News Roundup: June/July 2019

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Media coverage of the Commission this summer focused on these priorities:

  • State Budget – Workforce Investments, Loan Repayment
  • Healthy Aging & Care for Older Adults
  • Nurse Practitioners

STATE BUDGET – WORKFORCE INVESTMENTS, LOAN REPAYMENT

California’s new budget invests in overlooked piece of health care puzzle: workers
CalMatters – Op-ed by Sandra Hernández and Raymond Baxter
Is this the start of a new era for California’s health workforce? It sure looks like it. Gov. Gavin Newsom is poised to sign the largest, most comprehensive set of proposals in years to expand California’s health workforce pipeline—tapping $300 million in the 2019-20 budget to address an often overlooked threat to our health care system: a shortage of qualified health professionals. Our state has been acting boldly for years now on a variety of fronts to improve health and health care—from cutting the uninsured rate in half to reducing medical costs. But coverage is not care, and for millions of Californians to access the care they need, we are going to need more workers, particularly workers who represent the communities they serve.

Doctors in Debt: These Physicians Gladly Struck a Deal With California
New York Times
The state is providing up to $300,000 in debt relief for doctors who agree to accept Medicaid. The grant has lifted “an emotional burden,” one recipient said, adding, “I can focus on my patients.” Dr. Rishi Manchanda, who was part of a commission that put forward a $3 billion, 10-year plan to address the shortfall of doctors in California, called the repayment program “a big step in the right direction” that would immediately dispatch clinicians to serve these populations. But more needs to be done, he said, to bolster the pipeline of doctors practicing in the state. Among the commission’s recommendations: Increasing enrollment at medical schools in the state, raising reimbursement rates for doctors, giving nurse practitioners greater authority in the doctor’s office, and a shift toward “value-based” payment systems, which reward providers based on performance.

California doesn’t have enough doctors. To recruit them, the state is paying off medical school debt
Los Angeles Times
“The loan repaying program is huge,” said Sandra R. Hernández, a physician and president of the California Health Care Foundation. “You have a lot of young physicians who graduate from medical school with tremendous debt. We think this is a good long-term win for getting physicians to serve in under-served areas.” As California’s doctor shortage has grown, the state’s residents are growing older, with an aging baby boomer population increasing the need for healthcare workers. And one-third of the state’s doctors and nurse practitioners are baby boomers who are reaching retirement age, further depleting the workforce. Those trends led healthcare, education and business leaders to form the California Future Health Workforce Commission in 2017 to study the state’s impending healthcare crisis, with the task force ultimately proposing a $3-billion plan over the next 10 years to address it.

This story also ran in the following publications:

Editorial: California’s wise investment in medical care
Santa Rosa Press Democrat
California has steadily increased access to health care since the Affordable Care Act took effect five years ago, moving ever closer to the goal of universal coverage. According to a Census Bureau report issued last fall, just 7.2% of Californians were without health insurance in 2017. That’s good news, but more people with insurance coverage means more people seek medical care. And California is facing a shortage of 4,100 physicians and thousands of other health care workers in the coming decade, according to a report published this year by the California Future Health Workforce Commission. This past week, state health officials advanced a new remedy: paying off student loans for doctors willing to treat the neediest patients.

California Is Paying Off Med School Debt to Recruit Doctors
Fortune
California needs more doctors—and it’s going to extreme lengths to recruit them. The state is offering to pay off all of the medical school debt of physicians who pledge to spend roughly one-third of their time focusing on low-income patients. At present. California has $340 million budgeted for the program. The program is meant to fight a shortage of health professionals in the state, as California’s health care program for the poor (roughly one-third of the state) has outpaced the number of physicians who accept those patients. More than 60% of California’s students who attended medical school in 2017 left the state for their schooling, according to the California Future Health Workforce Commission. That task force has proposed a $3 billion plan that will run over the next 10 years to address the looming health care crisis.

Stories about the loan repayment program that did not mention the Commission were also published in the following outlets:

HEALTHY AGING & CARE FOR OLDER ADULTS

A silver wave? California braces for elderly boom that could overburden state
Sacramento Bee
Figuring out ways to get around without a car, affording housing in a city where rents are rising rapidly, living on a fixed income and finding affordable healthcare are about to be major problems for a large group of people in California. The Golden State is about to get a lot older. The gap between thesupply of seniors and the demand for services is likely to widen as the state’s population grows and ages, and historically vulnerable populations – rural, inner city and low-income people – will be hit the hardest.

More than 7 million Californians live in so-called Health Professional Shortage Areas, a designation given by the federal government. The majority of people living in the underserved areas are Latino, African American and Native American, the California Future Health Workforce commission found.

NURSE PRACTITIONERS

Jim Wood Talks Universal Health Care, Bipartisanship and the Uphill Battle for Change
Lost Coast Outpost
Interviewer: I wanted to ask you about AB-890 [the nurse practitioners’ unsupervised practice bill, which was held by the Assembly Appropriations Committee in May and is now a two-year bill].

Asm. Wood: It’s not over…This bill wasn’t something that I just pulled out of my hat. I spent a year and a half working on a workforce commission that was put together by the California Healthcare Foundation back in 2017. So it was about a year and a half of work, meetings, looking at this, and this was one of the top recommendations to come out of there…The bill made it through our policy committees in the Assembly. The chair of Appropriations [Assemblymember Lorena Gonzales] has concerns about the bill….so we will be meeting beginning in the latter part of August with [Gonzales] to address specifically the concerns that she has. And then my hope is that in January it will be released from Appropriations and we’ll go forward from there.

Mitchell backs more NP authority as state faces provider shortage
Politico Pro
By Angela Hart
Sen. Holly Mitchell said Monday she supports allowing nurse practitioners to practice independently of physicians, an idea that has faced intense opposition in the past from the California Medical Association.

“It makes perfect sense,” said Mitchell (D-Los Angeles).

The Senate Select Committee on the Social Determinants of Children’s Well-Being, chaired by Mitchell, met Monday in Fresno to consider ways to address mental health and primary care provider shortages.

Giving nurse practitioners independent practice authority was among the ideas under consideration. One such proposal, CA AB890 (19R) by Assemblyman Jim Wood (D-Santa Rosa), died in the Assembly Appropriations Committee this spring but could resurface next year.

Mitchell acknowledged intense opposition surrounding such scope-of-practice bills. She said she still has “missing teeth” from her 2012 bill that would have authorized registered nurses to dispense contraceptives ordered by a physician, nurse practitioner or physician’s assistant. Yet, she said, given deep provider shortages, especially in California’s Central Valley, the state must act more forcefully.

Central Valley residents told the committee that they have problems accessing affordable health care and voiced broader concerns around clean drinking water and housing costs.

“We can do better,” said state Health and Human Services Secretary Mark Ghaly.

He said California must focus on recruiting and training health care workers — particularly those who specialize in primary care and mental health in underserved communities. The state has already begun cracking down on county mental health plans for not offering enough providers to meet needs in the San Joaquin Valley and Inland Empire.

Other recommendations, put forward by the Healthforce Center at the University of California, San Francisco, include increasing funding for psychiatry residency slots and psychiatric nurse practitioner education.

Experts also encouraged the state to increase enrollment at UC medical schools and expand incentives for providers to accept Medi-Cal patients. Currently, 64 percent of California’s doctors accept Medi-Cal patients, according to the center.

The Healthforce Center also suggested earlier training and mentoring programs, especially for people in underrepresented and low-income communities, and greater state investment in the broader health care workforce, such as outreach workers.

“We’re going to have insufficient numbers of new primary care and behavioral health professionals to replace those who retire unless the state acts proactively to expand their numbers,” said Janet Coffman, a professor at the Healthforce Center and the Institute for Health Policy Studies at UCSF. “The budget for this year made a good down payment on that investment, but there’s still more to do.”

Mitchell, who also chairs the Senate Budget Committee, said the state must “figure out how we address medical school debt” that can prevent people from entering the medical field. The state could expand its loan repayment programs, she suggested.

She said the recommendations and public testimony could be used to develop next year’s budget and legislation.

Published by commission_staff