Much time was spent on niceties and posturing on bipartisanship (mostly that health care costs money), and very little on substance (except that health care costs money).  The president is still not clear on what he stands for (except that health care costs money) even though he put forth a slightly modified version of the Senate bill as his plan.  Americans want to know about being cared for–not about money.  The President did not have a clear message about why the Congress should pass legislation  that is not a true overhaul of the system. 

 The President has a messaging problem; the Republicans do not.  The Republicans  are saying “start over.”  The other simplistic Republican answer–medical malpractice reform– also came across  more clearly than the President’s analysis of the costs of insurance premiums.   The President spent too much time on the intricacies of  lawmaking, turning the summit into a  high school civics class. 

The American people want the President to be stronger–to say that health care is a right and that the President will not negotiate on that issue and will only work toward legislation that covers and protects all Americans and does not put money in the pockets of health insurers.  Only Senator Jay Rockefeller of West Virginia, with his analogy of insurers to sharks, brought clarity –and some emotion–to the day.

Americans don’t want to hear about the market based approach to health care, words that the  President used too often. Americans know that’s what got us to the place where we are today. Such rhetoric breeds fear not favor in the hearts of most Americans.  The President is having a hard time with the message because his legislation does not back up the promise of the campaign.

Some credit must be given to the summit participants who sat for 7 hours in THOSE CHAIRS–typical uncomfortable seating for weddings or bar mitzvahs when half the time is spent on the dance floor.  No wonder nothing happened.

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.

Academic health center activities noted by  Dr. Wartman include:

• The University of Miami has already placed a team on the ground, led by Chairman of Neurological Surgery Dr. Barth Green, and has been working with the South Florida Hospital Association to collect medical supplies that are urgently needed as well as to provide a mechanism for faculty and staff to be able to volunteer.
• Dr. John Williams, provost and vice president for Health Affairs at The George Washington University, reports that GW emergency medicine physicians have deployed with the Fairfax Urban Search and Rescue Team, and others will follow as needed.
• The University of Nebraska Medical Center, led by Dr. Harold Maurer, has indicated that UNMC Vice Chancellor for Academic Affairs Dr. Rubens Pamies, a native of Haiti, and Dr. Ayman El-Mohandes, dean of the College of Public Health, are in the midst of developing a centralized plan for relief efforts.
• Dr. Ora Pescovitz, executive vice president for health affairs and CEO of the University of Michigan Health System, indicates that the University of Michigan Health System is mobilizing for a swift response.
• Dr. David Ramsay, President of the University of Maryland, Baltimore, notes that a shock trauma team has been assembled and is working with the US Air Force and is either en route or on the ground at present.  He also points out that they have a PEPFAR project in Haiti, involving teams of physicians, nurses, and public health educators in HIV/AIDS, but they have not yet been successful in contacting them.
• The University of Alabama at Birmingham’s Clinical Care Transport program is on the national stand-by list and is awaiting orders, according to Dr. Robert Rich, Senior VP and Dean.  
• Dr. Robert Grossman, Dean and CEO of New York University Langone Medical Center, reports that NYU’s medical center community  is volunteering  to help with the emotional aspects of the disaster, including rallies to organize food, clothing drives, and donations.  They have also distributed information about how faculty, staff, and students can find information on the status of friends and loved ones in Haiti, along with a list of charitable organizations and agencies that are providing aid to earthquake victims.
• SUNY Downstate Medical Center is home to the largest Haitian population outside of Haiti, according to Dr. John LaRosa, President.  As a result, they have responded by offering expanded counseling for students, faculty, and staff on a 24/7 basis in two locations as well as an open forum in the Alumni Auditorium.  They are also working in the larger community in Brooklyn with team members who are fluent in Kreyol and French, and working with other New York area agencies to coordinate and develop relief responses.
• Dr. James Thompson, President of the Medical College of Georgia, reported that its Disaster Medical Assistance Team is ready to deploy as necessary, and that two faculty members are on the ground treating earthquake victims.  A hygiene supply drive is underway on campus as well.
• SUNY Upstate Medical University in Syracuse has initiated a relief drive through the Office of Community Outreach and Global Health education and the University’s Council for Employee Volunteerism, according to President Dr. David Smith.  A group of Upstate students who recently returned from Haiti are spearheading this effort.

This is only a sampling of the efforts underway from institutions where people work every day to help and care for those in need.

It’s easy to lose sight of that big picture when countless smaller pictures get in the way: the frenzy of holiday shopping; endless hours spent online looking for the perfect gifts, then making sure they get shipped on time; rushing to and fro from friends’ and relatives’ homes for meals and parties; candle lighting; decorating the house; packing everything we want to do with friends into our time off; and scrambling to finish work projects before the holiday break takes effect.

This splintered focus on the things surrounding the holidays, rather than on the sentiment that lies at their core, is understandably lamented. As a society, we are chided not only for our embrace of the commercial and materialistic aspects of the season, but also for an inability to consistently care about and for our fellows the way we do around the holidays. How often have we heard what a shame it is that the “spirit of the season” doesn’t last all year long, or that widespread compassion and caring don’t breach the confines of a few short weeks in early winter?

Yet, I would submit to you that the holiday spirit is in effect and on display year-round anywhere that those trained to provide health care to their fellows are putting their expertise into practice, including my institution and the many other academic health centers around the nation and the world.

Skilled hands and caring hearts know no season. They acknowledge the calendar for its effect on others, but — wholly focused on improving the lives of those who seek their help – ignore its seasonal vagaries of sentiment in favor of a consistent commitment to those who most need their attention and expertise.

This commitment to serving our fellows epitomizes “the spirit of the season,” and thus lives throughout the year anywhere compassion and caring are practiced consistently and well.  It is the greatest gift we can offer, and in its giving we shall be fulfilled.

Guest Blog by Philip Pumerantz, PhD, President, Western University of Health Sciences, in Pomona, California

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.

  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.

 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.

Earlier this month, House Speaker Nancy Pelosi released the House’s proposal for reform, calling, on page 1275,  for the establishment of a “permanent advisory committee…[that would] develop and implement an integrated, coordinated, and strategic national health workforce policy relective of current and evolving health workforce needs.”

The Association of Academic Health Centers is pleased to see both recommendations, which in part reflect our advocacy efforts on Capitol Hill to make the health workforce a priority issue in health reform.

These Bills reflect some of the recommendations in our 2008 report Out of Order, Out of Time: The State of the Nation’s Health Workforce.  The report presented a comprehensive overview of health workforce policy (or, perhaps more aptly said, the lack of health workforce policy) and concluded that health reform cannot ultimately be successful without health workforce reform.  The report was widely circulated and followed up with testimony before the Senate Finance Committee, multiple meetings with offices in the White House, DHHS, and a variety of letters, news releases and so forth.

While neither the House or Senate Bill captures many of the critical recommendations in the AAHC Report, both attempt to address critical workforce issues and raise the significance of health workforce policy.   At this point, the fate of these Bills and the outcome of health reform is not known.  However, we are taking this opportunity before floor debate in the Senate to stress with the Congress the need for broad and comprehensive approaches to workforce policy, and the compelling need to connect the health reform with the health workforce.

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.