COVID-19: Public Health Emergency and the Health Care Response – Where does the health workforce fit in?

by | Mar 18, 2020 | Policy, Topics of Interest

Public Health and Health Care

The public health and health care sectors are generally seen as “related but separate.” Public health emergencies, such as COVID-19, demonstrate how critical it is for public health and health care initiatives to be aligned and seen as integral parts of the larger system of health (Health System).

Public health and health care: How are they different?

The CDC defines public health as “the science of protecting and improving the health of people and their communities.”[1] Public health services include things such as public service announcements, health education campaigns, and monitoring population health statistics, like COVID infection rates.  On the other hand, health care includes services aimed at improving or restoring the health of individuals, like diagnostic testing.  The bottom line: public health is focused on POPULATION health and health care is focused on PATIENT health.

Public health and health care: How are they the same?

During a public health emergency, public health and health care can become practically indistinguishable. When an infectious disease is spreading, both public health (POPULATION) and health care (PATIENT) interventions are required to stop the spread, #flattenthecurve, treat the sick, and de-escalate the crisis.

Now let’s talk about the workforce.

We could separate the “health workforce” into the public health workforce (usually seen as epidemiologists, public health officials, etc.) and the health care workforce (physicians, nurses, dentists, etc.).  But, in a time of crisis like COVID-19, both public health and health care professionals have the same end goal: restore and maintain the health of each person, and ultimately the health of the public overall. This workforce is on the #frontline of the response.  But what about workforce shortages?

How are states ensuring a health care workforce response and addressing shortages?

They are creating plans to:

  • Enhance portability of the health care workforce across state lines
  • Use telehealth to screen patients and provide medical guidance
  • Extend scope of practice for the duration of emergency orders
  • Support effective delivery by hosting best practice guidelines for health care professionals on government websites

Research is ongoing to identify exactly what states are doing and how they are enacting these plans. Our team is working with the National Governors Association on a review of this, which we hope will inform state efforts.

 

[1] Source: Centers for Disease Control and Prevention. Available at: https://www.cdcfoundation.org/what-public-health

Senate Enrolled Act 223 (2018): What does it mean for Indiana’s health workforce data?

by | Aug 29, 2019 | Data, Policy, Topics of Interest

What is it?

Over the last several decades, information has been collected from health professionals during online license renewal. In 2018, Senate Enrolled Act 223 identified selected pieces of information (including educational and practice characteristics) as critical to the state of Indiana (1). Beginning in 2019, it will now be required for health professionals to provide this information when they renew their license.

Who is affected?

This information will be collected from all licensees under the following boards:

  • Indiana Medical Licensing Board
  • Indiana State Board of Nursing
  • Indiana State Board of Dentistry
  • Behavioral Health and Human Services Licensing Board
  • Indiana State Psychology Board
  • Indiana Board of Pharmacy

How will it be implemented?

Information will be requested in the form of questions during the renewal process. The only difference from previous years is that these questions will have to be completed in order for an individual to proceed with license renewal. Don’t worry! The questions take approximately 5 minutes to complete. Any professional that is renewing their license but isn’t actively practicing will always have a response option that fits them (ex: a “not applicable” option is available).

The Governor’s Health Workforce Council serves as the reviewing and approval body for licensure survey questions. Approved questions can be found on the Council’s website at: https://www.in.gov/dwd/ghwc.htm or on each individual survey located under the “Publications” tab on the Bowen Portal. 

Why is it necessary? 

This information will provide Indiana with an accurate representation of the health workforce in the state. This data will be used to inform various initiatives. Check out the infographic below to learn more about how this information is used.

Where will this information go?

The information is collected by the Indiana Professional Licensing Agency and will be maintained in the Indiana Health Professions Database by the Bowen Center under contract with the State of Indiana. Information will be made publicly available through technical reports and briefs. Examples of these reports can be found at under the “Publications” tab of this website.

Want more info?

Please contact the Bowen Center for Health Workforce Research & Policy for any
questions (bowenctr@iu.edu or 317-278-0316).

 

 

References:
1- 2018 Indiana Senate Enrolled Act 223. Available at:
https://iga.in.gov/legislative/2018/bills/senate/223#document-b0603ddf

Recap: 2019 Legislative Session in Indiana

by | Aug 7, 2019 | Other, Topics of Interest

What happened in health workforce policy and what’s on the docket?

The dust has settled from Indiana’s 2019 Legislative Session and we want to provide you with a recap of major changes in the health workforce policy realm. With 2019 being a “long session” (AKA a budget year), it was jam-packed with initiatives and much was accomplished. We hope you were able to follow along during the session using the Bowen Biweekly Bill Brief, or B4, Tracker. The B4 highlighted health workforce-specific bills and served to inform and update stakeholders on relevant initiatives. The latest version of the B4 is linked at the bottom of the post. (This was our first year implementing the B4 and we’d love to get your feedback on it. What worked? What didn’t? How can we make it better? Email us at bowenctr@iu.edu with your thoughts.)

Now, let’s jump into a summary of enacted health workforce related legislation from the 2019 General Session:

 Licensing/Regulation Changes

  • Nurse Licensure Portability: The Nurse Licensure Compact was signed into law and is set to go into effect in 2020. This will allow participating nurses to practice in any compact state under a single compact license. (HEA 1344 [1])
  • Behavioral Health Workforce License Requirements: Regulatory changes were made to select behavioral health professions. These changes impact education or experience requirements for licensure. (SEA 527 [2], HEA 1199 [3])
  • Regulation of Physical Therapists: Physical therapy now has its own licensing board (it was previously a committee under the medical licensing board). (SEA 586 [4])
  • Office-based Opioid Treatment Providers (OBOTs): Medication-Assisted Treatment, or MAT, is generally delivered in two types of settings:
    1) Opioid Treatment Programs, which are organizations regulated at both the federal and state levels, and 2) OBOTs, which are community-based providers with a federal waiver to prescribe associated medications (DATA 2000 [5]). Before 2019, there was minimal state regulation for OBOTs. Rules will now be created by the Medical Licensing Board (in consultation with Indiana State Department of Health, Family and Social Services Administration) for office-based opioid treatment (SEA 141) [6]. Federal code for OTPs outline staffing requirements.[7] It is unclear whether Indiana seeks to adopt staffing requirements for OBOTs.

Delivery/Practice Changes

  • Mobile Integration Programs: Emergency medical personnel are now permitted to provide (and be reimbursed through Medicaid for) expanded services including: transportation, acute care, chronic condition, or disease management services. This is consistent with national trends to allow and reimburse for community paramedicine services.[8] (SEA 498 [9])
  • Addressing Infant Mortality through Perinatal Care: HEA 1007[10] requires health care providers to screen and treat pregnant women for/with substance use disorder and SEA 416[11] requires Medicaid reimbursement for doula providers.
  • Telehealth: Psychologists may now deliver tele-psychology services to patients in Indiana (HEA 1200 [12]).

 Summer Session Legislative Initiatives

Indiana’s 2019 policy work does not stop at the spring general session. There were a number of health workforce initiatives that spilled into summer session agendas. The 2019 Interim Study Committee topics were announced at the end of May and can be found at: https://iga.in.gov/documents/4500c157.

  • Health Care Costs: There were a number of bills calling for a study of the contributing factors of health care costs. This topic made it onto the agenda of multiple interim study committees (Financial Institutions & Insurance; Fiscal Opportunities; Public Health, Behavioral Health, and Human Services)
    • What does this have to do with the health workforce?
      • Access to care in rural areas was one of the identified sub-topics. As Indiana seeks to address shortages of health care providers, wise allocation of workforce development funding will be critical.
      • As Indiana seeks to reduce health care costs, it is likely that alternative payment and/or delivery models may be explored. Many new mechanisms for care delivery require that a workforce is trained and ready to deliver care in an innovative way. This could be applied to technology innovations (such as telehealth) or emerging care team models/members (such as community health workers, paramedics in community settings, doulas, etc.).
    • Advanced Practice Registered Nurses (APRN) Operating without a Practice Agreement: Two bills this session sought to remove requirements for a practice agreement for APRNs delivering care (SB 394 [13], SB 343 [14]). There was a lot of discussion on both sides and from public testimony; ultimately, neither bill made it across the finish line. This topic will be studied by the Public Health, Behavioral Health, and Human Services Interim Committee.
      • What does this have to do with the health workforce?
        • This topic addresses the practice and supervisory provisions for advanced practice registered nurses in Indiana.
        • For information on the Advanced Practice Registered Nurse workforce in Indiana, check out the Data Report and Brief linked at the bottom of the post.

 

Save the Dates

Dates and agendas for interim study committees can be found at each committee’s respective homepage. Dates for the Public Health, Behavioral Health, and Human Services Interim Study Committee may be found below:

  • Wednesday, September 4: 9:00am in Senate Chamber | Agenda | Link to Watch Live
  • Wednesday, September 18: 10:00am in Room 431
  • Wednesday, October 2: 10:00am in Room 431
  • Wednesday, October 16: 10:00am in Room 431
  • Wednesday, October 30: 10:00am in Room 431

Resources Referenced in the Post:

Latest Version of the B4:
https://scholarworks.iupui.edu/bitstream/handle/1805/20130/2019%20Bowen%20Biweekly%20Bill%20Brief_8-1-19.pdf?sequence=1&isAllowed=y

2017 Nurse Data Report: https://scholarworks.iupui.edu/bitstream/handle/1805/17195/2017-Nursing-Data-Report-Final-RS_Authored%20Version.2.28.19.pdf?sequence=10&isAllowed=y

2017 Nurse Brief:  https://scholarworks.iupui.edu/bitstream/handle/1805/18302/RN%20Fact%20Sheet-FINAL%28revised%29.pdf?sequence=6&isAllowed=y

References

[1] https://www.iga.in.gov/legislative/2019/bills/house/1344

[2] https://www.iga.in.gov/legislative/2019/bills/senate/527

[3] https://www.iga.in.gov/legislative/2019/bills/house/1199

[4] https://www.iga.in.gov/legislative/2019/bills/senate/586

[5] U.S. Department of Justice, Drug Enforcement Administration. DEA Requirements for DATA Waivered Physicians. Available at: https://www.deadiversion.usdoj.gov/pubs/docs/dwp_buprenorphine.htm

[6] https://www.iga.in.gov/legislative/2019/bills/senate/141

[7] Minimum Standards for the Provision of Services by

Opioid Treatment Facilities and Programs. 440 IAC 10-4-13. Available at: https://iac.iga.in.gov/iac/T04400/A00100.PDF?

[8] https://www.hhs.gov/about/news/2019/02/14/hhs-launches-innovative-payment-model-new-treatment-transport-options.html

[9] https://www.iga.in.gov/legislative/2019/bills/senate/498

[10] https://www.iga.in.gov/legislative/2019/bills/house/1007

[11] https://www.iga.in.gov/legislative/2019/bills/senate/416

[12] https://www.iga.in.gov/legislative/2019/bills/house/1200

[13] https://www.iga.in.gov/legislative/2019/bills/senate/394

[14] https://www.iga.in.gov/legislative/2019/bills/senate/343