President Obama speaks at a rally on health care reform at the University of Maryland Photo: AP
...Senior advisor at the White House Office of Management and Budget (click title to entry - thank you) on health policy Ezekiel Emanuel (brother to Rahm) gave a presentation on Sunday at the Medical Group Management Association's annual conference on the need to restructure how physicians deliver care.
In a speech he titled, "High-Touch Medicine, the Future of the Physician-Patient Relationship," Emanuel, who is also bioethics chair for the National Institutes of Health, said that while the use of information technology is essential for improving healthcare quality, increasing the amount of time physicians spend with patients should be an equally compelling goal....
I have some reservations about the 'character' some of the Senate bill rolls out in the way of touting health care savings based in technology. I don't really buy it. I see a lot of that as a 'spending' bill and not a health care insurance reform bill. The Republican Senate is good at that. Republicans will put together a bill that will spend a lot, but, will it actually reform and revolutionize health care delivery? Maybe.
I believe electronic records, if perfected, can save lives. Absolutely. It will provide immediate information to any physician anywhere in the country to expedite care, especially in emergency rooms.
But, I have reservations about the 'prompts' to physicians delivering care. According to some of the reviews of the Senate bill there will be all this 'data base' availability to physicians when diagnosing a patient. There will be 'prompts' regarding the tests needed and medications to order. There will be prompts to new ideas and new venues of care.
I don't believe physicians that care about their practice need all that and I think it will serve to cause 'excellant' physicians to 'pause' in administering care. It is usually the dedicated and compassionate doctors that seek the most information with a willingness to establish state of the art care for his or her patient.
I don't want my physician to be making decisions regarding my care based upon the latest trend. I want solid diagnosis with proven treatment. One has to wonder what effects this 'automated' format will look like and who has time for it. I would think physicians think new methods and medicine through before using them in their practice and it is why I don't see 'bedside prompts' as an improvement to care. I mean, where is the 'filter' to this information and whom exactly is approving it to be used in a treatment modality.
I believe some of the technologies the Senate has proposed shows short sightedness. There needs to 'trials' of the new high tech bedside doctoring before it is used in general practice. I hope that was part of the bill. Trials of any new idea in the House bill is strongly noted and the venues of change in health care delivery can come swiftly provided there is overwhelming results to the benefits to patients. I also don't see supplying such 'prompts' as a commercial enterprise and/or a 'perk' for the MD. Either it improves patient care or it doesn't.
The next section deals with the Public Helath Service Act (click here) OR here. The Public Health Service Act has been around for decades and has appropriation spending every year. This section simply states it will continue and in a perscribed manner.
The Public Health Service Act has several amendments including Health Insurance Portability, a few issues with Cancer, Muscular Dystrophy and Family Planning. The bill gives the funding a name and states where the monies are found for this provision.
Page 859, lines 1 through 5 and page 860, lines 3 through 5.
SEC. 2002. PUBLIC HEALTH INVESTMENT FUND.
(a) ESTABLISHMENT OF FUNDS.—
(1) IN GENERAL.—There is established a fund to be known as the ‘‘Public Health Investment
Fund’’ (referred to in this section as the ‘‘Fund’’)....
Below is a list of the 'services' the Public Health Service Act provides. There is no option in replacing it or eliminating it. It was well written decades ago and is fine the way it is:
-coordinating with the States to set (click here) and implement national health policy and pursue effective intergovernmental relations;
-generating and upholding cooperative international health-related agreements, policies, and programs;
-conducting medical and biomedical research;
-sponsoring and administering programs for the development of health resources, prevention and control of diseases, and alcohol and drug abuse;
-providing resources and expertise to the States and other public and private institutions in the planning, direction, and delivery of physical and mental health care services; and
-enforcing laws to assure the safety and efficacy of drugs and protection against impure and unsafe foods, cosmetics, medical devices, and radiation-producing projects.
and
-reducing health care costs, through studies on the interaction of cost, quality, and access; microsimulation modeling, to understand the effect of proposed health care reform; and analyzing health care costs effected by acute, ambulatory, and long-term care and AIDS;
-expanding clinical practice guideline activities by increasing production of important guidelines and evaluating their effect on the cost and quality of health care; and
-enhancing the scientific evidence base for cost-effective clinical practices, by expanding research to improve clinical decisionmaking and strengthening clinical information systems for effectiveness research.
The Public Health Service Act illustrates and sets precedent to the reform the government is working on now. It demands good quality care to Americans at a reasonable cost. One could say, it provides a 'demand' on elected officials to seek reform now that the industry is so out of control and negligent of the priorities of physicans for their patients and providing coverage to everyone. So, when opponents to health care insurance reform refuse to participate they are actually conducting themselves in an Anti-American modality and against 'established' law. Those that oppose this reform bill are sincerely incompetent to understand their role as an elected offical.
In all honesty, The Public Health Services Act is where American Health Care gets 'its tone' and 'impetus.' It wasn't as though one day a House Representative 'thunk it up' and thought it would be a good idea to reform health care. There is a reason why the House bill is so well written and very structured for its implementation. This reform has been on the agenda of the House for some time and it is the Public Health Services Act that is the basis of these reform bills. It is THE LAW, not an option.
This House bill actually is providing another amendment to the Public Health Services Act. Page 862, lines 15 through 23:
(I) appropriated under the heading ‘‘Prevention and Wellness Fund’’ in title VIII of division A of the American Recovery and Reinvestment Act of 2009 (Public Law 111–5); and (II) allocated by the second proviso under such heading for evidence based clinical and community-based prevention and wellness strategies.
Of course, the ARRA (American Recovery and Reinvestment Act) is the stimulus package passed this year once President Obama was in office. This provision takes the monies of the stimulus and impliments it under established law.
Page 863, lines 16 through 24:
(3) BUDGETARY IMPLICATIONS.—Amounts appropriated under this section, and outlays flowing from such appropriations, shall not be taken into account for purposes of any budget enforcement procedures including allocations under section 302(a) and (b) of the Balanced Budget and Emergency Deficit Control Act and budget resolutions for fiscal years during which appropriations are made from the Fund.
The funds allocated for this portion of the bill cannnot be reallocated. They are dedicated funds for the purpose of which they are stated.
Page 864, lines 1 through 5:
TITLE I—COMMUNITY HEALTH CENTERS
SEC. 2101. INCREASED FUNDING.
Section 330 of the Public Health Service Act (42 U.S.C. 254b) is amended—
This is funding for a new provision under the Public Health Service Act to include "Community Health Centers."
"National Association of Community Health Care Centers" (click here)
The Associated Press has a nice artilce about them.
Community clinics have key role in health reform (click here)
By JULIANA BARBASSA (AP) – 3 days ago
SAN JOAQUIN, Calif. — Francisco Lupercio has insurance for his house, his truck and the store he runs with his wife. But he can't afford health insurance, so he joined dozens of other people lining up for exams at a community clinic.
As the recession grinds on, more and more people are relying on taxpayer-supported health centers that offer care on a sliding fee scale. If Congress passes a law giving more Americans access to health insurance, the clinics will also be a critical element to ramping up capacity to care for millions of new patients.
"There is going to be a wave of chronically ill people," said Tanir Ami, executive director of the Community Clinic Consortium for Contra Costa and Solano counties, east of San Francisco. "We're well positioned to care for them."...
Page 865, lines 6 through 14:
TITLE II—WORKFORCE
Subtitle A—Primary Care Workforce
PART 1—NATIONAL HEALTH SERVICE CORPS
SEC. 2201. NATIONAL HEALTH SERVICE CORPS.
(a) FULFILLMENT OF OBLIGATED SERVICE REQUIREMENT THROUGH HALF-TIME SERVICE.—
(1) WAIVERS.—Subsection (i) of section 331
(42 U.S.C. 254d) is amended—
This is establishing the 'status quo' of allowing certain waivers for loan repayment to those that come to work in a 'corp' placement. It provides for scholarships that if accepted by the candidate agree to service in places in the country where they are most needed. It is an 'equity' issue to provide high quality health care workers to all areas of the country, regardless of what is normally preceived as a low earning capacity region.
This provision goes on for awhile about definitions and how a participant has some options to satisfy the service of the contract. The physicians that funded their education through these programs actually have the option of 'servicing the contract' 50% of the time while they spend the rest of their time establishing their own private practice or entering a group practice if they desire. It is a nice option.
These programs also include funding for Dentists and Dental hygienists.
If the 'Loan Repayment Corp Program' has unused monies there is methods to use the monies for recruitment of folks to serve the underserved.
Page 875, lines 4 through 15:
‘‘(d) INSUFFICIENT NUMBER OF APPLICANTS.—If there are an insufficient number of applicants for loan repayments under this section to obligate all appropriated funds, the Secretary shall transfer the unobligated funds to the National Health Service Corps for the purpose of—
‘‘(1) recruitment of sufficient applicants for the National Health Service Corps for the following year; or
‘‘(2) making additional loan repayments under section 338B if there is an excess number of qualified applicants for loan repayments under such section.
There is an emphasis in this section to promote the 'specialty' called "Primary Care." It is also clear in the legislation that these applicants have to demonstrate financial need. There is a lot of legislative support for establishing training in family medicine, general internal medicine, general pediatrics, or geriatrics, including physican assistants including in community-based settings. Other specialties mostly take care of themselves. There is a lot of incentive to practice in high paying specialties and there really is no need to promote those, especially with government monies. There are also aspects of this section to make the public aware of these existing opportunities to those people that need financial assistance. A program is no good if no one knows about it.
Page 892, lines 14 through 25 and page 893, lines 1 through 3:
Subtitle B—Nursing WorkforceSEC. 2221. AMENDMENTS TO PUBLIC HEALTH SERVICE ACT.
(a) DEFINITIONS.—Section 801 (42 U.S.C. 296 et seq.) is amended—
(1) in paragraph (1), by inserting ‘‘nurse-managed health centers’’ after ‘‘nursing centers,’’; and
(2) by adding at the end the following:
‘‘(16) NURSE-MANAGED HEALTH CENTER.— The term ‘nurse-managed health center’ means a nurse-practice arrangement, managed by advanced practice nurses, that provides primary care or wellness services to underserved or vulnerable populations and is associated with an accredited school of nursing, Federally qualified health center, or indpendent nonprofit health or social services agency.’’.
"Institute of Nursing Centers" (click here)
The Institute for Nursing Centers is a network of organizations that focuses on the advancement of nurse managed health centers (NMHCs). The intent of the network is to enhance the work of all partners with an emphasis on developing a national data center for NMHCs. The founding members of the INC are the Michigan Academic Consortium (MAC), the American Association of Colleges of Nursing (AACN), the Nursing Centers Research Network (NCRN), the Michigan Primary Care Association (MPCA), the National Nursing Center Consortium (NNCC), and the National Organization of Nurse Practitioner Faculties (NONPF).
Nurse Health Centers can 'pick up the slack' when emergencies beset the nation. That is not all they do and many Advanced Practice Nurses have speciality areas such as anesthesia, midwives and pediatrics. Example of how a Nurse Health Center can participate:
Eugene schools offering H1N1 vaccine (click here)
Last Update: 10/15 8:07 pm
Eugene (KMTR) - Students in Eugene’s 4J school district started receiving the H1N1 flu vaccine Thursday.
The school health centers at Sheldon, North Eugene and South Eugene High Schools got a larger supply of H1N1 nasal spray vaccine than they expected, and made it available on a first-come, first-served basis.
The first doses were given to students who are in high-priority groups and who can take the nasal form of the vaccine. The live-virus vaccinations are being given to students whose parents bring them to the health centers, according to North Eugene school nurse Debbie Goodman.
“The live vaccine has very specific requirements in order to qualify for that,” Goodman said. “Number one, right now, we are targeting our most vulnerable population, so that's our priority. And with the live virus we can only give the vaccine to healthy individuals with no chronic health conditions, from the age of two years old to 24."...
There is no gender bias or discrimination as nursing is traditionally a woman's field. There are financing programs, loans and grant programs to promote Advanced Practice.
Page 907, lines 18 through 25 and page 908, lines 1 through 3:
SEC. 2232. ENHANCING THE PUBLIC HEALTH WORKFORCE.
Section 765 (42 U.S.C. 295) is amended to read as follows:
‘‘SEC. 765. ENHANCING THE PUBLIC HEALTH WORKFORCE.
‘(a) PROGRAM.—The Secretary, acting through the Administrator of the Health Resources and Services Administration and in consultation with the Director of the Centers for Disease Control and Prevention, shall establish a public health workforce training and enhancement program consisting of awarding grants and contracts under subsection (b).
Page 909, lines 22 through 25 and page 909, lines 1 through 4:
‘‘(4) to provide financial assistance in the form of traineeships and fellowships to public health professionals who are participants in any program described in paragraph (1) and who plan to teach in the field of public health, including nursing; health administration, management, or policy; preventive medicine; laboratory science; veterinary medicine; or dental medicine.
And yes, veterinary medicine is as much a public health concern as human medicine. So, we need veterinarians, too. Examples:
15 Oct 2009: Report
The Spread of New Diseases:The Climate Connection (click here)
by Sonia Shah
As humans increasingly encroach on forested lands and as temperatures rise, the transmission of disease from animals and insects to people is growing. Now a new field, known as “conservation medicine,” is exploring how ecosystem disturbance and changing interactions between wildlife and humans can lead to the spread of new pathogens.
Look up into the tree canopy of the urban tropics in South Asia, Australia, or equatorial Africa and as often as not you will find masses of Pteropos fruit bats, hanging from the branches like so many furry stalactites. Their forests cut down by bulldozers, torched by slash-and-burn farmers, or desiccated from a disrupted climate, fruit bats increasingly intrude upon human communities, adapting to the orchards and cultivated fruit trees of the cities, farms, and suburbs that have subsumed their forests....
It's showdown time over pet licensing (click here)
Houston vows to get tough with vets who defy law for rabies data
By CINDY HORSWELL
HOUSTON CHRONICLE
Oct. 17, 2009, 1:34PM
For more than two decades, many Houston veterinarians have engaged in a quiet mutiny of sorts.
They have refused to follow a law requiring them to essentially name names — to turn over the identities and addresses of pet owners whose dogs and cats received rabies shots.
The city of Houston wants these names to identify some of the hundreds of thousands of pet owners who have failed to obtain the required city license for their dog or cat — and which could result in a citation. Only 4 percent of Houston's estimated 1 million pets are registered today, city officials said....
This section of the House bill goes on for many more pages. It allows for financial assistance to disadvantaged students and sets limits to the extent they can receive those monies. Although this is a large section of the bill, the monies being appropriated are in the millions and not the billions. So, the investment into the workforce is important, but, the bill still has its primary focus on getting good health insurance for the populous of the USA.
This section also gives permission for much more fluidity for change in the health care professions with allowances for 'inter-disciplinary' education and monitoring the need for different specialities for a changing population.
Page 931, lines 14 thorough 19:
TITLE III—PREVENTION AND WELLNESS
SEC. 2301. PREVENTION AND WELLNESS.
(a) IN GENERAL.—The Public Health Service Act (42 U.S.C. 201 et seq.) is amended by adding at the end the following:
It is the next section of the House bill and where I will stop for now. I am almost complete in reading the House bill as the pages number to 1018.
Regards.
