• Prescription benefits manager Medco Health Solutions Inc., has released its 2007 Drug Trends Report.
• Consulting firm Towers Perrin has released its 2007 Survey on Account Based/ Consumer Driven Health Plans.

On Memorial Day, we pay tribute to the soldiers, sailors, and airmen who have fallen in defense of the United States, our country, as well as those who now are in service. At 3 pm todat, I hope that everyone will observe the National Moment of Remembrance. In particular, I will remember my cousin Army Capt. Eric T. Paliwoda (right), 4th Infantry Division, West Point Class of 1997, who was killed in combat in Iraq on January 2, 2004. We will never forget.

As promised at the May 18 FEHBP hearing, Senators Carper (D Del.) and Voinovich (R Ohio) did introduce yesterday their bill (S. 1456) that would mandate FEHB plans to offer the members electronic personal health records. The bill has been referred to the Committee on Homeland Security and Governmental Affairs.

• On the HIPAA National Provider Identifier (NPI) compliance date, May 23, CMS finally announced the publication of the NPI dissemination policy, which will permit payors to download NPIs off a CMS website beginning June 28. Of course, CMS has permitted health plans to create NPI contingency plans and Medicare itself has implemented such a plan. The official notice of the NPI dissemination policy will be published in the May 30 Federal Register. An advance copy of the Notice is available here.

• On May 22, a House Education and Labor subcommittee held a hearing on state health care reform movements and their interrelationship with federal law, particularly ERISA. Rep. Tammy Baldwin (D Wisc.) also testified about her bill (H.R. 506 ) which Sen. Voinovich (R Ohio) endorsed at the FEHBP hearing on May 18. Sen. Voinovich noted that Rep. Baldwin’s bill has been endorsed by both the Brookings Institution and the Heritage Foundation. Sen. Voinovich and Sen. Bingaman (D N.M.) have introduced a companion bill (S. 325) in the Senate. Rep. Baldwin’s bill would create a State Health Coverage Innovation Commission that could forward state health plan reform proposals to Congress for fast track consideration and approval. A Covington & Burling attorney testified about ERISA preemption and against state waivers.

• On May 10, the House Ways and Means health subcommittee held a hearing on Medicare’s quality initiatives. GAO testified about its own analysis of Medicare participating physician practice patterns which found that the patients of outlier physicians — MDs who treat a disproportionate share of overly expensive patients — were spread across the country and evidently were practicing medicine inefficiently. CMS plans directed education efforts but needs legislative authority to reduce payments to inefficient MDs. In a related development, the Blue Cross and Blue Shield Association proposed legislation to create “a new, independent institute – funded by all healthcare payers – to provide consumers and providers with much needed information on which medical treatments work best.”

Glaxo Smith Kline’s CEO Dr. Jean-Pierre Garnier offered this valuable perspective on the Avandia controversy today according to the Wall Street Journal:

“Dr. Garnier stressed that the absolute risk of heart attacks in patients taking Avandia was still low — between 0.43% and 1.85% of patients had heart attacks, according to Dr. Nissen’s paper, which was published in the New England Journal of Medicine. Those odds were 43% higher than the rate of heart attacks among patients taking other drugs or a placebo, which ranged from 0.34% to 1.44%.

Dr. Garnier said Dr. Nissen’s analysis is only one piece in a body of research that overall shows that Avandia is no riskier for the heart than other diabetes medications. “You cannot look at this in isolation,” he said.”

USA Today reports that next month HHS’s Hospital Compare tool will begin reporting “the first broad comparison of the death rates for heart attack and heart failure” at U.S. hospitals

The same cardiologist, Dr. Steven Nissen, of the Cleveland Clinic, who blew the whistle on the heart risks of the Merck blockbuster arthritis medicine Vioxx, has published a study in the New England Journal of Medicine finding that the blockbuster GlaxoSmithKline diabetes drug Avandia carries a high heart attack risk. In a press release, Glaxo announced that it “strongly disagrees with the conclusions reached in the NEJM article, which are based on incomplete evidence and a methodology that the author admits has significant limitations.” Patients and doctors are understandably confused by these developments; Glaxo’s stock is falling like a rock, and the FDA must be circling the wagons for another round of Congressional oversight hearings.

According to the Wall Street Journal, Dr. Nissen conducted his study using Glaxo studies that he dredged up with the Google search engine. Google Avadia now and you’ll find Avandia Heart Attack Class Action right at the top of the page. There has to be a better way to address these drug safety issues.

Since the Senate subcommittee hearing last Friday on FEHB Program premium trends, OPM has issued a press release and reports have appeared on Govexec.com and the Kaiser Foundation’s Capitol Hill Watch.

• The Senate subcommittee hearing on FEHB Program premiums held yesterday was uneventful. Sen. Voinovich (R Ohio) did announce that he and Sen. Carper (D Del.) will be introducing their FEHBP electronic personal health records bill next week.
• The Healthcare Information Technology Standards Panel is seeking public comment on the following two Requirements, Design and Standards Selection (RDSS) documents: HITSP Requirements Design and Standards Selection: Security and Privacy Capabilities for the Version 2.0 Biosurveillance, EHR-Lab and Consumer Empowerment Use Cases, and HITSP Requirements Design and Standards Selection: Emergency Responder Electronic Health Record (ER-EHR) Use Case. These are the AHIC work group use cases on which HITSP currently is focusing. Comments are due by June 14, 2007.
• The Hill newspaper printed an interesting article on the President’s nomination of Kerry Weems as CMS Administrator and the importance of that position.
• Modern Healthcare.com reported on privacy concerns being raised in connection with the recent IRS memorandum reported on the FEHBlog that allows non-profit hospitals to subsidize electronic health records technology for their medical staffs.
• The Wall Street Journal reported a sharp drop in artery stent implantation in heart disease patient since the recent COURAGE study questioning the utility of the treatment. Heart.org reports that: “According to the Journal, some experts believe COURAGE may in fact be having a swift impact. “We’ve definitely seen a decline,” Winstein quotes Dr William O’Neil (University of Miami, FL) “[The COURAGE study] is causing some people to think that angioplasty is unnecessary. A lot more patients are going to be treated with medical therapy.”
• An annual University of Maryland medical conference on historic deaths concluded that President Abraham Lincoln may have survived the assassin’s bullet that killed him in April 1865 if he had received modern trauma care.

Walgreen’s has taken a page out of the CVS and Wal-Mart playbooks by purchasing the Take Care Health Systems. Take Care operates “50 health care clinics in Chicago, Kansas City, Milwaukee, St. Louis and Pittsburgh.” Walgreen’s plans to open Take Care clinics in its pharmacies which total 5700 across the United States. Grace Marie Turner of the Galen Institute opined in the Wall Street Journal earlier this week that the clinics represent the free market at work:

Rick Kellerman, president of the American Academy of Family Physicians, concedes, “The retail clinics are sending physicians a message that our current model of care is not always easy to access.” The threat of competition from the in-store clinics means some doctors are keeping their practices open later and on Saturdays and holding an hour open for same-day appointments. Competition works.

And the clinics are working to solve another problem that is vexing Washington — creation of electronic medical records. Most retail clinics create computerized patient records, with the goal of making the records accessible throughout the chain. The records also can be emailed to a hospital or to the patient’s regular doctor — or sent by fax if necessary.

This industry is in its infancy and will hardly register in our nation’s $2 trillion-plus health care bill. But just as Nucor overturned the steelmaking industry with a faster-better-cheaper way of making low-end rebar, these limited service clinics could be the disruptive innovator in our health-care system. Package pricing for more complex treatments, like knee replacement surgery, may not be far behind.