Andrew B. Bindman

During the next year of presidential campaigning, candidates’ positions on their support of or opposition to the Affordable Care Act (ACA) will become shorthand

Problem To investigate whether and how faculty members in a department of medicine are engaged in public policy activities. Approach Between February and April 2011, the authors conducted a cross-sectional, Web-based survey of all active Department of Medicine faculty members at the University of California, San Francisco. Survey questions covered demographics, academic role, academic rank, and participation in three specific public policy activities during the past five years: (1) policy-related research, (2) expert advice to government officials, and (3) public policy advocacy in collaboration with organizations outside government. Outcomes Two hundred twenty of 553 faculty (40%) responded to the survey. One hundred twenty-four faculty members (56% of respondents and 22% of total active faculty) reported that they were engaged in at least one of the three types of policy-related activities: 51 (23%) conducted policy-related research, 67 (30%) provided expert advice to government officials, and 93 (42%) collaborated with organizations to advocate for public policy. Higher faculty rank was significantly associated with faculty members reporting that they were involved in one or more of the three policy activities (P = .04). Next Steps Academic departments should identify public policy expertise among their faculty and leverage this expertise by facilitating opportunities to develop a shared faculty awareness of their public policy activities, by supporting the establishment of mentoring relationships for less experienced faculty in the area of public policy, and by incorporating standards of excellence for work in public policy into the promotions process.

Each July, the Centers for Medicare & Medicaid Services (CMS) publishes in the Federal Register its proposals for updating the Medicare physician fee schedule for the upcoming calendar year.¹ The rule applies to the approximately 37 million beneficiaries in the fee-for-service program. Following a 60-day public comment period, the CMS finalizes the rule and typically implements it the following January. Although these rules cover a wide range of services, included within the document issued this past July is a little-noticed discussion of Medicare’s intent to make a substantial change in its payment policy. If the rule is finalized as proposed, for the first time physicians would be able to bill Medicare for the non–face-to-face delivery of complex chronic care management services provided by a practice that has the capability to furnish these services.

The establishment in recent years of a National Provider Identifier (NPI) offers a new method for counting and categorizing physicians and other health care professionals involved in clinical care. In this paper, I describe how the NPI is assigned, the information collected in association with assigning the NPI, potential ways to enhance information on health professionals through data linkages using the NPI, and how the assessment of the health care workforce could be improved by requiring health care professionals to update their information as a part of maintaining their NPI.

Public hospital safety net systems face constant financial constraints, hindering their ability to provide adequate healthcare services. Many healthcare reform proposals would further weaken these systems by redirecting current safety net resources toward private insurance. Despite or perhaps because of this challenging environment, many successes in improving care for poor and vulnerable populations have been pioneered in safety net systems. San Francisco, California, is implementing several innovative programs to strengthen the financial viability of its healthcare safety net while also attempting to improve the access to and the quality of healthcare services.