John Colbert

February 25, 2020

PULLING BACK THE CURTAIN

John Colbert

February 25, 2020

Two events that are prominent in the nation’s annual political pageant enable voters to obtain a glimpse of the kinds of policies that may be concealed behind the curtain. One is the President’s State of the Union Address, which makes it possible to boast of past achievements and describe in broad terms anticipated future legislative initiatives. While members of the President’s party cheer vigorously at each utterance, Congressional members of the opposition party typically are more reticent. The second noteworthy event is the release by the Administration of its federal budget for the next fiscal year. Stock full of details on how money should be allocated, it’s relatively easy to determine which budgetary elements are destined to undergo some exceptionally rough legislative sledding based on who cheered wildly at the State of the Union address and who remained silent.

Lobbyists and leaders of special interest groups pay close attention to the proposed federal budget. Each year, the plot lines in the drama are reasonably clear. Many liberals tend to fret that important discretionary social programs involving health care and education will be seriously underfunded, while proclaiming that some military programs are too bloated and either should be eliminated outright or undergo significant reductions in spending. Many conservatives view matters differently and it is rare for them to fail to acknowledge what they perceive as redundant and wasteful amounts of money allocated for ineffective social programs.

The budget sent to Congress on February 10, 2020 contained some of the following items:

The administration proposes funding $38.7 billion for the National Institutes of Health (NIH) in FY 2021, which amounts to $3 billion less money or more than a 7% cut below the FY 2020 enacted program level.
The Agency for Healthcare Research and Quality (AHRQ) would be funded as a new institute within the NIH in the amount of $257 million, representing an $82 million (24%) reduction below AHRQ’s current funding level.
On the plus side, the budget proposes a nearly $900 million increase in career and technical education funding.
The Food and Drug Administration (FDA) would obtain a small budget increase in FY 2021 ($25 million, for a total of $3.29 billion).

Apart from legislation that involves spending, bipartisan cooperation has aided in producing efforts aimed at protecting patients from surprise medical billing. House Ways and Means Committee Chairman Richard Neal (D-MA) and Ranking Member Kevin Brady (R-TX) on February 7, 2020 announced the Consumer Protections Against Surprise Medical Bills Act of 2020 while Education and Labor Committee Chairman Robert “Bobby” Scott (D-VA) and Ranking Member Virginia Foxx (R-NC) revealed their surprise billing legislation, the Ban Surprise Billing Act.

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PRESIDENT’S CORNER

John Colbert

February 25, 2020

Trends Archives

BY ASAHP PRESIDENT PHYLLIS KING

A Blueprint for the Future (2020 – 2024) of the Association of Schools Advancing Health Professions

I am pleased to announce a new Strategic Plan is in place that articulates ASAHP’s priorities and will focus our energy and resources to best serve the organization in accomplishing its mission of advancing health through interprofessional collaboration. This plan includes a shared vision of ASAHP being THE source for interprofessional collaboration to improve health.

Values driving our actions include quality education, interprofessional collaboration, connecting education and health, innovation, leadership and diversity. Five strategic areas of activity have been identified, each led by a board member with a committee structure, to achieve ASAHP’s mission and vision:

Communications, public relations and marketing – Andrew Butler
Leadership development – Deborah Larsen
Education – Ces Thompson
Partnerships, alliances and advocacy – Teresa Conner-Kerr
Research, member services and programs – Brian Shulman

Over the coming months you will receive more detailed information on the activities and metrics each committee is employing and how you can be involved. Member benefits of networking, professional development, research and development, the institutional profile survey, the leadership development program, representation on the Federal level and in other health organizations, and publications are retained with an eye toward adding even more value for members. Rest assured you have a dedicated leadership team excited to shape the future of ASAHP and adapt to ever changing environments with you.

TEAM ABOUT TO BREAK THE HUDDLE TO REVISE STRATEGIC PLAN

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GEOGRAPHIC INFLUENCE ON HEALTH DISPARITIES

John Colbert

February 25, 2020

Trends Archives

Individuals possess distinguishing characteristics, such as age, education, level of income, extent of health insurance coverage, and degree of health literacy that contribute to the likelihood they will experience health disparities. Where they live and work also will play an important role due to a rural-urban divide that exists. For example, an article in the January 2020 issue of the American Journal of Preventive Medicine discusses how in the U.S., rural residents have poorer health than urban residents and this disadvantage is growing. Compared with metropolitan county residents, inhabitants of the most rural counties were seven percentage points more likely to have a usual source of care (81% vs 74%), but their providers were 13 percentage points less likely to be physicians (22% vs 35%). Despite having to travel longer to reach their usual source of care providers, residents of the most rural counties were 12 percentage points less likely than metropolitan residents to have usual source of care providers with office hours on nights and weekends (27% vs 39%).

Rural counties make up approximately 80% of the land area of this nation, but they contain less than 20% of the U.S. population. The relative sparseness of the population in rural areas is one of many factors that influence the health and well- being of the inhabitants of these places. An important difference pertaining to the health workforce is that some rural counties may lack the presence of a single member of a particular health profession, such as dentistry or psychiatry. Older patients with chronic ailments often require rehabilitation care, which typically requires a team consisting at a minimum of physicians, nurses, dietitians, occupational therapists, physical therapists, and speech therapists.

Hospitals often serve as the main type of venue where such teams are located, but as Seema Verma, Administrator of the Centers for Medicare & Medicaid Services, pointed out in a presentation she made on February 12, 2020 at the National Rural Health Association’s policy institute, more than 120 rural hospitals have closed since 2010, which does not appear to be a step in the right direction of ensuring the presence of a sufficient network of health providers. Unlike students who live in big cities that have access to several academic institutions with health professions programs reachable by subway and bus, rural students lack this luxury and may live hundreds of miles from educational resources. Fortunately, telehealth services can benefit patients and online degree programs may be available to enable the pursuit of academic degrees necessary to become health professionals, but it is not the same as having face-to-face kinds of opportunities that exist in urban areas.

Health policy is in a state of flux. Some presidential candidates propose new approaches, such as Medicare for All, but it is not entirely clear what impacts possibly could materialize that affect the delivery of health care services. Changes in reimbursement patterns, for example, either could slow the pace of hospital closings in rural areas or accelerate their disappearance if financing levels prove to be less than what is necessary to enable these facilities to remain afloat financially.

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GEOGRAPHY DETERMINES WHEN A DEATH CAN BE DECLARED

John Colbert

January 24, 2020

Trends Archives

Apart from decision fatigue, there is the issue of decision confusion. An example is that it is possible for an individual to be pronounced dead in one state, but not dead in a neighboring jurisdiction. As described in an article appearing on December 24, 2019 in the Annals of Internal Medicine, this situation exists because only 36 states have incorporated the complete language of the Uniform Determination of Death Act (UDDA) into their respective definitions of death. An original goal was for all states to adopt the UDDA as the legal standard for death by neurologic criteria (DNC). Instead, there is ongoing confusion about DNC since medical standards of determination vary, public acceptance is inconsistent, and responses to family objections have ranged from continuation of organ support indefinitely to unilateral discontinuation. Unresolved problems pertain to: (1) lack of uniformity in the medical standards used to determine DNC, (2) uncertainty about whether “all functions of the entire brain, including the brainstem” entail hormonal functions, (3) the UDDA does not address whether consent is needed before a determination of DNC, and (4) the UDDA does not address religious objections to discontinuation of organ support after DNC.

In a related vein, a debate is underway in the field of Alzheimer’s disease (AD) research over the definition of the disease itself. As described in the December 11, 2019 issue of the journal Science Translational Medicine, a problem is that the terms dementia and AD have become interchangeable. Arguments in favor of using a biological versus a clinical diagnosis for AD are that: the latter is not specific for any etiology; a biological definition of AD will lead to a better understanding of the sequence of events that leads to cognitive impairment and dementia; biological markers will improve efficiency of clinical trials; and a biological definition of AD enables study of the disease from the preclinical stage through all symptomatic stages and of all disease phenotypes, not only the memory loss phenotype.

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A CONCEPTUAL ANALYSIS OF DECISION FATIGUE

John Colbert

January 24, 2020

Trends Archives

The Lovesong of J. Alfred Prufrock by T.S. Eliot contains the following verse:

Time for you and time for me,
And time yet for a hundred indecisions,
And for a hundred visions and revisions,
Before the taking of a toast and tea.

The memory of the TRENDS newsletter’s editor of this portion of the poem was triggered while perusing an article on the topic of decision fatigue that appeared in the January 2020 issue of the Journal of Health Psychology, in which it is estimated that an American adult makes 35,000 decisions each day. While some of them seemingly are benign, an emerging body of science indicates that making decisions may possess negative ramifications for controlling one’s behavior and the quality of subsequent decisions. The phenomenon is known as “decision fatigue,” an impaired ability to make decisions and control behavior as a consequence of repeated acts of decision-making that often lead to choices that seem impulsive or irrational. Decision-making is a central component of modern health care, with each decision possessing some level of influence on patient outcomes. With a substantial proportion of all adults possessing at least one chronic condition, decision-making may be considered a central facet of day-to-day chronic disease self-management.

Decision fatigue as a concept has been applied scantily to health care disciplines, despite its potential relevance to inform the decision-making behaviors of patients and clinicians. If health professionals are working to the point where they are in severe states of ego depletion (manifesting as decision fatigue) and are not in an ideal cognitive state to make logical and safe decisions for patients, an exploration of decision fatigue may serve as a highly relevant and necessary endeavor. Hence, decision fatigue analysis may possess significance to inform regulatory policies related to health care employee workload.

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AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

John Colbert

January 24, 2020

Trends Archives

U.S. Investments In Medical And Health Research And Development 2013 - 2018

A new report from the advocacy group Research!America finds that the total spending on health and medical research was more than $194 billion in 2018. Since 2013, medical and health R&D spending has increased by $51 billion. Industry and academia funding have increased by nearly 40% over this time. Industry was responsible for two-thirds of the 2018 R&D funding, while federal agencies invested about 22%. Academic institutions and foundations made up the rest. Spending on health care far outweighs spending on health research. In 2018, $3.6 trillion was spent on care, which means research funding accounts for only five cents of every health sector dollar. The report can be obtained here.

More Americans Delaying Medical Treatment Due To Cost

Approximately one out of four Americans say the cost of treatment caused them to delay care for a serious medical condition, according to Gallup’s annual Health and Healthcare poll in 2019. An additional 8% of respondents indicated that costs played a factor in deciding to delay seeking care for less serious conditions. In 2018, 19% of Americans claimed that treatment costs led to a delay in treatment for a serious condition. The poll tracked a few trends within this data, including the following: On the basis of household income, 36% percent of adults with household income of less than $40,000 reported delaying treatment for a serious condition, a jump in 13 percentage points since last year. Rates stayed relatively flat for middle-and high-income households. Americans who reported having a pre-existing condition, or living with someone who has, were more likely to delay medical care for a serious condition this year compared to 2018. According to Gallup, these trends could have broad implications for both the health care system and the economy. The report can be obtained here.

Do Advanced Driver Assistance And Semi-Automated Vehicle Systems Lead To Improper Driving Behavior?

According to a report from the AAA Foundation for Traffic Safety, the ultimate goal of advanced driver assistance systems (ADAS) is to increase traffic safety and driving comfort. Despite their potential safety benefits, there are concerns about unintended consequences associated with intermediate levels of automation. In these scenarios, speed control and/or steering are automated, but the driver still is required to monitor traffic and be ready to resume control. A key concern is that drivers may become inattentive due to engagement in non-driving-related tasks or become drowsy while driving using these systems. As drivers gain experience using advanced driver assistance systems (ADAS), such as adaptive cruise control and lane-keeping assist, they also are more likely to drive distracted while using the systems, according to research from AAA Foundation for Traffic Safety. Conducted in collaboration with the Virginia Tech Transportation Institute, the study found that drivers with experience using ADAS were nearly twice as likely to engage in distracted driving while using the systems compared to when they were driving without the systems. Researchers noted the opposite effect in drivers with less familiarity using the technology. Those drivers were less likely to drive distracted with the systems engaged compared to when the systems were not in use. The report can be obtained here.

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QUICK STAT (SHORT, TIMELY, AND TOPICAL)

John Colbert

January 24, 2020

Trends Archives

Adult Physical Inactivity Prevalence Maps By Race/Ethnicity

According to new state maps of adult physical inactivity made available by the Centers for Disease Control and Prevention (CDC) in January 2020, all states and territories had more than 15% of adults who were physically inactive and the estimate ranged from 17.3 to 47.7%. Inactivity levels vary among adults by race/ethnicity and location. The data come from the Behavioral Risk Factor Surveillance System (BRFSS), an ongoing state-based, telephone interview survey conducted by CDC and state health departments. Maps use combined data from 2015 through 2018 and show noticeable differences in the prevalence of physical inactivity by race/ethnicity. Hispanics (31.7%) had the highest prevalence of physical inactivity, followed by non-Hispanic blacks (30.3%) and non-Hispanic whites (23.4%). Non-Hispanic blacks and Hispanics had a significantly higher prevalence of inactivity than non-Hispanic whites in the majority of states.

Driving Under The Influence Of Marijuana And Illicit Drugs Among Persons Aged ≥16 Years—U.S.

Data from the Substance Abuse and Mental Health Services Administration’s National Survey on Drug Use and Health (NSDUH) indicate that in the United States during 2014, 12.4% of all persons aged 16–25 years reported driving under the influence of alcohol, and 3.2% reported driving under the influence of marijuana. This report provides the most recent national estimates of self-reported driving under the influence of marijuana and illicit drugs among persons aged ≥16 years, using 2018 public-use data from NSDUH. Prevalences of driving under the influence of marijuana and illicit drugs other than marijuana were assessed for persons aged ≥16 years by age group, sex, and race/ethnicity. During 2018, 12 million (4.7%) U.S. residents reported driving under the influence of marijuana in the past 12 months; and 2.3 million (0.9%) reported driving under the influence of illicit drugs other than marijuana. Driving under the influence was more prevalent among males and among individuals aged 16–34 years.

HEALTH TECHNOLOGY CORNER

Benefit To Patients Using Wearable Devices Such As Fitbit Or Health Apps On Mobiles

According to a study reported in the December 2019 issue of the American Journal of Medicine, wearable devices have become a standard health care intervention with emerging health care technologies. These devices are designed to promote healthy behaviors and decrease risk for chronic ailments, such as cardiovascular disease and diabetes. A systematic search of 550 articles revealed little indication that wearable devices provide a benefit for health outcomes. Only one study showed a significant reduction for weight loss among participants. No significant reduction was discovered in cholesterol or blood pressure. A conclusion reached is that current literature evaluating wearable devices indicates little benefit of these items on chronic disease health outcomes. Although wearable devices play a role as a facilitator in motivating and accelerating physical activity, current data do not suggest other consistent health benefits.

Light-Degradable Hydrogels As Dynamic Triggers For Gastrointestinal Applications

Different kinds of medical devices can be inserted into the gastrointestinal tract to treat, diagnose, or monitor GI disorders. Many of these items need to be removed by endoscopic surgery after their function has been performed. According to an article published on January 17, 2020 in the journal Science Advances, engineers at the Massachusetts Institute of Technology have developed a way to trigger such devices to break down inside the body when they are exposed to light from an ingestible light-emitting diode (LED). A potential advantage is that light can act at a distance and doesn't need to come into direct contact with the material being broken down. Also, light normally does not penetrate the GI tract, so there is no chance of accidental triggering. Light-triggerable hydrogels have the potential to be applied broadly throughout the GI tract and other anatomic areas. By demonstrating the first use of light-degradable hydrogels in vivo, biomedical engineers and clinicians are provided with a previously unavailable, safe, dynamically deliverable, and precise tool to design dynamically actuated implantable devices.

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DEVELOPMENTS IN HIGHER EDUCATION

John Colbert

January 24, 2020

Trends Archives

Supplementing the information provided on page three of this issue of the newsletter, it is worth noting that the appropriations portion of the bill for higher education programs provides $2.5 billion, an increase of $163 million above the 2019 enacted level and $941 million above the President’s budget request. For federal student aid programs, the bill provides $24.5 billion, which is $75 million above the 2019 enacted level and $1.5 billion above the President’s budget request. Within this amount, the bill furnishes $865 million for the Supplemental Educational Opportunity Grant (SEOG) program, $1.2 billion for Federal Work Study, and an increase to the maximum Pell grant to $6,345.

A report issued on December 10, 2019 by the Pew Charitable Trusts on how the U.S. has changed in key ways in the past decade indicates that nonwhites now account for the majority of the nation’s newborns, as well as the majority of K-12 students in public schools. More than half of newborn babies in the U.S. are racial or ethnic minorities, a threshold first crossed in 2013. Nonwhite students also account for the majority of the nation’s K-12 public school students. As of fall 2018, children from racial and ethnic minority groups were projected to make up 52.9% of public K-12 students. With the passage of time, these facts will have an enormous impact on higher education in general and on the health professions in particular. Future issues of the ASAHP newsletter TRENDS will serve as a vehicle for discussing how the education sector will be affected by these kinds of societal changes.

Costs Associated With Attending College

Year-over-year increases in college expenses have grown steadily in the U.S. since 1981. Although the Pell Grant Program also has expanded at regular intervals, the maximum does not align well with much higher tuition costs. Consequently, students and their families increasingly find it necessary to take out various kinds of loans. Beyond the day when degrees are awarded, the amount of debt borne by recent college graduates may delay the attainment of milestones associated with adulthood later in life, such as buying a house, getting married, and having children. The situation is even more gloomy for students who have incurred substantial debt, but never ended up graduating from college.

A report made available on December 31, 2019 from the National Center for Education Statistics (NCES) describes four measures of the price of undergraduate education in the 2015–16 academic year: total price of attendance (tuition and living expenses), net price of attendance after all grants, out-of-pocket net price after all financial aid, and out-of-pocket net price after all aid excluding student loans. Estimates are based on the 2015–16 National Postsecondary Student Aid Study, a nationally representative survey of students enrolled in postsecondary institutions in the 50 states, the District of Columbia, and Puerto Rico. The total price of attendance consists of tuition and nontuition expenses (fees, books, supplies, transportation, and living expenses )., For example, full-time students at public two-year institutions had the lowest average total price of attendance at $16,100 in 2015-16. The average total price of attendance was higher at public four-year institutions ($26,900), higher still at for-profit institutions ($32,600), and highest at private non-profit four-year institutions ($48,000). The percentage of students with loans was greatest at private for- profit schools (74%) and lowest at public 2-year institutions (20%).

Opposition To Student Loan Forgiveness Rule

Congressional Democrats aim to prevent implementation of a Department of Education policy that would make it more difficult for federal student loan borrowers to cancel their debt based on misconduct by any college. Set to take effect on July 1 of this year, the Trump administration policy that was finalized last year establishes more stringent rules for when the government will wipe out the debt of students claiming they were misled or deceived by a higher education institution. Democrats are using the Congressional Review Act, a tool that allows Congress to stop recently enacted regulations with a simple majority in both chambers and the president's signature.

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HEALTH REFORM DEVELOPMENTS

John Colbert

January 24, 2020

Trends Archives

Approximately 18% of the U.S. economy, the largest in the world, is represented by the health sector, which suggests that there always will be something occurring within that domain that will prove to be newsworthy. Typical stories in the media and relevant topics in policy discussions revolve around the central issues of cost, quality, and access. The last item is guaranteed to continue to attract significant attention as long as there are any individuals in this country who lack health insurance coverage.

The Patient Protection and Affordable Care Act was signed into law by President Barack Obama on March 23, 2010. Usually referred to as either the ACA or Obamacare, this key piece of legislation has been in the news since its various provisions began to unfold. Its enactment was supported wholly in Congress by Democrats in both legislative chambers, without a single Republican vote. That outcome alone essentially assured that the years ahead would be marked by strenuous efforts to repeal and replace its most important features either in whole or in part. Republicans came close to repealing the ACA in 2017 when they were the majority in both the House and the Senate and President Donald Trump occupied the White House, but the attempt did not meet with success, albeit by a close margin. Failure in Congress did not mean that opposition fervor would be diminished, however, as repeal efforts then shifted to the judicial arena.

Repeal Of the Individual Mandate Penalty Set The Stage For Repeal Of The ACA

As part of a successful attempt to overhaul U.S. tax law aimed at energizing the economy, Republicans were able to zero out the individual mandate penalty in 2017. Once that happened, they insisted that a mandate stripped of its penalty for not purchasing health insurance meant the provision no longer was enforceable and could not be considered as being constitutional. Because the mandate is viewed as being such an essential component of the Affordable Care Act, eliminating it led to a claim that the entire law now should be struck down. A federal district court in Texas subsequently declared the ACA invalid in December 2018.

Twenty-one Democratic attorneys general and the House of Representatives then appealed this ruling to to the Fifth Circuit. That court partially affirmed the district court in 2019 in a 2–1 decision, agreeing that the mandate absent a penalty is unconstitutional. Significantly, this narrow majority ruling did not include what should be done with the ACA as a whole. Instead, the case was remanded back to the Texas district court for a more complete severability analysis. A main issue awaiting resolution is whether the mandate can be severed from the ACA, leaving the rest of the law to continue to be constitutional. Meanwhile, the Democratic attorneys general have appealed the ruling by the Fifth Circuit to the U.S. Supreme Court. Whether it will accept the case and deal with it in 2020 is unknown at this juncture.

PCORI Remains In Effect While Some ACA Taxes Are Repealed

The Patient-Centered Outcomes Research Institute (PCORI) was established by the ACA to promote comparative effectiveness research to assist patients, clinicians, purchasers, and policymakers in making informed health decisions. Although it enjoyed widespread support from the time of inception, detractors viewed it as a politically-driven program with attendant dangers associated with central planning. During 2019, there was some opposition to reauthorizing PCORI. Instead, the Institute enjoyed bipartisan support and its funding was reauthorized for 10 years as part of appropriations legislation described on page three of this issue of the newsletter.

That same appropriations package affected the ACA in other important ways. Members of Congress fully repealed the health insurance tax beginning in 2021, along with the so-called Cadillac tax on beneficiaries who have expensive insurance policies, and the medical device tax beginning in 2020. Repeal of the medical device tax always enjoyed bipartisan support because many states have companies affected by it. A potential downside is that these taxes were intended to cover the costs of expanding health insurance coverage under the law. It is estimated that repealing them will result in the loss of approximately $400 billion in revenue over the next ten years.

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LABOR-HHS FUNDS ALLOCATED FOR FY 2020

John Colbert

January 24, 2020

Trends Archives

It is characteristic in any given year for Congress to be unable to complete work in the area of appropriations in time for necessary funds to be made available for the start of a new fiscal year each October 1. Instead, a series of short-term continuing resolutions (CRs) are implemented so that government functions can continue to operate. The year 2019 was no exception to this sequence of events. Even until late December when a CR was about to expire, there was no firm assurance that another one one would not be necessary.

Nevertheless, the holiday season proved to be a happier one as agreement was reached on how much funding to provide for a wide range of entities that come under the umbrella of the Departments of Labor, Health and Human Services, Education, and Related Agencies, which commonly are referred to as Labor-HHS. That piece of legislation was one of eight large bills that made up one minibus package (four national security bills made up another minibus package). The Labor-HHS bill included $184.9 billion in discretionary funding, an increase of $4.9 billion over the 2019 enacted level and $43 billion over the President’s 2020 budget request.

The Department of Health & Human Services (HHS) was allocated $94.9 billion, an increase of $4.4 billion above the 2019 enacted level and $16.8 billion above the President’s budget request. The largest increase, $2.6 billion, went to the National Institutes of Health. HRSA (the Health Resources & Services Administration) obtained $7.04 billion, a $193 million increase over the FY 2019 level. Within HRSA, Title VII health professions programs received $424.5 million, a $32.3 million increase over the FY 2019 level, and the Health Careers Opportunity Program was funded at $15 million. The Department of Education was awarded a total of $72.8 billion in discretionary appropriations, which was $1.3 billion above the 2019 enacted level and $8.7 billion above the President’s budget request, with the maximum Pell grant increasing to $6,345.

Moving forward, it is unclear to what extent any meaningful legislation involving social determinants of health, surprise billing, drug pricing, and lowering health care costs will be approved by Congress in 2020. One possible impediment to meaningful action is the necessity of having a trial in the Senate now that House officials have transmitted two articles of impeachment. Once the trial begins, its length could depend on whether both impeachment supporters and opponents agree to allow witnesses to testify. Also, a national election next November will contribute to a compression of the legislative calendar. Apart from determining the outcome to elect a U.S. President, all House members and one-third of the Senate who wish to remain in office must face the voters. As the time of the election approaches, campaign activities necessarily must take precedence over legislative business.

A related consideration is that even in the best of times, the nature of certain pieces of legislation will preclude any rapid action. The Higher Education Act (HEA), to cite one key illustration, last was reauthorized in 2008. That authorization expired in 2013. Now that almost seven years have elapsed and several hearings have been conducted, apart from separate bills currently being championed by members of the House and Senate, the prospect of reaching agreement any time soon does not appear to be on the near horizon.

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PRESIDENT’S CORNER

John Colbert

January 24, 2020

Trends Archives

BY ASAHP PRESIDENT PHYLLIS KING

Interprofessional Education and ASAHP – Fostering a Culture of Collaboration

The Association of Schools Advancing Health Professions (ASAHP) has a strong commitment to improving collaboration and outcomes in health care by supporting Interprofessional Education (IPE). Through the leadership of Immediate Past President Susan Hanrahan, ASAHP’s commitment to IPE in both the academic and clinical learning environments has grown significantly and gained clarity over the past two years.

ASAHP’s interprofessional identity comes from both its structure and its actions. We built off these strengths identifying that interprofessional collaboration threads throughout all aspects of ASAHP. The dedicated section on IPE in the Journal of Allied Health has grown in popularity and impact. ASAHP continued its engagement as members of the Interprofessional Education Collaborative (IPEC) Council, the National Academies of the Sciences, Engineering and Medicine Global Forum on Innovation in Health Professional Education, and the Health Professions Accreditors Collaborative (HPAC). ASAHP’s Annual Meeting has been recognized by the American Interprofessional Health Collaborative (AIHC) as an Affiliate Conference in 2018 and 2019.

ASAHP also engages academic institutions, governmental and industry partners to translate interprofessional education to improve society by addressing workforce readiness, health outcomes and social determinants of health. We sponsored the inaugural ASAHP Summit in 2018 to bring together a diverse group of key stakeholders in dialogue to address issues regarding IPE, collaborative practice and work-force readiness. The 2019 Summit teamed up with ASAHP’s Clinical Education Task Force to conduct an on-campus event at Saint Louis University where representatives from academia and industry engaged in conversation regarding the CETF’s recommendations and co-creating action steps moving forward.

In 2018, ASAHP also started to recognize best practice in IPE through a new “ASAHP Excellence and Innovation in Interprofessional Education and Collaborative Health Care” award. This provided a mechanism for sharing model initiatives from our members by highlighting institutions for excellence in interprofessional collaboration. Texas Tech University Health Sciences Center and Indiana University Purdue University at Indianapolis were honored with the award in 2018 and 2019 respectively. Additionally, three ASAHP member institutions were recognized as “Programs of Merit” each year.

The upcoming ASAHP board strategic planning meeting will no doubt address how we advance IPE initiatives to leverage our identity and our commitment to quality improvement in health care through interprofessional collaboration. ASAHP has a unique combination of attributes that other organizations strive to achieve with our institutional and industry membership, leadership development/networking, international outreach, student engagement, well-regarded journal, and vibrant annual meeting. We look to accelerate our current momentum with a continued commitment to innovation, excellence and impact.

ASAHP is well-positioned to emerge as a leader nationally in IPE and collaborative practice.

Anthony Breitbach PhD, ATC, FASAHP
Professor/Director, Athletic Training
Saint Louis University

Phyllis King PhD, OT, FAOTA, FASAHP
President, ASAHP

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RESOLVING NETTLESOME HEALTH POLICY DISPUTES

John Colbert

January 24, 2020

Trends Archives

Controversies often are involved when initiatives are undertaken to arrive at the best approach to gaining wide acceptance of proposals involving contentious public policy issues, such as gene editing, euthanasia/assisted dying, and recreational use of marijuana products. A basic question pertains to deciding whom to involve in making decisions that enable these policies to move forward. Three possible groups are: elected public officials; health scientists and other experts in fields, such as ethics; and voters, along with other concerned members of the general public.

To note just one example, President William Clinton, along with British Prime Minister Tony Blair, announced at the White House on June 26, 2000 that the international Human Genome Project and Celera Genomics Corporation both had completed an initial sequencing of the human genome, the genetic blueprint for human beings. This landmark achievement was hailed as promising to bring exciting new approaches to prevent, diagnose, treat, and cure disease. Since that widely heralded occasion, germline gene editing provides a vivid illustration of a current topic that has emerged as a serious concern because of its potentially grave threat to the health of future generations.

Netflix offered a four-episode documentary series in October 2019 entitled “unnatural selection” as a means of furnishing an overview of genetic engineering, with an emphasis on the DNA-editing technology of CRISPR (clustered regularly interspaced short palindromic repeats) from the perspective of scientists, corporations, the public, and biohackers tinkering in garages. Apart from the goal of editing genes to eradicate certain diseases or even to produce so-called designer babies who will possess enhanced abilities (e.g, intellectual, artistic, and athletic), it should be obvious that there are great amounts of money to be made by entrepreneurs able to reach the finish line first with the most effective products.

The problem currently is that: some envisioned new gene therapies may not improve human lives, various species may be at risk of changing in unforeseen ways or perhaps even being eliminated, and assurance still is lacking on whether desired sought after improvements ever will materialize. The Netflix episodes feature discussions with (1) residents of Nantucket Island in Massachusetts who are apprised of a proposal to modify a species of mice affected by ticks that cause disease among humans, (2) inhabitants of New Zealand where rats are killing off many breeds of birds, and (3) villagers in Burkina Faso, Africa where mosquitos continue to cause children to die from malaria.

In all three settings, the notion of Gene Drive to change an entire species to achieve a purported social good encounters resistance. A major concern is that apart from positive outcomes that are touted by proponents of genetic interventions, it remains worrisome that no firm guarantees can be offered regarding possible unanticipated, dangerous outcomes that might occur. While members of the general public may lack the sophisticated knowledge of scientific experts, their basic instincts make them wary of approving proposals that are equivalent to attempting to play God.

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HOUSING DISCRIMINATION AND RACIAL CANCER DISPARITIES

John Colbert

November 25, 2019

Trends Archives

In areas with greater mortgage discrimination, the gap between black and white cancer mortality rates was larger (correlation coefficient [r] = 0.32; P = .001). This relationship persisted in sex‐specific analyses (males, r = 0.37; P < .001; females, r = 0.23; P = .02) and in models controlling for confounders. As described in the November 1, 2019 issue of the journal Cancer, mortgage discrimination is associated with larger black‐to‐white cancer mortality disparities. Some areas are exceptions to this trend. Examination of these exceptions and of policies related to housing discrimination may offer novel strategies for explaining and eliminating cancer disparities. Racial cancer disparities represent a substantial proportion of the overall mortality disparity between blacks and whites and are a major consideration in the provision of clinical care and public health practice and policy. In 2010, cancer accounted for 17% of the life‐expectancy gap between black and white populations, second only to heart disease for women, and, for men, third, also after homicide. A higher chance of mortgage application denial for black applicants tends to reduce black home ownership and increase the likelihood of renting. As opposed to being able to purchase, renting results in a reduced ability to accumulate home equity—a primary source of wealth—which may limit resources available to offset the financial burden of cancer.

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WHY AN INSECT APOCALYPSE MATTERS

John Colbert

November 25, 2019

Trends Archives

In the grand cosmological scheme, insects although being relatively small and occasionally quite annoying, it is highly unlikely that the human species could survive without them. In marked contrast, the Anthropocene (the current geological age, viewed as the period during which human activity has been the dominant influence on climate and the environment) may be characterized as placing a much larger focus in the form of conservation efforts and public attention on big, charismatic mammals and birds, such as tigers, pandas, and penguins. Nevertheless, the bulk of animal life, whether measured by biomass, numerical abundance, or numbers of species, consists of invertebrates such as insects. According to a paper appearing in the October 7, 2019 issue of the journal Current Biology, recent studies from Germany and Puerto Rico suggest that insects may be in a state of catastrophic population collapse. German data describe a 76% decline in biomass over 26 years, while the Puerto Rican study estimates a decline of between 75% and 98% over 35 years. Corroborative evidence suggests that such declines are not isolated. Causes are much debated, but almost certainly include habitat loss, chronic exposure to pesticides, and climate change. The consequences are clear. Insects are integral to every terrestrial food web, being food for numerous birds, bats, reptiles, amphibians, and fish, and performing vital roles such as pollination, pest control, and nutrient recycling. Also, terrestrial and freshwater ecosystems will collapse without insects.

Occasionally, this ASAHP newsletter has served as a vehicle for demonstrating how humans stand to benefit from research involving other species. An article published on October 22, 2019 in the journal eLIFE discusses, for example, how ants, despite their behavioral simplicity, have managed the tour de force of avoiding the formation of traffic jams at high density. At the macroscopic level, ant traffic is best described by a two-phase flow function. At low densities there is a clear linear relationship between ant density and the flow, while at large density, the flow remains constant and no congestion occurs. From a microscopic perspective, the individual tracking of ants under varying densities revealed that ants adjust their speed and avoid time consuming interactions at large densities. The results point to strategies by which ant colonies solve the main challenge of transportation by self-regulating their behavior. Humans and ants are among the few species that engage in two-way traffic. Maintaining a smooth and efficient traffic flow while avoiding collisions is challenging for humans while ants seem to be masters of traffic management. They efficiently can move back and forth between their nests and food without overtaking or passing each other, forming a steady stream of traffic. Studying ant traffic management has been a source of inspiration for scientists working with large groups of interacting particles in many fields, including molecular biology, statistical physics, and telecommunications. It also has relevance for managing human traffic, particularly as scientists and engineers develop autonomous vehicles that might be programmed to work together cooperatively as ants.

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AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

John Colbert

November 25, 2019

Trends Archives

Dialogue About The Workforce For Population Health Improvement

The Roundtable on Population Health Improvement of the National Academies of Sciences, Engineering, and Medicine on March 21, 2019 convened a one-day workshop to explore the broad and multidisciplinary nature of the population health workforce. The event included speakers from professional and accrediting organizations, community health workers, supervisors, and policy experts and featured national and local examples of cross-sectoral collaboration to advance population health. The main objectives of the workshop were to explore the following topics that resulted from the Statement of Task for the workshop: (1) Facilitating a population health orientation/perspective among public health and health care leaders and professionals; (2) Framing the work of personnel such as community health workers (CHWs), health navigators, and peer-to-peer chronic disease management educators within the context of population health; and (3) Leveraging the competencies of public and private sector workforces, such as education, transportation, and planning, that are working to include a “health in all policies,” community livability, or well-being orientation in their activities. Workshop proceedings can be obtained here.

Economic Consequences Of Millennial Health

A new report by Moody’s Analytics revealed the serious impact millennials' health could have on the U.S. economy. Compared to when Generation X was the same age, millennials are projected to experience slower economic growth and pay more in health care costs over the next decade, which could have a crippling effect on the economy. Two different scenarios of millennial health and what the impact may be over the next decade are described in the study. If millennial health continues to decline and goes unaddressed over the next 10 years, the report predicts that in comparison to Gen Xers at the same age, millennials may experience some of the following outcomes: Health care treatment costs could rise as much as 33%; Mortality rates could rise as much as 40%; and Millennials’ annual income may, on average, be reduced by as much as $4,500 per person, as poor health will likely lead to job loss or reduced working hours. Moody’s Analytics analyzed the Blue Cross Blue Shield Health Index SM, which quantifies more than 300 health conditions to identify which may affect Americans’ longevity and quality of life. It is powered by annual data from more than 41 million commercially insured Blue Cross and Blue Shield (BCBS) members nationwide. The report can be obtained here.

Driving Toward Age-Friendly Care For The Future

The concept of age-friendly health systems resonates with most older patients and their caregivers, especially patients with multiple chronic conditions, according to a survey by WebMD released by the John A. Hartford Foundation. In general, caregivers perceived the older adults they cared for as having more chronic conditions. Age-friendly health systems focus on prioritizing the “4Ms” of care: what matters to patients; promoting mobility; ensuring medications do not interfere with quality of life; and treating dementias, depression and other mentation-associated conditions. Age-friendly health systems require attention to what matters to older individuals and their caregivers in order to ensure high-value care resulting in consumer satisfaction. The good news is that 87% of the more than 2,700 respondents to this survey of older adults and family caregivers report satisfaction with the care they have received in the past 12 months. This high satisfaction, however, has some caveats. For instance, it decreases as a patient’s health becomes more complicated and the number of health conditions increase. Survey results can be obtained here.

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QUICK STAT (SHORT, TIMELY, AND TOPICAL)

John Colbert

November 25, 2019

Trends Archives

Adolescents’ Engagement With Unhealthy Food And Beverage Brands On Social Media

According to an article in the latest issue (March 2019) of the journal Appetite, which still is in progress, 70% of adolescents reported engaging with any food/beverage brands on social media and 35% engaged with 5 + brands. Non-Hispanic Black and less-acculturated Hispanic adolescents were more likely than non-Hispanic White adolescents to engage with brands. Approximately one-half reported engaging with brands of fast food (54% of participants), sugary drinks (50%), candy (46%), and snacks (45%), while just 7% reported engaging with all other categories of food/beverage brands. Watching television more than 2 hours-per-day was associated with any brand engagement; while using other screens more than 2 hours-per-day was associated with following 5 + brands. The study surveyed U.S. teens in the age bracket 13-17 about their engagement (liking, sharing, or following) with food and beverage brands on social media, such as Facebook; their time spent watching TV and other screens (cellphones); and demographic characteristics.

Emergency Department Visits For Sport And Recreational Activity Injuries

National Health Statistics Reports on November 15, 2019 indicates that during 2010–2016, approximately 2.7 million annual ED visits for sports injuries were made by patients aged 5–24 years. The top five most frequent activities that caused ED visits for sports injuries were football (14.1%), basketball (12.5%), pedal cycling (9.9%), soccer (7.1%), and ice or roller skating or skateboarding (6.9%). Visits caused by playing football and basketball accounted for a higher percentage of visits by males than females (20.2% compared with 2.2%, and 14.3% compared with 8.9%, respectively), whereas visits caused by gymnastics and cheerleading accounted for a higher percentage of visits by females (11.8% compared with 2.1%). Visits for injuries to the upper extremities decreased with increasing age (37.1% for those aged 5–9 to 27.4% for those aged 20–24), whereas visits for injuries to the lower extremities increased with increasing age (16.2%) for those aged 5–9 to 41.0% for those aged 20–24).

HEALTH TECHNOLOGY CORNER

3D Bioprinting Of A Vascularized And Perfusable Skin Graft Using Human Keratinocytes

Researchers at Rensselaer Polytechnic Institute have developed a way to 3D print living skin, complete with blood vessels. The advancement, published online in the journal Tissue Engineering Part A on November 1, 2019 is considered a significant step toward creating grafts that are more like the skin that human bodies produce naturally. Presently, whatever is available as a clinical product is similar to a fancy Band-Aid, according to investigators participating in the study, because although it may provide some accelerated wound healing, it eventually just falls off and never really integrates with the host cells. A significant barrier to that integration has been the absence of a functioning vascular system in the skin grafts. More work will need to be done to address the challenges associated with burn patients, which include the loss of nerve and vascular endings. The grafts this study’s team has created bring researchers closer to helping individuals with more discrete issues, such as diabetic or pressure ulcers.

Jointly Optimized Microscope Hardware For Accurate Image Classification

Since its invention, the microscope has been optimized for interpretation by a human observer. With the recent development of deep learning algorithms for automated image analysis, there now is a clear need to re-design the microscope’s hardware for specific interpretation tasks. To increase the speed and accuracy of automated image classification, according to an article published on December 1, 2019 in the journal Biomedical Optics Express, engineers at Duke University present a method to co-optimize how a sample is illuminated in a microscope, along with a pipeline to classify automatically the resulting image, using a deep neural network. They demonstrate how their learned sensing approach for illumination design automatically can identify malaria-infected cells with up to 5-10% greater accuracy than standard and alternative microscope lighting designs and show how the new procedure can translate across different experimental setups while maintaining high accuracy.

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DEVELOPMENTS IN HIGHER EDUCATION

John Colbert

November 25, 2019

Trends Archives

November 20, 2019 marked the occasion for the release of data on first-year earnings of college graduates according to the academic programs in which they matriculated that are broken down for the first time by program level. Derived from federal tax data, information can be obtained for more than 40,000 programs, showing that median debt exceeded median first-year earnings by more than $1,000 for 6,520 of them.

A dollars and cents analysis should be of value as families decide how much they are willing to invest in programs that ultimately could lead to financial outcomes commensurate with the amount of money spent to obtain proper academic credentials needed for entry into the employment market. A potential downside is that decisions will be made that displace passion in order to acquire more earthly gains in the form of future salaries. A job provides one kind of satisfaction while having a passion for a particular field produces a feeling of satiety and self-fulfillment of a quite different nature. Students and their families must cope with the difficulty of deciding whether to pursue academic preparation in a field that one loves, which may not pay well later on, for an alternative that may be much less interesting, but substantially more remunerative.

Student Assistance, Recognition Of Accrediting Agencies, And State Agency Procedures

The Secretary of the U.S. Department of Education (USDE) on November 1, 2019 amended regulations governing the recognition of accrediting agencies, certain student assistance general provisions, and institutional eligibility, as well as making various technical corrections. The revised regulations continue the emphasis on accountability that has been characterizing federal involvement in accreditation, and providing additional opportunity for accreditation to embrace innovation, along with some streamlining of federal recognition (the periodic review of accreditation). Revised regulations addressing accountability: (1) Increase expectations by USDE concerning student achievement through the collection and analysis of key data and indicators, including institution’s or program’s performance and measures of student achieve- ment; (2) Require more transparency on regional accreditor websites regarding the states in which the organizations operate; (3) Mandate institutional disclosure to accreditors of any law enforcement actions or prosecutions that lead to adverse action; and (4) Protect students through enhanced institutional disclosure requirements about whether programs lead to licensure or qualification to sit for a licensing exam.

Revised regulations addressing innovation: (1) Provide more flexibility for innovation for institutions and accrediting organizations by encouraging accreditors to establish different methods of monitoring institutional success and provide opportunities for experimentation; (2) Open the door to student aid for non-institutional educational offerings from colleges and universities, including partnerships with alternative providers; (3) Provide a simpler path for new accrediting organizations to gain recognition to give priority to student needs and outcomes rather than traditional measurements; and (4) Enable more dual enrollment opportunities through flexibility in standards allowing high school teachers in certain circum- stances to teach these courses.

State Authorization of Distance and Correspondence Education regulations also have been updated and streamlined. The revisions make clear an institution’s responsibilities and the role of State reciprocity agreements while ensuring students have the information they need to make informed decisions. States that join a reciprocity agreement can no longer layer additional State higher education authorization requirements on institutions that participate, but can continue to apply other State laws and regulations that apply to all entities doing business in a State. The final regulations will provide students with more options to pursue a higher education credential of value, transfer credits between institutions, and qualify for career advancement.

Most provisions in the final rule are scheduled to take effect on July 1, 2020. Sections that include State Authorization were effective November 1, 2019. Sections that modify the timeline that accrediting organizations are to follow to become federally recognized will be effective on July 1, 2021.

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HEALTH REFORM DEVELOPMENTS

John Colbert

November 25, 2019

Trends Archives

Political campaigns for elected office can be exhaustive affairs for voters, particularly when they occur in months and even more than one year in advance of an election. A more optimistic view of the matter suggests, however, that these contests are enormously valuable in shedding light on the nature of important social issues and how best to address them.

Health care represents close to 20% of the U.S. economy, the largest in the world. Even when healthy, individuals want to know they are protected to a great extent from the ravages of illness and disease by being able to have insurance coverage. In its simplest form, they want to derive comfort from knowing that cost will not inhibit them from obtaining the care that they need when they need it from the providers they wish to furnish treatment.

Presently, several candidates are competing to determine which one will secure the nomination for the presidency in 2020. Rightfully so, they focus much of their potential electability in the eyes of voters on how they plan to address health care issues in this country. Proponents of a Medicare For All initiative promise to offer an extensive range of benefits by the government at no cost to patients. Their appeals differ on the basis of details, such as the time needed to implement the new program and how to pay for it. Other candidates stress the need to maintain a system of private insurance coverage.

As debates continue to unfold, policy analysts who support as well as those who oppose such proposals weigh in with their respective critiques of what is being touted as an overhaul of a a remarkably complex system. An advantage of their doing so is that a clearer picture emerges of whether ideas currently being proposed will represent either an improved or perhaps even a worse future arrangement.

Hospital Compare Data On Quality

November 4, 2019 began a 30-day preview period for hospitals to see the data that will be reported publicly on Hospital Compare next year. As part of the Inpatient Psychiatric Facility Quality Reporting (IPFQR), Hospital Inpatient Quality Reporting (IQR), Hospital Outpatient Quality Reporting (OQR), and Prospective Payment System (PPS)-Exempt Cancer Hospitals Quality Reporting (PCHQR) programs, hospitals have 30 days to preview their data prior to public reporting on Hospital Compare. As part of this preview, hospitals (excluding cancer hospitals) also will see an updated Overall Hospital Quality Star Rating that publicly will be reported on Hospital Compare next year.

Hospital Price Disclosure Rule

On November 15, 2019, the Centers for Medicare & Medicaid Services (CMS) finalized policies that follow directives in President Trump’s Executive Order, entitled “Improving Price and Quality Transparency in American Healthcare to Put Patients First,” that lay the foundation for a patient-driven healthcare system by making prices for items and services provided by all hospitals in the United States more transparent for patients so that they can be more informed about what they might pay for hospital items and services.

CMS is finalizing the proposal to define hospital “items and services” to mean all items and services, including individual items and services and service packages, that could be provided by a hospital to a patient in connection with an inpatient admission or an outpatient department visit for which the hospital has established a standard charge. Examples of these items and services would be supplies, procedures, room and board, use of the facility and other items (generally described as facilities fees), services of employed physicians and non-physician practitioners (generally reflected as professional charges), and any other items or services for which a hospital has established a standard charge.

It is highly likely that the hospital industry will mount a legal challenge to the imposition of this rule. At issue is a requirement that hospitals make public the rates they negotiate with insurers for all services.

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MASS MEDIA FOCUS ON CAPITOL HILL

John Colbert

November 25, 2019

Trends Archives

Recent weeks have involved an enormous amount of attention on Capitol Hill by the mass media, primarily due to events involving an effort to impeach President Donald Trump. Whatever the outcome of an attempt to unseat him as the White House’s occupant, a significant amount of important business continues to be pursued by members of both the Senate and the House of Representatives. Funding for key governmental operations is on temporary hold until disagreements can be resolved about what to fund and for what amounts.

Unable to complete business by the start of a new fiscal year on October 1, a continuing resolution (CR) was used to maintain operations until November 21. Recognizing that much appropriations business remains unfinished, members of both the House and Senate approved a second continuing resolution (CR) to fund the federal government through December 20. President Trump signed it on November 21.

The Patient Protection and Affordable Care Act of 2010 (ACA) resulted in the creation of the Patient-Centered Outcomes Research Institute (PCORI). As an example of that agency’s operations, on November 19 of this year its Board of Governors approved $70 million to fund 21 studies and related projects designed to improve care for health conditions that impose high burdens on patients, their families, and the healthcare system. Eighteen of the awards, totaling about $65 million, will fund studies comparing the most effective ways to treat a range of illnesses and health conditions. Three of these investigations focus on health issues of concern to older adults—two on hearing loss and one on safer prescribing of glucose- lowering drugs for individuals with Type 2 diabetes. Three other studies focus on children’s health issues; two seek to improve treatment of anxiety in children and adolescents; and one seeks to prevent obesity among preschoolers in rural, underserved areas.

Many federal initiatives, such as the Higher Education Act (HEA) and PCORI must be reauthorized at stated intervals to continue operating. Even when they no longer are authorized, there is pressure to enable them to continue functioning because of the essential functions that they perform. Some programs tend to be more vulnerable than others, however, and there always is a risk that an unauthorized entity could be eliminated. For example, the past few decades have involved several attempts to jettison the Agency for Healthcare Research and Quality. A way of reducing such danger is to seek the enactment of reauthorization legislation. A step in that direction was launched on November 19, 2019 with the introduction of S. 2897, a measure to reauthorize PCORI in order to boost research into health care costs.

Even when legislators agree on the importance of existing programs, technical difficulties can obstruct further progress. A case in point is funding for historically black colleges and other minority-serving institutions, which recently expired. Both Senate Republicans and Democrats support reauthorizing $255 million a year, but cannot agree on the best mechanism for doing so. A Republican proposal is to furnish permanent funding by including the measure in reauthorization of the Higher Education Act (HEA), which has not been reauthorized for the past six years. Critics among Democrats object to holding this form of support as hostage in a much larger bill that is not destined to go anywhere soon because of its complex nature.

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PRESIDENT’S CORNER

John Colbert

November 25, 2019

Trends Archives

BY ASAHP PRESIDENT PHYLLIS KING

A New....

Decade (2020 – 2029)

Association Name (Association of Schools Advancing Health Professions)

President (Phyllis King)

Strategic Plan (2020 – 2025)

I am honored, eager, and ready to serve ASAHP as your new President. Past leadership has positioned the Association well from a staffing, budget, and leadership perspective to enable the Association to sustain effective practices and take on new initiatives that advance and enhance the Association’s mission and vision. Special appreciation goes to Susan Hanrahan and the board for their great work.

The ASAHP Board is holding a strategic planning retreat in January. We will revisit what strategies and initiatives have and are serving the Association well, and what new actions should be taken to meet the needs of the Association in a rapidly changing environment. The outcomes of this retreat will be shared with the membership for feedback and endorsement. We will welcome your volunteerism to support the new plan.

Ongoing activities currently include tweaking the Institutional Profile Survey for administration to institutions in 2020, planning for the 2020 Leadership Development Program (applications are now being accepted for participants), generating publications and presentations on Interprofessional Education, surveillance and engagement in federal and legislative policies and actions affecting health care education, research and practice, advancing the work of the International Task Force and Tri-Alliance to develop a global rehabilitation health worker certification in rehabilitation, and supporting Alpha Eta.

The future of health and health care will likely be driven by digital transformation. Exponential change and innovations in healthcare practice will continue. I invite you to join me in embracing change and designing our destiny. This will require activism, engagement, education, strategy, and partnerships. Together we can do this!

I wish you a safe and joyous holiday season.

Phyllis King

Get to know your President here.

Photos of the Board of Directors can be obtained here.

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GEOGRAPHIC INFLUENCE ON HEALTH DISPARITIES

PRESIDENT’S CORNER