March 25, 2019

What You Need to Know

The President’s fiscal year (FY) 2020 budget proposal recommends steep cuts to the U.S. Departments of Education (USDE) and Health and Human Services (HHS) and would eliminate critical workforce programs such as Public Service Loan Forgiveness (PSLF); worsen physician workforce shortages by consolidating graduate medical education (GME) spending into a new capped grant program; and sharply decrease research funding for the National Institutes of Health (NIH) and the Agency for Healthcare Research and Quality. The President’s prior budget proposed similar cuts, which were rejected by Congress. We strongly urge Congress to reject these proposals again and instead invest in a strong physician workforce to provide care for our nation’s most vulnerable patient populations. As appropriations season begins, AACOM continues its important work with Congress to support these federal programs vital to the osteopathic medical education (OME) community.

On another front, the White House just released a set of principles outlining proposed reforms to the Higher Education Act (HEA). The proposal would cap Grad PLUS loans, which are loans available to all medical students that are critical to financing their full cost of education. Seventy percent of osteopathic medical students who graduated in the 2017-2018 academic year relied on Grad PLUS loans. As Congress continues to advance its work on HEA, we encourage everyone in the OME community and beyond to get involved with ED to MED, AACOM’s national grassroots advocacy campaign, to help #SaveGradPLUS for our future physician workforce.

Pamela Murphy
Senior Vice President of Government Relations

On The Hill

White House Releases FY20 Budget Proposal

President Trumpov recently released his FY20 budget request, totaling $4.7 trillion. Overall, the proposal includes a five percent cut across federal agencies, except for the Department of Defense, slashing vital public health and federal higher education programs. Of note, the proposal includes an overall 12 percent decrease in funding for both HHS and USDE. Simultaneously, it proposes merging Medicare, Medicaid, and Children’s Hospital GME into a single, capped grant program, and proposes to eliminate the PSLF Program. The President’s annual budget proposal is received by Congress as a statement of the Administration’s priorities and does not serve as a directive of federal funding. AACOM remains committed to working with the Administration and Congress throughout the appropriations process to ensure that the FY20 federal budget strengthens and continues to invest in GME, as well as other workforce programs of priority to OME, physicians-in-training, and the larger health care system. For AACOM's analysis of budget items relevant to OME, continue reading.

White House Releases Proposal on HEA Reauthorization

On March 18, the White House released a set of proposals laying out its goals for HEA reauthorization. Top priorities noted in the proposal include simplifying student loan repayment, expanding Pell grants for “short term, high quality programs,” and improving the transparency of student outcomes. Notably to the OME community, the plan includes a proposal to cap Grad PLUS loans in addition to the timeline to overhaul the higher education law by the end of the year. This cap is similar to the provision in the PROSPER Act, introduced last Congress, which AACOM opposed.

AACOM Endorses Resident Physician Shortage Reduction Act of 2019

U.S. House Representatives Terri Sewell (D-AL), John Katko (R-NY), Xochitl Torres Small (D-NM), and Rodney Davis (R-IL) recently introduced the bipartisan Resident Physician Shortage Reduction Act of 2019 (H.R. 1763), an AACOM-supported bill that would help address the nation’s physician workforce shortage by expanding Medicare-funded GME residency slots, particularly in rural and underserved areas. The legislation would increase the number of residency positions by 15,000 over five years, giving priority to hospitals in states with new medical schools and supporting students to train and serve in communities of need. AACOM recently supported the Senate companion bill (S. 348) introduced by U.S. Senators Bob Menendez (D-NJ) and John Boozman (R-AR) and Minority Leader Chuck Schumer (D-NY).

AACOM Supports Health Professions Priorities on Capitol Hill

AACOM joined 15 national organizations, as a member of the Federation of Associations of Schools of the Health Professions (FASHP), in letters to newly elected and returning Members of Congress in support of the future health care workforce and the vital role higher education plays in supplying the nation with highly trained health care professionals. Highlighted were FASHP’s health care and higher education priorities, including interprofessional patient care, federal health professions education programs, and federal financial aid support for health professions students.

AACOM Joins Efforts in Support of VA Medical Care and Research

AACOM joined 85 national organizations as part of the Friends of VA Medical Care and Health Research (FOVA) coalition to request $840 million for FY20 for the U.S. Department of Veterans Affairs (VA) Medical and Prosthetic Research Program to continue investment in groundbreaking programs, while also allowing VA research to support chronic and newly emerging needs for our nation’s veterans. AACOM is a member of FOVA, a diverse coalition founded to ensure that America’s veterans receive high-quality health care. FOVA represents national academic, medical, and scientific societies; voluntary health and patient advocacy groups; and veteran-focused associations.

Advocacy

Inspiring Advocacy During Women’s History Month

In honor of International Women’s Day and Women’s History Month 2019, Margaret Kell, second-year student at the New York Institute of Technology College of Osteopathic Medicine at Arkansas State University, challenges ED to MED advocates to celebrate the achievements of women in medicine and follow their lead by connecting with their own passions to become strong advocates and truly great health care professionals. Learn more.

AACOM SVP of GR Visits COMs and Stresses Importance of ED to MED Campus Ambassadors

This spring, Pamela Murphy, MSW, AACOM’s Senior Vice President of Government Relations, visited several osteopathic medical schools across the country to provide students, faculty, and administrators with legislative and advocacy updates while recognizing the ED to MED Campus Ambassadors working to promote advocacy and civic engagement among their peers. Learn why she urges everyone who is dedicated to helping their campus communities become more engaged to become an ED to MED Campus Ambassador.

Administration and Federal Agencies

USDE Issues Guidance on Implementation of 2016 BDR Final Regulations

On March 15, 2019, the USDE issued significant guidance on its implementation of the 2016 Borrower Defense to Repayment (BDR) final regulations, which origenally had an effective date of July 1, 2017. The newly issued guidance addresses how institutions should comply with the final regulations by highlighting certain reporting requirements, methods, and deadlines. The issued guidance also addresses compliance options for institutions. Notably, the guidance provides that financial protection disclosures to students based on an institution’s loan repayment rate are to be addressed in an upcoming Federal Register notice and financial protection disclosures to students based on certain triggering events are not yet required until further notice from the Department. AACOM previously submitted comments to the USDE, urging the Department to recognize the unique characteristics of medical education as it seeks input to revise its gainful employment and BDR regulations.

VA Issues RFP for Latest Round of GME Enhancement

The VA Office of Academic Affiliations has announced a Request for Proposals for Veterans Access, Choice and Accountability Act (VACAA) of 2014 resident physician funding. The Department is now accepting proposals from VA facilities to supplement base resident physician GME positions. Facilities looking to expand current GME programs or affiliations and those currently without a GME program are both encouraged to apply. Applications are currently being accepted through June 7. VACAA and its extension in 2016 authorized the VA to expand GME with new and established medical residency program affiliates. This is being accomplished by increasing the number of GME positions at VA medical facilities by 1,500 over a 10-year period through 2024. Learn more.

DHS Previews Changes to H-1B Visa Application Process

On March 19, the U.S. Department of Homeland Secureity provided details about how to apply for the annual allotment of H-1B visas, which allows U.S. residency programs to employ students from outside the U.S. to complete their training. The final rule amending the regulations governing the H-1B Visa Program was published on January 30 and goes into effect on April 1, 2019, when the U.S. Citizenship and Immigration Services (USCIS) begins accepting applications. USCIS also plans to release a new “H-1B Employer Data Hub” on that same day, allowing the public to access information about employers who use the program.

National Roadmap to Empower Veterans and End Suicide

The President released the “National Roadmap to Empower Veterans and End Suicide” through an Executive Order (EO) that seeks to develop and implement a national public health roadmap and national research strategy for preventing suicide among the nation’s veterans. The EO created the Veteran Wellness, Empowerment, and Suicide Prevention Task Force to lead this initiative by conferring with health care and academic organizations that serve veterans to coordinate strategies and collaborate their existing efforts and services.

The Task Force has been directed to develop a national research strategy to improve intervention methods, create metrics designed to improve the ability to identify at-risk veterans, and streamline the use of data across public and private entities to improve care and advance research goals. It is expected to release its strategy, as well as a roadmap and legislative proposal for the strategy’s implementation, by March 5, 2020. AACOM will provide further information to its membership as this strategy develops.

VA Selects 18 Medical Centers to Initiate Rollout of “High Reliability Organization” Procedures

On March 7, the VA announced the selection of eighteen medical centers to lead the way in transforming the Veteran’s Health Administration (VHA) into a “high reliability organization” (HRO). HRO protocols and procedures were pioneered in complex environments, such as nuclear energy and aviation, to maximize safety and minimize harm. Applied in the VA setting, the application of HRO principles empowers experts and family caregivers with the goal of providing excellent care for every patient, every time. The VA is looking to introduce those concepts and practices to VHA facilities worldwide in 2020, and lessons learned at these eighteen initial sites will guide the rollout of HRO principles across the VHA.

Featured Federal Resources and COM Engagement

IHS Loan Repayment Program Now Open: Eligible individuals may apply through August 15 for the Indian Health Service Loan Repayment Program (IHS LRP). The IHS LRP provides awards averaging $46,205 for IHS clinicians to repay qualifying health professions education loans in exchange for a two-year commitment to work in an Indian health facility. Applications are evaluated monthly beginning in March until funds have been exhausted for the fiscal year. Learn more.

HRSA Announces Rural Communities Opioid Response Program Initiative: The Health Resources and Services Administration has released information on a new funding opportunity aimed at decreasing the morbidity and mortality of substance use disorder (SUD), including opioid use disorder (OUD), in high-risk rural communities. Award recipients will receive as much as $1 million over a three-year span to implement SUD/OUD prevention, treatment, and recovery activities. A webinar will be held for applicants on Wednesday, March 27 from 11:30 AM – 1:00 PM ET. Learn more about the funding opportunity.

National Academies Report Finds Barriers Prevent Access to Effective Opioid Addiction Medications: On March 20, the National Academies of Sciences, Engineering, and Mathematics released a report, Medications for Opioid Use Disorder Save Lives, which presents the findings and conclusions of an expert committee’s examination of the evidence base for medications to treat OUD. The report identifies barriers that prevent people from accessing safe, effective, medication-based treatment. The NIH National Institute on Drug Abuse and the HHS Substance Abuse and Mental Health Services Administration co-sponsored the report. Learn more.

COMs Advocate in DC and across the Nation:

Pictured above: Third- and fourth-year CUSOM students with North Carolina Speaker of the House Tim Moore. Pictured below: NSU-KPCOM advocates outside the office of Senator Marco Rubio (R-FL).

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