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Arthritis Among Veterans — United States, 2011–2013

November 12, 2014 Comments off

Arthritis Among Veterans — United States, 2011–2013
Source: Morbidity and Mortality Weekly Report (CDC)

Arthritis is among the most common chronic conditions among veterans and is more prevalent among veterans than nonveterans (1,2). Contemporary population-based estimates of arthritis prevalence among veterans are needed because previous population-based studies predate the Persian Gulf War (1), were small (2), or studied men only (2) despite the fact that women comprise an increasing proportion of military personnel and typically have a higher prevalence of arthritis than men (1,3). To address this knowledge gap, CDC analyzed combined 2011, 2012, and 2013 Behavioral Risk Factor Surveillance System (BRFSS) data among all adults aged ≥18 years, by veteran status, to estimate the total and sex-specific prevalence of doctor-diagnosed arthritis overall and by sociodemographic categories, and the state-specific prevalence (overall and sex-specific) of doctor-diagnosed arthritis. This report summarizes the results of these analyses, which found that one in four veterans reported that they had arthritis (25.6%) and that prevalence was higher among veterans than nonveterans across most sociodemographic categories, including sex (prevalence among male and female veterans was 25.0% and 31.3%, respectively). State-specific, age-standardized arthritis prevalence among veterans ranged from 18.8% in Hawaii to 32.7% in West Virginia. Veterans comprise a large and important target group for reducing the growing burden of arthritis. Those interested in veterans’ health can help to improve the quality of life of veterans by ensuring that they have access to affordable, evidence-based, physical activity and self-management education classes that reduce the adverse effects of arthritis (e.g., pain and depression) and its common comorbidities (e.g., heart disease and diabetes).

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Millions of US women are not getting screened for cervical cancer

November 7, 2014 Comments off

Millions of US women are not getting screened for cervical cancer
Source: Centers for Disease Control and Prevention

Key findings:

  • In 2012, 11.4 percent of women reported they had not been screened for cervical cancer in the past five years; the percentage was larger for women without health insurance (23.1 percent) and for those without a regular health care provider (25.5 percent).
  • The percentage of women not screened as recommended (www.cdc.gov/cancer/cervical/basic_info/screening.htm) was higher among older women (12.6 percent), Asians/Pacific Islanders (19.7 percent), and American Indians/Alaska Natives (16.5 percent).
  • From 2007 to 2011, the cervical cancer incidence rate decreased by 1.9 percent per year while the death rate remained stable.
  • The Southern region had the highest rate of cervical cancer (8.5 per 100,000), the highest death rate (2.7 per 100,000), and the largest percentage of women who had not been screened in the past five years (12.3 percent).

CRS — U.S. and International Health Responses to the Ebola Outbreak in West Africa (October 29, 2014)

November 6, 2014 Comments off

U.S. and International Health Responses to the Ebola Outbreak in West Africa (PDF)
Source: Congressional Research Service (via Federation of American Scientists)

In March 2014, an Ebola Virus Disease (EVD) outbreak was reported in Guinea, West Africa. The outbreak is the first in West Africa and has caused an unprecedented number of cases and deaths. The outbreak is continuing to spread in Guinea, Sierra Leone, and Liberia (the “affected countries”); it has been contained in Nigeria and Senegal, and has been detected in Mali. As of October 22, 2014, more than 10,000 people have contracted EVD, more than half of whom have died.

In the aggregate, between 1976, when Ebola was first identified, through 2012, there were 2,387 cases, including 1,590 deaths, all in Central and East Africa. The number of Ebola cases in this outbreak is four times higher than the combined total of all prior outbreaks, and the number of cases is doubling monthly. The U.S. Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) have projected an exponential increase in cases. WHO estimated that by the end of November, some 20,000 people may contract Ebola; CDC estimated that “without additional interventions or changes in community behavior,” up to 1.4 million could contract EVD in Liberia and Sierra Leone by January 2015. CDC indicates, however, that the outbreak may not reach such proportions since responses are intensifying. In Liberia, for example, improvements in burial practices have resulted in roughly 85% of all bodies being collected within 24 hours of being reported to national officials.

See also: Increased Department of Defense Role in U.S. Ebola Response – CRS Insights (October 10, 2014) (PDF; via U.S. State Department Foreign Press Center)

The Ebola Outbreak: Quarantine and Isolation Authority, CRS Legal Sidebar (October 28, 2014)

November 5, 2014 Comments off

The Ebola Outbreak: Quarantine and Isolation Authority, CRS Legal Sidebar (PDF)
Source: Congressional Research Service (via Federation of American Scientists)

Recent quarantine policies announced by several states, including New York and New Jersey, for travelers arriving from areas affected by the outbreak of Ebola Virus Disease have raised legal and constitutional questions about federal and state authority to order quarantine and isolation measures.

Both the federal and state governments have authority to impose isolation and quarantine measures to help prevent the spread of infectious diseases. While the terms are often used interchangeably, quarantine and isolation are two distinct concepts. Quarantine typically refers to separating or restricting the movement of individuals who have been exposed to a contagious disease but are not yet sick. Isolation refers to separating infected individuals from those who are not sick.

Historically, the primary authority for quarantine and isolation exists at the state level as an exercise of the state’s police power in accordance with its particular laws and policies. Generally, state and local quarantines are authorized through public health orders, though some states may require a court order before an individual is detained. The Supreme Court has indicated that at least where Congress has not taken action, it is “well settled” that states may impose quarantines to prevent the spread of disease.

Can the President Bar Foreign Travelers from Ebola-Stricken Countries from Entering the United States?, CRS Legal Sidebar (October 23, 2014)

October 31, 2014 Comments off

Can the President Bar Foreign Travelers from Ebola-Stricken Countries from Entering the United States?, CRS Legal Sidebar (PDF)
Source: Congressional Research Service (via Federation of American Scientists)

The recent outbreak of the Ebola virus in West Africa has prompted concern over the risk that foreign travelers may carry the virus to the United States — a concern that has grown since an infected Liberian national who traveled to the United States infected two nurses who cared for him at a Dallas hospital. On Monday, October 21, the Department of Homeland Security announced new screening procedures at U.S. ports of entry for travelers from Ebola-stricken countries in West Africa. Several Members of Congress have gone further and suggested a blanket ban on the admission into the United States of foreign nationals who reside in or have recently traveled to Ebola-stricken countries – a suggestion that the Obama Administration has thus far opposed. Although it has never been used for such purposes, section 212(f) of the Immigration and Nationality Act (INA) seems to confer the President with authority to bar foreign travelers from Ebolastricken countries from entering the United States, if he deems such a restriction necessary to protect U.S. interests, regardless of whether there is a reason to believe that a particular traveler is infected with the Ebola virus.

New WHO guidelines for mammography screening and referral

October 31, 2014 Comments off

New WHO guidelines for mammography screening and referral
Source: World Health Organization

A new WHO position paper examines the balance of benefits and harms in offering mammography screening to women after the age of 40 in a variety of settings. WHO is also issuing new guidelines for the referral of suspected breast cancer cases in low-resources settings, applicable to primary care.

These two guidelines are part of a broader set of comprehensive breast cancer guidance that will be developed in the coming years.

HHS OIG — Medicare Paid for HIV Drugs for Deceased Beneficiaries

October 31, 2014 Comments off

Medicare Paid for HIV Drugs for Deceased Beneficiaries
Source: U.S. Department of Health and Human Services, Office of Inspector General

WHY WE DID THIS STUDY
Under the Medicare Part D program, CMS contracts with private insurance companies, known as sponsors, to provide prescription drug coverage to beneficiaries who choose to enroll. OIG has had ongoing concerns about Medicare paying for drugs and services after a beneficiary has died.
Drugs that treat the human immunodeficiency virus (HIV) can be a target for fraud, waste, and abuse, primarily because they can be very expensive. Although this report focuses on HIV drugs, the issues raised are relevant to all Part D drugs.

HOW WE DID THIS STUDY
We based this study on an analysis of Prescription Drug Event (PDE) records for HIV drugs in 2012. Part D sponsors submit these records to CMS for each drug dispensed to beneficiaries enrolled in their plans. Each record contains information about the drug, beneficiary, pharmacy, and prescriber. We used the Beneficiary Enrollment Database, the Social Security Administration’s Death Master File, and Accurint’s Death Records to identify beneficiaries’ dates of death.

WHAT WE FOUND
Medicare paid for HIV drugs for over 150 deceased beneficiaries. CMS’s current practices allowed most of these payments to occur. Specifically, CMS has edits (i.e., systems processes) in place that reject PDE records for drugs with dates of service more than 32 days after death. CMS’s practices allow payment for drugs that do not meet Medicare Part D coverage requirements. Most of these drugs were dispensed by retail pharmacies.
This review looked only at HIV drugs, which account for one-quarter of one percent of all Part D drugs in 2012. However, our findings have implications for all drugs because Medicare processes PDE records for all drugs the same way. Considering the enormous number of Part D drugs, a change in practice would affect all Part D drugs and could result in significant cost savings for the program and for taxpayers.

WHAT WE RECOMMEND
We recommend that CMS change its practice of paying for drugs that have a date of service within 32 days after the beneficiary’s death. CMS should eliminate or-if necessary for administrative processing issues-shorten the window in which it accepts PDE records for drugs dispensed after a beneficiary’s death. Such a change would prevent inappropriate payments for drugs for deceased beneficiaries and lead to cost savings for the program and for taxpayers. CMS concurred with our recommendation.

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