On January 11, 2016, the U.S. Government Accountability Office (GAO) released a report detailing HHS’s deficiencies in comprehensive planning and appropriate oversight of its 72 health care workforce programs. In FY 2014, HHS allocated approximately $14 billion to healthcare workforce education, training and payment. Despite the hefty price tag, HHS’s current strategic plan broadly references improved access to primary and preventive care in underserved areas, but lacks a single objective specifically dedicated to healthcare workforce issues, the GAO found.
In fact, HHS removed explicit language about workforce goals and objectives that existed in its prior strategic plan. According to the GAO, this means that HHS and its reporting agencies lack accountability. HHS’s programs relating to healthcare workforce are spread across a number of agencies, including CMS, the Administration for Children and Families, the Health Resources and Services Administration, the Indian Health Service, and the Substance Abuse and Mental Health Services Administration. Although an individual agency might track performance, HHS as the managing entity lacks any comprehensive performance measures of healthcare workforce programs, GAO concluded.
According to the report, some of HHS’s largest healthcare workforce programs by cost do not target strategic areas of identified need. For example, although its two Medicare Graduate Medical Education (GME) programs made up approximately 77 percent of HHS’s FY 2014 workforce obligations, HHS is unable to direct funds to track projected workforce needs (like primary care or rural health) because the funding is dictated by an unrelated statutory formula. Moreover, multiple stakeholders, including the Institute of Medicine (IOM) and Council on Graduate Medical Education, noted that the GME program lacks oversight and organization to “track outcomes, reward performance, and respond to emerging workforce challenges.” The IOM suggested, for example, that GME payments are not sustainable in the long-term and a strategic plan specifically dedicated to oversight of GME funding is therefore necessary.
The GAO includes in its definition of healthcare workforce a long list of professionals, including audiologists, chiropractors, dentists, medical assistants, nurses, occupational therapists, optometrists, pharmacists, physical therapists, physicians, physician assistants, podiatrists, psychologists, social workers and counselors. Although a shortage of primary care physicians and access issues in rural areas has been a focus of late, the GAO reports that provider shortages are also anticipated in dentistry, cardiology, behavioral health, and general surgery.
Ultimately, HHS agreed with GAO “that it is important for the Department to have a comprehensive and coordinated approach to guide its health care workforce development programs,” but noted that “health workforce is an important component of a multi-faceted strategy” to improve access to quality care.
The GAO’s report, GAO-16-17, is available here.
Reporter, Elizabeth N. Swayne, Washington, D.C., + 1 202 383 8932, eswayne@kslaw.com.
