COVID-19 UPDATE:
March 13, 2020 - The Milken Institute School of Public Health has suspended all classes and meetings for the next few weeks in an effort demonstrate public health stewardship. We are canceling the Spring 2020 RFHP in its traditional format, but are providing an asynchronous, virtual learning opportunity for registered participants. Traditional lectures and site visits will be suspended for this iteration in the interest of safety.
Spring 2020 Course Details
Background: The George Washington University (GW) Residency Fellowship in Health Policy (RFHP) is a three-week elective that provides multi-specialty resident and fellow physicians with an understanding of U.S. health policy and its implications for medical practice and healthcare delivery.
The program increases participant knowledge of key health policy issues impacting their local communities and the nation, thus preparing them to be effective physician-leaders in system-based practice. The elective traditionally has involved classroom-based learning and in-person site visits at various Washington, DC institutions. However, in light of the recent COVID-19 outbreak, we have migrated to an abbreviated online format for this iteration.
With the exception of the first day of the course (Monday, March 16), we will connect once weekly on Fridays from 9-11 am ET to review and discuss course materials. Please be prepared to discuss the articles/videos assigned to you as the program involves peer learning and education. On the final day of the program, you will be required to submit a single written assignment as outlined below. Successful completion of the elective requires attendance at all virtual sessions and satisfactory completion of the written assignment.
Meeting Schedule:
All sessions will take place remotely via Zoom.
The program increases participant knowledge of key health policy issues impacting their local communities and the nation, thus preparing them to be effective physician-leaders in system-based practice. The elective traditionally has involved classroom-based learning and in-person site visits at various Washington, DC institutions. However, in light of the recent COVID-19 outbreak, we have migrated to an abbreviated online format for this iteration.
With the exception of the first day of the course (Monday, March 16), we will connect once weekly on Fridays from 9-11 am ET to review and discuss course materials. Please be prepared to discuss the articles/videos assigned to you as the program involves peer learning and education. On the final day of the program, you will be required to submit a single written assignment as outlined below. Successful completion of the elective requires attendance at all virtual sessions and satisfactory completion of the written assignment.
Meeting Schedule:
All sessions will take place remotely via Zoom.
- Monday, March 16, 2020, 9:00-11:00am
- Friday, March 20, 2020, 9:00-11:00am
- Friday, March 27, 2020, 9:00-11:00am
- Friday, April 3, 2020, 9:00-11:00am
Week one: 3/16 - 3/20
Monday, March 16, 2020 9:00 - 11:00 am
During this session, we will provide an introduction and overview of the course format and materials for the three week elective, including the final assignment.
During this session, we will provide an introduction and overview of the course format and materials for the three week elective, including the final assignment.
- Course Orientation & Introductions
- Why Health Policy?
- Intro to Health Policy Analysis & Final Assignment
Friday, March 20, 2020 9:00 - 11:00 am
This session is our opportunity to review materials together and discuss the relevance to our patients and our practice. The session will include brief presentations.
- Arrive prepared to give a 5-10 minute overview of your assigned article/video
- Be an active participant in group discussion & polling
Preparatory Materials
History of Health Policy
Introduction and Overview of the U.S. Healthcare System:
- The Healthcare System of the United States, Healthcare Triage
- The Dysfunction of the U.S. Healthcare System, Vox
Federal Government Process and Spending:
- How a Bill Becomes a Law, USA.Gov
- Introduction to the Federal Budget Process, Center of Budget and Policy Priorities
- Where do our Federal Tax Dollars Go? Center of Budget and Policy Priorities
Insurance:
- Medicare: An Overview of Medicare, Kaiser Family Foundation Issue Brief*
- Medicaid: 10 Things to Know about Medicaid: Setting the Facts Straight, Kaiser Family Foundation Issue Brief*
- Insurance Explained, Kaiser Family Foundation
- Patient Protection and Affordable Care Act
- Datagraphic: The ACA Turns 10, Health Affairs
- The Uninsured and the ACA: A Primer, Kaiser Family Foundation
- How Have ACA Insurance Expansions Affected Health Outcomes? Health Affairs
- The Affordable Care Act at 10 Years, Brookings
Health Reform:
week 2: 3/23 -3/27
Friday, March 27, 2020 9:00 - 11:00 am
This session is our opportunity to review materials together and discuss the relevance to our patients and our practice. The session will include brief presentations.
This session is our opportunity to review materials together and discuss the relevance to our patients and our practice. The session will include brief presentations.
- Arrive prepared to give a 5-10 minute overview of your assigned article/video
- Be an active participant in group discussion
Preparatory Materials
Health Economics:
Overview:
Payment and Cost of Care:
Payment Reform:
Health Law:
Health Economics:
Overview:
- A Dozen Facts about the Economics of the US Healthcare System, Brookings
- Optional: Medical Mystery: Something Happened to U.S. Health Spending After 1980, The New York Times
- Health Economics, Harvard School of Public Health
Payment and Cost of Care:
- What if All Health Care Costs were Transparent? TEDMED
- Fact Sheet: Hospital Billing Explained, American Hospital Association (AHA)
- My Doctor Makes What? How Physicians are Paid, Forbes
- Optional: Special Deal: The Shadowy Cartel of Doctors that Controls Medicare, Washington Monthly
- Optional: Why Medical Bills In The US Are So Expensive, CNBC
Payment Reform:
- The Problem with Pay for Performance in Medicine, New York Times
- MACRA/Quality Payment Program - State Health Policy, American College of Physicians (ACP)
- Optional Video: MIPS Value Pathways: The Future of MIPS, CMS
- Optional Infographics:
- Five Things Everyone Should Know About MACRA, The Advisory Board
- MACRA at a Glance, American College of Rheumatology
Health Law:
- Malpractice:
- EMTALA:
- EMTALA Fact Sheet, American College of Emergency Physicians
- Judicial Branch Trends:
- Is This the “New Normal” for the Confirmation Process? Heritage Foundation
- Analysis | The U.S. Supreme Court is highly politicized. It doesn’t have to be that way., Washington Post
- State Health Policy:
- The State Health Department's Role in the Policy Process, CDC
- Hospital Transparency: Lessons from 12 States' Hospital Financial Reporting Laws – The National Academy for State Health Policy (NASHP)
- Maryland Total Cost of Care Model | Center for Medicare & Medicaid Innovation (CMMI)
- Opportunities to Expand Telehealth Use Amid the Coronavirus Pandemic, Health Affairs Blog
- Optional Additional Resources: State Health Policy, Commonwealth Fund
- Primary Care and Prevention:
- Association of Primary Care Physician Supply With Population Mortality in the United States, 2005-2015 Sanjay Basu, MD, PhD; Seth A. Berkowitz, MD, MPH; Robert L. Phillips, MD, MSPH; et al
- Declining Use of Primary Care Among Commercially Insured Adults in the United States, 2008–201
- The Evolving Role of Retail Clinics, RAND Corporation
Week 3: 3/30 - 4/3
Comparative Health Systems:
Health Equity:
Medical Ethics:
Health Workforce:
Health and the Media/Communications:
- Liberty, democracy, equity, and justice in healthcare: Leana Wen at TEDx University of Nevada
- New Perspectives on Global Health Spending for Universal Health Coverage, WHO -- Sections 2&3
- US Health Care from a Global Perspective, 2019: Higher Spending, Worse Outcomes? Commonwealth Fund
- International Health Care System Profiles, Commonwealth Fund -- Explore at your leisure
Health Equity:
- Inequality and the Health-care System in the USA, The Lancet
- What Makes Us Sick? Look Upstream, Rishi Manchanda, TED Talks
- Camara Jones: The Gardener's Tale and the Physician's Legitimate Role, Beyond Flexner Alliance
- The Social Mission of Medical Education: Ranking the Schools, Annals of Internal Medicine
Medical Ethics:
- America's Epidemic of Unnecessary Care, The New Yorker
- End-of-Life Care, The Hastings Center
- Flattening the Curve, Then What? The Hastings Center
- Economic Cost of Flattening the Curve, The Incidental Economist
Health Workforce:
- HRSA Resources
- The Role of Graduate Medical Education (GME)
- Interprofessionalism
- Workforce Panelist Presentations
- Optional: A Sociological Exploration of the Tensions Related to Interprofessional Collaboration in Acute-care Discharge Planning, Journal of Interprofessional Care
Health and the Media/Communications:
- Opinion | Take Two Aspirin and Call Me by My Pronouns, Wall Street Journal
- Immigration Pediatrics, Narrative Matters Health Affairs
- Kids in Cages: Inhumane Treatment at the Border, Testimony for House Committee on Oversight and Reform, Dr. Gutierrez
Final project DUE friday april 3, 2020
Final Assignment:
Choose one of the four health policy topics below and create a 1-2 page document that provides your analysis, using the framework provided (Background/Landscape/Options/Recommendation). See the “Health Policy Analysis” PowerPoint provided.
Question 1: COVID-19
With the wave of Coronavirus infections still to come, hospitals across the U.S. are preparing for a flood of critically ill patients who will strain their staff, equipment, and bed supplies.
Question 2: Health Reform
Health reform has been a key platform in the 2020 presidential election, and a significant campaign issue in the Democratic primary. Several candidates and Members of Congress have proposed or endorsed various permutations of a “public option” to expand health coverage and lower health care costs.
Question 3: Gun Violence
Baltimore has historically been one of the most dangerous cities in the country for gun violence. Homicide, the leading cause of death for African-American males aged 15-24, has become a prominent public health concern for the city and the state of Maryland. The National Network of Hospital Based Violence Intervention Programs has succeeded in bringing forth a bill to the Maryland General Assembly which provides 10 million dollars in grant funding for its programs.
Question 4: Surprise Medical Billing
“Surprise medical bills” often refer to charges incurred when an insured individual inadvertently receives care from an out-of-network provider. Among adults struggling to pay medical bills, charges related to out-of-network care are a frequent contributing factor. Accordingly, a bipartisan Senate working group is developing legislation to protect patients from surprise medical bills.
Choose one of the four health policy topics below and create a 1-2 page document that provides your analysis, using the framework provided (Background/Landscape/Options/Recommendation). See the “Health Policy Analysis” PowerPoint provided.
Question 1: COVID-19
With the wave of Coronavirus infections still to come, hospitals across the U.S. are preparing for a flood of critically ill patients who will strain their staff, equipment, and bed supplies.
- You are the Chief Medical Officer at George Washington University Hospital. What contingency plans do you advise to increase capacity while maintaining staff and patient safety? Please provide at least three viable options and one final recommendation.
Question 2: Health Reform
Health reform has been a key platform in the 2020 presidential election, and a significant campaign issue in the Democratic primary. Several candidates and Members of Congress have proposed or endorsed various permutations of a “public option” to expand health coverage and lower health care costs.
- You are advising Joe Biden on his campaign against Bernie Sanders to win the 2020 Democratic Primary and eventually take on President Trump. He is interested in further detailing his support for a public option – what proposal would you recommend he adopt? In your response, define three “public options,” considering the need to assuage both Medicare for All supporters and conservatives alike.
Question 3: Gun Violence
Baltimore has historically been one of the most dangerous cities in the country for gun violence. Homicide, the leading cause of death for African-American males aged 15-24, has become a prominent public health concern for the city and the state of Maryland. The National Network of Hospital Based Violence Intervention Programs has succeeded in bringing forth a bill to the Maryland General Assembly which provides 10 million dollars in grant funding for its programs.
- You direct the Baltimore City Health Department. You anticipate receiving state funds to target gun violence in your jurisdiction. In considering the bill, your state legislature seeks your stakeholder input and asks, “is funding hospital based violence intervention programs the most effective way to mitigate gun violence in Baltimore?” In your response, consider the state’s limited financial resources, potential programmatic trade offs, and propose at least two state policy alternatives to address your local gun violence crisis.
Question 4: Surprise Medical Billing
“Surprise medical bills” often refer to charges incurred when an insured individual inadvertently receives care from an out-of-network provider. Among adults struggling to pay medical bills, charges related to out-of-network care are a frequent contributing factor. Accordingly, a bipartisan Senate working group is developing legislation to protect patients from surprise medical bills.
- You are the Vice President of Professional Satisfaction and Practice Sustainability at the American Medical Association (AMA). You have been asked to provide the Senate working group with technical assistance. What proposed policy solutions might the AMA endorse to protect patients from surprise out-of-network bills while preserving fair reimbursement for providers.
Supplemental Material
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Policy Acronyms
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HHS Organizational Chart
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