George Orwell was certainly not referring to health reform when he uttered such a remark. But the role that myths are playing in the health reform debate continues to frustrate key supporters while fueling its opponents. With Congress still on August recess dealing with constituents, below are significant developments in health reform this week:
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Senate Finance Committee: In an effort to strengthen bipartisan support for health reform and perhaps respond to suggestions that Democratic efforts may proceed without Republican support, the Senate Finance Committee's ranking member, Sen. Chuck Grassley (R-IA) released a statement that indicated both sides of the aisle should keep working to find common ground. The Senator was quoted as saying that consensus is essential "because we're restructuring 17 percent of the economy and no law of Congress in the 225 years has ever done that."
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Myth Busters II: The Obama Administration continued its offensive (or retort) against what it calls health reform misinformation. President Obama, describing the debate last week as "a core ethical and moral obligation," focused on myths and misunderstandings in his weekly address. A video of President Obama's address is available here.
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Show me the money!
On August 20, Vice President Joe Biden announced the availability of grants worth nearly $1.2 billion to help hospitals and health care providers implement electronic health records. The grants, which will be funded by the American Recovery and Reinvestment Act of 2009 (ARRA), are designed to help health care providers qualify for 2010 payment incentives that will target medical errors, improving efficiency and improving quality. The grants will include $598 million to establish Information Technology Regional Extension Centers that will provide hospitals and health care providers with technical assistance in the selection, acquisition, implementation and use of
certified electronic health record systems. The remaining $564 million will support the development of mechanisms for information sharing within a nationwide system of networks. Grants will be issued beginning in 2010. For additional information regarding the application process for these grants, visit http://healthit.hhs.gov.
Sidebar: Below is a brief comparison of the Long-Term Care, Graduate Medical Education, and Workforce provisions within the Tri-Committee's H.R. 3200 and the Senate HELP Committee's Affordable Health Choices Act ("AHCA").
Long-Term Care
Senate HELP Committee: The AHCA does not address care provided by nursing homes.
House Tri-Committee:
H.R. 3200 does address various aspects of care provided by and payment to nursing homes. Coverage includes recalibration of payments based on assessments of certain RUGS, increasing payments for non-therapy ancillary services, decreasing payments for the therapy case mix components, with consideration under a future SNF case mix classification system. There are provisions related to advanced care planning with the potential for orders regarding life sustaining treatment flowing across the continuum of care, the development of end of life and advanced care planning quality of care measures, and clinical social worker coverage under the Medicare Skilled Nursing
Facilities ("SNF") prospective payment system. H.R. 3200 also contains a full subtitle covering nursing home transparency. Ownership and additional disclosable party information transparency to the public will be required. Disclosure items would include (without limitation) information regarding the governing body, officers, directors, persons and entities exercising certain controls over the nursing home, leases, loans and management and consultative services. Compliance and ethics programs will also be required. Quality Assurance and Performance Improvement Programs (QAPIs) will be implemented. Further direction will be provided regarding nursing home
compare website information. In rounding out long-term care coverage, among other things, H.R. 3200 also provides for: a facility's provision of survey, certification, and complaint investigation reports to requesting parties; the reporting of certain direct care expenditures and staffing information; the development of a standardized complaint form coupled with a complaint resolution process; a pilot program to examine interstate and large intrastate nursing facility chains; improved staff training in areas such as dementia and abuse prevention; and certified nurse aide training.
Graduate Medical Education
Senate HELP Committee: The AHCA discusses Graduate Medical Education within the context of workforce issues. AHCA provides for training of medical residents in community-based settings and preventative medicine.
House Tri-Committee:
H.R. 3200, directly addresses various Graduate Medical Education issues, including: redistribution of unused residency positions; reformat of teaching costs in non-hospital settings (hospitals will not need to compensate the non-hospital setting provider for resident rotation to the non-hospital setting in order to count resident time as long as the hospital continues to pay the resident's salary and benefits); rules for counting resident time for didactic and scholarly activities; redistribution of residency slots when a hospital closes; and goals and accountability for approved medical residency training programs (with a GAO study to evaluate such).
Health Care Workforce
Senate HELP Committee:
The AHCA includes multiple sections addressing the health care workforce. AHCA includes funding for a National Health Services Corps. Further, the Bill includes a full Title Addressing the Health Care Workforce - with the purpose of improving access to and the delivery of health care for all. A National Health Care Work Force Commission is contemplated to further the enumerated purposes by focusing on workforce supply and distribution, education and training capacity, policies effecting the workforce, and special needs populations. Also contemplated are State health care workforce grants to enable State partnerships to plan and carry out workforce
development strategies. AHCA would also establish a National Center for Health Care Work Force Analysis to develop work force information and analyses, with consideration of program effectiveness and performance benchmarks. This National Center would work with newly created State and regional counterparts. AHCA also focuses on increasing the health care workforce supply via student loans and attention to future public health, allied health, nursing, geriatric, mental/behavioral health and pediatric health care workforces. Also included are provisions for primary care, long-term care (and other care settings) direct care workers and dentistry training, to be
accomplished via grants and/or contracting. Finally, AHCA also provides focus for cultural competencies, prevention, and public health proficiencies in working with individuals with disabilities.
House Tri-Committee:
H.R. 3200 includes a full Title addressing the health care work force. Similar to AHCA, H.R. 3200 includes funding for a National Health Services Corp in addition to a Public Health Workforce Corps. Workforce focuses include: promotion of primary care and dentistry, including addressing health care workers' unmet needs areas via student loan repayment programs, and addressing training in family medicine, general internal medicine, geriatrics, pediatrics physician assistantship, and dentistry. There is a stand-alone subtitle for the nursing workforce, which includes provisions for a nurse-managed health center and nursing education grants and loans. There
are also provisions for adapting the health workforce to the evolving needs of health systems, with attention to diversity and cultural and linguistic competency. Finally, H.R. 3200 establishes an advisory committee on health workforce evaluation and assessment, which is charged with developing the methodologies to be used for data collection and analyses regarding the health workforce.
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