It can identify tuberculosis in 2 hours. That’s a far cry from a current modality which takes at least 2 days to even screen for. The latest advance in the war against TB — thought to have been largely won in the latter quarter of the 20th century — can now be characterized by a rapid assay said to be more than 97 percent accurate and is even able to diagnose drug-resistant TB. Current testing involves the use of a microscope and is prone to investigator error and poorly obtained samples — something that can result in a missed diagnosis at alarmingly high rates. In endemic areas of the globe, that inconsistency is, of course, problematic.

As a result, TB is able to be identified in one single office visit. TB is a chronic bacterial infection spread through the air and usually infects the lungs, although other organs of the body can be involved. Most people who are infected with tuberculosis bacterium (Mycobacterium tuberculosis) don’t have symptoms, but some will develop the disease. Around 2 billion people — one-third of the world’s population — are thought to be infected with M. tb. The World Health Organization estimates that 8 million people develop active TB each year and nearly 2 million die. The test will be up for FDA approval and is already available in Europe. | LINK

The huge drive to immunize the masses against threat of H1N1 in the 2009/10 influenza season (which the WHO has officially declared concluded) has created more than a watershed moment in 21st century public health response to a potential biological catastrophe, it has also touched off a political debate that’s just getting started. And it all has to do with authoritarian mandate of the vaccine for healthcare workers.

Contrary to popular thought, many healthcare workers do not receive the vaccine; in fact, approximately 40 percent of said workers actively refused [PDF link] the vaccine last year — during infection’s peak. This notion does not sit well with a couple of policy organizations — one academic and one medical. Both groups say mandatory influenza vaccine should be a condition of employment. The groups stress increased availability of the vaccine, a steadier supply of healthy workers to administer care in times of a crisis, and an overall decrease in the incidence of influenza-related deaths in already compromised inpatients with other medical problems.

Already, the state of New York is hard at work in developing regulatory actions for its public healthcare workers. | LINK

The U.S. Preventive Services Task Force, an independent, non-partisan body made up of primary care physicians involved in developing preventive medical guidelines based upon evidence-based medicine, has always reveled in its staunch self-governance. That could change ever so slightly in the new age of health reform.

The academic research-oriented group will continue to make recommendations on best-preventive practices and supply ratings (“A”, “B”, etc.); but this time, under reform, insurers will be required to cover services that receive such a rating. The Obama administration hopes that this increase in access (which will require a small premium increase by insurers in the near term) will reap savings in the future — as costs for preventive testing, screening for certain chronic diseases, vaccinations, and well-child visits would be covered (without health plan co-pays and deductibles) if so rated by the USPSTF.

Besides having to consider methodology involved in formulating its ultimate recommendations, the group will also have to contend with the specter of political agenda setting if lobbying groups and disease advocacy organizations have their way under this bit of legislation — scheduled to go into effect in September. | LINK

HIV is once again in the news lately — first with news of a new strategy to combat the infection with enhanced vaccination research, the commitment of HHS in reallocating funds for HIV research on a global scale, and now the creation of the first “national HIV strategy” by a sitting president.

In the report, the administration calls for steps to reduce the annual number of new H.I.V. infections by 25 percent within five years. [..] [T]he administration will redirect money to areas with the greatest need and population groups at greatest risk, including gay and bisexual men and African-Americans.

Obviously, simple “redirection” of federal funds for medications and treatments of HIV/AIDS is not the final mechanism of care access for the millions of patients afflicted with this chronic disease; it is unclear where these funds will provide an absolute siphon for spending. Kudos to the administration in its efforts to reacquaint an entirely new generation of Americans on the urgency of this disease, but it’s got a long way to go to reduce sharply its transmission rates and healthcare policy atrophy in this area. | LINK

Former HHS Secretary from the Clinton Administration, Donna Shalala told a standing room only crowd at the AHIP convention in Las Vegas over the weekend that the recently passed healthcare reform bill’s ultimate utility will depend more on the influence of insurers and not of the government.

“The American people voted not for a government takeover of healthcare, but they committed themselves to the employer-based system and private delivery,” she told the insurance industry crowd during a session titled, “A Way Forward: Next Steps for America’s Health Care System.”

While “a great deal of money” will be spent on public insurance programs, including Medicaid and Medicare, the “basic core” of reform will involve private insurers, she said.

Kudos to Shalala for being honest in this assessment. Although many insurers have begun taking steps to work within the framework of changes that will begin within the next two to four years, the reality is that private insurers will always have a stake in healthcare delivery. The development of exchanges, private-public contracts, and other mechanisms will be the result of the necessity to create innovation to maintain a robust healthcare marketplace. | LINK

Beginning this week seniors should have already started receiving checks from the federal government for the purpose of closing the so-called donut hole — a provision of the MMA of 2003 that left many Medicare Part D beneficiaries out in the cold when trying to pay for their prescription drug coverage. People who fall into this gap are responsible for $3,610 in drug costs in 2010 before their Medicare coverage kicks in again. The “hole” is gradually being phased out over the next 10 years.^[1] Over 4 million people will receive $250 checks this year.

Sounds innocuous enough. But one state is asking the government to reclaim those funds. Vermont, which has some 2800 low-income seniors scheduled to receive the Part D refund checks, is asking beneficiaries to return the money. Since the state of Vermont is funding drug costs for its beneficiaries via public-funded insurance programs (OVHA), it is asking seniors to return the checks — as the state is on tap to receive almost $600,000 in rebates due to the action.

While the goal of the feds is to eliminate this troublesome provision as part of Obama’s healthcare reform package, this episode does highlight the difficulty some states have with federal mandates to cover certain costs associated with the delivery of healthcare when they essentially don’t agree with those mandates. By the way, if seniors decide not to refund the government’s money, says Vermont, they will be subject to a $250 deductible in their state-subsidized insurance plan for drug costs. | LINK

1. Next year, the rebates will be replaced with discounts that will increase each year until the gap is effectively eliminated in 2020. [↩]

The tail end of the legislative session is bringing with it high drama. With regard to healthcare legislation, recent good news came with the agreement of the state’s largest safety net hospital to take part in a completely taxpayer-subsidized healthcare delivery program. Unfortunately, that program is only part of the healthcare delivery story. Challenging the Democrat-controlled legislature is the possible executive veto of last-minute provisions that generally are characterized by expanding Minnesota’s Medicaid program.

Democratic lawmakers are hoping to pre-empt any kneejerk reaction by the governor by explaining its rationale for the plan,^[1] which they will hope change the governor’s reservations about the scope of state spending^[2] with the bill. It appears things once again come down to the governor’s veto power. Will he believe the Dems’ claims of lowered commitments to federal Medicaid funds to pay for healthcare, or will he stick to his guns, continuing his record on his brand of fiscal responsibility? | LINK

1. Gov. Pawlenty earlier estimated that the move would bring in about $900 million over the next three years until 2014 — using state-matched funds that would not be paid for by the federal government until then. This would create a significant burden for Minnesota’ s current budget. Pawlenty says it’s too steep. [↩]
2. Dem lawmakers say the overall cost to Minnesota is less than a third of that projection. [↩]

The drama unfolding in the past week during which acute care hospitals struggled to find ways of participating in a reworked plan to provide care to Minnesota beneficiaries of the GAMC plan continues to unfold. Once balking at the state’s human services department’s plan overhaul as being too risky to guarantee care, HCMC — Minnesota’s largest acute care safety net — has decided to come on board. This naturally had the effect of bringing smaller hospitals along for the cost-sharing ride. HCMC’s participation at the last minute came as a result of a provision which will set limits on the numbers of patients they can see — a move made possible provided other acute hospitals sign on.

With a limit of 9,400 patients a month and $32 million to finance their care, Hennepin County Medical Center and the Hennepin County Board voted Thursday to participate in the revamped program, which starts in three weeks. A few weeks ago, only one of the 17 key hospitals, Regions Hospital in St. Paul, had said it might participate.

Interestingly, Governor Tim Pawlenty thought the Democratic-controlled legislature were being obstinate — pushing for this action in spite of his veto protestations on the matter. At that time, the governor had thought that HCMC, the anchor hospital here, already knew about the cap on beneficiary care. Apparently, the hospital didn’t.

That was news to Hennepin County negotiators, who had sought such a limit but weren’t offered it until that day, according to Hennepin County Board Chairman Mike Opat. “We’ll still lose money on every patient,” Opat said Thursday. “But with the cap on patients, we decided we were better off taking the money.”

Good move, and one which saves the GAMC program, which begins June 1. This blog will be watching how the state delivers this care in spite of decreased funds with which to provide it. Here’s hoping innovation trumps rote necessity in getting this done. | LINK

One way, in theory at least, to pay for certain facets of healthcare reform is coming not only from cost shifting within Medicare, but also from Medicaid. It involves pharma rebates states receive from drugmakers for many branded preparations. Typically at least 15% of costs associated using those drugs is given back to states after negotiations with pharma companies.

However, with increases in rebate rates, a certain amount usually reserved for payments to states will now be kept by the federal government in an effort to raise monies to offset the cost of healthcare reform.

Cindy Mann, the agency’s director for the Center for Medicaid and State Operations ,confirmed in an interview that meant states that already received drugmaker rebates between 15.1 and 23.1 percent would no longer be able to keep that portion of their savings. States and the federal government would continue to share in savings for the portion of the rebates both below and above that range. Many states already have average rebates well above 23 percent.

Naturally, some states are concerned with the potential losses to care access with such a move, as more pressure is placed on individual states to negotiate with managed care plans to recoup possible individual deficits. Time will tell if this plan (which creates incentives in purchasing drugs via Medicaid arrangements) will bring more states into the fold as only 25 states use this method to provide a drug benefit. | LINK

The increase is primarily for health programs in poor countries that will build on U.S.-funded efforts to combat AIDS. President Barack Obama’s budget boosts global health initiatives by almost 10 percent — expanding child and maternal health programs that coincide with AIDS relief programs in the world’s poorest countries.

The new global health initiative reiterated the administration’s pledge to put more than four million people on HIV/AIDS drug therapy and prevent more than 12 million new HIV infections by 2014.

AIDS/HIV continues to be a scourge worldwide, to say nothing of its prevalence here in the United States, as well as here in Minnesota — whose increases in incidence and prevalence should not only spur new efforts at education, but also at healthcare delivery with respect to this still-fatal virus. | LINK