Remarks to the National Association of Community Health Centers' 2008 Policy
and Issues Forum
by HRSA Administrator Elizabeth M. Duke
March 14, 2008
Washington, D.C.
I am delighted to be here with all of you today.
I'm sure you know that President Bush traveled to the One World Community Health Center in Omaha last December to celebrate the completion of his Health Center Expansion Initiative.
Since all of us began working in 2001 to implement the President's vision, we have created new health center sites or expanded existing ones in more than 1,200 communities.
The number of patients served has grown by 50 percent, and now approaches 16 million patients annually.
The number of patients receiving dental services has almost doubled; the number of patients receiving mental health care has almost tripled.
NACHC and its members – all of you here today – have been HRSA's invaluable partners in the expansion. HRSA's solid working relationship with NACHC, its officers and its members has been a major factor in the Initiative's success.
Along with HRSA staff at our Rockville headquarters and at regional offices across the country, you deserve much credit. You have earned my thanks and the gratitude of the American people.
Thank you and congratulations on a job very well done.
I'd like to thank several members of my staff:
- Jim Macrae and Don Weaver of the Bureau of Primary Health Care have made sure health center grant guidances are published early enough to give folks sufficient time to prepare applications.
- Henry Lopez is the new director of the Bureau's Office of Minority and Special Populations.
- Tanya Bowers is interim head of Jim's policy and program development office.
- Kay Felix-Aaron has done a lot of work on quality initiatives for Jim.
- Denise Geolot and Ahmed Calvo from HRSA's Center for Quality are working on HRSA-wide core measures.
- Rick Smith, who heads the Bureau of Clinician Recruitment and Service and the National Health Service Corps, is here, and he's brought Tamara Overby, the new director of the Bureau's Division of Applications and Awards.
- Caroline Lewis is Rick's new deputy associate administrator.
- Diana Espinosa, the deputy associate administrator of Health Professions, played a big role in getting the proposed new HPSA regulation published. I'll talk more about that in a few minutes.
- In our HIV/AIDS Bureau, Barbara Aranda-Naranjo has returned to HRSA as director of the Global HIV/AIDS Program, and Rafi Morales is the global program's new chief medical officer.
We can all be proud of our work in completing the President's Initiative. Reaching that milestone does not, however, mean that growth in the health center system has ended.
In this fiscal year, FY 2008, HRSA will continue to support the development of new sites and the expansion of services.
- We are supporting 42 New Access Point awards, worth about $25 million;
- We will offer 20 Expanded Medical Capacity grants, worth about $10 million;
- We will provide 160 grants worth $30 million for Service Expansion – that breaks down into 60 Mental Health/Substance Abuse grants, 60 Oral Health grants, and 40 Pharmacy grants;
- And we will offer 25 planning grants worth $2 million.
Jim tells me that the competition for these awards is fierce. We received:
- more than 250 applications for the New Access Point awards;
- 220 for the Expanded Medical Capacity grants;
- 600 for the Service Expansion awards; and
- about 100 for the planning grants.
We also will be continuing our efforts to support the implementation of health information technology by awarding $20 million in grants to Health Center Controlled Networks.
- We expect to award more than $7 million to current grantees to continue ongoing projects.
- And we will award about $13 million in new grants. We have already awarded HIT planning, implementation, and innovation grants worth $3 million. We will soon make available $10 million in one-time High-Impact Grants to help health center networks or large health centers implement HIT systems.
Here are the main points of HRSA's FY 2009 proposed budget:
- Health centers would receive a $26 million increase to just over $2 billion. The increase would fund up to 40 new health centers in high-poverty areas that currently have no health center sites and up to 25 planning grants to help community-based organizations in high-poverty areas win grants in future competitions.
Regarding what we are now calling “high-poverty area grants,” we heard the concerns many of you had about the limitation of counties as a geographic area to target funds. We remain as committed as ever to make sure that new access points dollars go to the poorest and neediest areas. But in the future, we will be looking to target funds to the truly neediest communities, and we will not restrict that search to counties.
Staffing these new sites with sufficient numbers of health professionals remains a challenge. It's a challenge that offers opportunities to physicians, dentists, nurses and other health care professionals who are dedicated to the delivery of primary care to underserved populations.
- With that in mind, the President asked for $11 million in for the National Health Service Corps in FY 09 to support four dental student scholars and new loan repayment contracts for 210 dentists and dental hygienists. That's over and above the 716 new loan repayment contracts that are projected to be made for the Corps.
Those funds would help some of you add dentists and hygienists to your operations, and their existence in the '09 budget reflects our stubborn determination to expand Americans' access to oral health care. Eighty-three percent of health center facilities now provide preventive dental care, but I won't relent until we hit 100 percent!
Let me now turn to HRSA's activities to improve quality. We are implementing a robust program to ensure that the patients we serve get the best possible care.
Our quality agenda is focused squarely on improving patient outcomes.
As many of you know, HRSA has selected its first set of Core Clinical Quality Performance and Improvement Measures. They are at the heart of aligning, tracking and improving the quality of care for patients.
Our goal was to develop Core measures that could be reported on by all HRSA programs that deliver direct clinical care. We also made sure that the measures are aligned with widely recognized national quality measures.
The first set of six Core measures have been incorporated into the 2008 UDS reporting, which will be due in mid-2009. They are:
- Childhood immunization rates;
- Entry into prenatal care;
- Low birth-weight babies;
- Percent of females with Pap tests;
- Diabetes control; and
- Control of high blood pressure.
In August we asked for volunteers to help us with a feasibility study of the HRSA Core measures. Many of you stepped up and offered to participate, and for that we thank you very much!
The feasibility study sought to find out grantees' capacity to collect data, report on the Core measures, and to see what type and amount of technical assistance HRSA may need to provide to support the process.
We expect the study to be completed soon, and we're looking forward to learning its results.
So together we're making progress. I thank you for your leadership in quality improvement and your involvement in the study.
I urge you to continue aligning your internal systems, quality improvement efforts, and reporting systems with the Core measures. Sessions explaining the measures and other quality improvement activities are being offered at this meeting, and I encourage you to attend them.
HRSA and dozens of partner organizations are also quickly moving forward on a bold, new national Patient Safety and Pharmacy Collaborative. The new Collaborative has three aims:
- Improve health outcomes;
- Improve patient safety; and
- Increase clinical pharmacy services.
We launched the Collaborative last November, and since then a HRSA team has been visiting high-performing health centers, hospitals, and other health care organizations to see how they maintain good outcomes for their patients. This study process will conclude at the end of April with an Expert Panel.
Several health centers have participated in this early work and I'd like to recognize them for helping us. They are:
- the El Rio Community Health Center in Tucson;
- the JWCH Medical Clinic at Wiengert Center in Los Angeles;
- Westside Community Health Center in Minneapolis; and
- Denver Health and Hospitals.
I also want to thank NACHC for your participation. Last month, NACHC joined HRSA, the American Society for Health-System Pharmacists, the Joint Commission, the Institute for Healthcare Improvement, and more than 50 other national organizations for a major meeting to get them engaged in the Collaborative. These organizations have been overwhelmingly enthusiastic and supportive of our efforts.
In May and June, health centers and other organizations will be given an opportunity to form teams and complete a “Participation Package,” which signals their desire and intent to join the initiative. I hope you will form teams and join us!
Finally, I am pleased to announce that the First Learning Session of the Collaborative will occur on August 13 to 15 here in Washington -- please save the date! Additional details about the session will be provided to teams as they join.
At the same time HRSA is pushing to make sure our patients get the best available care, we're pushing to help them avoid the chronic illnesses that are so costly to the American health care system.
I am delighted, for example, to announce HRSA that has funded a second year of grants to Primary Care Associations to support cancer and tobacco control initiatives in health centers.
Many grantees will participate on their state's comprehensive cancer control or tobacco control coalitions. Five hundred and fifty (550) health center grantees are involved in tobacco cessation programs to date. That's less than three in five centers, so obviously we can do much better.
That means you and that means us at HRSA. The goals of Healthy People 2010 on tobacco use have not been met and 440,000 deaths annually – still, in 2008! – almost half a million people die needlessly each year because they smoke tobacco, something scientists have known causes lung cancer for two generations! And we've all known in our guts that it's a killer for a lot longer than that. So we have to act.
As I said, that means you and that means HRSA. HRSA is determined to do a better job of organizing our efforts and sending out a single message against tobacco use. So we've organized a Tobacco Cessation Committee, headed by Dr. Tanya Pagan Raggio-Ashley of our Office of Minority Health and Health Disparities. Tanya is also HRSA's chief medical officer and I want to thank her for her leadership o n smoking cessation.
The committee met last month for the first time. We want Tanya and her team to find out what each of the separate parts of HRSA is doing to stop smoking and pull together a stronger, unified message on stopping tobacco use that we can share with our grantees.
Additionally, our Center for Quality is working to add smoking cessation to the core clinical performance measures I mentioned a minute ago, so I think health centers should prepare to report on that measure in the near term.
We've also gotten more involved in making sure people get their flu shots each year. HRSA staff has begun working with the Acting Assistant Secretary for Health on an initiative to make sure more health care workers get immunized against influenza in the future. I was dumbfounded to learn recently that vaccination rates among health care workers nationally remain below 50 percent!
Influenza may be common, but it kills 36,000 people and causes 200,000 hospitalizations annually in the United States. Unvaccinated health care workers who get the flu from patients can transmit it to patients and other staff, not only making more people sick but jeopardizing medical operations.
So if your staff isn't vaccinated, please make sure they are. Make sure they're ready for each flu season. And not just your clinical staff, but all support staff, too – after all, they're in contact with patients and staff as well.
Finally, let me mention activities we're planning to combat obesity. You will hear from Surgeon General Galson about the new HHS Childhood Overweight and Obesity Prevention Initiative. HRSA plans to work closely with him and others in the Department on this important initiative.
Many of you in the audience are aware that we have proposed a new rule to improve the way underserved areas and populations are designated and target federal resources to the people and communities who need them most. The proposed new rule appeared in the Feb. 29 Federal Register. It has been 10 years in the making.
If the proposed rule becomes final in its current form, we feel confident it will:
- create a simpler system by consolidating the two existing procedures and sets of criteria.
The proposed rule also:
- incorporates better measures of health status and access; and
- improves identification of new, currently undesignated areas of need and currently designated areas no longer in need.
- And it will minimize unnecessary disruptions.
I urge you to read this proposed new rule very carefully. A 60-day public comment period began following publication, so you still have about a month and a half to weigh in, if you choose to do so.
In closing, I thank you again for inviting me to be with you. Our partnership has sparked great advances in access to quality health care for the American people.
I thank you for your energy and commitment to the underserved, and I ask you to continue -- and even accelerate -- that dedication and resolve in the future.
I hope to see many of you again in late June (23-25) for the Primary Health Care all-grantee meeting. It will be one of the first big meetings at the brand-new Gaylord Hotel across the Woodrow Wilson Bridge from Alexandria.
Now, I'd like to open the floor to questions.
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