Healtlh Care Workforce Workgroup Comment Ltrx

Maryl

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• Publié par: Efta
• Nombre de lectures: 35
• Langue: English

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September 29, 2010 The Honorable Thomas McLain Middleton, CoChair Chairman, Senate Finance Committee Wendy Kronmiller, CoChair Chief of Staff and Assistant Secretary, DHMH Health Care Workforce Workgroup Health Care Reform Coordinating Council Dear CoChairs Middleton and Kronmiller: On behalf of the 67 members of the Maryland Hospital Association (MHA), I am writing to share our comments on the key issues being considered by the Health Care Workforce Workgroup of the Maryland Health Care Reform Coordinating Council (HCRCC).Reform holds the promise of increased access and improved care quality for all Marylanders, but that promise can only be met if there are enough qualified people to deliver on it. Nursing and Allied Health MHA has been very active in addressing the many workforce issues that challenge Maryland’s health care delivery system.We have worked diligently on nursing education and faculty programsboth through the Nurse Support I and II programs, funded through hospital ratesand the Who Will Care? campaign, which has so far raised more than $17 million in private donations to help double the number of nursing graduates by 2016. MHA also has worked with the Governor’s Workforce Investment Board (GWIB) to examine Maryland’s shortage of allied health professionals.Shortages in these areas may be even more acute than those in nursing, because allied education programs are smaller, with limited faculty and student size, and as a result do not have the flexibility to respond quickly to shortages. GWIB (and others nationally) has looked to the Baltimore Alliance for Careers in Healthcare (BACH) as a model.BACH targets collaborative partnerships in a regional manner by identifying shortage areas and training entrylevel workers to advance to higherlevel positions, focusing on professional development within the existing workforce and broadening access to the “pipeline” of workers that are educated and then fill vacancies.

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The Honorable Thomas McLain Middleton Wendy Kronmiller September 29, 2010

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Together with policymakers, community, education, and health care leaders, MHA remains committed to enhancing the recruitment, retention, and practice environment for Maryland’s nurses and allied health professionals. Physicians The 2008 MHA/MedChi physician workforce study revealed shortages of primary and emergency doctors in all areas of Maryland, with acute shortages in the state’s three rural regions. Thedifficulty in recruiting physicians, especially specialists, to rural areas is even more challenging and while reimbursement for Maryland physicians is in the lowest quartile compared to the nation, reimbursement is even lower in rural areas. In addition, many surgical specialties are in short supply.Maryland had 16 percent fewer physicians available for clinical practice than the national average and the shortage is projected to grow at least until 2015.To bolster these findings, a recent Maryland Health Care Commission study projects that 13 percent of specialty areas will show a shortage in 2015, including primary care, emergency medicine, and general surgery. According to the Association of American Medical Colleges (AAMC), the number of physicians enrolling in medical school has declined by 50 percent since 1980, while the number of residents trained in Maryland that remain instate is projected to decline from 52 percent in 2008. Meanwhile, the number of patients 65 and older nationally will increase 104 percent between 2000 and 2030; further, AAMC ambulatory medical care data shows that physician visits are sharply higher for those over 65.The bottom line:Maryland competes nationally for physicians, physicians nationally are in short supply, and Maryland, therefore, enters the competition for these physicians at a distinct disadvantage. If the physician shortage is not solved, uninsured and insured consumers alike, (including those newly insured under the Affordable Care Act), will face barriers in accessing care, will experience increased waiting times to see a physician, alreadycrowded emergency departments will be further strained, and Maryland will continue to lose highly qualified and locally trained talent to other states.Reform’s promise of greater access to primary care and preventive services for the uninsured could end up empty for many Marylanders. The solutions to these shortages are the same that MHA has advocated for years.They center on improved reimbursement, medical liability reforms, and retention of Maryland residentsin training. Implementingthe 2009 changes to the Physician Loan Assistance Repayment Program, strengthening the state’s apology statute, enacting Good Samaritan provisions, creating a pilot medical care track within the state’s judicial system, and continuing to enhance the practice environment for primary and hospitalbased physicians (including practice expense reductions and administrative streamlining), should be the first steps that Maryland takes to strengthen the physician workforce. To assist in your discussion, and in response to the Workgroup’s discussion document, we have attached a synopsis of our recommendations regarding nursing, allied health, and physician

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Recommendations Regarding Nursing, Allied Health, And Physician Workforce Issues Page 3

workforce issues.Maryland’s hospitals believe the state also should take advantage of all available public health dollars to buttress state and local health department personnel, through grants, demonstration projects, or other pilots that may be available. Health reform represents an exciting opportunity for Maryland to pursue the creation of an innovative health care system that expands access and gets people the right care, at the right time, and in the right place.We look forward to working with other stakeholders to help reform achieve our shared goal. MHA appreciates the opportunity to comment on the key issues before the Health Care Workforce Workgroup, and we look forward to working together to move Maryland’s health care reform efforts forward. Sincerely, Valerie Shearer Overton Senior Vice President, Legislative Policy Attachment

Recommendations Regarding Nursing, Allied Health, And Physician Workforce Issues Page 1

Immediate Needs  Implement Physician Loan Assistance Repayment Program (LARP) changes enacted during 2009 Legislative Session that enable implementation of the 0.01% assessment in hospital rates (approximately $11 million annually) be used to enhance the current LARP program.  Se fundingfor faculty and staff positions at Maryland schools that offer education for cure health professionals.Most of the available funds are specifically targeted (scholarships, traineeships, servicepayback loans); very few, if any, pay for faculty, staff, or space for classrooms or labs.An annual federal appropriation through the Congressional budget process would be required. Education and Training  To address the ongoing needs in nursing and allied health, schools will need access to qualified faculty and the technology used for clinical training, electronic medical records, and other state of the art facilities.  Distance learning strategies would improve access for rural students when allied health career development courses are available only in metropolitan regions of the state Recruitment and Retention  With the exception of medical students as noted, Maryland schools have many more qualified applicants for nursing and allied health programs than can be admitted.Student retention, particularly for members of the minority population, involves intensive academic support and more instructors, language specialists, tutors, and counselors are needed.Local, national, and federal grants currently provide funds for many of these efforts.Sustaining funds will be needed in the next year or two.  For physicians, several specific recommendations would improve the current Maryland practice environment and enhance recruitment and retention efforts. Specific tort reform enhancements: Strengthening the state’s apology statute, enacting Good Samaritan provisions. Creation of a pilot medical care track within the state’s judicial system. Continued enhancements to the practice environment for primary and hospitalbased physicians, including practice expense reductions and administrative streamlining (e.g., 2005 article from Health Affairs estimated hospital administrative expenses at 21 percent, of which billing and insurance related costs were 11 percent; physicians were 27 percent, with billing and insurance related costs at 14 percent).

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Recommendations Regarding Nursing, Allied Health, And Physician Workforce Issues Page 2

Licensure/Scope of Practice  RecentThe physician shortage is opening expanded opportunities for many practitioners. legislation to remove limitations on nurse practitioners, physician assistants, and pharmacist scopes of practice are examples.Optimizing the potential for all of these providers can help assure access to care for the newly insured and others.It also will require continued coordinated efforts across the professions, as well as any necessary subsequent changes in laws, regulations, policies, and procedures governing credentialing, granting practice privileges, and reimbursement. Federal Funding Focus  Advocate for continued and expanded federal funding for advanced education for faculty, nurse practitioners, physician assistants, and others.  Advocate for expanded federal funding for clinical simulation and access to electronic medical records for students.  Advocate for federal funding for demonstration projects involving accelerated or non traditional education programs to expand the reach of existing programs to include more diverse populations.