Transcript Two Views on Health Reform and Workforce Thomas C. Ricketts, PhD, MPH.

Two Views on Health Reform and
Workforce
Thomas C. Ricketts, PhD, MPH
The negative, cynical view
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Congress added to the existing
macro-policy of “nudging” workforce
market behavior through professionspecific, producer-focused, grantstructured programs.
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Little assessment of past performance
No unifying goals stated
A Policy-Recommending Commission has been created
with no clear guidance over how they are to influence
policy—and no appropriation.
A potential rival to the GME “1000-pound gorilla” may
emerge in the Community Health Center Trust. Teaching
centers and primary care extensions may create conflict.
The positive, constructive view
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Experimentation is encouraged via
many new approaches
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Teaching health centers, a natural
extension of current activities gives
momentum to multiple programs
Outreach structures, that can build on successful AHEC-like
activities, can unify the system
There is a potential for the expanded programs to create a
“tipping-point” for primary care
Institutionalizing nurse leadership and acceptance of new
professional roles will help meet needs and produce
efficiencies
Structures for coordination across (all) workforce
stakeholders are recognized if not encouraged
Doctors and Reform: New Stuff
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New support for Trauma Care (a bona fide success)
New incentive for surgeons in HPSAs
Pediatric subspecialist loan repayment
Redistribute GME slots to primary care, count OPT time
ACA has a strong primary care bent and assumes primary
care can Lower costs and Improve Outomes
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NHSC and Teaching Health Centers
Primary Care Grants to schools
Bonus to primary care
Primary Care Extension Centers (AHRQ)
Doctors and Reform: Unresolved
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Regulatory
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ACOs and balance between generalists and specialists
Medical Homes and the same
Geographic adjustments to payment
Relative Value (RVUs) and Bundling
Legislative
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SGR and Medicare payments
Tort reform
GME in general
Meanwhile…medicine will be affected
by…
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Policy for Nurse Practice: A big report from some nursing
advocates lays claim to an expanded share of the
primary care need.
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Medicine replies with a strong demurral, but in the words
of a leader of one discipline: “We haven’t solved the
primary care problem ourselves”
Expansion “on the edge” continues with
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new medical schools, programs and plans
CNPs (Creative New Practitioners) emerging to soak up the
prevention benefit under Medicare
Who, what where, when, why, how?
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Who: Will program advocacy define roles (Grinch)
What: Is there potential for a new interprofessional
policy culture? (Pollyanna)
Where: The states have wildly different cultures and
conditions that affect the “mix” of policy approaches
When: The urgency of “reform” runs up against the
realities of training cycles—inevitable frustration.
Why: Have we turned a corner to patient and community
centered-ness? Will we now have clearer workforce
policy
How: Will the money run out? Will it get off the ground?
Grinch or Pollyanna, you choose
Thomas Ricketts
(919) 966-5541
[email protected]