Summary of Physician-Related Provisions in Affordable Health Choices Act

The Senate Committee on Health, Education, Labor and Pensions (also known as the Senate HELP Committee) chaired by Senator Edward “Ted” Kennedy (D-MA) released the Affordable Health Choices Act on June 9, 2009, outlining the committee’s option for health care reform. The draft legislation deals with key issues such as affordable coverage for all Americans; improving the quality and efficiency of health care through quality measures, and resolving the future workforce issues.
     » View HELP Committee press release on the Affordable Health Choices Act

The following is the Society's summary of physician-related provisions in the Affordable Health Choices Act:

Health Quality and Delivery System Reform

— National Strategy to Improve Health Care Quality
This section requires the Secretary of Health and Human Services (HHS) to establish a national strategy and support infrastructure necessary to improve the quality of the U.S. health care system. The strategy will target priority areas, use health information technology to incorporate quality improvements, and focus on health outcomes and population health. An interagency working group will coordinate and implement health care quality improvement initiatives. Quality measures will be identified, developed and endorsed. A streamlined and integrated quality reporting process will minimize the burden on providers. Among the provisions are:

National Strategy for Quality Improvement in Health Care: The secretary is required to establish a national strategy through a transparent process. The strategy will target priorities, which will:

• Address health care provided to patient with high cost chronic diseases
• Reduce health care disparities across population and geographic areas
• Address gap in quality of care
• Improve the federal payment policy
• Enhance the use of health care date to improve quality, transparency and outcomes

Creation of the “Interagency Working Group on Health Care Quality”: This working group will coordinate on planning and implementing quality improvement activities as defined in the national strategic plans. Each agency will need to develop its own individual strategic plans and report to the Public and Congress on the progress toward implementing the plan. The working group will be chaired by the Secretary of HHS and will also include senior level staff from the following departments:

• HHS
• Labor
• Office of Personnel Management
• Defense
• Education
• Veterans Affairs
• any other agencies with activities related to improving health care quality

Quality Measures Development: The strategy plan will use health information technology to incorporate quality improvement and focus on health outcomes and population health. The quality measures will be developed in “gap” areas where no quality measures exist or where they need improvement, updating or expansions. The measures will be developed according to the priorities area related to coordination or care, patien experience, health disparities, and the appropriateness of care and will be endorsed by defined entities. Eligible entities will develop the measures supported by federal grants. This program will receive an annual $75 million from 2010 through 2014.

Quality Measure Endorsement, Public Reporting; Data Collection: This section provides for a streamlined process for use of quality measures for Federal health programs. The data from the reporting of these quality measures will be made available in a user-friendly format to inform providers, patients, consumers, researchers, and policymakers.

Collection and Analysis of Quality Measure Data: To encourage robust participation, resources will be provided to local entities to collect and aggregate quality data. The Secretary will establish standards for data aggregators and ensure health information privacy is protected.

— Reporting Health System Quality Improvement
This section establishes health quality initiatives to reduce medical errors, reduce hospital readmissions, improve patient safety, promote evidence-based medicine and disseminate best care practices. An integrative model of patient-centered care will be supported through the establishment of Community Health Teams. Research and informational tools will be encouraged to assist patients make informed decisions about care options available to them. In order to eliminate waste, routine administrative processes that divert scarce health resources from patients to paperwork will be streamlined. Among the provisions are:

Establishment of the Patient Safety Research Center: This center will identify, develop, evaluate and provide strategies for quality improvement practices in the delivery of healthcare services known as best practice. The Center should develop tools to facilitate the adoption of best practices that improve quality, safety, and efficiency of healthcare services delivered. The center will create grants to disseminate best practices to local providers and patients in the goal to prevent medical errors.

Community Health Team: The Secretary of HHS would establish a grant program to creating the “community health team which is community-based, multi disciplinary, interprofessional teams (on the model of medical home) to increase access to comprehensive coordinated care.

Medical Therapy Management Program: This legislation will create a grant program through the Patient Safety Research Center to implement medication management services in the treatment of chronic disease to reduce medical errors, improve patients adherence to therapies while reducing acute care costs. This provision also includes grants to develop of quality measures that assess the use and effectiveness of medication therapy management services.

Reporting and Reducing Preventable Readmission: After analyzing readmissions rates and reporting  the results to Congress, the secretary of HHS with the help of CMS and AHRQ staff will select the condition or procedures subject to the readmission reporting program. The selection will be based on both high volume condition or procedures and high readmission rate. Once those conditions have been selected, the secretary of hhs will establish a program requiring hospital with high readmission rates (determined as hospitals among the highest 25% of national rate) to work local patients safety organizations to improve their care transitions practice.

Program to Facilitate Shared Decision Making: Educational tools will be developed, tested, and disseminated to help patients and caregivers understand their treatment options. Materials will assist patients to decide with their provider what treatments are best for them based on these beliefs and preferences, options, scientific evidence, and other circumstances. Providers will be educated on the use of these tools. Quality measures related to utilization of these tools as well as patient and caregiver experiences will be developed.

Center for Health Outcomes Research and Evaluation: This legislation established the Center for Health Outcomes Research and Evaluation which will provide health outcomes research and evaluation that enables patients and providers to identify which therapies work best for most people and to effectively identify where more personalized approaches to care are necessary for others. In order to conduct his study, the center will use existing registries, award grants to conduct research where existing evidence is inadequate. The secretary will create the National Advisory Council which is composed of representatives from scientific research, patient, provider and health industry communities to ensure research conducted is meaningful to patients and providers.

Demonstration Program to Integrate Quality Improvement and Patient Safety training into health professionals’ clinical education: Grants will be provided to develop and implement academic curricula that integrate quality improvement and patient safety into health professionals’ clinical education

Health Care Workforce

Summary: This section seeks to improve access to and the delivery of health care services for all individuals, particularly low income, underserved, uninsured, minority, health disparity, and rural populations by: gathering and assessing comprehensive data in order for the health care workforce to meet the health care needs of individuals, increasing the supply of a qualified health care workforce, enhancing health care workforce education and training, and providing support to the existing health care workforce to improve access to and the delivery of health care services for all individuals. Among the provisions are:

— Healthcare workforce assessment
National Health Care Workforce Commission: This legislation establishes national commission tasked with reviewing health care workforce and projected workforce needs. The overall goal of the commission is to provide comprehensive, unbiased information to Congress and the Administration about how to align federal health care workforce resources with national needs.

State Health Care workforce Development Grants: Competitive grants are established for the purpose of enabling state partnerships to complete comprehensive planning and to carry out activities leading to coherent and comprehensive health care workforce development strategies at the state and local levels. Grants would be used to support innovative approaches to increase the number of skilled health care workers such as health care career pathways for young people and adults.

Health care workforce program assessment: This provision establishes the National center for Health Workforce analysis which will develop of information describing the health care workforce and analyze the workforce related issues. The national center will work with states center to collect and analyze the data.

— Increasing the Supply of the Health Care Workforce
Federally supported student loan funds: Current law is amended to ease criteria for schools and students to qualify for loans, lower interest rates, shorten payback periods, and ease the non-compliance provision.

Nursing Student Loan Program: Increases the grant amounts and updates the years for nursing schools to establish and maintain student loan funds.

Public Health Recruitment and Retention Program: Offers offer loan repayment for a relevant public health professions degree to full time employees in federal, state, local or tribal public health agencies in exchange for working at least 3 years.

Allied Health Recruitment and Retention Program: Offers loan repayment for a relevant allied health professions degree to full time employees in federal, state, local or tribal public health agencies or in settings where patients might require health care services, including acute care facilities, ambulatory care facilities, residences, and other settings.

— Enhancing Health Care Workforce Education and Training
Training in Family Medicine, General Internal Medicine, General Pediatrics, and Physician Assistantship: Provides grants to develop and operate training programs, financial assistance of trainees and faculty, and faculty development in primary care and physician assistant programs. This section provides grants to establish, maintain and improve academic units in primary care. Priority is given to programs that educate students in team-based approaches to care, including the patient-centered medical home. Authorization is $125 million.

Nurse education, practice, and retention grants: Awards grants to nursing schools to strengthen nurse education and training programs and to improve nurse retention.

— Supporting the Existing Health Care Workforce
Centers of Excellence: The Centers of Excellence program, focusing on development of a minority applicant pool to enhance recruitment, training, academic performance and other supports for minorities, is reauthorized at 150% of 2005 appropriations, $50 million.

Health Professions Training for Diversity: Provides scholarships for disadvantaged students who commit to work in medically underserved areas as primary care providers. Funding is increased from $37 to $51 million for 2009 through 2013. This section increases loan repayments for individuals who will serve as members of faculties of eligible institutions from $20,000 to $30,000.

Interdisciplinary, Community-Based Linkages: This section establishes community-based training and education grants for Area Health Education Centers (AHECs) and Programs. Two programs are supported — Infrastructure Development Awards and Points of Service Enhancement and Maintenance Awards targeting individuals seeking careers in the health professions from urban and rural medically underserved communities. Authorization is for $125 million annually 2009 through 2013.

Workforce Diversity Grants: Expands the allowable uses of diversity grants to include completion of associate degrees, bridge or degree completion program, or advanced degrees in nursing, as well as pre-entry preparation, advanced education preparation, and retention activities.

Primary Care Extension Program: Creates a Primary Care Extension Program to educate and provide to technical assistance to primary care providers about evidence-based therapies, preventive medicine, health promotion, chronic disease management, and mental health. The Center for Primary Care, Prevention, and Clinical Partnerships at the Agency for Healthcare Research and Quality (AHRQ) will award planning and program grants to state entities including state health department, state-level entities administering Medicare and Medicaid, and at least one health professions school.