Feature Article

Unprecedented change

This article discusses the President’s visionary health care legislation being client/patient-centered rather than practitioner-oriented

By Patrick H. DeLeon, PhD

With the enactment of President Obama’s landmark health care reform legislation, the Patient Protection and Affordable Care Act (PPACA), our colleagues serving within the public sector must seriously expect the next five to ten years of implementation to be extraordinarily interesting, if not professionally challenging. It is important to appreciate that the President’s visionary legislation is foremost client/patient-centered, not practitioner-oriented. The Administration wanted to highlight the critical nature of providing high quality Primary Care, with a special recognition of the importance of Wellness, Prevention, and developing Healthy Lifestyles. Throughout the extensive bill there is express recognition of the potential contributions of a wide range of healthcare professions, as well as the importance of developing data-based, gold standards of care, and systematically capitalizing upon the unprecedented advances occurring within the communications and technology fields (i.e., comparative effectiveness research, health information technology (HIT), telehealth, virtual realities, etc.) Inter-professional collaboration and the expansion of practitioner clinical skills must replace our traditional silo-oriented, hierarchical approach to providing health care. The all-important psychosocial-economic-cultural gradient of care, which APA’s Norm Anderson has long heralded, will finally be receiving appropriate recognition.  PPACA will ensure that 94% of Americans have health insurance while ultimately reducing the federal deficit by $143 billion over its first decade of enactment. It will bend the ever-escalating health care cost curve. Change is always unsettling and these will definitely be interesting times.
Inter-professional Collaboration: Ron Rozensky was appointed by the Secretary of Health and Human Services (HHS) to the Health Resources and Services Administration’s (HRSA) Advisory Committee on Interdisciplinary, Community Based Linkages (ACICBL) within the Bureau of Health Professions, re-authorized by PPACA. The Advisory Committee recently released its 8th Annual Report to the Secretary and to Congress titled, “An examination of healthcare workforce issues in rural America.” Psychology is represented on the advisory committee as I sit in a seat designated for the Graduate Psychology Education (GPE) Program and serve as the current Chair. Recommendations from this report include assuring a more comprehensive review of the healthcare workforce across all disciplines thus insuring a truly inter-professional workforce for the future. In my judgment it is imperative that psychology be included as one of the professions studied in order to assure that we are seen as an important and integral component of the workforce and this will then dictate funding for our education and training in years to come. Another recommendation suggests that the number of health professions that can receive funding via Graduate Medical Education dollars should be broadened (from just Medicine to others including psychology), and suggests moving some of that funding from teaching hospitals into community-based training programs. The report also recognizes the need for educational and training funding and reimbursement for all healthcare providers, including psychologists, who prescribe medications to their patients. Serving on this advisory committee permits me to interact with, and learn from, a group of dedicated healthcare leaders from across the country that all see the importance of inter-professional education and training for the healthcare professionals of tomorrow. It is rewarding to contribute to writing recommendations that truly focus on best practices in inter-professional education and training, and our words already have directly impacted policy, including the drafting of the administration’s PPACA bill, and where funding is going to be directed. The evidenced based content of our reports and our recommendations have great utility as material supporting advocacy for quality healthcare and, in particular, psychology education, training and practice.

Interdepartmental Collaboration:  During this year’s deliberations on the Fiscal Year 2011 appropriations bills for the Departments of Veterans Affairs(VA) and Defense, Congress focused upon the credentialing process for practitioners working in co-located and/or joint treatment facilities. The includes the Department of Defense (DOD)  credentialing and licensing of healthcare providers. The committee believes that providing the highest quality of healthcare for our service members, retirees and their families, and veterans must always remain a top priority for both DOD and VA. It is essential that systems established to ensure quality care, including the credentialing and licensing of healthcare providers, are responsive to the evolution of new healthcare delivery models. Such new models include the establishment of joint service medical facilities, DOD and VA healthcare facilities, and the delivery of health services via telecommunications technologies. The Committee directs the Assistant Secretary of Defense (Health Affairs), in coordination with the Under Secretary for Health of the Veterans Health Administration, to report on the current processes for licensing and credentialing of providers serving in joint service facilities, and joint DOD and VA facilities. The report shall include ways in which those processes can be improved, including proposals for any necessary legislative changes. In addition, this report shall also describe the rapidly evolving programs in both Departments involving tele-health services, and the current policies and procedures governing the quality of clinical practice and clinical providers utilizing tele-health technologies, both within the DOD and VA systems, and, as appropriate, those utilizing non-DOD or VA providers. The Committee directs that the report contain an analysis of the specific challenges involving credentialing of providers at joint service facilities, joint DOD and VA facilities, and at individual DOD and VA facilities utilizing tele-health within and among states, and what effect, if any, those challenges present to the continuity of high-quality healthcare, both among and within DOD and VA systems. The Committee directs that the report be provided to the Committees by March 4, 2011.

The Institute of Medicine (IOM) Nursing Report: In conjunction with the Robert Wood Johnson (RWJ) Foundation, the IOM released its report The Future of Nursing: Leading Change, Advancing Health. The IOM highlighted the passage of President Obama’s comprehensive health care legislation. This report is being published at a time of great opportunity in health care. The implications of this new demand on the nation’s health care system are significant. How can the system accommodate the increased demand while improving the quality of health care services provided to the American public? Nursing represents the largest sector of the health professions, with more than 3 million registered nurses in the United States. What nursing brings to the future is a steadfast commitment to patient care, improved safety and quality, and better outcomes. To take advantage of these opportunities, however, nurses must be allowed to practice in accordance with their professional training, and the education they receive must better prepare them to deliver patient-centered, equitable, safe, high-quality health care services; engage with physicians and other health care professionals to deliver efficient and effective care; and assume leadership roles in the redesign of the health care system. In particular, we believe the search for an expanded workforce to serve the millions who will now have access to health insurance for the first time will require changes in nursing scopes of practice, advances in the education of nurses across all levels, improvements in the practice of nursing across the continuum of care, transformation in the utilization of nurses across settings, and leadership at all levels so nurses can be deployed effectively and appropriately as partners in the health care team. The committee envisions a future system that makes quality care accessible to the diverse populations of the United States, intentionally promotes wellness and disease prevention, reliably improves health outcomes, and provides compassionate care across the lifespan. In this envisioned future, primary care and prevention are central drivers of the health care system. Inter-professional collaboration and coordination are the norm. Payment for health care services rewards value, not volume of services, and quality care is provided at a price that is affordable for both individuals and society. PPACA represents the broadest changes to the health care system since the 1965 creation of the Medicare and Medicaid programs. Although passage of PPACA is historic, realizing the vision outlined above will require a transformation of many aspects of the health care system. This is especially true for the nursing profession. The Chair of the Committee was the former Secretary of HHS and the current President of the University of Miami, Donna Shalala.
These are indeed interesting and challenging times. Aloha.

Pat DeLeon is the former APA President Division 18, November, 2010