Archive for October, 2009

October 30, 2009

House Health Reform Takes AAHC Health Workforce Recommendation: More Needed

Yesterday, House Speaker Nancy Pelosi (D-Cal.) unveiled proposed health reform legislation from the House.  Put together from the work of three House Committees the bill  includes a public option. 

Also significant, the legislation also now includes language identical to the recommendation made by the Association of Academic Health Centers (AAHC) that a permanent health workforce advisory committee develop and implement “an integrated, coordinated, strategic national health workforce policy.”  The AAHC has advocated for a national workforce planning entity because it believes that the nation’s workforce policy must be changed; the nation’s customary piecemeal approach to the workforce is no longer viable or appropriate for the 21st century.

A  comparable Senate bill is still being negotiated. The Senate should not only include such language in any final bill but also move to ensure the creation of a permanent planning entity that operates continuously, makes ongoing findings and recommendations, and is available at any time to provide consultative support to federal, state, and private health workforce stakeholders. The planning entity must serve as an active policymaking partner, not a passive advisor.

The AAHC has been urging the congressional committees and congressional leadership to broaden the scope of activity of the proposed advisory committee/national commission to fully support a strategic national policy approach.

Specifically, the AAHC recommends the following modifications be incorporated into any health reform legislation considered by the full House and Senate:

  1. Make development and implementation of an integrated, coordinated, strategic national health workforce policy the primary objective of any advisory committee or national commission.
  2.  Constitute the advisory committee or national commission as a continuously available policy research and consultative resource, not simply as a body of external experts that convenes from time to time to make periodic recommendations.
  3. Amend the enumerated issues to be addressed by the advisory committee or national commission to include the harmonization of conflicting national and state-based regulatory and private self-regulatory standards (e.g., licensure, scope of practice, accreditation).

4.    As an interim step, create a national health workforce coordinator to assess current federal capabilities and prepare agencies for their interactions with the advisory committee or national commission once it is fully functional.

 This is the way to ensure that the nation  has the health workforce it needs for the short and long-term.

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October 29, 2009

Create Health Workforce Jobs for U.S. Economic Recovery

We all know that the employment picture in the U.S. continues to be dark. One in 10 Americans who wanted a job last month were unemployed. What many do not know is that private sector employment growth fell short of the number of new people entering the labor force by more than 500,00 jobs each year throughout the 1990s! The bottom line: Economists say the U.S. job creation engine has been stalled for the better part of a decade.  New enterprises are not coming on line. As older industries die, established industry and entrepreneurs are not entering the market place and using capital to create jobs.

 So where will jobs come from? Health care is an obvious choice. It’s time for a public policy to support this growth industry with a Jobs Bill for Health Care (similar to the post World War II GI bill). The bill would provide funds to train all comers – from the returning war vets to the unemployed, from the dying manufacturing industries to the recent high school graduates. This will produce not only the health workforce that the U.S. so desperately needs in the near and long term but also create a “product” that can be exported overseas – trainers for other countries’ healthcare challenges.

 In addition to direct investment, the government should ensure funding from the insurance industry and providers who do not now train health professionals but depend on the health workforce . Let’s ensure the health and economic future of the United States with a public-private partnership that makes sense.

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October 22, 2009

Interprofessional Education and Practice: Infrastructure Needed to Go From Rhetoric

For years there is talk about interprofessional teams.  For more than 20 years, educators and policymakers have put this forth as part of the health care vision for the 21st century.  It is also directly and indirectly referred to in health reform legislation before the Congress.  Policymakers are enamored of the idea of an interprofessional team of caregivers providing patient centered care (whatever that means).

 I learned about some of the latest innovations in  interprofessional programs in academic health centers throughout the nation.  Students from two or more health professions are educated together and/or engage in practice together and, in so doing, are not only improving the learning environment but also patient care and outcomes.

 

Rural practitioners tend to embrace interprofessional practice more fully than practitioners anywhere else in the country for obvious reasons.  However, in the last decades, interprofessional education has not gone mainstream and been fully embraced by health professions schools and academic health centers.  Interprofessional activities have been person directed (by a passionate advocate), thus remaining at the margins of health professions education.  Passion on the part of institutions is not quite as evident.

 What’s the problem.  Money is always an issue.  With universities and hospitals waiting for the next budget cut, institutions are hampered from creating new programs so needed for the future.  In addition, we still don’t have enough evidence that such practices make a difference.  There has not been enough study of the long-term impact of interprofessional initiatives.  Research is needed.  And that also cost money. Regulations don’t support it.  State licensing boards and accreditation agencies often inhibit innovation within institutions. Scope of practice laws are barriers to interprofessional practice.  Faculty incentives are still based on what makes a difference to the “profession,” whichever that may be—thus making it hard to engage appropriate teachers in the process. Finally, the current health care delivery system—specifically the reimbursement system—does not support interprofessional practice—and may not support it for the future. 

 The bottom line:  Interprofessionalism lacks focus.  There is no standardization, no uniformity anywhere in the nation.  There is no framework for programs, policy or practice.  There is no infrastructure and no guidelines for establishing the infrastructure that is needed within institutions, particularly academic health centers where most of health professions education takes place.    To fill this void, leaders of academic health centers are engaging on the issue—not only to mainstream interprofessional education and practice but to educate policymakers about the best way to deliver care for the future.

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October 20, 2009

Challenges for the Health Care Sector

I recently returned from the World Health Summit in Berlin, a large substantive meeting dealing with many aspects of health and well-being.   On one of the meeting’s many panels, I was asked to address what the health care sector needs in order to thrive.  In thinking somewhat about this topic, I decided to focus on the serious challenges that health care, from a global perspective, faces, and chose to comment on five of them.

1. Increasing Dualism.  By this I refer to the growing health disparities that exist within and among countries, as well as the significant gap between what we know scientifically and what we practice clinically.

2. Overextension of the health system, such as in needed responses to pandemics, wars, natural or man-made disasters, emerging diseases, behavioral and planetary changes, and so forth.

3. Loss of Focus on the Patient and the Community.  Here the concern relates to growing economics of health care and the delicate balance between seeking profit and good health.

4. Shortage and Maldistribution of Healthcare Workers.  Readers of this Blog should not be surprised by this one.  These shortages range from a general lack of practitioners to specific kinds of medical specialties, and include ethical issues of the international migration of health workers.

5. Support of Research.  Research is a critical engine of progress for health care delivery.  Continuing the flow of these dollars and directing them to areas with the highest yield remain substantial challenges.

There has never been a more relevant opportunity for those institutions educating the next generation of health professionals, conducting biomedical and clinical research, and caring for patients to work together collaboratively.  In response, AAHC International has been created to foster the concept of an international academic health center community driven by the ideal of improving the public good.

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October 15, 2009

Olympia Snowe’s Trigger Will Shoot Americans in the Foot.

What qualifies Olympia Snowe to be the arbiter of health reform?  Her health reform option is nothing to write home about.   Snowe would have states get a government-run plan–a public option– if at least five percent of residents lack access to affordable care.  Congress should not create a subpar Medicaid option–something only for the poorest in our society–rather than a true health plan for all Americans.  

What is “affordable access to care,” according to Olympia Snowe?  How will states decide that they have  more than five percent of the population who qualify?  Who decides how much a health plan will cost?  Who decides what the plan will cover–and for how long?  What about the middle class people–with coverage–who are now going bankrupt because of their medical bills?  Will they be in the five percent?  

Who decides at what point premiums get raised–or that certain conditions will no longer be covered?  What about the family with the 17 pound baby who was denied health insurance coverage and deemed to have a pre-existing condition–obesity– by the health insurers?  Will his family be counted? Maybe it takes 17 pounds to pull the trigger?

Here’s the bottom line: With a true public option, Americans would not have to ask those questions–or worry now about what a public option means.  Olympia Snowe’s “trigger” is just another way of shooting ourselves in the foot!  It’s time to stop playing games and have a real public option as an American right.

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October 8, 2009

Include Health Workforce Planning Entity in Health Reform Legislation

It’s still not too late to put a national workforce planning entity into health reform legislation (or I am supposed to say health insurance reform).  This would neither be a commission nor a short-term advisory or research group. This would be a permanent entity–perhaps a quasi-governmental organization that has some clout–not only to bring constituencies together but also to get things done that change the shape of health workforce policy in this nation.  The goal–plan so that the health workforce can care for the American people now and in the future.

Academic health center CEOs said as much this week when they told congressional staff and representatives of national health care organizations at a congressional briefing that pending health reform legislation(including the Senate Finance Committee proposal) does not yet reflect the strategic emphasis on health workforce needed to implement successful health system reform.

  “Pending bills include numerous important workforce-related provisions, but they lack sufficient means to effectively coordinate workforce policy among federal, state, and private laws, regulations, and standards,” said Dr. Steven A. Wartman, President and CEO of the Association of Academic Health Centers (AAHC).

Dr. Wartman was joined in the panel discussion by: Dr. Nancy Dickey, President, Texas A&M Health Science Center, and Vice Chancellor for Health Affairs, Texas A&M University System, and past chair of the AAHC Board of Directors; Dr. Philip A. Pizzo, Dean, School of Medicine at Stanford University, and chair of the AAHC Board of Directors; and Dr. M. Roy Wilson, Chancellor, University of Colorado Denver, and a member of the AAHC Board of Directors.

 Dr. Wilson told the group that the nation must have a national agenda for the workforce.  Without such an effort, federal, state and local governments and agencies will continue to work in isolated silos as they attempt to solve workforce issues.

 Dr. Dickey emphasized that health workforce reform has to start today so the nation can build a viable infrastructure and rationalize our health workforce policy.  With a permanent national workforce planning body, the nation can address the full range of workforce issues — from shortages and geographic disparities, to regulatory and policy conflicts that prevent health professionals from practicing to the full extent of their training, to the paucity of reliable data on the workforce — in a comprehensive and coordinated manner.

 Dr. Pizzo cautioned that when policymakers consider changes in health care reimbursement, they must take account of the unique academic health center education and research missions, which in part are dependent on clinical revenues.  The nation must ensure that reimbursement reform does not financially undermine these academic health center missions that are so vital to the nation’s economy and its preeminence in education and research worldwide.

 “Comprehensive health workforce reform is necessary for successful health system reform, and the key to health workforce reform is creation of a permanent, ongoing health workforce planning body,” concluded Wartman.

It’s about health care.  It’s about jobs.  It’s about the economic future of the nation.  We can’t make the health workforce a second-class issue.

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October 2, 2009

Congress: Listen to the Academic Health Center Leaders on Health Reform

I heard today that congressional staffers are “punch drunk” from logging in so many hours working on health reform.  I am not comforted by that thought given they are trying to  write one of the most significant pieces of legislation in decades.  I am  wary of the urgent rush to produce something—good or bad—to show that Congress is not twiddling its thumbs.  Does the Congress really have all the facts?  Or are they also developing legislation based on minimal or biased information, evidence, experience, or truth?

 I would point to an opinion piece in the LA Times by Dr. Philip Pizzo, dean of the school of medicine of Stanford University and chairman of the board of the Association of Academic Health Centers, where he wrote, “Undertaking such an important shift in how we deliver healthcare requires a robust national debate.” With the members of Congress getting ready to say yea or nay on health reform,  we still have not had sufficient debate from all sides.  The nation has heard too much from those leaders who, as Dr. Pizzo says, “choose to rely on fear instead of facts to make their case.”

 Before the votes get counted, we need to hear from the patients who really use and have experience with the health care system as it exists today.  We need to hear more from the leaders of the nation’s academic health centers–some of the most experienced experts on health care in the nation.  Most are physicians who not only have practiced medicine for decades but also have had distinguished careers in academe (and sometimes government).  Most of all, they know what it means to lead and operate an institution, without which our communities–and the health system–cannot function. 

These leaders, who also include nonphysicians, can tell us about patient care, the impact of health on communities, the health and economic consequences of  having no insurance,  and the problems with the current reimbursement system.  They can tell us what it is like to run health professions schools–from medicine to allied health,   major departments at a children’s or other teaching hospital, or an entire teaching hospital or  health system–and what facilitates or impedes care delivery.  

Academic health center leaders are the people at ground zero, making sure that the nation can provide health professions education, biomedical research, and patient care.  They are sustaining the infrastructure that may determine the nation’s future.  Congress should be listening to these voices of experience and reason.

Academic health center leaders know what it takes to provide patient care and sustain a health system in challenging economic times. They not only know the problems but also how to resolve them.  Academic health center  leaders for example, will tell the Congress why we need to establish a permanent workforce planning entity or board so we can resolve primary care shortages and rural health problems–and  ensure the nation has a health workforce for the future.  

Congressional staffers—stop running on empty and get MORE input, advice, and recommendations from the academic health center community.

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