill contains a clear statement that the
purpose of its advisory committee is "to develop and implement an
integrated, coordinated, and strategic national health workforce
policy reflective of current and evolving health workforce needs,"
while the Senate bill only lists national health workforce policy as
one of several priorities.
-- The AAHC recommends the list of enumerated issues to be addressed by
the advisory committee or national commission include the
harmonization of conflicting national and state-based regulatory and
private self-regulatory standards (e.g., licensure, scope of practice,
accreditation). The Senate bill expressly directs its national
commission to "identify barriers to improved coordination at the
Federal, State, and local levels," but the House bill does not
expressly address the need for harmonization.
-- The AAHC recommends the creation of a permanent, independent advisory
committee or national commission that serves as a continuously
available policy research and consultative resource. The Senate bill
creates an independent national commission composed of members
appointed by the Comptroller General, while the House bill only
creates an advisory committee appointed by and reporting through the
Secretary.

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NCPA Commends Pentagon Decision to Cover Pharmacist-Administered Vaccinations

(BUSINESS WIRE)--The Department of Defense today issued an interim final rule designating pharmacies as providers for H1N1, seasonal flu and pneumonia vaccinations under its TRICARE program. The policy change, effective today and expected to be fully implemented later this month, brings the program in line with other insurers that have covered pharmacist-administered vaccinations for years. TRICARE is also seeking comments on additional vaccines that should be covered through community pharmacies.

In response, National Community Pharmacists Association (NCPA) Executive Vice President and CEO Bruce T. Roberts, RPh, issued the following statement:

“NCPA strongly supports the Pentagon’s decision to cover the provision of these critical vaccines at community pharmacies. This is truly a case where everyone wins. The 9.5 million TRICARE-eligible patients gain a convenient new vaccination option. Taxpayers and plan administrators will save money when vaccines are administered at pharmacies instead of costlier doctors’ offices or hospitals. And community pharmacists can welcome millions of new patients through their doors.

“This is a shining example of how community pharmacists can help produce better health outcomes at lower cost. We commend the Defense Department for taking this step, which NCPA has long advocated. In addition, as these benefits are realized, we’re hopeful Pentagon officials will expand the program to cover additional vaccinations.”

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Secretary Pulls Cover Off the Work of Government Medical Panel

/PRNewswire/ -- U.S. Health and Human Services Secretary Kathleen Sebelius is to be commended for publicly stating the government panel opposing mammograms is "an outside independent panel of doctors and scientists who ... do not set federal policy and ... don't determine what services are covered by the federal government."

ZERO - The Project to End Prostate Cancer has long criticized this panel, known as the U.S. Preventive Services Task Force (USPSTF), for being out of touch due to its steadfast opposition to recognize the need for prostate cancer early detection as an important men's health issue.

Now, this panel is criticizing the need for mammograms.

Based on its advisory opinions on both breast cancer and prostate cancer, USPSTF has created much confusion among millions of women and men who are now being told that preventive health measures should not be followed as a means to detect cancer.

"Prostate cancer is essentially 'the forgotten illness' as far as this outside government panel is concerned," said ZERO's CEO Quentin "Skip" Lockwood.

"We're pleased the Secretary is speaking up in defense of a woman's right to continue receiving mammograms to protect her health," he said.

"We now call upon the Secretary to address the importance of prostate cancer early detection for men as well, since USPSTF has turned its back on this issue."

Advocates for mammograms and prostate cancer testing also question the membership of the USPSTF panel due to the glaring omission of medical specialists relating to women's and men's health in the fields of radiology, oncology and urology, for example.

Earlier today, the American College of Radiology called upon the Secretary to ensure the panel included "experts from the areas on which they will be advising lawmakers and submit their recommendations for comment and review," as is done with Medicare guidelines.

Ironically, the supporting data used by USPSTF does indicate mammography screening reduces breast cancer deaths by 15 percent annually. For prostate cancer, USPSTF references an ongoing screening study where early detection (using the PSA test) has so far reduced deaths by 20 percent.

"It's obvious this government panel has some explaining to do and hopefully, with prodding from the Secretary, we will get some answers to explain their contradictory position," Lockwood said.

Similarities between breast and prostate cancer data in the U.S. are striking. Each is the most frequently diagnosed noncutaneous cancer and the second leading cause of cancer death for their gender. In 2009, new cases of each cancer were at about 194,000. One in six men is struck with prostate cancer annually; for breast cancer, it's one in eight women.

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Cancer Community Alarmed at CMS Policy Lumping Life-Saving Cancer Therapy With Diagnostic Testing For Major Funding Cuts

/PRNewswire/ -- The following is being released by US Oncology:

Concerned members of the cancer community, including physicians, patient organizations and other care advocates, spoke out today in opposition to a proposed federal policy under consideration by the Centers for Medicare and Medicaid Services (CMS) that would lump life-saving radiation therapy in with diagnostic testing services in receiving major Medicare funding cuts. In support of their cause, a bipartisan letter led by Reps. Parker Griffith (D-AL), Sue Myrick (R-NC), Lois Capps (D-CA) and Mike Rogers (R-MI), was sent to Health and Human Services Secretary Kathleen Sebelius urging a reversal of this proposal.

"I am very alarmed at the prospect of these dangerous funding cuts being made to radiation therapy, which is a safe and effective treatment proven as a trusted tool in the fight against cancer," said Bernard W. Taylor, M.D., a radiation oncologist at Texas Oncology-Longview Cancer Center in Longview, Texas. "For vulnerable cancer patients like mine, this proposed policy would limit their access to vital radiation treatment through longer wait times and less time spent with their doctors. We must educate policymakers on the radical difference between life-saving, therapeutic radiation therapy and diagnostic testing, and the critical need to spare radiation therapy from these cuts."

At issue is a 19 percent funding cut in Medicare reimbursement to the radiation oncology specialty contained within the CY 2010 Physician Fee Schedule Proposed Rule, equating to cuts of up to 44 percent for certain codes critical to the provision of radiation therapy treatments. Of particular concern in the rule is a proposed policy that raises the utilization rate for medical equipment costing over one million dollars from 50 to 90 percent. The lawmakers and other experts in the industry warn that cuts of this size will result in the closing of many freestanding and community-based cancer centers, particularly in rural areas, harming patient access to care.

"As a radiation oncologist who practiced in the community setting, I am aware of how these severe cuts would limit access to life-saving radiation therapy for cancer patients," said Rep. Griffith. "I am proud to be working on healthcare reform to expand access to high quality, effective care for cancer patients and all Americans, and I look forward to working with both parties as well as the administration to find a solution that averts these cuts and protects patient access to care."

The Congressional letter submitted to Secretary Sebelius, signed by more than 60 Members of Congress, asked CMS to refrain from finalizing the proposed reductions in Medicare payment for radiation oncology services, and to refrain from applying a higher assumed equipment utilization rate to radiation oncology equipment. The letter states:

"We are writing you today to emphasize a clear distinction: Radiation therapy is not diagnostic imaging. . . The therapeutic use of radiation to treat cancer should not be the target of those concerned with volume growth in the area of diagnostic imaging."

The proposal to reduce rates for diagnostic imaging was made by the Medicare Payment Advisory Commission (MedPAC) in their March 2009 report. MedPAC has subsequently stated that it never intended to include radiation therapy in any Medicare reimbursement cuts and yet CMS proposed to extend the cuts to radiation oncology anyway.

According to the National Cancer Institute (NCI), radiation therapy has been found to be under-utilized, with a variety of barriers, including travel time to care, cited as standing between patients and treatment. Following a review of relevant literature, the Agency for Health Care Research and Quality (AHRQ) found evidence of disparities in radiation therapy use among older patients; women; and African Americans, with the exception of care provided in the Veterans' Administration system. In another study of more than 11,000 women in Florida who had undergone breast conserving surgery, the odds of receiving post-surgical radiation therapy decreased by 3 percent for every 5-mile increase in the distance to the nearest radiation therapy facility.

"We support using data to ensure that payment rates for medical procedure are appropriate," said Leonard Kalman, M.D., Chairman of US Oncology's Public Policy Steering Committee. "However, making cuts of this size to radiation therapy - a treatment modality that more than 1 million cancer patients rely upon each year for both curative intent and palliative treatment - without an expressed rationale backed by supporting data is unsound and frankly quite frightening. On behalf of our country's cancer patients, many of whom will rely on radiation therapy at some point in their illness, we must ensure that these cuts are not applied."

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Massive Cuts to Medicare Home Oxygen Therapy Benefit Taking Effect January 1 Creating Acute Anxiety Among Beneficiary and Provider Communities

/PRNewswire-USNewswire/ -- As Americans nationwide prepare to celebrate the New Year, the home oxygen community is looking to 2009 with great unease due to significant Medicare policy changes that will present many challenges to beneficiaries and providers alike. On January 1, two new policies in the form of a 36-month cap on payments for home oxygen therapy and a 9.5 percent across-the-board payment cut will take effect, deeply impacting a community that cares for more than 1.5 million elderly and chronically ill patients.

Under the new 36-month cap, Medicare will stop payment for stationary home oxygen therapy equipment and related services after the beneficiary reaches the three year mark. Despite the discontinuation of payments after 36 months, providers will still be required to continue all servicing of patient needs and equipment including patient-generated, non-routine emergency home visits and routine replacement of disposable oxygen supplies, such as tubing and masks. Providers will also be responsible for ensuring that patients are appropriately serviced even if the patient moves out of the provider's service area within or following the first 36 months of service.

"The provider community is extremely committed to making every effort to meet patient needs and provide uninterrupted services," said Peter Kelly, Chairman of the Council for Quality Respiratory Care (CQRC). "However, it is difficult to comprehend how providers can maintain patient service levels on an uncompensated basis. Based on the magnitude of these cuts, the provider community cautions that service reductions may be unavoidable as a result of business failures or financial hardship and cause potential access problems for the vulnerable patient population we care for."

Historically, the home oxygen benefit has been subject to repeated cuts. The implementation of the 36-month cap, enacted by Congress in the Deficit Reduction Act of 2005 (DRA), and the 9.5 percent cut, part of the Medicare Improvements for Patients and Provider Act of 2008 (MIPPA), translate to a 27 percent, or $845 million, cut in 2009 alone. A recent analysis from Avalere Health "indicates that the average Medicare home oxygen payment by 2009 will be less than half of what it was in 1997."

The CQRC urges Centers for Medicare and Medicaid Services (CMS) officials to exercise the Secretary's authority to create reasonable post-cap policies, including payments for emergency and non-routine services and reimbursement for disposable supplies after 36 months. CMS should also reset the cap when a beneficiary moves out of his or her service area and requires a new provider. The CQRC asks policymakers to closely monitor the effects of these deep cuts on both beneficiaries and providers to ensure that patient access to essential home oxygen care is not compromised. Ultimately, the home oxygen community hopes to work with policymakers to develop thoughtful, comprehensive reforms of Medicare policies that protect patient access to quality oxygen care.

"We want all patients to have complete access to all services related to their home oxygen care, throughout their entire period of medical need," added Kelly. "With more than one quarter of home oxygen beneficiaries requiring oxygen for more than 36-months, the impact of the cap, coupled with the dramatic 9.5 percent cut, is going to resonate throughout the oxygen community. Although providers are working hard to prepare for the approaching payment changes, these cuts are simply unsustainable and may negatively impact beneficiary care."

The Council for Quality Respiratory Care is an alliance of the nation's leading home oxygen therapy providers and manufacturers, representing nearly one half of the 1.5 million Medicare beneficiaries who depend on the home oxygen benefit for independence and quality of life.

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Public Funding Impacts Progress of Human Embryonic Stem Cell Research

Bolstered by supportive policies and public research dollars, the United Kingdom, Israel, China, Singapore and Australia are producing unusually large shares of human embryonic stem cell research, according to a report from the Georgia Institute of Technology in the June 2008 issue Cell Stem Cell. Aaron Levine, assistant professor of public policy and author of the book Cloning: A Beginner’s Guide, studied how countries output of research papers related to human embryonic stem cell research compared to their output in less contentious fields. He found that even though the United States still puts out far more research in this field than any other single country, when one compares the amount of research in human embryonic stem cells to other forms of research in molecular biology and genetics, the U.S. lags behind.

“The U.S. is still the largest producer of research in this field, but compared to other similar fields, our share is smaller,” said Levine, assistant professor in Georgia Tech’s Ivan Allen College of Liberal Arts. “You have to ask yourself, are we happy producing this relatively small share?”

In comparison, the study showed that the U.K. and Israel were producing substantially more research in this area than in other fields. According to the study, the U.K. produced 5.3 percent more research related to human embryonic stem cells than research performed in other areas of molecular biology and genetics, while Israel produced 4.6 percent more research. Levine attributed that to the long-held public and political support of human embryonic stem cell research in those countries.

“Both the U.K. and Israel have long-standing policies that support research in this field,” said Levine, “And this support seems likely to have bolstered scientists’ efforts to set up labs and acquire funding for their research.”

But the biggest surprise was China and Singapore, with China producing 3.2 percent more human embryonic stem cell research than other areas of molecular biology and genetics, and Singapore producing 2.6 percent more research.

“China and Singapore both showed impressive performance in human embryonic stem cell research,” said Levine. “Although these countries are very different, both have been striving to grow their biomedical research communities and it seems likely they focused on human embryonic stem cell research, in part, because they saw that traditional scientific powerhouses like the United States were moving so tentatively in this area.”

Australia had a more mixed policy and a more mixed result. While Australia does allow new stem cell lines to be created from fertility treatments, it explicitly banned the use of stem cells derived from somatic cell nuclear transfer from 2002 to 2006. Beginning in 2006 scientists were allowed to use stem cells from somatic cell nuclear transfer, but under strict regulatory guidelines. That may explain why Levine’s study found that Australia showed a more modest result of producing only 1.6 percent more human embryonic stem cell research than other areas of molecular biology and genetics.

The United States, however, is significantly under-performing in this area. Although Levine’s study found that the U.S. produced 36 percent of the research performed on human embryonic stem cells, far more than any other country, when he compared those studies to other areas of research in molecular biology and genetics, he found that the U.S. had a deficit of 10 percent.

Although the U.S. government is the funding source for 63 percent of academic research and development, federal funds can only be used for studies on a small number of stem cell lines produced before August 9, 2001. As a result, much research in this area in the U.S. is done either with state money or private money.

Given that scientists have less incentive in the private sector to publish research papers, it’s possible that Levine’s metric undercounts the amount of research done in this area in the U.S. But even so, the contribution from the U.S. is still reduced since research that isn’t published does little to increase public knowledge.

But that may change. Venturing where the federal government fears to tread, states like California, New York, Connecticut and Maryland are becoming places researchers can turn to for human embryonic stem cell funding. But Levine thinks that development may complicate matters.

“There are a variety of funding sources out there now, but it makes the field more complicated for scientists to follow the various rules set forth by the states and foundations,” said Levine. “I think scientists would prefer clear oversight from a federal government that’s supportive of their research.”

Levine plans to follow up this current work with a look at how collaboration is affected by these different state policies.