Archive for November, 2009

November 24, 2009

The Health Workforce and Health Reform: Progress Report

In the recently released Senate Bill on Health Reform, the establishment of a National Health Care Workforce Commission that “develops and commissions evaluations of education and training activities to determine whether the demand for health workers is being met” is proposed on page 1278.  (As an aside, I am concerned with the use of the word “demand” in the sentence, as the word “need” would more accurately reflect the spirit of true health reform).

Earlier this month, House Speaker Nancy Pelosi released the House’s proposal for reform, calling, on page 1275,  for the establishment of a “permanent advisory committee…[that would] develop and implement an integrated, coordinated, and strategic national health workforce policy relective of current and evolving health workforce needs.”

The Association of Academic Health Centers is pleased to see both recommendations, which in part reflect our advocacy efforts on Capitol Hill to make the health workforce a priority issue in health reform.

These Bills reflect some of the recommendations in our 2008 report Out of Order, Out of Time: The State of the Nation’s Health Workforce.  The report presented a comprehensive overview of health workforce policy (or, perhaps more aptly said, the lack of health workforce policy) and concluded that health reform cannot ultimately be successful without health workforce reform.  The report was widely circulated and followed up with testimony before the Senate Finance Committee, multiple meetings with offices in the White House, DHHS, and a variety of letters, news releases and so forth.

While neither the House or Senate Bill captures many of the critical recommendations in the AAHC Report, both attempt to address critical workforce issues and raise the significance of health workforce policy.   At this point, the fate of these Bills and the outcome of health reform is not known.  However, we are taking this opportunity before floor debate in the Senate to stress with the Congress the need for broad and comprehensive approaches to workforce policy, and the compelling need to connect the health reform with the health workforce.

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November 19, 2009

Mammogram Payment Leads to Empty Seat at CMS

The brouhaha about breast cancer screening is raising major concerns about who should get mammograms.  It is also heightening anxiety about whether mammograms will be paid for by Medicare and private  insurers.  Which leads me to the  Centers for Medicare & Medicaid Services (CMS), the government agency charged with responsibilities for health care  payments.  CMS, the agency with control over Medicare and Medicai,  is still leaderless even though more than a year has passed since President Obama took office. 

Secretary Sebelius, as secretary of Health and Human Services (HHS), presides over this agency and knows something about payments to insurers, having been an insurance commissioner back in Kansas.  With that background, she should know how critical CMS is to the functioning of the health care system. It is troubling that Secretary Sebelius has not taken action to fill what is the perhaps the most significant and essential slot in HHS.  At this critical juncture, there is no leadership in place to assess the structure and resources of CMS that will have the massive task of implementing any health reform legislation. 

Of great importance to academic health centers,  the Administration has not taken action on some of the most pressing issues for Medicare beneficiaries, which fall under the purview of CMS, specifically  participation of Medicare beneficiaries in clinical trials.  The current clinical trials policy hampers such participation.  In fact, the clinical trial policy threatens the nation’s ability to conduct clinical research and compete globally?  Secretary Sebelius and Mr. Sunstein, our new regulatory czar in the White House, have been made aware of the future dangers but have taken no action.   Why is CMS not an issue?  

Waiting for health reform is no answer.  The problems with CMS organization, resources, and policies will only be heightened.  Action must be taken now.  Nominating and appointing someone to head this agency is critical.

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Posted in Health Reform, Policy, clinical trial policy, research | No Comments »

November 11, 2009

Who’s Watching the Store? Congress Emboldens Insurers

The voluminous healthcare bill  passed by the House of Representatives last week overlooks several of the most egregious problems in our dysfunctional system.  Among them:

 Lack of meaningful oversight of the hugely expansive and expensive private insurance industry bureaucracy, resulting in rate increases that do not go to patient care. The most recent memorandum from the board of the group health insurance plan associated with my workplace shows double digit increases in the rate history of the medical plans provided by this group.  These are increases above inflation and cost of living and above the rate of any raises received by the average American. 

 Interestingly, some of the largest increases came in 2009, as health insurance reform started to move forward (from 12.4 to 28%, depending on the plan). Insurers are not stupid. They know how to make a fast killing as reform creeps forward and there is nothing to mandate that such actions do not continue into any reform era.      

 Tiered prescription and prescription precertification. Insurers are making medical decisions.  Insurance companies are mandating increasing numbers of medications must be pre-certified.  Insurance companies, not physicians, will tell you whether you are allowed to take the drug prescribed by your physician.  This is happening now and nothing in the legislation will prevent more of this in the future.

 Who will investigate the subversive practices that are emerging, such as demanding precertification for an ever-expanding list  of procedures and then denying payment (a practice that is growing at a startling speed)?  

 Will Congress now make a change and ensure strong oversight of this industry?  Who will monitor the rate increases?  What will be the penalities?  Who will enforce the law? Too many in the Congress have conflicts of interest when it comes to the industry–whether through contributions or spouses sitting on boards or lobbying for the industry. 

 The insurance companies have been emboldened by the ineffectiveness of Congress on health reform.  Until Congress can push back and ask the hard questions of the companies that over the last decade increased rates well beyond any cost of living or national standard, we will have no real reform.

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November 2, 2009

More on Interprofessional Education and Practice

As we have previously noted, interprofessional education and practice is somewhat of a buzz word these days.  While there might be an informal consensus of opinion that the health care of the future needs to involve meaningful integration of various health professions into patient-care teams, we have pointed out how the rhetoric in this area is far in front of the reality (see Oct 22 post).  We are aware of many fine institutions engaging in important interprofessional activity, but not enough has been done to focus on this issue at the national level.  At a recent meeting that we convened on the topic, the following observations emerged:

  • The current approach to interprofessional education is a study in grass roots development, as opposed to top-down leadership;
  • Interprofessional education and practice sometimes operate at the periphery of the institution, and are not engrained in the institutional fabric;
  • Attaining accurate predictions and assessments of the skill sets that will be required of health professionals in the future is vital;
  • Determining whether the “education tail” wags the “practice dog” or vice versa is important in developing the content and substance of these programs;
  • The drivers of interprofessional education and practice need to move beyond “belief” and be more empirically driven; and,
  • Health care reform may create demand for interprofessional education and practice by pushing to better  align health professional education with the evolving health care needs of the public.

Health care reform holds the potential to serve as a catalyst for disruptive innovation in health care, and, in so doing, bring interprofessional health care into the mainstream.  Indeed, the drive to create value in health care may lead to team-care as a paradigm that needs to be integrated with health professions education.

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Posted in Health Reform, Uncategorized, health professions education, health workforce | 1 Comment »