Archive for the ‘Policy’ Category
February 5, 2010
President Obama –and the Congress for that matter–need to focus on JOBS in the HEALTH WORKFORCE. The Bureau of Labor Statistics reports that the health sector ranks high among the areas that will provide the greatest number of new jobs over the next decade. Four million jobs will be created in the health care sector will be a leader in producing new jobs, including high-skill, high-paying jobs like doctors and nurses. Among the top ten occupations needed will be: Registered nurses, home health aides, personal and home care aides, and nursing aides, orderlies and attendants.
With the aging baby boomer population, the need for a greater number of trained people in the health professions goes well beyond nurses and home care workers. Shortages across the professions will be exacerbated by the retirement of physicians, nurses, pharmacists, dentists and other professionals. In 2004, 23 percent of licensed pharmacists, for example, indicated they were leaving the profession within the year and 80 percent of pharmacy directors said they would leave within the decade. Substantial retirements of faculty in all schools of the health professions add to the problem.
With the overwhelming need for a health workforce for the nation, President Obama should be focusing his Jobs Initiative on education and innovative training programs for the health workforce. President Obama should be looking for ways to provide incentives to academic health centers and their health professions schools for new ideas and innovative ways to develop a quality health workforce in a short time frame.
One way is to receive funding and other incentives to create new career ladders for those people who are already employed within the health system and want to raise their skill levels and receive education in one of the more-skilled professions (and this can include the myriad allied health, imaging, medical records and IT jobs that are critical to the system).
There should also be funding to health professions schools to create innovative, perhaps fast tracked, retraining programs for the thousands of people who are losing their jobs in America’s dying manufacturing industries.
The Obama Administration needs to look beyond small business and the green industries with regard to JOBS. The health workforce should be the priority when it comes to jobs.
Tags: Academic Health Cdnters, allied health professions, Bureau of Labor Statistics, dentists, Health, Health care, health professions schools, health professions shortages, Home Health, job retraining, job training, jobs, Nursing, pharmacists, physician shortages, president Obama, Registered nurse, Service Providers, United States
Posted in News, Policy, health workforce, jobs | No Comments »
December 17, 2009
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.
Tags: George Will, Health care, health insurance, health policy, Health Reform, president Obama, Senator Bernie Sanders, Senator Tom Coburn, Single-payer health care, United States, United States Congress, United States Senate, Washington Post
Posted in Health Reform, Policy, health insurance, president Obama | No Comments »
December 10, 2009
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.
Tags: association of academic health centers, Cass Sunstein, Centers for Medicare & Medicaid, clinical trial policy, clinical trials, Medicare beneficiaries, phase I clinical trials
Posted in Health Reform, Policy, clinical trial policy | No Comments »
December 3, 2009
Academic health centers, the core of biomedical research operations, are facing major research funding issues, as revealed in responses to a recent questionnaire from the Association of Academic Health Centers on budgets and research costs. Approximately 1/5 of member institutions have responded to date, and the findings raise great concern–not just for the institutions but also for the nation’s R&D, economic growth, and job development.
The approximate amount of unrecovered costs of research for the past fiscal year ranged from 8 to 40 percent, with almost half of the institutions in the 20-40 percent range. The same or higher amounts of unrecovered costs are projected for 2010. Only two institutions are projecting slight decreases of 1-2 percent.
Academic health centers are being required to take on increasing amounts of cost sharing on grants received from the federal government. The cost sharing issue was particularly evident in funding of the clinical and translational science awards (CTSAs), an NIH program launched in 2006 to transform the conduct of clinical research through multisite, multi-disciplinary research. CTSAs, while heralding major transformations in the nature, scope, and outcomes of biomedical research, are nevertheless an expensive undertaking. Current grantees noted cost sharing in the range of 15 to 50 percent annually, with the majority of institutions citing 25-50 percent in cost sharing.
Opportunities for new investigators and a strong pipeline of talent are always significant issues and signs of stability within a system. Such signs have not been positive for several years as reflected in the percent of first time RO1 grants awarded by the National Institutes of Health; the percentage of new RO1s have been on the decline for some time. Less interest by American students in seeking careers in academic research has also been an ongoing concern and does not speak well of the nation’s commitment to science and math education or, indeed, to higher education.
Academic health centers are experiencing increasing difficulties to fill the gap in research funding. Clinical practice revenues have been the traditional source of funds as academic health centers recycle monies from clinical practice into research endeavors. Several AAHC institutions said that 95-100 percent of funding comes from clinical revenues, which this year may be in grave danger depending on the outcome of health reform. Indications are that physician fees will be reduced, which in turn will result in cuts in reimbursement to academic health major reductions in monies available for the research enterprise.
For public institutions, monies are not available from the state. State budget cuts were noted in the range of 2-27 percent (in many instances this was the second, third, or even fourth year of decreases from the state). Decreased funding for endowments, which are particularly critical to funding at private universities, ranged from 9.9% to 30%, last year with the majority of institutions in the 18-25% range. For 2010, the projections for decreased funding ranged from 4-30 % for endowments and up to almost 25% for state funding.
These are only some of the critical warning signs of erosion of the research enterprise that call for review and reassessment of the nation’s commitment to and strategies for R&D and biomedical research, in particular, for the future. With many other nations and companies throughout the world now making investment choices that will have an impact on the next decade of technology development , the U.S. choices and policy on biomedical research are of profound importance. The nation needs to recommit to biomedical research and consider a new business model for the research enterprise for the future–one that is viable and sustainable and competitive in a global marketplace. This is what the Association of Academic Health Centers is now examining. Stay tuned for updates on this important endeavor.
Tags: association of academic health centers, biomedical research, research business model, research funding, research policy
Posted in Policy, U.S. Economic Growth, research | No Comments »
November 19, 2009
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.
Tags: Cass Sunstein, centers for medicare & medicaid services, clinical trials policy, health policy, insurance payments, kathleen sebelius, mammograms, Medicare beneficiaries, United States Secretary of Health and Human Services
Posted in Health Reform, Policy, clinical trial policy, research | No Comments »
November 11, 2009
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.
Tags: Congress, doctor-patient relations, Health Reform, House health reform bill, insurance industry, insurance rate increases, patient care, precertification
Posted in Health Reform, News, Policy, Uncategorized, health insurance | No Comments »
October 30, 2009
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.
Tags: association of academic health centers, Health Reform, health workforce, House health reform bill, nancy pelosi, national health workforce planning entity, national health workforce policy, Senate health reform bill
Posted in Health Reform, News, Policy, Uncategorized, health workforce | No Comments »
October 29, 2009
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.
Tags: GI Bill, Health Care Workforce Bill, Health Reform, health workforce, jobs, U.S. Economy
Posted in Health Reform, Policy, U.S. Economic Growth, health economics, health professions education, health workforce | No Comments »
October 22, 2009
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.
Tags: academic health center, clinical practice, health professions education, Health Reform, interprofessional education, interprofessional practice, rural health, team care
Posted in Policy, health professions education, health workforce | No Comments »
October 20, 2009
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.
Tags: biomedical research, health disparities, health needs, health worlkforce, international health workers, medical education
Posted in Health Reform, Policy, health workforce | No Comments »
![Reblog this post [with Zemanta]](http://img.zemanta.com/reblog_e.png?x-id=8c3e2ebd-1ff3-4407-a8d6-815f7edc1421)
