Three Federal agencies announced request for comments on Section 2706, Non-Discrimination in Health Care: respond by June 1

In a document that is “a request for information regarding provider non-discrimination,” the Departments of Labor, Health and Human Services (HHS), and the Treasury are requesting comments on all aspects of the interpretation of section 2706, the Non-Discrimination in Healthcare section. The request comes following the inter-governmental disputes on interpretation in which U.S. Senator Tom Harkin (D-Iowa) chastised HHS for violating Congressional intent. (These are captured in Beltway Battle Over Patients’ Rights to Integrative Medicine and Health.) The request states that it “includes but is not limited to comments on access, costs, other federal and state laws, and feasibility.” The comment period began March 6, 2014 and runs for 90 days. The Integrative Healthcare Policy Consortium (IHPC) is working on this, according to Alyssa Wostrel, MBA, executive director. The organization is collaborating with MPA Media, publisher of Acupuncture Today and Massage Today. Each of these publications sent out the IPHC’s survey on issues regarding 2706 to its readers. These will be compiled and reported to the three agencies.

Comment: This is a time to act! Terrific to see IHPC and MPA media collaborating. If you have anything relevant to share, do so. The request is a broad net: ” … includes but is not limited to comments on access, costs, other federal and state laws, and feasibility.” Get your comments and experience in.

Leading workforce research conference switches from “physician workforce” to “health workforce” focus and includes integrative health and medicine disciplines

On May 1-2, 2014, the American Association of Medical Colleges (AAMC) hosted its annual gathering of 200 plus of the nation’s top researchers on the nation’s workforce requirements. Only this year, rather than being called the “Physician Workforce” conference the event was titled: AAMC’s 10th Annual Health Workforce Research Conference: Finding the Right Fit – The Workforce Needed to Support the Affordable Care Act. AAMC’s leader on the conference Clese Erickson, MPAff, shared that the shift in conference’s content preceded the shift in name. Since the 2010 Future of Nursing report and the passage of the Affordable Care Act put a focus on team care, AAMC’s conferences have increasingly focused on contributions of nurses and physicians’ assistants, and more recently health coaches, social workers and community health workers. The 2014 iteration was the first to include a plenary segment on “Integrative Health and Medicine,” which was presented by this writer in his capacity as executive director of the Academic Consortium for Complementary and Alternative Health Care (ACCAHC). Slides available here: Doing Well by Doing Good: Building the Case for Broad Workforce Partnerships Finding the Right Fit: The Workforce Needed to Support the ACA: Integrative Health and Medicine (May 2014). ACCAHC also presented a poster on its Project for Integrative Health and the Triple Aim (PIHTA), a focus of the oral presentation.

Comment: Credit the AAMC for widening the circle and, in general, creating such a stimulating conference. As my fellow panelist Leon Assael, DMD told the assembled crowd: “This is not about counting noses [of types of providers]. It’s not about ‘access.’ It’s about outcomes.” Another of the session’s panelists, Lloyd Michener, MD, spoke about community and public health interventions that can significantly disrupt overutilization patters and create huge savings. Michener shared how huge reductions in need for ER and other services can come by getting out of the system and clinical care and directly building relationships with individuals and their community support teams. These powerful outcomes present challenges for all clinicians, and quite likely, for the assembled workforce experts whose business has historically been MD-centric and health system-centric.

RWJF-funded report finds impact, but limited, of Choosing Wisely campaign in combating the 30% of waste in the medical industry

“Some experts say as much as 30 percent of the health care delivered in the United States is duplicative or unnecessary; may not improve people’s health; and may even be harmful.” So leads the e-mail boost from the Robert Wood Johnson Foundation of a new RWJF-sponsored survey of physicians on the successes of the Choosing Wisely campaign. The exceptional campaign, funded by $2.5-million from RWJF, attempts to have professions self-govern to limit waste. Each specialty is asked to select certain of their own over-performed or over-ordered procedures and tests that they will seek to use less.  Among findings: 21% of MDs say they are aware of the campaign. Of those, 62% are more likely to have reduced the number of times they recommended a test or procedure because they learned it was unnecessary, versus 45% for those who are unaware of the Choosing Wisely. In more general findings: 73% perceive of all MD respondents believe  unnecessary tests and procedures are a “very or somewhat serious” problem, 72% believe that an average doctors prescribes at least one unnecessary item a week, and 58% believe they themselves are the best people to manage the problem. Said Richard J. Baron, MD, president and CEO of the ABIM Foundation, the Choosing Wisely sponsor: “Old habits are hard to break, but this research suggests that America’s physicians are slowly making progress in efforts to reduce unnecessary care.”

Comment: More urgency and outrage with the slowness of the uptake of this campaign, fine as it is, is in order. Do the math: the 30% that is waste equals nearly $1-trillion per year. The one procedure per week that is perceived by slightly over 70% of MDs to be over-performed does not come even close to representing 30%. Notably, 30% of MDs don’t even think they have a hand in the waste. This waste represents a huge opportunity cost to efforts to fund teachers, parks, schools, health care, environmental initiatives, and more. The initiative is excellent. Yet can practitioners engage this transformation in practice with the ferocity needed through self-policing? Notably, only 15% thought the government should get involved in any way. Through one means or another, more fire in the campaign is necessary.

In an interesting note, the ABIM Foundation’s campaign is expanding to include non-MD provider organizations. These include the American Dental Association, American Physical Therapy Association and the American Academy of Nursing. These will each release lists of medical tests and procedures which will be their profession’s targets. What might such lists be for chiropractors, or naturopathic doctors, or massage therapists, or others in the integrative health and medicine communities? Or, as one practitioner has suggested to me, does an excess of “health creating” activity only lead to positive side-effects and more health creation?