ePolicy News April 2013
Tuesday, April 2, 2013
Congress Reconsiders Workforce Legislation
Congress is once again considering legislation to address workforce training and employment as a means of putting Americans back to work. Workforce legislation has typically been addressed through the Workforce Investment Act (WIA). Originally enacted in 1998, WIA serves as the preeminent federal employment service and job training law. Last month, the U.S. House of Representatives voted to support the SKILLS Act (Supporting Knowledge and Investing in Lifelong Skills) (H.R. 803), which moved through the House Committee on Education and the Workforce. The SKILLS Act has been forwarded to the U.S. Senate and is being considered by the Senate Committee on Health, Education, Labor and Pensions (HELP). Read the summary of the SKILLS Act here.
In addition, House Democrats have introduced the Workforce Investment Act (WIA) of 2013. Congressmen John Tierney (D-Mass.), Rubén Hinojosa (D-Texas), and George Miller (D-Calif.) introduced H.R. 798 which has yet to be considered by the House Committee on Education and the Workforce. Read a summary of WIA 2013 here.
According to the U.S. Bureau of Labor Statistics, there are 3.5 million open positions nationwide, many that cannot be filled due to a lack of qualified candidates. This is certainly the scenario in laboratory medicine, with a growing need for laboratory professionals, yet laboratory training programs are unable to train a sufficient number of qualified personnel to fill the gap. ASCP has long championed WIA as a mechanism to fill that void.
Theoretically, the aim of both pieces of legislation is to solve this job crisis by strengthening the existing system through streamlining and increasing access to training, promoting innovation, and ensuring accountability and transparency.
“Workforce development programs are an important part of the nation’s economic recovery and job creation efforts,” said Rep. Miller, the senior Democrat on the Education and the Workforce Committee. While the economy is turning around, there is much more work to be done to help the millions of Americans without jobs, especially for the long-term unemployed.
Congress Tackles Graduate Medical Education, Seeks to Fill Physician Shortage
Legislation that would increase the number of Medicare-supported residency positions was recently reintroduced by U.S. Representatives Aaron Schock (R-Ill.) and Allyson Schwartz (D-Pa.), and U.S. Senators Bill Nelson (D-Fla.), Charles Schumer (D-N.Y.), and Senate Majority Leader Harry Reid (D-Nev.).
“Because it takes seven to 10 years to train a doctor, Congress must act now to increase Medicare’s support for graduate medical education [GME],” said Darrell G. Kirch, MD, Chief Executive Officer of the American Association of Medical Colleges. “We commend the leadership and long-term vision these lawmakers have shown in reintroducing this measure.”
The Training Tomorrow’s Doctors Today Act (H.R. 1201 ) and The Resident Physician Shortage Reduction Act of 2013 (S. 577) would both phase in 15,000 Medicare-supported residency positions over five years. At least 50 percent of the available new slots each year must be used for shortage specialty residency programs, as identified by a U.S. Government Accountability Office report (GAO). ASCP supports the legislation and would like to have pathologists classified as primary care physicians.
“The primary way our country can address the physician shortage is by ensuring we increase the number of Graduate Medical Education slots,” said Rep. Schock. “By doing so, we are increasing the number of medical school graduates who will receive hands-on training in a patient setting to gain the experience needed to become a practicing physician.”
“The United States is on the cusp of a crisis in access to both specialty and primary care physicians,” Rep. Schwartz added. “We have an urgent need to take action to ensure Americans have access to quality, well-trained doctors. While there will be more than 74 million American seniors in need of healthcare services within 20 years, experts estimate that 130,000 new physicians will be necessary to eliminate the workforce shortage by 2025. This bipartisan legislation is critical.”
The legislation also seeks to establish quality measures of “patient care priorities” to strengthen accountability and transparency within the Medicare GME system.
Beginning in fiscal year 2018, each hospital that does not report patient care measures would have its Medicare indirect medical education (IME) payments reduced by 0.5 percent. Beginning in fiscal year 2019, hospitals that fail to achieve the new performance standards would have their IME payments reduced by 2 percent.
CLIAC Focuses on Quality, Examines Key Areas in Infection Prevention
The Clinical Laboratory Improvement Advisory Committee (CLIAC) of the Centers for Disease Control and Prevention (CDC) held its first meeting of the year to discuss issues pertaining to improvement in clinical laboratory quality and laboratory practice. The agenda included updates from the CDC, the Centers for Medicare and Medicaid Services (CMS), and the Food and Drug Administration (FDA). Presentations included activities related to the upcoming FDA infection prevention guidance for the use of fingerstick and point-of-care blood testing devices, in particular, glucose meters. Quality assurance of new DNA sequencing technologies in the clinical laboratory and harmonization of clinical laboratory test results were also discussed.
There have been clinical reminders and public health notifications from the CDC, CMS, and FDA regarding the risk of transmission of disease from shared use of fingerstick devices and point-of-care blood testing devices. These reminders were in response to recent outbreaks of viral hepatitis among patients where the devices were shared between users. Melissa Schaefer, MD, of the Division of Healthcare Quality Promotion at the CDC, states that there is a “need for basic infection prevention practices, no matter where assisted monitoring of blood glucose is performed.” Discussions also focused on standardization of clinical laboratory results to increase quality of care and reduce cost. Many patients are asked to take laboratory tests that are “doubled up,” due to the use of different medical laboratory terminologies.
ASCP supports the development and maintenance of high-quality practice standards for laboratory testing to assure patient safety and to reduce medical errors associated with laboratory medicine.
To view ASCP’s public policy statement on Quality Laboratory Practice and its Role in Patient Safety, click here.
ASCP Opposes Tennessee Proposal to Expand Exemption from State Licensing Laws
ASCP has joined with several other organizations representing pathology and laboratory medicine to raise concern about legislation currently making its way through the Tennessee General Assembly. The bills, HB1164 and SB1269, would expand the state’s current exemption of laboratories that provide forensic and compliance drug testing from the need to use licensed laboratory professionals to perform or supervise testing.
The measure would expand the exemption to include toxicological and biochemical testing as well. Moreover, it appears that the exemption would allow exempt laboratories to provide testing services that may be used for diagnostic, prevention, or treatment of a disease or impairment. The bill also relieves testing personnel at these facilities from the need to be supervised by a licensed medical laboratory director, medical laboratory supervisor, or medical laboratory scientist.
In response, ASCP, along with the American Society for Clinical Laboratory Science, American Medical Technologists, and the Clinical Laboratory Management Association, have contacted members of the Tennessee House of Representatives and Senate Health Committees in opposition to the measures. ASCP has also launched an e-Advocacy campaign against the bill. To date, more than 200 members of Tennessee’s pathology and laboratory medicine community have urged their state legislators to oppose the measure.
Unfortunately, the measures are advancing through the legislative process, with both bills having recently cleared their respective Health Committees.
ASCP Tackles the Laboratory Workforce Shortage
The U.S. healthcare system is on the precipice of tremendous change. The country’s aging population, coupled with reforms already under way as mandated by the Patient Protection and Affordable Care Act, will significantly increase the demand for services and significantly affect the ways those services are performed. At the same time, the practice of medicine itself is changing almost daily as new diagnostics and therapies provide customized patient care.
In light of these profound changes, ASCP has invited leaders from across its membership to examine the interplay of all these issues and their impact on the workforce. Specifically, their charge will be to 1. review and evaluate the current data on all professions, identify gaps, and make recommendations for future data collection initiatives; 2. review ASCP’s role in workforce development and its current initiatives; 3. examine how ASCP could leverage its resources and standing among other pathology or laboratory medicine organizations, industry, government, and the broader healthcare system to develop long-term initiatives that will provide meaningful, measurable impact; and 4. provide the ASCP Board of Directors with a report of its findings, and make recommendations.
In December, an ASCP Task Force convened in Washington, D.C., to discuss the laboratory professional workforce. Current and projected staffing needs, access to education, scope of practice, and the impact of new technologies were discussed. This month, the ASCP Leadership Forum, in Fort Myers, Fla., will feature a Pathologist Workforce Round Table discussion to develop a conceptual framework as a basis for an ASCP Pathologist Workforce Policy. This policy will, in turn, allow for the creation of strategies to offer the field as its workforce needs continue to evolve.
The mission of the both ASCP Workforce groups is to recommend a comprehensive organizational strategy to address the future workforce needs of the nation’s medical laboratories in order to continue to provide timely and safe patient care and fully realize the benefits of personalized medicine.
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