Citizens’ Council on Health Care
CCHC HEALTH eNEWS
Tuesday, June 26, 2001

+++++++++++++++++++++++++++++++++++++++++++++++++++++
+ The CCHC HEALTH eNEWS will be published only +
+ ONCE A WEEK during the summer due to other +
+ priorities. REMEMBER: If you enjoy receiving +
+ the eNEWS, consider contributing financially +
+ to its publication. Contributions are being +
+ taken at the address at the bottom of this +
+ publication. Thank you. +
+++++++++++++++++++++++++++++++++++++++++++++++++++++


=====================================================
Providing news and commentary on health care policy,
health insurance issues, and medical confidentiality.
=====================================================


* MEDICARE ADMINISTRATION CHANGES NAME IN ATTEMPT TO CHANGE IMAGE

* MENTAL HEALTH RECORDS NOT SO PRIVATE

* WHY PRESSURE WILL MOUNT FOR BIOMETRIC IDENTIFICATION

* HIGH-COST PATIENTS ACCOUNT FOR MOST DRUG SPENDING

* EMPLOYEES TRUST OWN INSURANCE DECISIONS MORE THAN EMPLOYERS

* CAN OLD FDA REGULATORY STRUCTURE COPE WITH NEW TECHNOLOGIES?

* INCREASING THE RANKS OF THE UNINSURED


-----------------------------------------------------
TO BE REMOVED FROM THIS LIST, UNSUBSCRIBE INSTANTLY
AT: http://www.cchconline.org/enews.php3
-----------------------------------------------------


_____________________________________________________
MEDICARE ADMINISTRATION CHANGES NAMES TO CHANGE IMAGE

Tommy Thompson thinks there’s little to love in the name
HCFA (Health Care Financing Administration, pronounced
”Hic-Fa”) According to the AAPS News, he is quoted in
Bloomberg News Service (5/31/01) as saying “It’s hard to
love something called a HCFA. So I was thinking about
changing the name. What about the Medicare and Medicaid
Association? Then you could call it MAMA, and that’s
something you can love” Not only would such a monikor
sound unprofessional, but it also might sound more like
a nanny state than the Bush administration could tolerate.

Tom Scully, administrator of HCFA, gave a presentation June
4^th in Washington, D.C. saying that there was an employee
contest to choose a new name for the federal agency that pays
for and monitors the two programs. The winner gets to have
lunch with Scully. In addition, Scully, an advocate of HMOs
for Medicare and Medicaid recipients, plans to make the
agency more friendly and open to patients and practitioners,
but he also intends to begin collecting boatloads of performance
data on everyone who provides care to a government patient.

What Scully didn’t say is that the HCFA employee who wins is
the one “whose suggestion comes closest to the name proposed
by a public relations firm hired by the agency.” (AAPS News,
July 2001)The more things change the more they stay the same.
HCFA still manages from the top down. Small wonder that the
only reward is lunch with the boss. The money went to a PR firm.

So what is the new name? The Centers for Medicare and Medicaid
Services (CMS). The idea is to emphasize service, something the
agency has never been known for. One wonders why it took a PR firm
to come up with that name, and how many tax dollars it cost. Now
tax dollars will also be required to change the website, the
signage, the stationary, and anything else related to the old
name. After all that, is anyone convinced that anything has
changed about the agency that has recently hired scores of new
armed investigators to make surprise visits to doctor’s offices?
Time will tell.

Interestingly, although the administration announced the change on
June 14^th, the HCFA website has not yet changed its name and
there is no announcement of the change on the site: www.hcfa.gov

- Twila Brase, R.N., President
- Citizens’ Council on Health Care
- 6/26/01


____________________________________
MENTAL HEALTH RECORDS NOT SO PRIVATE

Although mental health professionals were adamant that the rule
be implemented, the new federal medical privacy rule does not
protect mental health records from disclosure. It protects only
the “therapists’ notes documenting or analyzing the contents of
conversations during counseling sessions,” according to the
California Coalition for Ethical Mental Health Care (Winter
2001).

Still available to Federal oversight agencies, and permitted
to be disclosed without consent to law enforcement, researchers,
public health officials, government databases and other entities
are: diagnoses, functional status, treatment plan, symptoms,
prognosis, progress to date, medication prescription and
monitoring, session start and stop times, modalities and
frequencies of treatments, and results of clinical tests.

- Citizens’ Council on Health Care
- 6/26/01


___________________________________________
WHY BIOMETRIC IDENTIFICATION WILL BE PUSHED

British employees were surveyed and the result concern security
experts. Many of the passwords used by employees contain
information that is either obvious to others or easy to “crack.”
CentralNic, a UK domain registry, found that nearly half of the
workers use their own name or a nickname, and one-third use a
favorite sports team or a famous celebrity. These choices are too
easy to guess say security experts.

Password crackers make other choices vulnerable. They check for
words in the dictionary and “systematically go through every
number-letter combination,” says Michael Sutton, senior security
engineer at iDefense.

The best defense against intruders is a random password, such as
one that replace various letters with numbers or symbols, or
creating an acronym that is not a word.

Keep in mind that the federal government intends to create and
issue a unique patient identifier for every citizen. It’s part
of the 1996 Health Insurance Portability and Accountability Act
passed by a Republican Congress and signed by President Clinton.

Rep. Dick Armey has written of his concerns to Secretary Tommy
Thompson (5/15/01 letter according to the AAPS News, July 2001)
regarding the U.S.Health and Human Services Department
instructing private insurers and others to reserve a field in
their software for this identification system. Biometrics will
not be the first identifier, but according to 1998 HHS testimony
it might be the preferred and final identifier.

Source:”Survey: Security Password Picks Are Easy Prey,” Jay Lyman,
ECommerce Times, June 26, 2001, http://www.ecommercetimes.com/perl/story/11524.html

- Citizens’ Council on Health Care
- 6/26/01


_________________________________________________
HIGH-COST PATIENTS ACCOUNT FOR MOST DRUG SPENDING

A very small percentage of people receiving prescription drug
benefits are responsible for a significant proportion of drug
spending, a new study suggests.

Very high-cost patients are defined as those responsible for a
minimum of $174 a month in pharmacy costs. The study by Express
Scripts, a pharmacy benefits manager, found that:

o More than 50 percent of drug expenditures are attributable
to five percent of its members.

o The top two percent of patients are “very high-cost”
users, accounting for 33 percent of prescription drug
expenditures, it said.

o Furthermore, high-cost patients remained high-cost from
one year to the next; of patients in the high-cost
category in 1998, 75 percent remained high-cost in 1999.

Most high-cost patients have conditions like cancer, diabetes or
heart disease, and they are using drugs in multiple classes.

The highest-cost adult patients have very high use rates for
certain drug classes. For example, 48 percent use antidepressants
or anti-anxiety medications, 40 percent use anti-ulcer drugs and
59 percent use drugs for treating high blood pressure.

The highest cost patients also are more likely to fill
prescriptions with branded products, mostly because they are
taking drugs for which there is no chemically equivalent generic
available.

Source: Kathleen Fairman, “Fact Sheet: Understanding the High-
Cost Patient,” Outcomes Conference 2001, June 19, 2001, Express
Scripts; “Targeting high-cost patients may cut drug spending,”
Reuters Health, June 20, 2001.

For Express Scripts text
http://www.express-scripts.com/other/news_views/outcomes2001/highcost.pdf

Source: Directly taken from Daily Policy Digest, National
Center for Policy Analysis, 6/26/01, http://www.ncpa.org


___________________________________________________________
EMPLOYEES TRUST OWN INSURANCE DECISIONS MORE THAN EMPLOYERS

Employee Benefit News June 15^th issue reports on an in-depth
survey of 300 employed adults commissioned by the publication.
The poll says that 71% “view benefits as very important in
deciding to accept a job,” but that “respondents expressed
more confidence in their own abilities than in their employers’
to choose the best health plan.” 82% said they are “very” or
”somewhat” confident they could choose the best plan. It adds
that 40% say their employer has never informed them of the cost
of their benefits, and these workers are less satisfied with
their coverage than those who are informed.
SOURCE: http://www.benefitnews.com

Source: Quoted directly from the Health Policy Week, Greg
Scandlen, National Center for Policy Analysis, 6/24/01.


____________________________________________________________
CAN OLD FDA REGULATORY STRUCTURE COPE WITH NEW TECHNOLOGIES?

Innovation in medical technology could slow unless the U.S. Food
and Drug Administration (FDA) reorganizes to better handle
emerging technologies and new “hybrid” products, warns a report by
the Lewin Group for the Advanced Medical Technology Association
(AdvaMed). Hybrids are products that combine device and drug
technology into one treatment—such as a laser-activated drug
or an inhaler that delivers insulin.

The products can pose regulatory difficulties because their
components must undergo review by different centers of the FDA.
The report calls on the agency to improve collaboration and
communication between the Center for Devices and Radiological
Health (CDRH), the Center for Biologics Evaluation and Research
(CBER) and the Center for Drug Evaluation and Research (CDER).

o The Lewin report notes FDA review times for new medical
devices—so-called 510(k) and PMA submissions—have
been getting consistently shorter since 1994.

o And it found that innovation in medical technology has
remained healthy thus far, with research and development
funding jumping from 5.4 percent of sales in 1990 to 12.9
percent in 1998.

o However, despite important improvements in FDA
productivity and processes, total review times for
breakthrough technologies are still averaging about 12
months—twice the statutory deadline of 180 days.

The FDA should set up a system for tracking the progress of
hybrid products throughout the review process, the authors say.
They also called on the FDA to develop and maintain state-of-the-
art staff expertise to review medical devices, make better use of
outside expertise when needed and encourage reviewers to consider
innovative scientific approaches to evaluate new technologies.

Source: “Report Finds FDA Unprepared to Regulate New
Technologies,” Reuters Health, June 18, 2001.

For Reuters text
http://www.medscape.com/reuters/prof/2001/06/06.19/20010618rglt001.html

For AdvaMed text http://www.advamed.org/publicdocs/61801_toc.html

Source: Directly taken from Daily Policy Digest, National
Center for Policy Analysis, 6/2001, http://www.ncpa.org


_____________________________________
INCREASING THE RANKS OF THE UNINSURED

The Congressional Budget Office estimates that proposed Patients’
Rights legislation would increase health insurance costs by
”only” about 4 percent. But as the Health Insurance Association
of America points out, for each one percent increase in the cost
of insurance, 300,000 Americans will lose coverage.

Thus, as a new analysis by the Employment Policy Foundation
points out, the managed care reform bills now being debated in
Congress could cause an additional 9.2 million Americans to lose
their health insurance by 2010 -- increasing the proportion of
Americans without coverage to a quarter of the population.

Patients’ rights legislation would change federal law to allow
patients who are denied health benefits the ability to collect
punitive damages or “pain and suffering” damages in lawsuits.
Under current law, patients must follow a grievance procedure
before resorting to the legal system to contest denied benefits.
Individuals unhappy with those appeals may file a federal lawsuit
to recover the cost of the denied benefits only and may not sue
in state court.

o Thus, EPF estimates that approximately 56,000 new lawsuits
would be filed annually, with a cost burden to employers
and health care plans of $7.9 billion to $16.3 billion.

o Lawyers could receive at least $1.4 billion to $2.8
billion annually from the new lawsuits.

o More than 88 million people in the United States are now
covered by managed care or Health Maintenance Organization
(HMO) plans, but data from the Bureau of Labor Statistics’
Current Population Survey reveals there were 47.1 million
people, 17.2 percent of the population, without any form
of health insurance in 2000.

Source: “Patients’ Rights Legislation: The Triangle of Health
Insurance: Quality, Cost and Access,” Policy Backgrounder, June
20, 2001, Employment Policy Foundation.

For EPF text
http://www.epf.org/research/newsletters/2001/pb20010620.pdf

Source: Directly taken from Daily Policy Digest, National
Center for Policy Analysis, 6/20/01, http://www.ncpa.org


================================================
* Link quickly to starred (*) articles - online
newspapers may remove them soon after published
================================================
NOTE: These news items have been taken directly
from email received by CCHC or from Internet
newspaper publications. Titles in ALL CAPS are
CCHC creations except for those heading articles
from the National Center for Policy Analysis,
the Health Law Pulse, PrivacySecurityNetwork,
and LIST.HEALTHPLAN. Credit to the sending
organization or news service is listed at the
end of each article.
================================================
CITIZENS’ COUNCIL ON HEALTH CARE
1954 UNIVERSITY AVE. W., SUITE 8
ST. PAUL, MN 55104, 651-646-8935
HTTP://WWW.CCHCONLINE.ORG

-----------------------------------------------------
TO BE REMOVED FROM THIS LIST UNSUBSCRIBE INSTANTLY
AT: http://www.cchconline.org/enews.php3
-----------------------------------------------------



*************************************************************
A citizens resource for designing the future of health care
*************************************************************

Citizens’ Council on Health Care
1954 University Ave.W., Suite 8
St. Paul, MN 55104
651-646-8935 phone
651-646-0100 fax
http://www.cchc-mn.org
**************************

NOTE: If you do not wish to receive this email,
contact CCHC to remove your name from the list.
Thank you.

ALL INFORMATION, DATA, AND MATERIAL CONTAINED, PRESENTED, OR PROVIDED HERE IS FOR GENERAL INFORMATION PURPOSES ONLY AND IS NOT TO BE CONSTRUED AS REFLECTING THE KNOWLEDGE OR OPINIONS OF THE PUBLISHER, AND IS NOT TO BE CONSTRUED OR INTENDED AS PROVIDING MEDICAL OR LEGAL ADVICE.  THE DECISION WHETHER OR NOT TO VACCINATE IS AN IMPORTANT AND COMPLEX ISSUE AND SHOULD BE MADE BY YOU, AND YOU ALONE, IN CONSULTATION WITH YOUR HEALTH CARE PROVIDER.