State Protections Against Medical Debt

Medical debt, or personal debt incurred from unpaid medical bills, is a leading cause of bankruptcy in the U.S. As many as 40% of U.S. adults currently are in debt because of medical or dental bills. A new report from the Commonwealth Fund discusses findings from a review of federal and state laws to protect patients from medical debt and its negative consequences.  

It can be obtained at https://www.commonwealthfund.org/publications/fund-reports/2023/sep/state-protections-medical-debt-policies-across-us.

Department of Education Call for Nominations for Negotiated Rulemaking on Student Debt Relief

The Department of Education has issued a call for nominations for negotiators to represent a variety of categories in an upcoming negotiated rulemaking session on student debt relief. Nominations must be received by September 14. Negotiators selected by the Department will meet virtually on October 10-11, November 6-7, and December 11-12 to discuss ideas for regulatory reform. Sessions will be open to the public and include opportunities for public comment.

More details may be accessed here.

How States Are Protecting Consumers From Medical Debt

Nearly 40% of U.S. adults are burdened by medical debt incurred from health care costs they are unable to meet. A new report from the Commonwealth Fund examines the web of laws and regulations designed to protect patients from medical debt. 

The report can b obtained at State Protections Against Medical Debt: A Look Policies Across US | Commonwealth Fund.

Developing Educators at Cleveland Clinic: A Systems Approach Webinar

ASAHP's Clinical Education Committee will be hosting "Developing Educators at Cleveland Clinic: A Systems Approach" on Thursday, September 14 at 1pm ET. The webinar will define characteristics of a systems-based approach to faculty development in a large healthcare system, discuss the Office of Educator & Scholar Development (OESD) approach to interprofessional educator and scholar development at Cleveland Clinic, and discuss skills and knowledge needed by all educators.

Register here.

Managed Care In The Medicare And Medicaid Programs

The Office of Inspector General in the Department of Health and Human Services (HHS) released a strategic plan to align its audits, evaluations, investigations, and enforcement of managed care plans in Medicare Advantage and Medicaid. 

More information about the plan is available at https://oig.hhs.gov/reports-and-publications/featured-topics/managed-care/.

Call for Clinical Prevention and Population Health Curriculum Framework 5-year Revision Workgroup Members

The Healthy People Curriculum Task Force, convened by the Association for Prevention Teaching and Research, is seeking health professions and public health faculty with expertise in population health to serve on a national curriculum revision workgroup for one year beginning in October 2023.   Faculty experts are needed to serve on four component-specific workgroups of the Clinical Prevention and Population Health Curriculum Framework (Framework), a national teaching resource that provides a common core of knowledge for clinical health professions about individual and population‐oriented prevention and health promotion efforts. The Framework was first published by the Task Force in 2004 and undergoes revision every five years.

Curriculum Revision Workgroups

1.    Foundations of Population Health: Quantitative and analytic skills used to assess, compare, describe, and monitor the health of populations.

2.    Clinical Preventive Services & Health Promotion: Evidence-based, health promotion and disease prevention interventions in the clinical setting.

3.    Clinical Practice & Population Health: Opportunities and disciplines that require individual- and population-based health perspectives.

4.    Health Systems & Health Policy: Systems and policies that help to govern the health and healthcare system, including collaborations between the clinical care and public health communities.

Curriculum Revision Workgroups Charge

The role of the workgroups is to address redundancy, gaps, and recommend major and minor editing for their respective Framework Component. Workgroups will also review edits proposed to other Components and may participate in the open comment period revisions and final review.  The Workgroups will assemble comments and proposed edits into one document for sharing with the Task Force and other curriculum revision workgroups in December 2023, March 2024, and May 2024. 

Responsibilities of Workgroup Member

·  Contributes to the development of themes and general goals for the Component revision, considering health equity, the pandemic, and changes to global health since the last revision.

·  Provides comments and specific editing suggestions (in MS Word Track Changes or Google Doc).

·  Compares and aligns proposed edits with content of other Framework Components.

·  Identifies evidence-based resources that support the Component’s content and revisions as needed.

·  Attends quarterly virtual meetings of the workgroup. 

·  Reviews draft and final versions of the Curriculum Framework.

·  Participates in dissemination efforts.

Eligibility to Serve on Workgroups

The Task Force encourages applicants from diverse backgrounds, perspectives, and geographic areas. Individuals wishing to serve on a workgroup must be either an APTR faculty member or member representative (departmental membership) or health professions faculty nominated by one of the organizations represented on the Task Force.

Length of Service: 

October 2023 through December 2024

Estimated Time Commitment:

3 hours/month October-May; 1 hour/month June-December 

How to Serve

Complete the Self-Nomination Form by September 22, 2023.  Workgroup members will be selected to balance expertise, perspectives, and geographic distribution on each workgroup. Selections will be made by mid-October.

Questions? Contact vsc@aptrweb.org

SELF-NOMINATION FORM (https://fs7.formsite.com/APTR/CurriculumRevision/index)

More details may be accessed here.

Congratulations to the IPEC and COF 2023 Interprofessional Education Collaboration Awardees

Last month on June 29, the Interprofessional Education Collaborative (IPEC) and the PHS Commissioned Officers Foundation for the Advancement of Public Health (COF) hosted a ceremony at the Association of American Medical Colleges (AAMC) Learning Center in Washington, DC to celebrate innovation in interprofessional engagement. The IPEC Membership Meeting and IPEC/COF Award Ceremony also featured poster presentations by honorable mention finalists. All honorees were recognized for their innovative and transformative solutions to improve the health of their communities.

Learn more here.

Joint Commission And National Quality Forum Combine Forces

The National Quality Forum will combine with the Joint Commission, while maintaining its independence in convening and developing consensus-based measures. The affiliation will allow both groups to build upon their shared expertise in measuring quality and rationalizing the measurement landscape. The focus shifts from competing measures to advancing key outcomes.  

More information is available at https://www.jointcommission.org/resources/news-and-multimedia/news/2023/08/joint-commission-and-national-quality-forum-join-forces/.

Responding To Clinician Burnout And Moral Injury

A new report from the Commonwealth Fund explores the causes of burnout and moral injury, and how health care leaders have begun to respond. Some initiatives are going beyond wellness to create structured processes for soliciting clinician input and identifying problems that might require systemic solutions. 

The report can be obtained at Transforming Care: Burnout and Moral Injury Among Clinicians | Commonwealth Fund.

Department of Education Releases Resources on How Universities May Address Race in Admissions

The Department of Education and the Department of Justice released resources on how universities may address race in admissions, in light of the U.S. Supreme Court’s Decision in June rejecting race-based affirmative action. The Department of Education also plans to circulate a best practices document to the field in September.

Resources from the Department of Education and Department of Justice, including a Dear Colleague letter and Q&As, may be accessed here. An article from the Washington Post may be accessed here.

ASAHP Travel Award to 2023 ASAHP Annual Conference

The Association of Schools Advancing Health Professions is sponsoring a travel award for a faculty member belonging to an underrepresented group to help cover the cost of attending the 2023 ASAHP Annual Conference in Fort Lauderdale Beach, FL. There will be one award this year of $1,000 each for an attendee at large from an ASAHP member institution.

Deadline: September 1, 2023

The 2023 ASAHP Annual Conference theme is "Moving Forward – Emerging Practices and Lasting Changes in Higher Education and Health Professions" and will take place at the Westin Fort Lauderdale Beach Resort in Fort Lauderdale Beach, FL. The dates are October 17-19, 2023.

We will hear from nationally recognized speakers on issues currently impacting health professions education and practice along with over 210 concurrent and poster presentations will be offered on issues including

• Technology in Health Professions Education and Practice

• Models of Excellence for Interprofessional Education/Collaboration

• Improving Diversity, Equity, Inclusion, and Accessibility (DEIA)

• Enhancing Wellness in Academic Communities

• Addressing Shortages in Health Professions Education and Practice

• Select Topics Related to Health Professions

Employer Insurance Coverage Of Older Adults

As premiums and deductibles outpaced income growth over the past decade, employer health plans are failing to protect many older adults from health costs or ensure access to affordable care, according to a new Commonwealth Fund study.

The results of the study can be obtained at Can Older Adults with Employer Coverage Afford Their Health Care? | Commonwealth Fund.

Bias And Unfair Treatment In Health Care

A new issue brief from the Urban Institute assesses unfair treatment in health care settings among parents and their children under age 19. 

The brief can be obtained at https://www.urban.org/sites/default/files/2023-07/To%20What%20Extent%20Are%20Parents%20and%20Children%20Exposed%20to%20Bias%20and%20Unfair%20Treatment%20in%20Health%20Care.pdf.

HRSA Webinar On The Hispanic And Latino Workforce

The Health Resources and Services Administration (HRSA) Office of Intergovernmental and External Affairs (IEA) will host Part 4 of the Advancing Health Equity Webinar Series among Hispanic/Latino Populations titled Forging Pathways to Increase the Hispanic and Latino Health Workforce.

Register for the event at Webinar Registration - Zoom (zoomgov.com).

House Subcommittee Holds Hearing on Rising Costs of College

The House Education and the Workforce Subcommittee on Higher Education and Workforce Development held a hearing today on “Lowering Costs and Increasing Value for Students, Institutions, and Taxpayers.”  

Subcommittee Chair Burgess Owens (R-UT) set the tone for the discussion in his opening statement:

“For far too long, the federal government has doled out hundreds of billions of dollars to colleges without any sense of accountability. Presently, public funding and institutional profit is based on the number of seats college fills, not on the students performance or success. This profit over performance receipt has resulted recipe has resulted in many students with more debt and worse outcomes.

This antiquated financial structure needs to be realigned so that the college success is linked directly to the student success. This will involve innovation, funding based on outcomes not inputs, skin in the game for colleges whose students take out loans. That should be a financial benefit to aiding graduates educational success, building a career and repaying their loan. That also should be financial accountability with institutions that live up to their promise to graduates.

Presently the burden of the students that is almost entirely burden a sole shouldered by the taxpayer and the borrower's it's time to think of colleges as stakeholders in the student's success versus observers. With a fresh, innovative mindset and willingness for accountability, we can assure that both students and taxpayers will receive a positive return on investment for their college.”

The hearing examined a variety of ways to increase accountability in postsecondary institutions, including:

• Accreditation (H.R. 3724, the Accreditation for College Excellence Act),
• Requiring more transparency from institutions on costs and quality, 
• The need to measure student outcomes, rather than inputs, to assess the performance of postsecondary institutions,
• Adjusting data on student outcomes for demographics and circumstances,
• Mandating risk sharing or skin in the game for institutions to incentivize a reduction in high student default rates, such as co-signing loans (Loan Repayment Assistance Programs),
• Return on Investment (ROI) metrics to track benefits relative to costs and apply carrots and sticks such as performance bonuses or sanctions such as losing access to federal financial aid programs,
• Alternative tuition pricing models to reduce student costs -- including competency based models, guaranteed pricing for each of four years, tuition reset to actual price, partnering with employers to pay tuition,
• Focusing on student outcomes, not inputs to measure postsecondary performance,
• The efficacy of the Department of Education’s Gainful Employment rulemaking to increase accountability, particularly with for profit institutions,
• The cohort default rate and 90-10 rule, 
• The expansion of Pell Grants to help students access postsecondary education, 
• State disinvestment in higher education resulting in higher student borrowing,
• Online education and Online Program Management companies (OPMs),
• H.R. 1311, The College Cost Transparency and Student Protection Act,
• H.R. 496, the PELL Act, as a more effective alternative to Gainful Employment to ensure high bar outcomes,
• Performance based funding models (such as performance-based financing used by Texas State Technical College),
• A debate about the value of liberal arts education v. market driven education in high demand sectors. 

Please find a link to the archived video of this hearing, along with Chair Owens’ opening statement, as well as those of the hearing witnesses. A recap form Inside Higher Ed may be accessed here.

Gainful Employment Rule And Student Loan Repayment

A brief from the Urban Institute estimates loan repayment rates in the Biden administration’s new income-driven repayment (IDR) plan before and after the gainful employment (GE) rule goes into effect. 

The brief can be obtained at https://www.urban.org/sites/default/files/2023-07/How%20the%20Gainful%20Employment%20Rule%20Will%20Affect%20Student%20Loan%20Repayment.pdf.

Senate Appropriations Committee Advances FY 24 Labor-HHS-Education Spending Bill

The Senate Appropriations Committee marked up its Labor-HHS-Education bill earlier today, which was approved by a bipartisan vote of 26-2. It provides $224.4 billion overall for programs within its jurisdiction, a 1% cut below current levels and in stark contrast to the 28% overall cut proposed in the House version of the bill. The Senate Labor-HHS-Education bill includes $79.6 billion in discretionary funding for the Department of Education and $117.0 billion in discretionary funding for the Department of Health and Human Services. The bipartisan Senate markup includes a $250 increase for the maximum Pell Grant.

“The bill provides $35 million more for the Mental Health Block Grant over fiscal year 2023 and includes $172 million for the Behavioral Health Workforce Education and Training Program, a $19 million increase over fiscal year 2023, to expand community-based clinical training and for repayment of education loans for individuals working in either a Mental Health Professional Shortage Area or where the overdose death rate exceeds the national average. Additionally, the bill provides $400 million for Certified Community Behavioral Health Clinics, a $15 million increase over fiscal year 2023, and an $18 million increase over fiscal year 2023 for the 988 Suicide Prevention Lifeline, building on the nearly $400 million increase in fiscal year 2023. The bill also includes over $100 million in investments within the Department of Education to address the shortage of school-based mental health professionals in our nation’s K-12 schools.”

“The bill protects essential funding to address public health threats, improve health care access and affordability, and strengthen the health care workforce. This includes: $1.86 billion for Community Health Centers, including $55 million for school-based health centers; $1.4 billion for Health Professions Workforce Development; $1.2 billion for the core Maternal and Child Health programs; $341 million for the Improving Maternal Health Initiative to combat the unacceptable levels of maternal mortality; and $4.1 billion for the Centers for Medicare and Medicaid’s administrative needs.”

In her opening remarks, Ranking Member Collins noted that the bill “invests in workforce training, including funding to increase the number of geriatric health professionals…[and] provides significant resources for substance abuse prevention and treatment programs and mental health programs.” Her press release noted the inclusion of “$302.5 million for Title VIII Nursing Workforce programs, an increase of $2 million above the FY23 enacted level, $48.2 million for HRSA Geriatric workforce education programs, which include the Geriatrics Workforce Enhancement Program and Geriatric Academic Career Awards, and $172 million for Behavioral Health Workforce Education and Training, an increase of $19 million above the FY 23 enacted level.”

The Senate Labor-HHS-Education bill text is here, report is here, summary is here, and resource page which should be updated by the Committee with further details is here. Sen. Murray’s remarks are here and a joint statement from Chair Murray and Ranking Member Collins is here.

Congress is leaving town for an extended summer recess with the Senate returning to session on September 5 and the House not slated back until September 12. That leaves only eleven legislative days with both chambers in session before the end of the fiscal year, with none of the twelve appropriations bills having been enacted, foreshadowing a busy September.