The Senate has reached a tentative agreement on food-safety legislation and will brief staffers Thursday, a Senate staffer said, although it's still unclear how the bill might move forward. The panel is also scheduled to post the manager's package and a Congressional Budget Office score, another source said.

Food safety advocates immediately applauded the news.

"It's a clear signal that this is going to happen when they come back in September," said Sandra Eskin, director of the Pew Health Group's Food Safety Campaign.

The Senate bill, introduced by Dick Durbin (D-Ill.), cleared the Senate health panel late last year on a 16-0 vote.

The House passed its own version of food safety legislation in July 2009.

Rep. Wally Herger (R-Calif.) on Tuesday filed a discharge petition aimed at forcing the House to vote on repeal of the Democrats' new healthcare reform law — the second such GOP effort this year.

The first petition, sponsored by Rep. Steve King (Iowa), made headlines after GOP leaders — including House Minority Leader John Boehner (Ohio) and Republican Whip Eric Cantor (Va.) — showed an early reluctance to endorse the measure.

They won't attract the same attention this time around: Both Boehner and Cantor have already signed onto the Herger measure. 

"The more the American people learn about ObamaCare," Boehner said in a statement, "the less they like it. We need to repeal it, and start over on common-sense, step-by-step reforms to lower costs."

Still, the issue has caused something of a rift in conservative circles over the Republican strategy for attacking the Democrats' healthcare law. The King proposal would repeal the reforms outright; Herger's legislation would repeal the law and replace it with a Republican alternative.

Some conservatives have slammed GOP leadership for potentially dividing the Republican caucus over the issue.

"Notice that Cantor and Boehner were absolutely silent on Rep. King’s efforts until they had Wally Herger’s discharge petition ready to go," Red State's Erick Erickson wrote in June. "Why? Because they want to bully Republican House members into signing the Herger petition and undercut the repeal effort with a '[repeal] and replace with lame legislation' effort. 

"In effect," Erickson added, "this undercuts a unified repeal effort and muddies the waters."

The discharge petition, which requires 218 signatures, allows lawmakers to circumvent both the committee process and House leadership by pulling legislation directly to the floor.

The Environmental Protection Agency (EPA) on Tuesday is warning consumers that bedbug-battling pesticides, applied improperly, could make consumers' homes unlivable.

"Using the wrong pesticide or using it incorrectly to treat for bedbugs can make you, your family, and your pets sick," the EPA said in a consumer alert. "It can also make your home unsafe to live in — and may not solve the bedbug problem."

With bedbug infestations on the rise in urban centers around the country, more and more consumers are reaching out to extermination companies for relief. That's led to a subsequent rise in the number of those companies, which don't always apply their chemicals correctly, EPA warns. 

In fact, the agency suggests consumers should avoid chemical solutions altogether. 

"Prevention and non-chemical treatment of infestations is the best way to avoid or eliminate a bedbug problem," EPA suggests.

Examples of preventative measures, the agency says, include frequent vacuuming, filling wall cracks and wrapping mattresses in bedbug-proof covers.

If consumers are intent on going the pesticide route, EPA says, they should first:

• Make sure the chemical is approved for fighting bedbugs. "If bedbugs are not listed on the label, the pesticide has not been tested for bedbugs and it may not be effective."

• Check that the pesticide has EPA approval. "Any pesticide product label without an EPA registration number has not been reviewed by EPA to determine how well the product works."

• Make sure the chemical is designed for use indoors. 

The consumer alert comes less than a week after the EPA joined forces with the Centers for Disease Control and Prevention to highlight the public health dangers surrounding the "alarming resurgence" of bedbug infestations in recent years.

"Many people have mild to severe allergic reaction to the bites with effects ranging from no reaction to a small bite mark to, in rare cases, anaphylaxis (severe, whole-body reaction)," the agencies wrote. "These bites can also lead to secondary infections of the skin such as impetigo, ecthyma, and lymphanigitis. Bed bugs may also affect the mental health of people living in infested homes. Reported effects include anxiety, insomnia and systemic reactions."

House Republicans are arguing the $26 billion state-aid bill scheduled for a vote Tuesday is not fully offset, contrary to what Democrats say.

The bill, which includes $16 billion in enhanced federal Medicaid payments for states and $10 billion in education funding, is paid for in part by promised cuts to future spending.

House Budget Committee Republicans argue some of those cuts target "emergency" spending, which cannot be used to offset new spending under pay-as-you-go rules. As a result, the GOP calculates, the bill would increase the statutory PAYGO deficit by $12.634 billion during 10 years.

Responding to concerns that new tax filing law will hobble small businesses, Senate Democrats last week proposed to scale back their newly enacted paperwork requirements.

But don't hold your breath for Sen. Mike Johanns's endorsement. The Nebraska Republican, who's leading the charge to repeal the new filing requirement altogether, says the Democratic alternative would still cripple businesses with expensive new paperwork burdens.

"The alternative is complicated, unfair and impossible to administer," Johanns said in a statement last week. "It hurts small businesses, costing them money on useless paperwork and discourages hiring."

At issue is a provision of the Democrats' new health reform law requiring businesses to file 1099 forms with the IRS when goods purchased from another business, even a corporation, exceed $600 in a year. 

Under previous law, businesses had to file 1099 forms only when purchasing services, not goods, and only when those services were provided by unincorporated entities, not corporations.

Behind the U.S. Chamber of Commerce, the business community has cried foul, leading Senate Democrats last week to propose relaxing the new filing requirements, which take effect in 2012.

Sponsored by Sen. Bill Nelson (D-Fla.), the Democrats' proposal would eliminate the filing requirement for small businesses — those with fewer than 25 employees — purchasing goods from other businesses, either incorporated or not. It would also hike the threshold for larger businesses reporting purchased goods — from $600 to $5,000 — and exempt all purchases made with a credit card.  

The nuanced approach has done nothing to satisfy Johanns, who's urging a decidedly unnuanced full repeal of the new filing requirements. 

"If you are a business owner with 25 employees, why would you hire more if your reward is a mountain of new tax paperwork?" he said. "This approach simply defies logic at a time when our country continues to struggle with high unemployment."

A procedural vote on Johanns's amendment is scheduled for September 14, when Congress returns from its summer vacation. The Senate is then expected to move immediately to the Nelson proposal.

Mississippi Gov. Haley Barbour (R) says he doesn't want the Democrats' $26 billion state aid bill. The bill would provide $16 billion in enhanced Medicaid funding and $10 billion in education dollars.

"The bill as passed [by] the Senate will force Mississippi to rewrite its current year (FY11) budget," Barbour said in a statement. "Preliminary estimates of the Mississippi Department of Finance and Administration show that we will now have to spend between $50-100 million of state funds — funds that must be taken away from public safety, human services, mental health and other state priorities and given to education — in order for an additional $98 million of federal funds to be granted to education. There is no justification for the federal government hijacking state budgets, but that is exactly what Congress has done."

The nation's anesthesiologists are pushing back — and hard — against a new report urging repeal of Medicare rules that require physician supervision of certified registered nurse anesthetists (CRNAs).

The report, sponsored by the American Association of Nurse Anesthetists (AANA), an industry group, found that patients fare just as well when CRNAs treat them unsupervised as when physicians oversee the process.

"We don't find any statistical differences for CNRAs working alone," said Jerry Cromwell, senior fellow at the Research Triangle Institute (RTI) and co-author of the report, which appeared in the latest issue of Health Affairs. 

Cromwell has joined the AANA in calling on the Centers for Medicare and Medicaid Services (CMS) to repeal the physician supervision requirement.

But don't try to convince Alexander A. Hannenberg. The president of the American Society of Anesthesiologists (ASA) said this week that the RTI report is nothing but "purchased junk science" reminiscent of the tobacco industry finding that cigarettes are safe. In a phone interview Monday, Hannenberg argued anesthesiologists provide valuable medical services that the lesser-trained CRNAs simply can't, and he has a laundry list of things he said undermine the RTI findings. 

FMAP's BIG DAY

Governors finally get to breathe a sigh of relief if the House, as expected, passes the Senate's state-aid bill, which includes $16.1 billion in extra Medicaid funds and $10 billion in education help.

The first votes are expected around noon, according to a GOP e-mail, but could take place as early as 10 a.m. Members expect to be off the floor by 3 p.m. or 4 p.m. Next votes: Not before 6 p.m., Sept. 14.

HEAD OF EXCHANGES NAMED

Pennsylvania Insurance Commissioner Joel Ario will help create the new state health insurance exchanges created by the healthcare reform law, Pennsylvania Gov. Ed Rendell announced in naming Robert Pratter as his replacement. Ario becomes director of the Office of Insurance Exchanges within the Office of Consumer Information and Insurance Oversight at the Department of Health and Human Services.

Preventable medical errors cost the country $19.5 billion in 2008 — or roughly $13,000 for each avoidable case, according to a report published Monday by the Society of Actuaries (SOA).

And that number is likely low, according to consultants at Milliman, who crunched the data. 

"We used a conservative methodology and still found 1.5 million measureable medical errors occurred in 2008," says Jonathan Shreve, an actuary for Milliman who co-authored the report. "This number includes only the errors that we could identify through claims data, so the total economic impact of medical errors is in fact greater than what we have reported."

More than half of those costs were associated with just five avoidable medical injuries: pressure ulcers; post-op infections; mechanical troubles with devices, implants or grafts; post-laminectomy syndrome; and hemorrhages.

Aside from the direct financial effect, the 2008 errors also resulted in more than 2,500 avoidable deaths and more than 10 million missed work days.  

The report arrives as lawmakers are hoping to rein in the skyrocketing cost of healthcare by reducing waste and linking provider payments more closely to the quality of the care delivered, not just the quantity.

If the SOA study is any indication, there's plenty of savings out there to be had.