Commission Is Likely to Set Nation's Health Workforce Policies, Say Experts

One of the provisions of the recently enacted health care reform legislation is the creation of a national commission that will be dedicated to making recommendations regarding health care workforce issues. According to some analysts, this commission could emerge as the dominant force in driving and shaping the nation's health care workforce policies.

Establishment of the 15-member National Health Care Workforce Commission, which will be a multistakeholder advisory committee, is promulgated in the Patient Protection and Affordable Care Act (at the THOMAS website, type "H.R. 3590" in the search field after selecting "Bill Number"). The commission will make recommendations to Congress, the U.S. Department of Labor and HHS on a broad range of workforce-related topics, including national workforce priorities and goals, current and projected workforce supply, and needs and assessments of current education and training activities.

By law, the commission will be required to submit two annual reports to Congress and the president -- one will serve as a strategic plan for achieving the priorities and goals identified by the commission and the other will address high-priority areas targeted by the commission or Congress.

Unlike similar advisory committees, the National Health Care Workforce Commission will evaluate and make recommendations for the nation's entire health care workforce, giving it a broad perspective and scope.

"Our nation has never really had a national planning body for health workforce," said Daniel Derksen, M.D., of Albuquerque, N.M., professor of family and community medicine at the University of New Mexico and a senior fellow for the University of New Mexico's Robert Wood Johnson Foundation Center for Health Policy.

"The National Health (Care) Workforce Commission would bring together not only issues about how we subsidize health professions training at the federal level, but also how we would deploy that workforce -- how we get them to the areas of need and how we make sure we are producing the types of health professionals most needed," he said.

Derksen worked as a Robert Wood Johnson Foundation health policy fellow on the staff of Sen. Jeff Bingaman, D-N.M., in 2007 and 2008. During that time, he researched and drafted legislation that became the foundation for the current workforce commission provision in the Patient Protection and Affordable Care Act. Derksen is convinced that the commission will create greater collaboration among physicians, nurses and other health care professionals, benefiting both health professionals and their patients.

"We have needed more collaboration and integration of planning with nursing, dental, and other health professions and disciplines to make sure that we improve overall quality and access to care in our country," said Derksen.

According to AAFP Board Chair Ted Epperly, M.D., of Boise, Idaho, the current response to the nation's health care needs is "reactive and totally market driven." Establishing the workforce commission will give officials and other stakeholders an opportunity to better align resource use with creating an adequate workforce, he said.

"The commission will help the country as a whole start to think about the workforce that we need for the future instead of the workforce we have for the present," said Epperly.

The commission itself will function as a "high-level body," giving it direct access to high-ranking members of the Obama administration and thus putting the commission in a position to shape national workforce policies, according to Kavita Patel, M.D., director of the health policy program at the New America Foundation in Washington and a former director of policy for the White House Office of Public Engagement and Intergovernmental Affairs.

"This commission will be able to comprehensively look at the entire landscape of workforce issues across disciplines, communicate priorities to the HHS secretary in a timely manner and articulate to the public what the issues are," said Patel, who also worked on the workforce commission provision in the health care reform legislation.

The commission's work will coincide with provisions in the health care reform legislation that are intended to bring millions of currently uninsured individuals into the health care system during the next several years. These coverage expansions will underscore the need for an adequate primary care workforce, said Derksen. "We have known for some time that if we are gong to cover millions more Americans, we are going to have to have a primary care workforce to take care of them. The time to prime the pipeline for that is right now."

The commission will analyze and make recommendations to eliminate barriers to entering health professions where demand is not being met, such as primary care. In the process, said Derksen, the commission will address compensation by public payers, including Medicare and Medicaid.

This means the commission must address the "enormous gap in income potential between primary care and subspecialties," said Derksen. As a result, the commission is likely to zero in on the disparities between primary care and subspecialty payments under Medicare and could issue recommendations aimed at these disparities. If this happens, it could affect the nation's entire payment system because most public and private payers base their payment systems on the Medicare program, Derksen said.

"Unless you address Medicare payment of primary care, it will be hard to convince people to come into the (primary care) profession," he added.

The commission will evaluate the relationship between health care delivery and workforce needs, issuing recommendations to ensure that both aspects are compatible and do not conflict with each other, according to Patel. This type of analysis could have particular relevance for innovative delivery models, such as the patient-centered medical home, said Patel.

"The needs of the medical home and all of the professionals who are involved in executing the medical home are critically tied to the primary care workforce," she said. "If you don't have enough people trained to deliver comprehensive primary care, then you cannot have a successful patient-centered medical home."

Patel also expects the commission to address controversial issues, such as scope of practice. "It is a hot button issue for every provider," she said. "But when we are talking about the workforce or the needs of the workforce, we inevitably get into a conversation about scope of practice."

There is a great deal of controversy about whether nurse practitioners in Medicare should be able to write prescriptions to admit patients to hospice, said Patel, citing an example. "There also is a lot of back-and-forth around home health equipment prescribing," she added.

The workforce commission will be able to work through these types of "sticky issues that are way too political for Congress to legislate," said Patel.

Epperly also predicted that the commission will "get into some controversial areas where people have some sacred cows."

"But for the good of the country, those dialogues and discussions must happen," he said. "Quite frankly, the work of the commission must be transparent ... so that people can see what is being talked about and what is being proposed."