October 01, 2009
This letter was sent to the Chair and Ranking Minority Member of the House Committee on Education and Labor, Committee on Energy and Commerce, and Committee on Ways and Means, as well as the Senate Committee on Health, Education, Labor and Pensions, and the Committee on Finance.
RE: AAHC Recommendations, Pending Health Reform Bills
Dear Mr. Chairman / Ranking Minority Member:
The Association of Academic Health Centers (AAHC) has reviewed the health workforce provisions contained in pending House and Senate health reform legislation. The AAHC believes that health workforce reform is an essential element of success health system reform. We are committed to working with you to ensure that health reform legislation adequately addresses the factors contributing to the erosion of the nation's health workforce. Therefore, the AAHC offers four specific recommendations for improving the effectiveness of the health workforce provisions.
The AAHC recommends the following four modifications be made to 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.
- 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 self-regulatory 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. Rationale for New Approach
The AAHC proposes a new approach to health workforce policy because 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 policymaking and planning has been decentralized among hundreds of federal, state and private entities that often respond to policy needs in isolation and with little coordination. Many of the problems afflicting the health workforce -- including shortages in health professions that have received recent media attention -- are a consequence of this lack of coordination, which also limits policymakers’ ability to address urgent national needs in an integrated, comprehensive, and effective manner.
Each of the pending House and Senate Committee bills include expansion of and improvements to current federal health workforce programs. The effectiveness of these program expansions and improvements will be significantly diminished, however, without creation of a mechanism to coordinate these programs not only among the disparate federal agencies, but also with the hundreds of state agencies and private standard-setting bodies that also impact the health workforce. To date, disparate 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 of the pending bills creates either an advisory committee or a national commission to examine an enumerated list of health workforce needs and make periodic reports and recommendations. Only your mark recognizes the crucial importance of integrated, coordinated policymaking by expressly making development of a strategic national health workforce policy the primary objective of the advisory process. The AAHC strongly agrees that the customary piecemeal approach to health workforce policymaking is inadequate, and urges all the Committees to broaden the scope of activity of proposed policymaking bodies and to support a strategic national policy approach.
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 are committed to leading by example and working with you achieve health system reform and to develop an integrated national health workforce policy agenda.
Steven A. Wartman, MD, PhD