The Senate Homeland Security and Governmental Affairs Subcommittee on Oversight of government management, the federal workforce and the District of Columbia will be holding a Federal Employees Health Benefits Program hearing tomorrow titled “Up, Up, and Away! Growth Trends in Health Care Premiums for Active and Retired Federal Employees.” The hearing begins at 10:30 am in Dirksen Senate Office Building, Rm. 342

According to the Subcommittee, “The purpose of the hearing is to review growth trends in health care premiums under the Federal Employee Health Benefits Program and assess proposals to curb the cost to employees, retirees, and the Federal government as an employer without the loss of service.” The hearing was provoked by a GAO report issued last winter that the subcommittee’s chairman, Sen. Daniel Akaka (D Hawaii) had requested.

The scheduled witnesses are Nancy Kichak, OPM’s Associate Director and Chief Actuary; John Dicken, GAO’s Health Team Director; Steven Gammerino, Blue Cross Blue Shield Association Sr. Vice President, National Programs, and Alan Lopatin, NARFE’s Legislative Counsel.

The Internal Revenue Service has released guidance stating a non-profit hospital will not jeopardize its tax exempt status if its provide doctors with staff privileges with financial incentives to acquire and implement software necessary to access the hospital’s electronic health records system provided the subsidy complies with the Health and Human Services Department’s regulations under the federal health care programs anti-kickback act and the Stark Act.

A new government study reveals that fewer women are undergoing annual mammographies for various reasons, including difficulties in obtaining appointments, and the drop in hormone use following menopause (Good news, hormone users received more regular medical care — bad news according to a 2002 government study hormone use increases the risk of breast cancer, heart attack, and stroke.” At least in the FEHB Program, the cost of the test is not an issue as the Program provides 100% coverage for routine annual mammographies for the over 40 age group. However, the Washington Post notes that “the drop was greatest — 6.8 percent — among women ages 50 to 64, the age group most likely to benefit.” The Post report quotes Carolina Hinestrosa of the National Breast Cancer Coalition, an advocacy group, as commenting “Some women are beginning to balance the risks and the benefits. If women are making a careful determination and an informed decision after weighing the risks and benefits, I don’t necessarily think that’s a bad thing.” Other commentators and researchers take a less nuanced view of the study.

The American Cancer Society quotes lead researcher Nancy Breen, Ph. D., of the National Cancer Institute:

Whatever the cause, the drop in mammography rates is worrisome, Breen adds. She and her group are trying to develop new studies that could shed light on why mammogram use is declining. “We really need to know why it is that screening isn’t happening before we can talk about developing strategies that are going to work [to raise levels again],” she notes. However, at least one strategy has already been proven to help boost screening rates: reminder systems. People are more likely to get screened if they get a phone call or card or email reminding them to make that appointment. Another thing that could help, Breen says, is to keep the message about screening front and center. “We can’t assume that people who have been screening will continue to screen, and we need to continue to make it clear that this is of benefit to them,” she says.”

The New England Journal of Medicine published a study on the efficacy of Merck’s expensive and heavily marketed Garasil vaccine. Gardasil is intended to protect young women (and men) against an HPV virus that is a major cause of cervical cancer. The studies find that the vaccine is very effective against young people who have not been previously infected with this sexually transmitted virus. However the NEJM editorializes that

Although this is a remarkable achievement, the efficacy of the vaccine is limited by at least these two factors. First, not all cervical cancer is caused by HPV-16 or HPV-18, and second, it appears necessary to vaccinate young women before they are infected with these two serotypes. Also, whether this approach will extend the paradigm of vaccination to the prevention of death and disability from cervical cancer is an unanswered question.

[C]orrelation with the ultimate outcome — cancer prevention — will require the long-term observation of a large number of treated women. We must also carefully monitor for unintended adverse consequences of vaccination.

Many other questions are raised by these remarkable data. Should young men be vaccinated? What is the durability of immune protection? Could fewer than three vaccinations provide adequate protection? Will future HPV vaccines extend protection to cover additional pathogenic serotypes? Will the economics allow this therapy to reach all who may benefit, such as those in the developing world? Might HPV vaccination be beneficial in preventing other, noncervical HPV-induced cancers (such as HPV-related oropharyngeal cancer)?

The last sentence of this quote relates to another article in this NEJM issue about a study associating these HPV viruses with throat cancer, e.g. oral sex can cause throat cancer.

On May 9, the Senate by a 93-1 vote passed its Food and Drug Administration user fee reauthorization bill (S. 1082). The user fees are paid by prescription drug manufacturers to support the new drug approval process. The bill includes many new drug safety measures. The House is working on its own version of the bill, which reportedly is similar to the Senate bill. The legislation is expected to be on the President’s desk by the end of this summer.

HHS Secretary Mike Leavitt held a value driven health care event today. “Less than a year after launching his Value-Driven Health Care [A/K/A transparency] Initiative, Secretary Leavitt announced that more than 100 million Americans are now served by health plans that are committed to providing consumers with transparent quality and cost information. The federal government; half of the states; about 775 employers, including almost half of the top 200 U.S. corporations; and numerous unions, communities, doctors and hospitals have joined the movement.”

The Senate Finance Committee has released a report on drug company grants for medical education. The committee, chaired by Sen. Chair Max Baucus (D-Mont.), is investigating allegations that such grants are used for improper purposes. The report suggests that some “independent” educational programs may still be susceptible to excessive influence by pharmaceutical sponsors, and that the Accreditation Council for Continuing Medical Education’s (ACCME) oversight is insufficient to guarantee independence. In a subsequent letter to ACCME President Murray Kopelow, Baucus and Senate Finance Committee Ranking Member Sen. Charles Grassley (R-Iowa) faulted the accreditation process itself, including the absence of content monitoring by ACCME of programs of accredited providers, the standards of compliance ACCME requires, and the extent to which instances of noncompliance are tolerated.

AISHealth.com reports on a Research Triangle Institute survey of HIPAA Privacy Rule compliance commissioned by the Department of Health and Human Services’ Agency for Healthcare Research and Quality. The report finds much health care provider confusion over the minimum necessary use and disclosure provision of the Privacy Rule and its complex state law preemption provisions. The first finding is surprising because the minimum necessary rule merely requires the application of common sense. The second finding is hardly surprising because of the complexity of the rule’s preemption provisions. More information on the survey is available here from RTI. The final report with “solutions” is due in the summer. HHS is relying heavily on this process to respond to Congressional pressure to incorporate privacy and security safeguards in the National Health Information Network’s architecture. I hope they don’t throw the baby out with the bath water, particular considering how much money and human capital was invested in the HIPAA privacy rule implementation process.

• A coalition of large employers and health insurers called the Coalition to Advance Healthcare Reform has been formed in order to encourage Congress and state legislatures to use market based reforms to improve quality and to reduce the number of uninsured.
• The medical community has begun to mobilize against the nurse practitioner staffed clinics being established on growing scales in workplaces, discount stores, and pharmacies.
• GAO issued a report today encouraging the Department of Health and Human Services to make better use of information technology to reduce the increasing quality data collection burden that the Medicare program imposes on hospitals. The Medicare program, which HHS just recently enhanced, collects data on all admissions, not just Medicare admissions, and had lead to the creation of robust online hospital quality comparison tools such as HHS’s Hospital Compare tool. “GAO recommends that the Secretary of HHS identify the specific steps the department plans to take to promote the use of health IT for the collection and submission of data for CMS’s hospital quality measures and inform interested parties about those steps, the expected time frame, and associated milestones.” HHS agrees with the recommendation according to the report.

ABC News reports that the Senate passed a bill today that would allow prescription drug importation but by a separate 49-40 vote the Senate conditioned importation on HHS certification of the safety of the importation process. That has been the law for nearly a decade and HHS under both Democrat and Republican administrations have declined to issue the certification due to a concern that importation would open the door to counterfeit drugs.