2014

Thursday, April 24, 2014

Report shows 20-year US immunization program spares millions of children from diseases


Recent measles outbreaks underscore importance of sustaining high vaccination coverage
The CDC estimates that vaccinations will prevent more than 21 million hospitalizations and 732,000 deaths among children born in the last 20 years. Despite the U.S. immunization program’s success, according to CDC officials, 129 people in the U.S. have been reported to have measles this year in 13 outbreaks, as of April 18.
In 1994, the Vaccines for Children program (VFC) was launched in direct response to a measles resurgence in the United States that caused tens of thousands of cases and over a hundred deaths, despite the availability of a measles vaccine since 1963. The VFC program provides vaccines to children whose parents or caregivers might otherwise be unable to afford them.
This year’s 20th anniversary of the VFC program’s implementation is occurring during an increase in measles cases in the U.S. In 2013, 189 Americans had measles. In 2011, 220 people in the U.S. were reported as having measles--the highest number of annual cases since 1996.

"Thanks to the VFC program, children in our country are no longer at significant risk from diseases that once killed thousands each year,” said CDC Director Tom Frieden, M.D., M.P.H. “Current outbreaks of measles in the U.S. serve as a reminder that these diseases are only a plane ride away. Borders can’t stop measles, but vaccination can.”

Benefits from Immunization During the Vaccines for Children Program Era — United States, 1994–2013


The VFC program has contributed to high immunization rates and a dramatic decline of serious diseases like measles in the U.S. Sustaining high vaccination coverage rates is crucial to protecting children from vaccine-preventable diseases that are still common in other parts of the world. The Vaccines for Children program, which provides vaccines to children whose parents or caregivers might otherwise be unable to afford them, has been highly effective improving the health of U.S. children. For children born in the VFC era (1994-2013), CDC reports that vaccination will prevent an estimated 323 million illnesses, 22 million hospitalizations, and 732,000 deaths over the course of their lifetimes and at a net savings of $295 billion in direct costs and $1.38 trillion in total societal costs. Although the VFC is one of our most successful public-private partnerships for improving public health, ongoing effort is needed to sustain immunization rates and ensure children are staying up-to-date with their vaccinations.

Surveillance Systems to Track Progress Toward Global Polio Eradication — Worldwide, 2012–2013


Weaknesses in detecting and investigating cases of paralysis have prevented early recognition of polio outbreaks in the Middle East, Central Africa and the Horn of Africa in 2013 that would have allowed faster outbreak control. To achieve and certify polio eradication, intensive efforts are needed to strengthen and maintain AFP surveillance throughout the world, including in field investigation and collection of specimens, particularly in countries with current or recent active poliovirus transmission and those countries in proximity to those countries. Polio cases are detected by searching for paralyzed children (acute flaccid paralysis [AFP] surveillance) and testing of stool specimens by the laboratories in a global network. The number of countries in Africa and the Middle East meeting national performance targets for disease detection and collection of adequate specimens declined from 27 (90 percent) in 2012 to 22 (73 percent) in 2013, primarily due to weakness in the African Region. Subnational areas of some countries meeting performance criteria still have severe weaknesses in surveillance. The laboratory network is meeting standards for rapid testing of specimens and identification of polioviruses. Intensive efforts are urgently needed to strengthen and maintain polio surveillance globally in countries of Africa, the Middle East and Asian subcontinent where there is current or recent active poliovirus transmission. Polio-free areas in all parts of the world also need to maintain strong polio surveillance.

Indoor Firing Ranges and Elevated Blood Lead Levels — United States, 2002–2013


People using or working around indoor firing ranges are being exposed to lead which can cause harmful health effects. Range owners and patrons should follow available guidance to reduce the exposures. Indoor firing ranges are a source of lead exposure to employees, their families, and range customers. From 2002–2012, 1,987 employees of law enforcement and amusement/ recreation industries had elevated blood lead levels (BLL), defined as >10 micrograms of lead per deciliter of blood, as reported by the Adult Blood Lead Epidemiology Surveillance Program. Other workplace investigations in Washington and California have also documented elevated BLLs among firing range employees and found the potential for “take-home” and community exposure to lead. The Occupational Safety and Health Administration’s lead standard is based on lead toxicity information that is now over 30 years old. Current medical information clearly demonstrates harmful effects at levels well below those allowed in the workplace.

Occupational Ladder Fall Injuries — United States, 2011


Ladder fall injuries represent a substantial public health burden of preventable injuries for workers including Hispanic, male, and older workers in construction, extraction, installation, maintenance, and repair occupations. Employers, healthcare providers and safety professionals should collaborate to ensure availability and training of safe ladder practices both on and off the job. Ladder fall injuries represent a substantial public health burden of preventable injuries for workers. CDC’s National Institute for Occupational Safety and Health (NIOSH) analyzed data across multiple injury surveillance systems to fully characterize fatal and nonfatal injuries associated with ladder falls among workers in the United States. In 2011, work-related ladder fall injuries resulted in 113 fatalities; an estimated 15,460 nonfatal injuries were reported by employers that involved at least one day away from work; and an estimated 34,000 nonfatal injuries were treated in hospital emergency departments. The findings of this study reinforce the need for workplace safety research to prevent falls, including developing and disseminating innovative technologies to prevent LFIs.

Diagnostic Error in Medicine Conference


Submit Your Abstract Today for September 14-17 DEM Conference in Atlanta


The Diagnostic Error in Medicine 7th International Conference will be held September 14- 17, 2014, in Atlanta, Georgia.  You are invited to submit abstracts that address the epidemiology of diagnostic error, factors that predispose to diagnostic error, and strategies to reduce diagnostic error or improve detection. As an event dedicated to the problem of diagnostic error, the Diagnostic Error in Medicine Conference will provide instruction, insight, dialogue, and tools to enable health care providers to reduce diagnostic harm.

Thursday, April 17, 2014

Outpatient Diagnostic Errors Affect 1 in 20 Adults


A new study co-funded by AHRQ found that diagnostic errors—missed opportunities to make a timely or correct diagnosis based on available evidence—occur in about 5 percent of U.S. adults and that about half of those errors could severely harm patients. The study, “The frequency of diagnostic errors in outpatient care: estimations from three large observational studies involving U.S. adult populations,” was published in the April 21 issue of BMJ Quality & Safety.
The study used data from three previous studies of errors in general primary care diagnosis, colorectal cancer diagnosis and lung cancer diagnosis. In all three studies, diagnostic errors were confirmed through rigorous chart review. Diagnostic errors can harm patients by delaying their treatment. For example, a delayed or incorrect cancer diagnosis could make the disease harder to treat or more deadly. The study is significant because it is based on a large sample size and is the most robust estimate thus far to address the frequency of diagnostic error in routine outpatient care. 

National report card on food safety indicates more can be done


The nation’s food safety grades are out and the results are mixed. CDC’s annual report card shows that foodborne infections continue to be an important public health problem in the United States.
The rate of salmonella infections decreased by about nine percent in 2013 compared with the previous three years, bringing it to the rate last observed in the 2006-2008 baseline period. But campylobacter infections, often linked to dairy products and chicken, have risen 13 percent since 2006-2008. Vibrio infections, often linked to eating raw shellfish, were at the highest level observed since active tracking began in 1996; however, rates of infections caused by Vibrio vulnificus, the most severe species, have remained steady. Rates of the other foodborne infections tracked have not changed since the period between 2006 and2008.
“CDC data are essential to gauge how we’re doing in our fight against foodborne illness,” said Robert Tauxe, M.D., M.P.H, deputy director of CDC’s Division of Foodborne, Waterborne and Environmental Diseases. “This year’s data show some recent progress in reducing salmonella rates, and also highlight that our work to reduce the burden of foodborne illness is far from over. To keep salmonella on the decline, we need to work with the food industry and our federal, state and local partners to implement strong actions to control known risks and to detect foodborne germs lurking in unsuspected foods.”

Public health interventions close health equity gaps among diverse U.S. populations


Evidence-based interventions at the local and national levels provide promising strategies for reducing racial and ethnic health disparities related to HIV infection rates, immunization coverage, motor vehicle injuries and deaths, and smoking, according to a new report by the CDC’s Office of Minority Health and Health Equity.
The report,published today as an MMWR Supplement, describes CDC-led programs addressing some of the health disparities previously highlighted in the CDC Health Disparities and Inequalities Reports, CHDIR, 2011 and 2013. The CHDIR reports highlight differences in mortality and disease risk for multiple conditions related to behaviors, access to health care, and social determinants of health – the conditions in which people are born, grow, live, age, and work.

“Reducing and eliminating health disparities is central to achieving the highest level of health for all people,” said CDC Director Tom Frieden, M.D., M.P.H. “We can close the gap when it comes to health disparities if we monitor the problem effectively and ensure that there is equal access to all proven interventions.”

Concerns Regarding a New Culture Method for Borrelia burgdorferi Not Approved for the Diagnosis of Lyme Disease


Some tests for Lyme disease are not adequately validated and can be misleading to patients and health care providers. Recently, CDC has received inquiries regarding a test that uses a novel culture method to identify Borrelia burgdorferi, the spirochete that causes Lyme disease. Published methods and results for this test were reviewed by CDC. The review raised serious concerns about false-positive results caused by laboratory contamination and the potential for misdiagnosis and improper treatment of patients. This situation highlights the importance of FDA clearance/approval of diagnostic tests, which provides assurance that the test itself has adequate analytical and clinical validation and is safe and effective. CDC recommends that laboratory tests cleared by FDA be used to aid in the routine diagnosis of Lyme disease. 

Incidence and Trends of Infection with Pathogens Transmitted Commonly Through Food — Foodborne Diseases Active Surveillance Network, 10 Sites, 2006–2013


The partnership of state public health and community organizations can play an Progress in preventing foodborne illnesses has been limited. Salmonella infections decreased slightly in 2013 compared with the preceding 3 years, and are back to levels seen in 2006–2008. The frequency of most other infections tracked in Foodborne Diseases Active Surveillance Network (FoodNet) has not changed much at all; however, Vibrio infections increased in 2013. These findings highlight the need to continue to identify and address food safety gaps that can be targeted for action.Foodborne diseases continue to be an important public health problem in the United States. Progress in preventing these infections has been limited in recent years, as evidenced by a modest decrease in the incidence of Salmonella and an increase in incidence of Vibrio. FoodNet, a foodborne disease surveillance component of CDC's Emerging Infections Program, conducts surveillance in 10 U.S. sites for all laboratory-confirmed infections caused by selected pathogens transmitted commonly through food to help assess whether efforts to decrease illnesses are succeeding. This report describes 2013 surveillance data and trends since 2006; the information contributes to our understanding of the human health impact of foodborne diseases.

Blood Lead Levels Among Children Aged 1–5 Years — Zamfara State, Nigeria, June–July 2012


Much has been done to address the problems of lead exposure in Zamfara, Nigeria, since the lead poisoning crisis of 2010. New and safer processing techniques that control dust and residual ore wastes, a better understanding of potential exposure to lead contaminated foodstuffs, continued blood lead surveillance, chelation therapy when warranted and environmental cleanup of hazardous sites remain critical. Since 2010, Nigerian government officials and the international community have responded to childhood lead poisoning caused by the processing of lead-containing gold ore in Zamfara State, Nigeria. Widespread education, surveys of high-risk villages, testing and surveillance of blood lead levels (BLLs), medical treatment, and environmental clean-up have all been implemented. To evaluate the current prevalence of lead poisoning and dangerous work practices, a population-based assessment of children’s blood lead levels and ore processing techniques was conducted during June–July 2012. Unlike earlier studies, this assessment found few children in need of medical treatment, lower average BLLs, and less exposure of children to dangerous work practices. Although work remains, when these strategies are successfully implemented, a sustained reduction of blood lead levels in children is possible.

Coccidioidomycosis Among Cast and Crew Members at an Outdoor Television Filming — California, 2012


Anita Gore
Deputy Director, Office of Public Affairs
California Department of Public Health
(916) 440-7259



Workers, employers, and medical providers should recognize that employees can be exposed to Valley Fever even if they are not directly engaged in soil disruptive work. In 2012, more than 4,000 Californians were diagnosed with Valley Fever, a potentially serious disease caused by inhaling fungal spores common in Central and Southern California. Occupationally acquired Valley Fever most often occurs in people whose work involves digging or working in soil, such as construction workers, military personnel, or archaeologists. However, this study highlights Valley Fever in a group of workers whose occupations do not typically put them at risk of Valley Fever exposure. —The study reports on several members of the cast and crew of a popular TV series who became ill shortly after filming outdoor scenes in Ventura County. Workers, employers, and medical providers should be aware that employees working outdoors in Coccidioides (a fungus that lives in soils)prevalent areas might be exposed to Valley Fever from recent soil disturbances or windy conditions, even if they are not working in the soil.

Tuesday, March 18, 2014

Health Plan Certification of Compliance Comment Period Extended to April 3


The Department of Health and Human Services (HHS) has extended the comment period for the proposed rule, “Administrative Simplification: Health Plan Certification of Compliance.” HHS is specifically looking to receive additional comments from third party administrators (TPAs) and self-insured plans.

HHS is now accepting public comments on the proposed rule through April 3, 2014.
The Certification of Compliance for Health Plans proposed rule is different from previous Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification regulations because it affects more and different types of entities.

For example, many third party administrators, self-funded health plans, and group health plans that have not been impacted by previous HIPAA Administrative Simplification requirements will be affected by this rule, even if they do not directly conduct HIPAA covered transactions.

The proposed rule would require controlling health plans to submit documentation on or before December 31, 2015. It would also establish penalty fees for a controlling health plan that fails to comply with the Certification of Compliance requirements. 


The goal of the extension of the comment period is to provide these entities with time to understand and offer feedback on the business impacts of the Certification of Compliance proposed rule. HHS encourages these entities to submit feedback so that their comments and suggestions can be considered during the policy-making process.

Thursday, March 13, 2014

Prevalence of Influenza-like Illness and Seasonal and Pandemic H1N1 Influenza Vaccination Coverage among Workers — United States, 2009–10 Influenza Season


Adults employed in certain industries and occupations may be at a higher risk for influenza infection compared with other workers. During the 2009-2010 influenza season, when a global pandemic of novel influenza A (H1N1) was underway, adults employed in certain industries and occupations were more likely to report experiencing influenza-like illness compared with other workers. These groups included Real Estate and Rental and Leasing, Accommodation and Food Services, and Community and Social Services. Among these same groups, relatively low proportions of workers received seasonal or H1N1 influenza vaccination. Employers should evaluate risk levels in workplace settings and implement control measures that include influenza vaccination programs, education on hand hygiene and cough etiquette, policies that encourage workers to stay home from work when ill, and provision of personal protective equipment.

Alcohol-Attributable Deaths and Years of Potential Life Lost — 11 States, 2006–2010


Excessive alcohol use is a leading cause of preventable death in the United States, particularly among working-age adults. Evidence-based strategies for reducing excessive drinking, such as those recommended by the Community Preventive Services Task Force, could help reduce the health and economic impact of this leading health risk behavior. Excessive alcohol use is a leading cause of preventable death and years of potential life lost in states, according to a new study released by the Centers for Disease Control and Prevention. In the 11 states studied, there were a median of 1,600 deaths and 43,000 years of life lost annually due to excessive drinking. About 70 percent of these deaths and 80 percent of the years of life lost involved working-aged adults. Of the 11 states, the highest death rate due to excessive drinking was in New Mexico, and the lowest was in Utah. Although most deaths were among white non-Hispanics, the median death rate for American Indians/Alaska Natives was twice as high as for any other racial or ethnic group.

Likely Female-to-Female Sexual Transmission of HIV — Texas, 2012


Although the risk of sexual transmission of HIV between women who have sex with women (WSW) is low, the potential for transmission exists because HIV can be transmitted when certain bodily fluids (e.g., menstrual blood; vaginal fluids; etc.) come into contact with a mucus membrane or a cut or abrasion. This report documents a case with unique circumstances pointing to likely sexual transmission between female partners. In this case, the discordant couple (one HIV-infected partner and one uninfected partner) routinely had direct sexual contact – without using barrier methods for protection – that involved the exchange of blood through abrasions received during sexual activity. Because all other HIV risk exposures were ruled out for the newly infected partner, it is likely she was infected by her female partner. The authors note that, although HIV transmission between women is possible, it remains rare. This report underscores the need for all couples – including WSW – to take steps to prevent transmission, including avoiding all contact between HIV-infected blood or blood-contaminated bodily fluids and broken skin, wounds or mucus membranes.

Wednesday, March 12, 2014

Modifications to Quality Measures and Reporting in Section 1915(c) Home and Community-Based Waivers


Modifications to section 1915(c) waiver quality assurance expectations are being posted today at: http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/Home-and-Community-Based-1915-c-Waivers.html. These changes strengthen the oversight of beneficiary health and welfare and realign the reporting requirements. We believe this changed emphasis will improve the success of home and community based programs. This document includes a narrative description of the modifications, an overview of each of the section 1915(c) statutory assurances in a chart with a comparison of previous and current sub-assurances expected to be measured, and the step-by-step method to apply these changes electronically in the Waiver Management System.
The modifications to the section 1915(c) Quality System were developed over more than a year’s time with The National Association of States United in Aging and Disability (NASUAD), National Association of State Directors of Developmental Disabilities Services (NASDDDS) and National Association of Medicaid Directors (NAMD), along with waiver administrators from eleven states and the National Quality Enterprise. Other stakeholders also had opportunity to comment through conference and webinar sessions. The statutory requirements for section 1915(c) waivers are not changed and states are still required to monitor all of the waiver assurances as before. This update clarifies the expectations of CMS on the reporting that states should provide to meet the waiver assurances. The continuous quality improvement cycle remains the same as illustrated below.
Continuous Quality Improvement Cycle, including Improvement, Design, Discovery, and Remediation
If you have questions about this information, please contact Dianne Kayala, Technical Director in the Division of Long Term Services and Supports at Dianne.Kayala@cms.hhs.gov or (410) 786-3417.

Register Now for the AHRQ 2014 TeamSTEPPS® National Conference


Join AHRQ June 11-12 in Minneapolis, Minnesota, for our annual TeamSTEPPS® National Conference. The mission of the conference is to bring techniques, tools, and new thinking to assist health care professionals in successfully implementing TeamSTEPPS®. The National Conference includes educational programming beginning June 10 with pre-conference sessions followed by keynote presentations, concurrent presentation panels, networking opportunities, and a poster session.  There is no cost to register, but space is limited. To sign up now, visit the TeamSTEPPS® National Implementation website

Gnathostoma spinigerum in Live Asian Swamp Eels (Monopterus spp.) from Food Markets and Wild Populations, United States, R.A. Cole et al.


During 2005–2008, more than 1 billion live animals were legally imported into the United States for food or pet trade markets. One such animal, the swamp eel, can carry parasites (worms) called gnathostomes. If those eels are eaten undercooked or raw, this parasite can cause mild to serious (blindness, paralysis, and even death) consequences. This parasite is native to Southeast Asia but not to the United States. However, because swamp eels imported into the United States end up in ethnic food markets or are released into the wild, this situation is in flux. When researchers tested eels from US ethnic markets and open waters, they found that those eels do indeed carry this parasite and that they could be a source of infection for US consumers. Thus, consumers should be aware of this risk, and clinicians should consider their patients’ dietary history, not just travel history, when diagnosing this infection.

Pandemic Vibrio parahaemolyticus, Maryland, USA, August 2012, J. Haendiges et al.


When you think of a pandemic, you don’t first think of foodborne illnesses. However, a pandemic strain of bacteria that causes foodborne illness, Vibrio parahaemolyticus, has been emerging worldwide; these bacteria usually infect people who eat contaminated raw oysters. This strain is not commonly found in the United States, but in 2012 it caused an outbreak in Maryland. The affected patients had not eaten oysters, leaving cross-contamination during food preparation as a possible source of their illness. The presence of this dangerous strain in Maryland calls for public health measures to improve its tracking and shorten response times when it is found.

Regional Variation in Travel-related Illness Acquired in Africa, March 1997--May 2011, M. Mendelson et al.


Africa’s diverse geography, ecosystems, and climate make that continent a popular tourist destination, yet we do not clearly understand how that diversity affects travellers’ risks for exposure to various illnesses. A large collaborative effort using a database of travelers found that the highest risk for gastrointestinal illnesses and dog bites was in northern Africa; the greatest risk for illnesses with fever in sub-Saharan Africa; the highest risk for malaria in central and western Africa; the highest risk for schistosomiasis, strongyloidiasis, and dengue in eastern and western Africa; and the highest risk for eye worm infection in central Africa. Understanding what the greatest health risks are in different parts of Africa can help with dispensing travel advice, diagnosing illness in returned travelers, and deciding where in Africa to visit.

High Acquisition Rates of Antimicrobial Drug Resistance Genes after International Travel, the Netherlands. C. J.H. von Wintersdorff et al.


The genes that code for resistance in bacteria do not discriminate and can be transferred from harmless to harmful bacteria and vice versa. Although antibiotic resistance in harmful bacteria has been thoroughly studied, the development of resistance genes in otherwise harmless bacteria could have unpredictable and immense health consequences if transferred to harmful bacteria. A study conducted in the Netherlands found that the risk of acquiring such bacteria with those genes increases during international travel. Any contact with food, water, soil, other people, or animals from foreign environments provides opportunities for travelers to introduce many resistance genes into their gastrointestinal tract. Although the consequences of acquiring these genes are difficult to predict, it is possible that international travelers could contribute to the spread of antibiotic resistance.

Ciprofloxacin Resistance and Gonorrhea Incidence Rates in 17 Cities, United States, 1991–2006, H. W. Chesson et al.


Antimicrobial resistance can hinder gonorrhea prevention and control efforts. In this study, CDC wanted to see if antimicrobial resistance could increase the number of gonorrhea cases. CDC analyzed antimicrobial resistance data from the Gonococcal Isolate Surveillance Project (GISP) and city-level gonorrhea incidence rates from surveillance data for 17 cities from 1991 to 2006. CDC’s analysis found a strong, positive association between ciprofloxacin resistance and increased gonorrhea cases at the city level. Due to widespread drug resistance, CDC has not recommended ciprofloxacin (a type of fluoroquinolone) be used to treat gonorrhea since 2007. While the number of gonorrhea cases has decreased since the 1970s, the organism is now becoming resistant to cephalosporins, the foundation of the last available treatment option. Emerging cephalosporin resistance could have substantial health and economic consequences in the future. Efforts to control the spread of resistant strains might reduce this potential burden.

Low Income Health Access Open Door Forum Update


htttp://www.cms.gov/Outreach-and-Education/Outreach/OpenDoorForums/ODF_lowincomehealthaccess.html

The next CMS Low Income Health Access Open Door Forum is scheduled for:

Date: Wednesday, March 12, 2014;
Start Time: 2:00-3:00 PM Eastern Standard Time (EST);
Please dial-in at least 15 minutes prior to call start time.

Conference Leaders: John Rigg & Jill Darling

**This Agenda is Subject to Change** 

I. Opening Remarks
Chair – John Rigg, HRSA, Office of Policy Analysis 
Moderator – Jill Darling, CMS Office of Communications

II. Announcements & Updates

  • Marketplace.gov/Healthcare.gov
  • Duals Office Update- State Integrated Care Demos
  • Medicaid Updates
  • Hospital Presumptive Eligibility-CMCS
  • Preventive Services Regulation (New Models for license providers & community health workers)- CMCS
  • Marketplace and Medicaid enrollment numbers
  • Latest “messaging” from the Department on Marketplace
http://www.cms.gov/Outreach-and-Education/Outreach/Partnerships/Downloads/WeeklyChampionUpdate022114.pdf
  • Provider resources
http://marketplace.cms.gov/training/get-training.html
http://www.hrsa.gov/affordablecareact/toolkit.html

III. Open Q&A 

**Next ODF: Wednesday, June 11, 2014**
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Open Door Forum Participation Instructions: 
This call will be Conference Call Only.

1. To participate by phone:
Dial: 1-800-837-1935 & Reference Conference ID: 71246839. 
Persons participating by phone are not required to RSVP. TTY Communications Relay Services are available for the Hearing Impaired. For TTY services dial 7-1-1 or 1-800-855-2880. A Relay Communications Assistant will help.

Encore: 1-855-859-2056; Conference ID: 71246839.
Encore is an audio recording of this call that can be accessed by dialing 1-855-859-2056 and entering the Conference ID, beginning 2 hours after the call has ended. The recording expires after 2 business days.
For ODF schedule updates and E-Mailing List registration, visit our website at http://www.cms.gov/OpenDoorForums/.
Thank you.
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New Date for CMS National Training Program Learning Series Webinar on Medigap Plans - March 24, 2014


The March CMS National Training Program Medicare Learning Series Webinar on Medigap (Medicare Supplement) Insurance Has Been Rescheduled

The webinar will be held on Monday, March 24, 2014 from 1:00 - 2:30 pm ET.
The National Training Program team will provide an overview of Medigap insurance policies.
Join the audio portion of the webinar on 1-877-267-1577, meeting number: 993 599 450 and join the webinar at https://webinar.cms.hhs.gov/ntplearnseriesmar2014/

Thursday, March 6, 2014

MMWR – Morbidity and Mortality Weekly Report


1. Impact of Requiring Influenza Vaccination for Children Attending Licensed Childcare or Preschool Programs — Connecticut, 2012–13 Influenza Season

Preschool-aged children are at high risk for serious consequences of influenza and should be vaccinated against influenza, especially those in settings where transmission is common such as child care facilities. Effective January 2011, preschool-aged children in Connecticut were required to be vaccinated against influenza to attend licensed child care. Investigators from the Yale School of Public Health and the Connecticut Department of Public Health evaluated the effect of this requirement on vaccination rates and on hospitalizations of young children during the 2012-2013 influenza season. Vaccination rates in Connecticut rose more quickly and were higher than children in the rest of the United States. After the requirement was implemented, hospitalization rates for influenza in young children in Connecticut were lower compared with 10 other sites in the United States with similar monitoring.  Requiring influenza vaccination in children attending child care facilities appears to have contributed to lower hospitalization rates from influenza among young children in Connecticut.

2. Trends in Incidence of End-Stage Renal Disease among Persons with Diagnosed Diabetes — Puerto Rico

Interventions such as blood glucose and blood pressure control to improve diabetes care and to increase awareness of risk factors for kidney disease in persons with diabetes might be considered to reduce the incidence of kidney failure in Puerto Rico, particularly among women and older persons.Diabetes is a major risk factor for kidney failure, accounting for about two thirds of new cases in Puerto Rico. CDC assessed recent trends in incidence of diabetes-related kidney failure among adults (aged 18 years or older) with diagnosed diabetes in Puerto Rico. After increasing in the late 1990s, the rate of new cases of diabetes-related kidney failure decreased in the 2000s among those aged 18–44 years with diabetes and among men with diabetes. Similar progress was not seen for other groups. From 1996 to 2010, rates of diabetes-related kidney failure showed little change for women with diabetes or for persons with diabetes aged ≥45 years, with the exception of persons with diabetes aged 65–74 years whose rates increased.

3. CDC Grand Rounds: Preventing Hospital-Associated Venous Thromboembolism

Public health programs and organizations concerned with patient safety (for example, hospital networks and healthcare payers) should work together to prevent venous thromboembolism (VTE).  VTE is a major public health problem, with hundreds of thousands of people affected each year. Half of all VTEs are hospital-associated and could be prevented.  Hospitals that have implemented improvements, such as provider education and systems to record and monitor risk assessment and prophylaxis use have shown that up to 70 percent of hospital-associated VTE can be prevented. For more information on preventing VTE, visit http://www.cdc.gov/dvt.

Wednesday, March 5, 2014

New CMS/ONC Children's Measures Project Draft Quality Measures Available in USHIK for Public Comment


Using AHRQ’s USHIK website, the Centers for Medicare and Medicaid Services (CMS), along with the Office of the National Coordinator for Health IT (ONC), has released additional draft Quality Measures developed under the CMS/ONC Children's Measures project for public comment.  The measures, “Immunizations by 13 years of age - HPV” and “Immunizations by 13 years of age - Meningococcus, Tetanus, and Diptheria” are now available.
To access and comment on the draft measures, select the “Draft Measures” tab in USHIK. Select the individual measure you would like to view. You must authenticate to UMLS using your (free) UTS account credentials to view the value sets and codes of a measure. To submit feedback on a specific draft measure select the “Provide Feedback” button located at the top of the individual quality measure’s page, fill the form out on the screen and submit.  All feedback is sent to CMS and ONC for review.

USHIK is an on-line, publicly accessible registry and repository of healthcare related data, metadata, and standards. USHIK is funded and directed by the Agency for Healthcare Research and Quality (AHRQ) with management support and partnership from the Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control and Prevention's (CDC) National Center for Health Statistics.

Friday, February 28, 2014

Administrative Simplification News: eHealth University Resources


Administrative Simplification eHealth University Resources

CMS has launched eHealth University, a new education portal designed to give providers information vital for understanding, implementing, and successfully participating in a range of CMS eHealth programs. The curriculum offers resources organized by level, from beginner to advanced, in a variety of formats, including fact sheets, guides, videos, checklists, webinar recordings, and more.
As part of eHealth University, CMS is offering tools and resources to help you understand Administrative Simplification initiatives such as claims and eligibility operating rules, electronic funds transfer and remittance advice operating rules and standards, and the health plan identifier. These resources include:

Once you have an understanding of the basics of Administrative Simplification through these beginner-level resources, you should move on to the intermediate and advanced resources also available on the eHealth University website.

January Medicaid and CHIP Application and Eligibility Data


Today the Centers for Medicare & Medicaid Services (CMS) is pleased to release the January 2014 monthly report on state Medicaid and Children's Health Insurance Program (CHIP) application and eligibility data.
Today's report represents state Medicaid and CHIP agency activity for January 2014, which coincides with the fourth month of the Health Insurance Marketplace open enrollment period. These data were reported by state Medicaid and CHIP agencies as part of the Medicaid and CHIP Performance Indicator process. The report focuses on those monthly indicators that relate to key processes relevant during the Marketplace open enrollment period. This information supplements data on the Marketplace activity that has been released by HHS.
These data will continue to be released monthly, and we will refine and improve the information as more comprehensive information becomes available.
To see the full report, please access it online under Eligibility Data at http://www.medicaid.gov/AffordableCareAct/Medicaid-Moving-Forward-2014/medicaid-moving-forward-2014.html

MMWR News Synopsis for February 27, 2014


MMWR – Morbidity and Mortality Weekly Report

MMWR News Synopsis for February 27, 2014

Click here for the full MMWR articles. If you have any questions about these summaries, please contact media@cdc.gov.

1. Histoplasmosis Associated with a Bamboo Bonfire — Arkansas, October 2011

When physicians see an individual with an illness consistent with histoplasmosis, they should ask about potentially ill contacts to be assured that the patient is not a member of an outbreak. Human infection with Histoplasma capsulatum occurs sporadically and in outbreaks in endemic areas along the Ohio, Mississippi, and Missouri River valleys. Outbreaks classically have been observed in situations where individuals come in contact with disturbed ground, bird feces or bat guano. This outbreak report highlights a cluster of acute histoplasmosis cases among persons who attended a bonfire where bamboo, previously used as a blackbird roost, was burned. Observations from this outbreak raise the question whether exposure to a bonfire might be a newly recognized risk factor for histoplasmosis infection.

2. Multiple-Serotype Salmonella Outbreaks in Two State Prisons — Arkansas, August 2012

Ensuring prison staff and inmates involved in food service receive training and comply with state and local food preparation guidelines is key in preventing the occurrence and spread of foodborne outbreaks in prisons. Salmonella is the most common cause of bacterial foodborne outbreaks in the United States. Two outbreaks of Salmonella among nearly 600 inmates and staff in two Arkansas prisons were linked to deficiencies in safe food preparation practices and to eggs produced in the Arkansas correctional system. An investigation conducted by the Arkansas Department of Health (ADH) revealed infections with 15 different pulsed-field gel electrophoresis (PFGE) patterns of Salmonella. To prevent future outbreaks, ADH recommended training in food safety for correctional staff and inmates involved with food preparation, adherence to state guidelines for safe food preparation in prison kitchens, and inspection of prisons by health department staff to ensure staff follow food preparation standards equivalent to commercial food establishments.

3. Two-Dose Varicella Vaccination Coverage among Children Aged 7 years — Six Sentinel Sites, United States, 2006–2012

Substantial progress has been made towards ensuring as many children as possible are protected against varicella. Adoption of two-dose varicella vaccination school entry requirements by more states will help further increase the number of children protected against the disease. In 2007, the Advisory Committee on Immunization Practices (ACIP) recommended a routine second dose of varicella vaccine for children at age 4-6. The number of states with a two-dose varicella vaccine elementary school entry requirement has increased from four in 2007 to 36 in 2012. Two-dose varicella vaccination coverage levels among children aged 7 years in six Immunization Information System sentinel sites increased from a range of 3.6 percent to 8.9 percent in 2006 to a range of 79.9 percent to 92.0 percent in 2012 and are approaching levels of two-dose measles, mumps, rubella (MMR) coverage, which ranged from 81.9 percent to 94.0 percent in 2012. These increases suggest substantial progress in implementing the routine two-dose varicella vaccination program in the 6 years since its recommendation by ACIP.

4. Notes from the Field

  • Emergence of Wildlife Rabies on an Island Free from Canine Rabies for 52 Years — Taiwan, 2013


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Posting of Draft Comprehensive ESRD Care Initiative Quality Measures for Public Comment


The Centers for Medicare and Medicaid Services (CMS) is currently working on developing quality strategy for the Comprehensive ESRD Care Initiative. Interested organizations have expressed to CMS interest in learning more about the quality performance measures that will be part of the quality strategy for the Comprehensive ESRD Care Initiative. We are releasing a draft list of recommended quality measures for public comment from February 24, 2014 to March 14, 2014 at 5:00pm EST. Please visit the Comprehensive ESRD Care Initiative web page, Additional Information section, to access the draft recommendation for quality measures to be considered in the Comprehensive ESRD Care Initiative. 

Thursday, February 27, 2014

Deadline Extended for Request for Information: Specialty Practitioner Payment Model Opportunities


The Centers for Medicare and Medicaid Services (CMS) are considering policy options for the development of innovative payment and service delivery models for specialty practitioner services in the outpatient setting. Due to the high level of interest from the public and our desire to receive detailed comments and feedback on the models discussed in the Request for Information, CMS is extending the deadline for comments through April 10, 2014.
CMS is seeking input from stakeholders on two potential models:
1) A procedural episode-based payment model
2) A complex and chronic disease management episode-based payment model


Stakeholders can access the Request for Information and submit comments by visiting the CMS Innovation Center Specialty Practitioner Payment Model Opportunities web page. To ensure consideration of your comments, please submit responses to CMS by 5pm EDT on April 10, 2014. All questions in the Request for Information are optional. There is no need to respond to all questions for your submission to be successful. For any additional questions, please email SpecialtyCareModels@cms.hhs.gov.

Upcoming Topic Refinement for Review


The Agency for Healthcare Research and Quality's (AHRQ) Technology Assessment Program will be posting a Topic Refinement draft key question document for review on March 6, 2014. The topic refinement is entitled Therapeutic Options for Obesity in the Medicare Population.
If you are interested in reviewing this document, please visit: http://www.ahrq.gov/research/findings/ta/index.html. This document will be available for review from 9:00 AM on March 6, 2014, to 5:00 PM on March 20, 2014.

If you have any questions, please contact ahrqtap@ahrq.hhs.gov.

Wednesday, February 26, 2014