When you’re trying to learn more about the health workforce, you may want to search the Health Workforce Information Center. February marks the one year anniversary of the launch of the center, a free online library of health workforce resources funded by the Health Resources and Services Administration (HRSA). If you haven’t already made use of our website or reference services to find statistics, funding, program ideas, or other information, check it out http://www.healthworkforceinfo.org/.
Archive for the ‘Health Reform’ Category
February 27, 2010
Obama’s Health Summit: Not a Quadruple or Even a Triple Lutz
Was anything accomplished at President Obama’s health care summit on Thursday? Some policy wonks did not even turn on the TV, so interest is apparently lagging at this point. Who calls a summit in the middle of the Olympics, when any accomplishment pales in comparison to the thrill of watching snowboarders, skiers, Apolo Ohno or the South Korean skating queen?
Much time was spent on niceties and posturing on bipartisanship (mostly that health care costs money), and very little on substance (except that health care costs money). The president is still not clear on what he stands for (except that health care costs money) even though he put forth a slightly modified version of the Senate bill as his plan. Americans want to know about being cared for–not about money. The President did not have a clear message about why the Congress should pass legislation that is not a true overhaul of the system.
The President has a messaging problem; the Republicans do not. The Republicans are saying “start over.” The other simplistic Republican answer–medical malpractice reform– also came across more clearly than the President’s analysis of the costs of insurance premiums. The President spent too much time on the intricacies of lawmaking, turning the summit into a high school civics class.
The American people want the President to be stronger–to say that health care is a right and that the President will not negotiate on that issue and will only work toward legislation that covers and protects all Americans and does not put money in the pockets of health insurers. Only Senator Jay Rockefeller of West Virginia, with his analogy of insurers to sharks, brought clarity –and some emotion–to the day.
Americans don’t want to hear about the market based approach to health care, words that the President used too often. Americans know that’s what got us to the place where we are today. Such rhetoric breeds fear not favor in the hearts of most Americans. The President is having a hard time with the message because his legislation does not back up the promise of the campaign.
Some credit must be given to the summit participants who sat for 7 hours in THOSE CHAIRS–typical uncomfortable seating for weddings or bar mitzvahs when half the time is spent on the dance floor. No wonder nothing happened.
December 17, 2009
Bernie Sanders and George Will Got It Right on Health Reform
Two people recognize the health reform bill is not reform and are signaling that we need to start anew.
Sen. Bernie Sanders, the Independent from Vermont, is telling the world that the proposed legislation is not good. Yesterday, he said that he could not accept the health reform bill in its current form because it does not control costs or rein in health insurance companies. More important, Senator Sanders showed the courage of his convictions and brought a real answer to the Senate and the American people. He proposed a single-payer amendment to the current bill. In calling up his amendment, Sanders said, “For the first time in American history, the Senate will debate a proposal to create a single-payer, Medicare-for-all health care system.” Unfortunately, Senator Tom Coburn (R-Okla.) objected to Mr. Sanders’s request to dispense with the reading of the 767-page amendment (as called for earlier by Coburn). After nearly three hours of listening to a team of Senate clerks read the proposal, Mr. Sanders gave up and withdrew his amendment (Why, Bernie? There’s nothing to fear but fear itself.)
(Of course, Coburn knew that would be the outcome because the dealy would prevent a vote on a funding bill for the Department of Defense. The current funding provision expires at midnight tomorrow).
George Will reflects today in The Washington Post on the latest CNN poll showing that 61 percent of the public oppose what the Democratic Senate is trying to do to health care. “It is clear what the public wants Congress to do: Talke a mulligan and start over.”
Bernie and George are both saying that what we have is not good enough. President Obama should say the same and ask for the creation of a “super special” congressional committee to start anew in January. Health reform before the holidays may not make the season jolly.
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December 10, 2009
Medicare Clinical Trial Policy: Health Reformers Not Paying Attention
With all the talk about Medicare in health reform, it’s troubling that no attention is being paid to access to clinical trials for Medicare beneficiaries. The nation’s clinical trial policy (CTP), which was designed to expand participation in clinical trials by Medicare beneficiaries, is inlimbo at the U.S. Department of Health and Human Services (HHS) and both the Administration and the Congress need to wake up to a problem area. The Association of Academic Health Centers (AAHC) has been putting the issue before policymakers for quite some time, and most recently asked the regulatory czar, Cass Sunstein, administrator of the Office of Budget and Management, to turn his attention to the CTP as well.
An essential step to improving health care is for the Department of Health and Human Services, specifically the Centers for Medicare & Medicaid Services (CMS) to more effectively support the innovative and life-saving therapies available during clinical research studies. The AAHC has urged the CMS to reassess the CTP to resolve the problems that emerged after its hasty establishment in 2000 but have not been addressed in an appropriate or satisfactory manner to date.
The AAHC requests CMS to revise the CTP to ensure that its intended goal of opening new realms of treatment for Medicare beneficiaries can be achieved.
The CTP’s current wording, and CMS’ deference to Medicare contractors in its interpretation, has produced inequitable disparities in coverage among different regions of the country. The Medicare program’s CTP, as currently constituted, not only inhibits access to clinical trials for Medicare beneficiaries, but also endangers the clinical research enterprise in the United States, by imposing a disproportionate compliance burden on the inclusion of Medicare beneficiaries in clinical trials.
This is particularly troublesome given that the clinical enterprise is critical to having the U.S. remain a world leader in health. The aging of America’s population and the need for new treatments and cures for cancer and other diseases that disproportionately strike the elderly are the transformational forces motivating our call for change. The uneven application of the CTP has been a particular concern for our members in coverage of services during clinical trials relating to cancer, HIV and other medically and financially devastating diseases. By discouraging Medicare beneficiaries from participating in clinical trials, the CTP:
HHS needs to ensure that CMS acts now to:
• Reconsider the Medicare Clinical Trial Policy;
• Make immediate changes to the current CTP related to Medicare coverage to explicitly cover Phase I drug trials;
• Establish a position at CMS to oversee and coordinate Medicare coverage policy during clinical trials and to interact with other HHS agencies on clinical research; and
• Establish an interagency taskforce within HHS to harmonize regulations of CMS, the National Institutes of Health (NIH), the Agency for Health Research and Quality (AHRQ), the Food and Drug Administration (FDA) and other agencies that affect clinical research.
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.
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.
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.
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:
- Make development and implementation of an integrated, coordinated, strategic national health workforce policy the primary objective of any advisory committee or national commission.
- 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.
- 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.
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.
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.
