May 17, 2017
Health Care Repeal Takes a Leap Toward the Senate
Welcome back, my friends, for the third and final installment of the blog depicting my misadventures on Capitol Hill! For those of you just tuning in, my name is Fritz Stine, OMS-IV, with the University of Pikeville Kentucky College of Osteopathic Medicine (UP-KYCOM) and I am the current AACOM Osteopathic Health Policy Intern. If you haven’t read my two previous posts, check them out below!
I know it’s hard to believe but SO much has happened since my last post and the wave of compelling news has hit the Hill hard! Below is just the tip of the news iceberg:
- The House passed the GOP-synthesized American Health Care Act (AHCA) by a slim margin of 217 to 213, successfully sending the bill to the Senate for consideration. However, the plot thickens. Many Senate Republicans have noted that they may be crafting an entirely new bill. The Congressional Budget Office also announced that it will release its score of the revised AHCA on May 22! Keep your finger to the pulse of this story, folks, cause it’s gonna get live!
- Insurance providers continue to drop out of state exchanges or publicly claim that they will not be offering Affordable Care Act-specific insurance plans in 2018. Aetna recently announced that it will not be offering plans in 2018, leaving Delaware and Nebraska with just one insurer apiece to provide such plans.
There are also multiple efforts springing forth to make the world a more charitable place. Let’s talk about a few of them!
Week 6 – “Exploring Solutions to Violence and Abuse” and the “13th Annual AAMC Workforce Conference”
Week 6 hit the ground running! I started out by attending a briefing sponsored by the non-profit organization Futures Without Violence with the theme, “Public Health Crisis: Solutions to Violence and Abuse.” This briefing was one of the more powerful experiences I’ve had in a Hill briefing, as those in attendance were shown video footage of individuals affected by intimate-partner violence and drug abuse. These individuals shared compelling testimony about how these destabilizing social determinants of health caused their lives to spin out of control. Afterward, they shared how Futures Without Violence and similar non-profit organizations helped them get back on their feet.
If you remember, week 5 was almost entirely devoted to the Joint AACOM & AODME 2017 Annual Conference. Following this, I attended the 13th Annual Association of American Medical Colleges’ Workforce Conference! This year’s conference had the theme, “Working Together for Health: Aligning the Health Workforce with Population Needs,” and focused not just on the physician workforce shortage but also on the critical nursing shortage our country now faces, and so much more. The presentations I found most compelling regarded the Department of Veterans Affairs (VA) health system and health workforce realignment strategies. The VA health system talk focused primarily on fellowships the VA offers (i.e., VA Quality Scholars Program), panel management, and curriculum creation for attracting health care students to the VA as a learning hub. The health workforce realignment talk was fascinating as well, because it spoke to the different technologies and management systems being pioneered that can aid health systems in analyzing workforce needs in real time and filling the employment and need-based gaps to create more functional workforce systems. With so many great minds together in the same room, it certainly made me confident that there are practical solutions to the critical workforce shortages that the medical profession faces.
Week 7 – “House Appropriations Subcommittee Hearing on Veterans Affairs Oversight” and “A Rising Tide Lifts All Boats!”
With week 7 being my last full week on the Hill, I was very excited to learn that I would have the opportunity to attend the House Appropriations Subcommittee on Military Construction, Veterans Affairs, and Related Agencies hearing on veteran’s affairs oversight. The key witness during this hearing was none other than Secretary of the VA, the Honorable David J. Shulkin, MD. With this being the committee’s first opportunity to publicly interview Secretary Shulkin, many members of the committee wished to inquire about proposed solutions to some of the VA’s most challenging current issues. Among those discussed, most pertinent were the budget increase, the Veterans Choice Program and “Choice 2.0,” opioid abuse among veterans and alternatives to narcotic pain relievers, the appeals and benefits backlog, and the Secretary’s perceived notions on privatizing portions of the VA health system. In response to what was arguably the most pressing issue, the potential privatization of the VA health system, Secretary Shulkin noted that while he has no intent of privatizing the entire VA, there are some aspects of the VA that he recommends outsourcing, such as the electronic medical records system and care sought by veterans outside of the VA system (which is seen in the “Choice 2.0” initiative). There are many interesting developments ahead in this debate!
Lastly, this week saw the culmination of my independent study project for my internship, which was focused on researching grassroots movements. With the title, A Rising Tide Lifts All Boats, I sought to answer three primary questions about grassroots movements: (1) How is the concept of the grassroots movement defined in the literature? (2) How are these movements formed and what causes people to join? and (3) How do organizations measure the effectiveness of the movement? Organizational Research Services (ORS) outline six key categories of measurement:
- Shifts in social norms: Advocacy and policy work focuses closely on this value, as grassroots movements typically seek to align themselves with core and enduring social values and norms.
- Strengthened organizational capacity: This includes improving staffing and leadership, organizational structure and systems, finances, and strategic planning of nonprofits and formal coalitions that perform advocacy and policy work.
- Strengthened alliances: This allows for an organization to band together with others to create larger, denser power structures.
- Strengthened base of support: “The breadth, depth, and influence of support among the general public, interest groups, and opinion leaders for particular issues are a major structural condition for supporting policy changes.”
- Improved policies: Most organizers and non-profits will use this measurement as their gold standard of measuring success. However, it should be noted that this category cannot occur in a vacuum and typically occurs as a result of achieving success in the other categories.
- Changes in impact: This encompasses the long-term changes achieved through advocacy (i.e., the effect felt within the community and amongst individuals) (Reisman, Gienapp, & Stachowiak, 2007).
These six core guidelines can be used effectively by any organization to #MeasureTheMovement to ensure that a grassroots endeavor is striving for its goals productively and is headed in the right direction. In my opinion, these metrics of success were one of the more important findings of my research, with far-reaching implications in both the worlds of organizing and community medicine, and I will certainly come back to these guidelines later in my political life.
Alas, All Good Things Must Come to an End…
Well, my friends and dutiful readers, I am afraid that we have come to the end of the line, as the end of my internship is imminent. Firstly, I wish to thank you, reader, for taking the time to follow my adventures! It has been a true pleasure! Secondly, a HUGE shout out to the AACOM Government Relations team, without whom I would not have had this excellent experience. It has been an absolute honor! Lastly, I wish to give one more shout to the #EDtoMED campaign, which seeks to educate medical students about legislation that affects their graduate-level higher education and student loan debt burden, and what they can do about it. You can visit the ED to MED website at http://edtomed.com/, follow the campaign on Twitter at @ed2med, and connect on Facebook at Ed to Med. Again, thank you so much for reading and, as always, take care, be well, and don’t forget to connect with #EDtoMED!
May 2, 2017
Congressional Spring Recess Is Over and It’s Time to Get Back to Work!
Greetings again, friends! In case you forgot or are just tuning in, my name is Fritz Stine, OMS-IV, and I am currently the AACOM Osteopathic Health Policy Intern (OHPI)! As I dive head first into week five of this eight-week internship, Congress is just returning from their two-week recess and their current schedule is chock-full of activity, to say the least! A few of the topics that have dominated the headlines recently include:
- The GOP effort to repeal and replace the Affordable Care Act (ACA) in time for President Trump’s 100th day in office
- The timeline for stabilizing insurance markets to maintain current ACA coverage
- Congress’s spending budget to keep the federal government running
This is certainly a dramatic time here on Capitol Hill! Humor me a moment and let me show you some of the deeper policy waters I have been wading in these last couple of weeks.
Week 3 – “The Future of Rural Medicine” and “Health Care Goes from Volume to Value!”
At the outset of my third week, I had the opportunity to observe the proceedings of the National Advisory Committee on Rural Health and Human Services, which is a panel of 21 experts in rural health issues which convenes to advise the U.S. Secretary of Health and Human Services, Dr. Tom Price, on ways to meet the health care needs of rural America (photo at left). For me, this meeting was so valuable to attend because the committee discussed the rural “upstream social determinants of care,” which are the social issues that either prevent individuals from seeking care (i.e., lack of transportation, living more than 35 miles from a critical access hospital, lack of insurance) or that directly impact the care they receive (i.e., living in an economically depressed community and being unemployed, being an IV drug abuser and contracting hepatitis). The panel spoke about the current lack of availability of health services in rural America and how this has destabilized insurance markets, pushed ACA exchanges to the brink of failure, and been exacerbated by Medicare debt loads on regional hospitals. Having gone to school in a rural community, this hearing was positively eye-opening to the struggles of providing rural medicine.
I also had the opportunity to attend a forum titled, “Securing the Future of Value-Based Payment,” which was sponsored by Health Affairs, the self-described leading peer-reviewed journal at the intersection of health, health care, and policy (photo at right). This forum focused on what some of you may know as the inevitable shift in health care delivery culture from “volume to value,” or rather, it’s not about how many patients you see but how well you deliver care. The panelists mainly discussed current efforts being taken to transition our system toward value-based payments, and even took on the thorniest question of all, “If the value of something is in the eye of the beholder, how do you standardize and measure it?”
Week 4 – “The Future of Health Care” and “How Much Does This Prescription Really Cost?”
My 4th week on the job started with the epic task of attempting to tackle the future of health care at a forum hosted by The American Cancer Society and The Cancer Action Network (photo at left). This forum focused primarily on what patients need and can expect from a reformed health care system, some of the subtleties of the changing health care landscape, and what the practical issues are behind implementing a replacement health care package in Congress. This forum was incredibly educational because some of the brightest minds in health care today came together to talk about innovative ways to work within and fix some of the ACA’s most difficult issues. For example, not only did the forum discuss flipping the system upside-down and spending more to address the social determinants of health care, but they also talked about a total restructuring of the state-wide insurance markets to allow for states to work together in “regional markets.”
To add another proverbial Jenga piece to the top of the delicate tower that is health care in America, I next attended a forum on the future of prescription drugs in the context of a value-based market hosted by The Atlantic magazine (photo at right). This dizzying discussion on the real price of pharmaceuticals made it easy to understand why, after a period of relative drug expenditure slowing, we are beginning to see a steep rise in the cost of prescription drugs borne by the consumer (Cox et al. 2016). Panelists spoke about the lifecycle of a drug and how, when you pay for a prescription, you are paying for that drug, the research and development that went into it, and for all the failed drugs that never made it to market. In this way, the pharmaceutical companies can recoup their lost investments and continue to operate. In closing, one of the panelists noted that value may not necessarily mean that drugs will be cheaper, but it should mean that patients get more bang for their buck.
Week 5 – #EducatingLeaders17 at the Joint AACOM & AODME Annual Conference
This week was, by far, the most jam packed and “flyin’-by-the-seat-of-my-pants” week that I have had in Washington. Week five saw the beginning of the five-day Joint AACOM & AODME Annual Conference titled, “Educating Leaders: Integrated Health Systems, a Paradigm for the Future.” The conference addressed current and emerging issues in osteopathic medical education (OME) for individuals across the medical education spectrum, from deans of medical colleges to students. Each day was full of splendid workshops and lectures dedicated to the furtherance of OME. I also had the opportunity to meet some strong student and faculty advocates at the ED to MED booth and even managed to take a few selfies!
One particularly enlightening talk was the Thursday morning plenary session with Matthew Kelleher, MD, and Benjamin Kinnear, MD, titled, “From Bedside to Milestones: Successes and Stumbles While Building an Assessment System.” These two physicians from the University of Cincinnati created a new learning assessment tool over the course of the last seven years that focuses on maximizing resident training potential and supporting individual strengths while identifying and correcting deficiencies. Another innovative workshop that I attended was entitled, “Addressing Health Disparities in Osteopathic Medical Education.” This talk focused primarily on how we can structure our curriculum to address social determinants of health, such as homelessness or food insecurity. The talk was led by J. Aaron Allgood, DO, FACP, a faculty member of A.T. Still University School of Osteopathic Medicine in Arizona and full-time physician with Circle the City Medical Respite Center, which is a non-profit community health organization dedicated to providing high quality, holistic health care to people experiencing homelessness in Phoenix, AZ.
On the second-to-last day of the conference, AACOM’s Office of Government Relations hosted an ED to MED Town Hall to raise awareness about the campaign, provide an update on its first-year accomplishments, and inspire others to become advocates in support of the future physician workforce. The town hall was moderated by AACOM’s Senior Vice President of Government Relations, Pamela Murphy, (photo at left), who led a panel comprised of professionals and a medical student, including AACOM’s President and CEO, Stephen C. Shannon, DO, MPH, through a discussion about their advocacy efforts and what their visions were for moving forward. It was also at this town hall that the ED to MED campaign announced its exciting strategic alignment with multiple organizations throughout the medical spectrum, such as the American Medical Student Association, Student Osteopathic Medical Association, and many others who have signed on to endorse the ED to MED campaign principles. This town hall was an exciting opportunity to rally students, physicians, and deans alike to the cause of crafting responsible, common sense solutions to soaring student debt in osteopathic graduate medical education.
See you again next time…
Well folks, this signals the end of another installment of my health policy intern blog spot. It has been an exciting five weeks so far and I so look forward to continuing to share this experience with you further. We will continue to see how things on the Hill unfold and will continue to advocate on behalf of osteopathic medical students, osteopathic physicians, and most importantly the patients whom we serve. Remember, you can visit the ED to MED website at http://edtomed.com/, follow the campaign on Twitter at @ed2med, and connect on Facebook at ED to MED. Until next time, take care, be well, and don’t forget to connect with #EDtoMED!
Works Cited: Cox, C., Kamal, R., Jankiewicz, A., & Rousseau, D. (2016). Recent Trends in Prescription Drug Costs. Jama, 315(13), 1326-1326.
Apr 14, 2017
A little bit about your new author … G
reetings, reader!! My name is Fritz Stine and I am a 4th year osteopathic medical student from the Kentucky College of Osteopathic Medicine in Pikeville, Kentucky! I am so grateful to share that I will be your health policy intern with AACOM’s Government Relations (GR) office from March 27th to May 17th! I will be posting on this blog throughout the course of my internship about my policy misadventures in our nation’s capital, so make sure you don’t miss out!
A little bit about my policy interests …
Being in Washington, DC for two months sampling the entire health care policy landscape can be overwhelming, particularly at a time when the American health care system is such a hot topic. While I will be attending all kinds of meetings on behalf of AACOM GR, I will try to blog only about the particularly juicy stories that may interest you, reader. I want to make sure that you get the VIP, inside scoop of what is going down in the health care policy scene on the Hill.
Topics that I will likely be exploring in the coming weeks:
- Medical student advocacy on the Hill and on the grassroots scene
- Affordable Care Act (ACA) repeal efforts
- Higher education and student loan repayment efforts (e.g., AACOM’s ED to MED grassroots advocacy campaign … more on this later)
- Health care finance (aka “How does all this health care stuff get paid for?!?”)
- Health care workforce issues in rural America (e.g., the physician shortage)
So, how did my first week go … ?
The Osteopathic Health Policy Internship (OHPI) has already been an experience like no other, and there is never a dull moment! The AACOM GR staff are tireless advocates for osteopathic medical students and the profession, and they certainly expect the same from their interns! In my first week on the Hill, I was fortunate enough to have had the opportunity to sit in on a Health and Human Services (HHS) budget hearing with Secretary Tom Price testifying (pictured above) in defense of proposed budget cuts to the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC) for Fiscal Year (FY) 2017, and of the President’s “skinny budget” proposal for FY18.
While Secretary Price came to the meeting with the intention of laying out his public health policy priorities for the next four years, he was also inquired about the HHS plan for the ACA, the proposed cuts to the CDC and NIH, and how the HHS would deal with the current opioid epidemic. However, the Secretary largely exempted himself from providing logistic details of the budget, which he stated would be further expounded upon in May. Secretary Price noted that his public health policy agenda items would be to focus primarily on the opioid crisis, substance abuse, the childhood obesity epidemic, mental health, and emergency preparedness and responsiveness. As a medical student, it was particularly thrilling to be present at this hearing because I know that the legislation being debated has the power and authority to alter the way physicians practice medicine.
Also in my first week, which just so happened to be National Public Health Week (#NPHW), I had the opportunity to attend a day-long seminar entitled The Affordable Care Act: What’s Next? at the George Washington University Milken Institute of Public Health. (at right) This seminar brought together some of the most influential and brilliant minds in public health to discuss three sets of issues:
- ACA—Achievements, Challenges, and What Comes Next
- Health Insurance, Hospitals, and Economic Considerations
- Population and Public Health Issues
I know what you’re thinking: this sounds like a total nap-factory. And I get where you’re coming from, but once you realize how vitally integral these factors are to the health of our communities and our families—once you bridge the understanding gap—you begin to see just how mysterious and intriguing this subject matter really is!
Week 2 – Advocating for Change: Going Live on Capitol Hill
My second week as an OHPI was dominated by advocacy. This spring, I took part in two events on Capitol Hill—AACOM’s COM Day on Capitol Hill and the American Osteopathic Association’s (AOA’s) DO Day on the Hill—that brought together osteopathic medical students, deans, and physicians in practice to advocate on behalf of our patients, communities, and profession. (Photo: KYCOM students from the Bowling Green area in Western Kentucky met with their Representative, Mr. Brett Guthrie.)
(Photo: The KYCOM delegation had a meeting with Sen. Rand Paul to discuss GOP healthcare efforts and his thoughts as a physician-legislator.) During these advocacy days, we shared our stories with policymakers about primary issues that affect the health care profession. AOA’s DO Day emphasized advocacy on behalf of Teaching Health Centers Graduate Medical Education, while AACOM’s COM Day urged students to share their stories on graduate student loans, the reauthorization of the Higher Education Act, and federal public service scholarship and loan repayment programs. Graduate student loans are a very important piece of the puzzle because in 2017, osteopathic medical students will routinely graduate from their four-year program with over $240,000 in student loan debt. AACOM sparked a revolutionary new campaign, ED to MED, which seeks to educate medical students about legislation that affects their graduate-level higher education and student loan debt burden, and what they can do about it. You can visit the ED to MED website at http://edtomed.com/, follow the campaign on Twitter at @ed2med, and connect on Facebook at Ed to Med.
Ciao, au revoir, aloha, auf wiedersehen, see ya’ next time …
Well, reader, that’s it for our first post! I hope that you enjoyed hearing about my first two weeks on the Hill! Stay tuned for my next post, wherein I will share more advocacy mysteries, more intense conference photos, and who knows … maybe even some DC foodie pics! Thank you so much for reading and, as always, take care, be well, and don’t forget to connect with #EDtoMED!