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Social determinants of health have greater influence on health than does health care, yet Medicare and most other payers have yet to adjust payments to better support the capacity of health care providers to address social needs. The 2014 Improving Medicare Post-Acute Care Transformation (IMPACT) Act directed the secretary of Health and Human Services (HHS) to review evidence linking social risk with performance under existing federal payment systems and to suggest policy options. In response, HHS produced two reports and commissioned a series of five additional reports from the National Academies of Sciences, Engineering, and Medicine (NASEM). The second HHS report suggests that area-based (or, geographically based) measures of social deprivation could play a role in payment adjustment.
In May 2020, the Coalition for Physician Accountability recommended that all residency programs pivot to virtual interviews for the2020–2021 season.1This kept more than 45 000applicants from traveling cross-country during a pandemic, aiding social distancing efforts. Addition-ally, it removed travel costs, granting applicants the opportunity to assess more programs. With opportunity and human nature, however, comes the risk of an arms race, where a more open residency market compounds pressure on students to apply to more programs. The residency application process has gone down a behavioral economics rabbit hole, where fear and uncertainty are unnecessarily driving up applications, despite evidence of no benefit to applicants or programs. In what follows, we contextualize the growing problem of application inflation, describe contributing drivers including those introduced by virtual interviews, raise concerns about a conflict of interest for the application steward, and discuss potential solutions.
WASHINGTON — Ensuring access to high-quality primary care for all people in the United States will require reforming payment models, expanding telehealth services, and supporting integrated, team-based care, says a new report from the National Academies of Sciences, Engineering, and Medicine. No federal agency currently has oversight of primary care, and no dedicated research funding is available. The report recommends the U.S. Department of Health and Human Services (HHS) establish a Secretary’s Council on Primary Care and make it the accountable entity for primary care, as well as an Office of Primary Care Research at the National Institutes of Health (NIH).
Building on the recommendations of a 1996 report by the Institute of Medicine, the new report, Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care, provides an implementation plan for high-quality primary care in the U.S.