Diagnostics & Imaging Week Washington Editor

Comity, not partisanship, was the order of the day yesterday when the Senate Finance Committee met to discuss the nomination of Kansas Gov. Kathleen Sebelius as Secretary of Health and Human Services (HHS), and the subject of irregularities with regard to her campaign finances was never brought up.

All the same, a crack appeared in the wall of Democratic Party philosophy on healthcare reform on the question of a mandate for enrollment in a health plan, and the nominee once again opted to make no commitment regarding the use of budget reconciliation to force through healthcare reform.

Despite here silence, Sebelius still won approval from the Senate Finance Committee in a 15 to 8 vote, largely along party lines, as HHS secretary.

Her nomination will now go before the full Senate.

In his opening remarks, Senate Finance Committee chairman Max Baucus (D-Montana) made a point of emphasizing the responsibilities that go with the job of HHS secretary. He noted that HHS oversees Medicare, which he said "is at the heart of our compact with seniors and those with disabilities." He also mentioned that HHS oversees Medicaid and the Children's Health Insurance Program, and hence the department is intimately "involved in the effort to reform our ailing healthcare system."

Baucus's remarks also seemed to hint that he expected little or no opposition to the nomination. "I'm counting on you to help" in the effort to reform healthcare, he said. However, Sebelius smartly peppered her responses to questions with the phrase "if confirmed."

Sen. Chuck Grassley (R-Iowa), the committee's ranking member, highlighted the concerns of the GOP by remarking that where reform is concerned, "doing nothing is not an option, but as always, the devil is in the details." He took an implicit swipe at the prospect of the use of budget reconciliation to pass healthcare reform. "We can do it without some processes that have been circulating lately," Grassley said, describing reconciliation as "a partisan exercise that is not a real vehicle for reform."

Grassley also made the case that Americans "do not need a plan where the government sets the rates" paid to doctors and hospitals, a reference to proposals to establish a government healthcare system outside of or building on existing public-sector programs.

Former Kansas Republican Sen. Bob Dole went to bat for Sebelius, as he did on behalf of the first HHS nominee, Tom Daschle. He opened by noting the dominance of the committee, of Congress and of the White House by one party, remarking "the Democrats don't need to worry about bipartisanship" in order to pass bills and confirm nominations.

All the same, Dole remarked that Congress's greatest accomplishments came when "things were done in a bipartisan manner," which he said always has more credibility with voters. Nonetheless, he sounded hopeful. "If any committee can do it, the Finance Committee can."

"Gov. Sebelius understands bipartisanship," Dole told the committee, adding that "she's got a lot of good things done by her willingness to reach across the aisle." He also said that Sebelius has the chops to lead the department during a turbulent time. "If we have some namby-pamby leader at HHS, we'll never get anywhere," he said, stating further that Sebelius is "going to give us the leadership to get you through some of the very tough times you're going to have."

Sebelius made the case that where reform of healthcare is concerned, "action is not a choice, it's a necessity." She also hinted that she has the credentials to steer HHS through what promises to be a politically and administratively tortured path. "Kansas has been ranked high for healthcare affordability by insurers," she said as the former commissioner for healthcare insurance in the state, noting further that she has served as the state's governor at a time when the Republican Party held the majority in the state's legislature.

Sebelius said CMS "will have a vital role to play" in reform. "I want to work with you to assure that all those eligible" for public programs are enrolled, she stated, adding that long-term care is an issue and that CMS "will be a critical partner in expanding our capacity in providing community[-based] long-term care services."

"Should I be confirmed, health reform will be my mission," Sebelius affirmed. She also noted that "previous opponents of reform are now demanding it," and are engaged in the process, she said, declining to directly address the reconciliation question posed by Grassley.

Baucus asked Sebelius specifically about mandatory enrollment for all U.S. citizens, which he said is crucial to avoid cost shifting, noting that the addition of healthy, low-cost enrollees "would help make the market work." She responded that "the President is committed to . . . have a dialogue with Congress," but went no further than to state, "I think he's open to all proposals."

Sen. Mike Enzi (R-Wyoming), the ranking member of the Senate Health, Education, Labor and Pensions Committee, asked about reconciliation, noting that the previous nominee foreswore the mechanism. Enzi remarked that should Democrats resort to reconciliation, "it would be an indication that the other side won't listen because they don't need to listen," a reference to the solid majority enjoyed by congressional Democrats.

Sebelius refused to make a comment specific to reconciliation, answering only that "I've already learned some important lessons" about how to make legislation pass, given her history as "an elected official in a minority party."

AHRQ: Colorectal cancer diagnoses flat

Colorectal cancer (CRC) screening has been a hot topic in healthcare and medical technology circles thanks to the fact that this is the third most lethal of all cancers, and the Agency for Healthcare Quality and Research recently released figures from its Hospital Cost and Utilization Project that indicates that while the disease has not gone down, it hasn't gone up either.

According to AHRQ, the number of hospitalizations related to CRC in 2006 totaled more than 571,000, which comes to a rate of more than 191 stays per 100,000 population. However, that flat overall number is derived from mixed numbers under the surface. AHRQ states that the numbers, crunched from community hospitals, show that the rate of hospitalizations between 1995 and 2006 for CRC as a principal diagnosis fell by 15%, but that patients admitted with CRC as a secondary diagnosis rose by the same 15%.

As might be expected, the rates of hospitalization for CRC "is dramatically higher among patients 65 years and older," the April 6 report notes. Men aged 65 and older had the highest rates of hospitalization for CRC. The report pegs the rate of admissions for patients 65 years and older at more than 254 stays per 100,000 population for principal diagnoses, and a rate of 818 stays per 100,000 for secondary diagnoses.

There was a considerable geographic disparity in the distribution of diagnosed cases of CRC. According to AHRQ, residents of the Northeast were hospitalized for CRC at a rate of 247.6 stays per 100,000 while those living in the West had the lowest rate at 135 stays per 100,000. On the other hand, most of this was from CRC as a secondary diagnosis. Primary diagnoses were said to be roughly equal among the Northeast, the Midwest and the South, but secondary diagnoses of CRC in the Northeast were roughly 192 stays per 100,000 population, which was more than double the rate of 95.8 stays per 100,000 in the West.

As is so often the case, the distribution by sex is uneven for CRC, but the numbers are close before adjusting for age. The agency states that men accounted for 49.5% of all stays for CRC as a principal diagnosis, and 48.6% for CRC as a secondary diagnosis. On the other hand, men over the age of 65 were said to have been admitted for primary diagnoses 20% more often than women, and 24% more often for secondary diagnoses.

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