November 03, 2009
The Honorable Harry Reid
Senate Majority Leader
S-221 Capitol Building
Washington, DC 20510-7020
RE: Health Workforce Provisions in Pending Health Reform Bills
Dear Majority Leader Reid:
On behalf of the Association of Academic Health Centers (AAHC), I am writing to urge you to ensure that health reform legislation creates an integrated, coordinated national health workforce policy. The AAHC reviewed health workforce provisions contained in pending House and Senate health reform legislation and made four recommendations for improving the proposed provisions to the Committees with jurisdiction over the legislation. Last week House Speaker Pelosi released a health reform bill that incorporates the first (and most important) of these recommendations. The AAHC urges you to incorporate all four recommendations in any health reform legislation scheduled for a Senate floor vote.
The AAHC’s Health Workforce Recommendations
The AAHC recommends the following four modifications be made to any health reform legislation considered by the Senate.
- Make development and implementation of an integrated, coordinated, strategic national health workforce policy the primary objective of any advisory committee or national commission.
- Amend the list of 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 selfregulatory standards (e.g., licensure, scope of practice, accreditation).
- 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.
- As an interim step until an advisory committee or national commission is fully functional, create a national health workforce coordinator to assess current federal capabilities and prepare agencies for their interactions with the committee/commission.
Why These Modifications Are Needed
The nation’s current health workforce policymaking and planning infrastructure is inadequate to meet existing health workforce challenges, much less the additional challenges posed by health system reform. Historically, health workforce policy has been fragmented among hundreds of federal, state and private entities that often respond to policy needs in isolation and with little coordination. Many of the problems facing the health workforce – including, but not limited to, shortages in many health professions – are a consequence of this lack of coordination because it limits policymakers’ ability to address urgent national needs in an integrated, comprehensive, and effective manner.
Committee-passed bills include expansion of, and improvements to, current health workforce programs. The effectiveness of these program expansions and improvements will be significantly diminished, however, without creation of a mechanism to coordinate them not only among disparate federal agencies with health workforce-related responsibilities, but also with the hundreds of state agencies and private standard-setting bodies that also impact the health workforce. To date, federal health workforce-related agencies have failed to develop and implement a coordinated national policy; there is no reason to expect them to successfully address past failures without considerable assistance.
Each Committee-passed bill creates either an advisory committee or a national commission to examine enumerated health workforce needs and make periodic reports and recommendations. Only the Senate Finance bill recognizes the crucial importance of integrated, coordinated policymaking by expressly making development of a national workforce strategy the primary objective of the advisory process. The AAHC strongly agrees that the customary piecemeal approach to health workforce policymaking is inadequate, and urges that any health reform legislation you bring before the full Senate adopt this strategic national policy approach.
The AAHC’s Commitment
The AAHC represents more than 100 academic health centers, with a mission to improve the nation's health care system by mobilizing and enhancing the strengths and resources of the academic health center enterprise in health professions, education, patient care, and research. We believe that health workforce reform is an essential element of successful health system reform. We are committed to working with you to achieve health system reform and to develop an integrated national health workforce policy agenda that adequately addresses the factors contributing to the erosion of the nation's health workforce.
Sincerely,
Steven A. Wartman, MD, PhD, MACP
President/CEO