HealthLawProf Blog

The $53 Finger Splint

On July 28, my home-town newspaper, the Spokane, Washington Spokesman-Review, reported a story that points out many of the perverse incentives in our current method of reimbursing health-care providers. James Munroe, 22 years old and unemployed, sliced his fingers in an accident. He is uninsured. His neighbor, Elizabetth Cobbs, a registered nurse, recognized that the cuts needed medical attention, but were not a life-threatening emergency. Being a good neighbor, a decent human being, and understanding the economics of health care which dictate that an emergency room is the most expensive place to get care, Cobbs took him to U.S. Healthworks' urgent care center, and guaranteed payment of what she thought would be around a $200 bill. Instead, the bill came to nearly $700, including a $179 "first-time patient fee," and $106 for two finger splints, which can reportedly be purchased for $6 each on-line.

What is wrong with this picture? First of all, Munroe and Cobbs would have been better off seeking care in the most expensive setting available, the hospital emergency room. Unlike U.S. Healthworks, the hospital is legally obligated to at least screen and stabilize Munroe, and is also required under state law to provide charity care and utilize it for people like Munroe. Although the bill would have been more than $700, Munroe and Cobbs would probably have paid very little, if any, of it. Instead, these costs would have been ultimately born by all of us, either through subsidies to the hospital made possible by our tax dollars, or through cost-shifting to those of us with insurance, who ultimately pay higher premiums to subsidize care to the uninsured.

Second, I am reasonably certain that no insured patient would have been billed $700 for these services. Insurers negotiate with providers for discounted prices; uninsured people are powerless to negotiate in this manner. Thus, the people who are least able to bear the costs of care, the uninsured, wind up with the highest bills. As Cobbs reportedly said, "There is a moral imperative here . . . Why are you charging $53 apiece for a $6 item?" The answer, unfortunately, is because they can, and it's all about profit for U.S. Healthworks. U.S. Healthworks is a for-profit company, which has just been acquired by the non-profit Dignity Health (formerly Catholic Healthcare West). Dignity Health will own U.S. Healthworks through a for-profit subsidiary. This will allow the moral imperative to continue to bow to U.S. Healthworks' profit imperative while Dignity can continue to tout its high-minded mission ""Delivering compassionate, high-quality, affordable health services; serving and advocating for our sisters and brothers who are poor and disenfranchised; and partnering with others in the community to improve the quality of life."
 
Is $53 for two finger plints "affordable?" Does this service and advocacy for the poor include unemployed 22 year-old James Munroe? And if it does, will Dignity communicate that message to its for-profit subsidiary, U.S. Healthworks? And should non-profit health care systems be able to limit their mission statements to apply to only to some parts of their enterprise? I would guess that given the publicity surrounding Munroe's situation, U.S. Healthworks will discount or write-off his bill. But what about all of the others in the same position, without neighbors like Cobbs or connections to the newspaper?

Cross-Posted on Healthy Interests

(VJW) 

Health Care Disparities

Yesterday's New York Times Sunday Magazine provided a profound reminder about the disparities in health and health care in the U.S. While many Americans may have access to the best health care in the world, that is not the case for the rural poor in Mississippi. And giving them access to care is only a small part of the solution. The health care system does little to address the causes of illness that bring the rural poor to the hospital.

There are many troubling pieces of data in the article by Suzy Hansen. For example, a "Mississippi black man’s life expectancy is lower than the average American’s life expectancy was in 1960." And she cites one of the most important deficiencies in the U.S.: "American health care is not preventive, and it’s not a system."

[DO]  

What Skills Should a Health Law Professor Have?

 

Here in West Texas, we are less than three weeks away from the start of school!  Target overflows with notebooks and pencils.   So I am giving considerable thought to how and what I will be teaching.  It’s in that context that I read that, my alma mater has made something of a splash by announcing that it’s offering a Ph.D. in Law which is intended  “to prepare students who have earned a J.D. degree from an American law school to enter careers in legal scholarship prepare future law professors.”   Dean Robert Post explained further that the degree was necessary because, ““It’s becoming increasingly hard to transition directly from law practice to teaching” because “candidates are now expected to present a relatively mature scholarly profile; they need a defined research agenda and a substantial portfolio of writing.”

Given the near frenzy of criticism directed at law schools for not teaching skills, and in general for being a scam, that seems to be very poor timing.  And certainly there’s been plenty of criticism of the new degree.  But it’s also an opportunity to stop and reflect.  What skills do you need to be a law professor and in particular, a health law professor?  Health Law, as we all know, is an extremely big tent including, among other areas of practice transactional, regulatory, personal injury, patent, constitutional, labor, disability, tax etc.  It seems unlikely that any one person could have an expertise in all of these subject areas, let alone the practice skills that go with it.   So every one of us is probably at some point teaching something we have never seen in practice.

 As I’ve written before, this is one of the big differences between law school and medical school.    Pretty much, medical students are taught by people who know how to do what they’re teaching. 

Continue reading

Worth Reading This Week

Richard Kaplan, Top Ten Myths of Medicare, SSRN

Abigail R. Moncrieff, Understanding the Failure of Health-Care Exceptionalism in the Supreme Court's Obamacare Decision, SSRN/CHEST

Karen Davis et al, Medicare Beneficiaries Less Likely To Experience Cost- And Access-Related Problems Than Adults With Private Coverage, Health Affairs 

Tim Jost & Sara Rosenbaum, The Supreme Court and the Future of Medicaid, NEJM

[NPT]

 

Study finds link between Medicaid coverage and lower death rates

A study was just published in the New England Journal of Medicine that found Medicaid coverage lowers death rates.  The researchers, from Harvard's School of Public Health, studied three states that had expanded Medicaid coverage to poor adults who, until the ACA, were an optional coverage category for the states.  Comparing these states to those without such Medicaid expansions, the study found:

Medicaid expansions were associated with a significant reduction in adjusted all-cause mortality (by 19.6 deaths per 100,000 adults, for a relative reduction of 6.1%; P=0.001). Mortality reductions were greatest among older adults, nonwhites, and residents of poorer counties. Expansions increased Medicaid coverage (by 2.2 percentage points, for a relative increase of 24.7%; P=0.01), decreased rates of uninsurance (by 3.2 percentage points, for a relative reduction of 14.7%; P<0.001), decreased rates of delayed care because of costs (by 2.9 percentage points, for a relative reduction of 21.3%; P=0.002), and increased rates of self-reported health status of “excellent” or “very good” (by 2.2 percentage points, for a relative increase of 3.4%; P=0.04).

In other words, much like the study in Orgeon, these researchers found that Medicaid improves health -- important information for governors considering their "options".  (Governor Perry?  Governor Scott?  Where are you going?)

Clinical Outsourcing

Don Lee reporting for the LA Times, here, on the growth of clinical outsourcing. "In one of its recent efforts, WellPoint laid off pre-service nurses in Colorado and Nevada so the work could be done in Manila, according to a Labor Department filing by a WellPoint human resource manager in Denver… WellPoint's offshoring covers a wide range of departments and tasks involving claims, enrollment, billing, post-service clinical claims review, utilization management and pre-service nursing…" [NPT]

 

Congress, Privacy, and Data Brokers

I can't resist a second post today.  A bipartisan group of Congressional representatives have just sent letters to nine major data brokers: Acxiom, Epsilon (Alliance Data Systems), Equifax, Experian, Harte-Hanks, Intelius, Fair Isaac, Merkle, and Meredith Corp.

The letters seek information concerning the brokers' data gathering activity.  Information requested includes entities providing data (including sources of health data), types of data items collected, and products or services offered by the brokers to third parties using consumer data.  The representatives also want to know whether consumers have access to the information and whether they can request correction or deletion.  Companies' replies are due by August 15, and it will be fascinating to see what they say.

Copies of the letters can be found on Representative Markey's website, http://markey.house.gov/content/letters-major-data-brokers.

[LPF]

Gene Patents and Myriad, Redux

Myriad Genetics holds a number of patents on two genes implicated causally in breast cancer, BRCA1 and BRCA2.  In 2009, scientific organizations devoted to genetics and pathology, genetics researchers, clinicians, genetics counselors, patients, and breast cancer and civil liberties advocacy groups filed a complaint seeking to have the patents declared invalid. In addition to Myriad, defendants in the suit are the US Patent and Trademark Office (USPTO) and the University of Utah Research Foundation (in this spirit of full disclosure, I teach at Utah and have colleagues who have appeared as amici in the case but otherwise have no relationships with Myriad).  The patients claimed that the patents harmed them medically, as they were unable to obtain testing because of its high cost.  Plaintiffs also contended that Myriad's test did not include additional variants of these genes that might be clinically relevant for them. Clinicians contended that they were unable to offer testing that differed from Myriad's, except under license from Myriad. The researchers claimed that Myriad had withheld scientifically important information and that they were unable to engage in research that could develop further understanding of the etiology of breast cancer and testing for it.

Central to the case is whether the patents come within the "law" or "product" of "nature" exception to 35 USC 101, or whether the DNA Myriad had "isolated" is a patentable discovery. The district court held that the patents were invalid and granted summary judgment for the plaintiffs, Association for Molecular Pathology v. United States Patent and Trademark Office, 702 F. Supp.2d 181 (S.D.N.Y.2010). On the merits of the patent claims, the U.S. Court of Appeals for the Federal Circuit affirmed in part and reversed in part.  Myriad's patents on methods for comparing DNA sequences were held invalid as covering only an abstract analytic method.  Myriad's other patents, on the "isolated" DNA molecules were held valid, as the molecules in the judgment of the court do not exist in nature.  Finally, the Federal Circuit concluded that Myriad's method claim for screening potential cancer therapeutics through changes in cell growth rates was not a law of nature and was thus patent eligible, Association for Molecular Pathology v. US Patent and Trademark Office, 653 F.3d 1329 (Fed. Cir. 2011).

In March, 2012, the US Supreme Court decided the Prometheus Labs case, invalidating a patent on a process for determining the proper dosage of thiopurine drugs in treating autoimmune disease, Mayo Collaborative Services v. Prometheus Labs, Inc, 132 S.Ct. 1289 (2012). The goal of the Prometheus test was to tell physicians how to adjust dosages so that they would be at a level high enough to be therapeutic but without causing patients harm.  The test did this by measuring metabolites in the patient's blood.  In invalidating the patents, the Court concluded that the algorithm for adjusting dosage merely stated known laws of nature and did not add anything inventive to the application of these laws. 

Six days later, the Court granted cert. in the Myriad case, vacated the decision of the Federal Circuit, and remanded for further consideration in light of Prometheus Labs., Association for Molecular Pathology v. Myriad Genetics, 132 S.Ct. 1794 (2012).

This past Friday, the case was re-argued in the Federal Circuit, before the same panel that upheld the Myriad patent (it was a 2-1 decision). According to the Bloomberg News report of the oral argument, http://www.businessweek.com/news/2012-07-20/myriad-defends-patent-claims-on-genetic-material-in-court-case#p1, at issue were patents concerning the isolated DNA molecule. Lawyers from the ACLU argued for the plaintiffs, contending that the patents come under the law or product of nature exception as understood in Prometheus.  The Department of Justice also argued for the invalidity of the patents, analogizing the DNA extraction to taking coal from the ground.  Myriad argued that the patent claims refer to human-made compositions, not natural products.  Circuit Judge Bryson (the judge in the minority in the original panel decision) reportedly analogized the molecule to a piece of marble with the non-essential bits chopped away, like Michelangelo's David. As Circuit Judge Moore, noted, there's lots of money at stake in the decision--as well as important consequences for genetics research, clinicians, and patients.

In subsequent posts, I'll note updates to the case as they occur.

[LPF] 

 

   

 

The CBO Weighs In

The Congressional Budget Office today released two reports on the post-SCOTUS world of the Affordable Care Act. First, the CBO estimates the effect of the Court's ruling that makes the Medicaid expansion a state option. The estimate, here, is that for the period 2012–2022 this will reduce spending by $84 billion though with the cost of an additional 3 million uninsured. The second report assesses the impact of H.R. 6079 (the Repeal of Obamacare Act). The CBO estimates, here, a net increase in federal budget deficits of $109 billion for the period 2013–2022. [NPT]

 

Fukushima Fallout

As debris from the March 2011Japanese tsunami washes ashore in Alaska and other West Coast states, it is worth reflecting on the toll it took on lives. It relates to the "clean" energy debate - nuclear power is being touted as the low carbon footprint alternative to coal fired power plants. However, all costs need to be assessed, including the risks of major accidents.

A Stanford University study released last month revealed that the radiation toll from the Fukushima Daiichi nuclear accident could eventually result in anywhere from 15 to 1,300 deaths. Reports of radiation exposure could be underestimated though. On Sunday, the Washington Post reported that workers at the stricken Fukushima nuclear power plant may have placed lead around radiation detection devices in order to stay under a safety threshold for exposure. Disturbing, since current exposure rates affects the predictions of long-term effects.

A Wall Street Journal report commented that the human deaths resulting from Fukushima are probably far lower than those at Chernobyl, since about 80% of the radioactivity was blown towards the ocean. At Chernobyl, most of the radioactivity settled over land and the amount released was far greater.

If 80% of the radiation went out to sea, the amount absorbed into marine plants that eventually make their way into fish and the human food chain is a concern. In Chernobyl, children were affected long after the accident from drinking milk from cows that fed on grass near the plant. These cows could have been prevented from grazing in the areas near the plant, but obviously the same cannot be said for fish feeding near the Japanese site. Hopefully there will be monitoring of cancers and thyroid disease throughout the Pacific rim, so the true costs of poorly sited nuclear power plants can be assessed accurately.

[MM]

Two Approaches to Health Disparities

This is a very interesting video on addressing health disparities.  It's particularly enlightening to compare Onie's approach to promoting health to that of Accretive--an entity with vastly more resources, support from Wall Street investors, and backing from Rahm Emmanuel and a former secretary of Health and Human Services.  

[FP]

Predicting ACA's Consequences

Two weeks ago I blogged about criticisms that were being raised about the financial consequences of the Affordable Care Act.   I referenced in particular an article by John Klatch of the organization, Americans for Tax Reform.  In response to that posting I heard from Professor Fran Miller, one of the smartest people I know, who is currently a visiting Professor of Law University of Hawaii at Manoa, & Professor of Law Emerita Boston University School of Law.  Professor Miller referred me to an article in Forbes which showed ACA as having far less an effect on capital gains taxes than Klatch suggested.  This got me curious both about the specific claims made about ACA’s effect on the capital gains tax and, more generally, the continued back and forth about what bad things lay ahead now that ACA was the law of the land.

First, whether or not ACA can in any sense be described as increasing the Capital Gains tax rates depends on your definition of cause and effect.   Whether ACA was upheld or not, the current Capital Gains tax rates, which temporarily lowered rates, are set to expire in 2013.  If Congress takes no further action, rates will go up.

But second, it seems that ACA has become something of a blank slate onto which Americans are still imposing their own hopes, fears and concerns.  Rather than fade away, interest has intensified with the new topic being debate over what is likely to happen as the Act is implemented.   Picking up on nature of speculation, the public editor of the New York Times, Bill Keller, felt compelled to write a this article “debunking” myths about ACA, discussed here by the National Catholic Reporter, which itself was debunked in the fast response by Foreign Policy Journal.

A related stream of commentary comes from those asserting that there will still be flaws in our health care system even when ACA is fully implemented.  See here.

What to make of this?   The public seems to be caught in the middle with Fox News reporting divisions along party lines among Democrats who want to move on and focus on the future of health care in the United States and Republicans who are still committed to at least partial repeal.   The Fox results are similar to those found by the Kaiser Family Foundation shortly after the decision.

JSB

 

 

Worth Reading This Week

Liz Tobin Tyler, Aligning Public Health, Health Care, Law and Policy: Medical-Legal Partnership as a Multilevel Response to the Social Determinants of Health, SSRN/J Health and Biomedical Law

Michael Frakes, Does Medical Malpractice Deter? The Impact of Tort Reforms and Malpractice Standard Reforms on Healthcare Quality, SSRN

Efthimios Parasidis, Defining the Essence of Being Human, SSRN/Minnesota Journal of Law, Science & Technology 

Wendy Mariner, Leonard Glantz, & George Annas, Reframing Federalism — The Affordable Care Act (and Broccoli) in the Supreme Court, NEJM

[NPT]

Kaplan: The Top Ten Myths of Medicare

Richard L. Kaplan (Illinois), Top Ten Myths of Medicare

In the context of changing demographics, the increasing cost of health care services, and continuing federal budgetary pressures, Medicare has become one of the most controversial federal programs. To facilitate an informed debate about the future of this important public initiative, this article examines and debunks the following ten myths surrounding Medicare: (1) there is one Medicare program, (2) Medicare is going bankrupt, (3) Medicare is government health care, (4) Medicare covers all medical cost for its beneficiaries, (5) Medicare pays for long-term care expenses, (6) the program is immune to budgetary reduction, (7) it wastes much of its money on futile care, (8) Medicare is less efficient than private health insurance, (9) Medicare is not means-tested, and (10) increased longevity will sink Medicare.

[KVT]

2013-2015 Academic Fellowship Program at the The Petrie-Flom Center for Health Law, Bioethics, and Biotechnology at Harvard Law School

The Petrie-Flom Center for Health Law, Bioethics, and Biotechnology at Harvard Law School is currently accepting applications for the 2013-2015 Academic Fellowship Program on a rolling basis through November 16, 2012.

The fellowship is designed for applicants who have the intellectual focus to make top-rate academics in health law policy, bioethics or biotechnology, and who would benefit from time to develop their ideas and writing before they enter the academic job market. Our prior fellows have found homes on the law
faculties at Harvard, Berkeley, BU, UCLA, the University of Arizona, Cornell and the University of Illinois. The fellowships include stipends of $60,000/yr for two years, a research budget, limited benefits and access to the full range of the Center's and Harvard's facilities and research resources. 

If you know of any well-suited candidate who might be interested, please direct them to the call for applications available here to learn more: 

http://www.law.harvard.edu/programs/petrie-flom/fellowship/pdf/afcfa2013.pdf

[KVT]

A New Poll on Public Approval for the Court: Sour Grapes?

A New York Times/CBS News poll indicates that the public's support for the Supreme Court is at a low after the Healthcare Cases were decided.  The Times reports:

The nation is now evenly divided, with 41 percent of Americans saying they approve of the job the court is doing and the same share voicing disapproval, according to a new poll conducted by The New York Times and CBS News. In a poll a few weeks before the health care decision, the court’s approval rating was 44 percent and its disapproval rating 36 percent.

More than half of Americans said the decision in the health care case was based mainly on the justices’ personal or political views. Only about 3 in 10 of them said the decision in the case was based mainly on legal analysis. ...

More than half of Republicans now express disapproval of its work, compared with just over a third in early June. Among Democrats, the court continues to be somewhat more popular, with about half approving and a third disapproving.

Among independents, positive views of the court also held steady, with about 4 in 10 Americans approving. But disapproval among independents rose, to 43 percent from 32 percent.

The poll seems to have mostly measured sour grapes:

Partisanship also affected the public’s assessment of how the justices conducted themselves in rendering the health care decision. Nearly two-thirds of Republicans said it had been based on politics, compared with about 4 in 10 Democrats and more than half of independents.

I am not certain that the Court should care that the public believes its most high-profile case this term was politically motivated. The 7 in 10 who believe it was political and not legal analysis probably knew little about the ACA and even less about the Constitution or how the Court applies it.  And, despite the lack of civic knowledge, Americans seem to hold the Court in high esteem, regardless of whether they "approve" of its work.  Perhaps "approval" is the wrong way to ask the question. 

Either way, I remain convinced that the Obama administration needs to strengthen its information campaign for the ACA.

On Political Opposition to the ACA

Here’s a really brief summary, excerpted from Jonathan Bernstein:

1. Opposing the ACA Medicare cuts was what Republicans ran on in 2010, and are running on today.

2. Republicans support the cuts that they ran, and are running, against. Soon after arriving in Washington, that Tea Party class of 2011 voted for the Ryan budget which contained the very Medicare cuts they campaigned against.

3. [There is] absolute Republican opposition to the long-term cost-cutting measures in ACA (such as the IPAB) — while at the same time Republicans also have been bashing Barack Obama and the Democrats for not being willing to do “entitlement reform.”

Thus, Ross Douthat is unfair to say that “There was no meaningful Republican plan for reform during the heat of the original debate, and for all the notional talk about repealing and replacing, much the same void exists today.” There was a plan, and there is a plan. The plan is just being disguised or disclaimed as vigorously as tax-exempt groups now hide their donations. (For example, “even as Aetna’s president publicly voiced support for” the ACA, his company secretly donated millions to groups that attacked the plan. Private insurers generally spent over $100 million in this way over 15 months.) To understand what either party in the DC will do regarding the future of health care, we should look to their donor base, rather than their publicly stated positions. [FP]

 

Carter v. Canada: A Landmark Right to Die Case?

On June 15, 2012, the British Columbia Supreme Court handed down a much-anticipated judgment in Carter v. Canada, [2012]B.C.J.No. 1196; 2012 BCSC 886, 2012 BC.C. LEXIS 2467.  The case challenged Canada's prohibition on assisted suicide, to the extent that it restricted physician-assisted dying sought voluntarily by competent, grievously and irremediably ill adults. The constitutional argument was that the prohibition violated the Canadian Charter of Rights and Freedoms s. 15 equality rights and s. 7 rights to liberty and security of the person.  The nearly 200-page (in LEXIS) opinion is an extraordinary review of the current state of the law and practice of aid-in-dying, including extensive and careful discussion of medical ethics and end-of-life practices, the law in various jurisdictions where aid-in-dying is permissible, and the feasibility of effective safeguards.  

The plaintiffs in the case were Gloria Taylor, a patient with ALS who wanted to know that she could arrange for physician assistance should her condition become unbearable to her; Lee Carter and Hollis Johnson, the son and son-in-law of a patient with spinal stenosis who arranged for her to go to DIGNITAS in Switzerland for an arranged death; and Dr. William Schiochet, a family practice physician in Victoria willing to participate in aid-in-dying in appropriate circumstances.

The argument that prohibiting aid-in-dying violates s.15 equality rights depends on the differing circumstances between patients who are able to take their own lives and patients who, because of physical disabilities, require assistance of others. Section 15 of the Charter provides that every individual has "the right to equal protection and equal benefit" of law "in particular, without discrimination based on race, national or ethnic origin, colour, religion, sex, age or mental or physical disability."  This provision does not preclude law with the object of ameliorating conditions of disadvantaged individuals. Reasoning that the "animating norm" of this provision is substantive equality based on the enumerated ground of physical disability, the Court concluded that the absolute prohibition of assisted suicide imposed a disproportionate burden on people with physical disabilities. The Court applied the norm of substantive equality both to cases in which the allegation was that the plaintiff had not received equal benefit of the law and to cases such as this one in which the plaintiff contended that the law had the effect of unduly burdening individuals in the protected class. Finally, the court reasoned, the prohibition did not function to protect disadvantaged individuals, but to deprive them of the dignity of choice.

S. 7 of the Charter provides that everyone has "the right to life, liberty and security of the person" and may not be deprived of these rights "except in accordance with the principles of fundamental justice."  Here, the defense argument was that this was a limit on liberty in accord with fundamental justice.  The Court, in rejecting this argument, found that the absolute prohibition was overbroad and grossly disproportionate to any anticipated harms.  Instead, the Court invited the government to design safeguards to ensure that aid-in-dying was permissible only in appropriate cases.

In issuing the decision, Justice Smith placed a one-year stay on the ruling to give the Canadian government time to consider its options.  The stay included a "constitutional exemption" for Taylor, allowing her to get help to end her life if she so wished.  On July 13, the Canadian federal government announced that it is appealing and sought a stay on the decision, including the exemption for Taylor.  Stay tuned.

The case was litigated with great care and included a remarkable set of affadavits and testimony in favor of and opposed to aid-in-dying, from experts in bioethics, end of life treatment, and disability discrimination. The discussion of the evidence about the efficacy of safeguards, especially those aimed to insure voluntariness of the patient's decision such as assessments of competence or structures to avoid physician influence or forms of social coercion, are especially enlightening. For opponents, the decision has become a focus of resistance.  Whatever happens as the case is appealed, the opinion is worth reading (and assigning to students, at least in part) as analysis of the justification for legalization of aid-in-dying with appropriate safeguards.

[LPF]

New IOM Report: Higher Payments Are No Cure For Doctor Shortage

An Institute of Medicine report issued yesterday and reported on at Kaiser Health News concluded that while "there are wide discrepancies in access to and quality of care across geographic areas, particularly for racial and ethnic minorities,” these variations do not appear to be due to Medicare payments and were unlikely to be influenced by changes in rates.

The committee concluded that Medicare beneficiaries in some geographic pockets face persistent access and quality problems, and many of these pockets are in medically underserved rural and inner-city areas. However, geographic adjustment of Medicare payment is not an appropriate approach for addressing problems in the supply and distribution of the health care workforce. The geographic variations in the distribution of physicians, nurses, and physician assistants and local shortages that create access problems for beneficiaries should be addressed through other means.

The alternative solutions put forth in the report include having Medicare pay for services such as telemedicine that improve access to medical care in underserved regions. Another poposal was to encouraged states to change scope of practice laws so that nurse practitioners can provide more care, something the institute has pushed for in the past.

[KVT]

Southern Illinois University--Garwin Distinguished Professor of Law and Medicine

The Southern Illinois University School of Law is seeking nominations and applications for the Garwin Distinguished Professor of Law and Medicine for the 2013-14 academic year.  Established in 1996, the Garwin Professorship is funded in part by a grant from the Garwin Family Foundation which was established in 1993 for the purposes of fostering education and academic research.  Support for the position includes a competitive salary, benefits, travel allowance, housing for one year, and a research assistant.

Applicants must possess the Juris Doctor degree or its equivalent from a nationally-accredited law school, be currently on the faculty of an accredited school of law or other graduate professional school, and have an outstanding national reputation as a health law/policy scholar and teacher.  Factors to be considered in assessing candidates for the Garwin Distinguished Professorship include the following: scholarly and teaching record, honors received (e.g. awards, fellowships, etc.), participation and leadership in national and international organizations, letters of recommendation, and other factors relevant to assessing qualifications for this position.

For Associate or Full Professor rank: significant teaching experience and demonstrated achievements in scholarship consistent with the tenure and promotion standards of the Southern Illinois University School of Law. For details see: http://www.law.siu.edu/Faculty_staff/garwin.php

A complete application will require a letter of application detailing your interest, qualifications and relevant experience, along with a vitae or resume and three references with names. Address or email applications to:

Patty Lynn, Assistant to the Dean
Mail Code 6804
Southern Illinois University School of Law
1150 Douglas Drive
Carbondale, Illinois 62901
Email:  [email protected]

[KVT]