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Nation without standards: Healthcare instance

The U.S. Constitution, laws and regulations constitute the basis for “national standards” if and when Congress and the President decide to act to create them. What that means in our system of states and federal government is that states compose standards if they want to, and the federal government may enact them if the need arises to that level, and Congress supports the action.

National healthcare standard are incomplete
Photo: Ryan McVay, Getty Images

Take healthcare, for instance. The President of the United States did not go before the American people to say that we need a national standard for healthcare. Congress didn’t explain to the nation that we need a national standard for healthcare. What the President said included these things:

  1. Quality healthcare in America has gotten too expensive.
  2. Too many citizens don’t have healthcare insurance because they cannot afford it.
  3. Therefore, the federal government needs to address these problems with a new law.

That law became the Affordable Healthcare Law that has been enacted, challenged, and supported by the U.S. Supreme Court. In constructing that law, it became apparent that there needed to be a standard for baseline healthcare in America. Therefore that action was the first time in America that a national standard was established that would be applied throughout all of the states and honored by all healthcare insurance providers. Until that time, America had no standard for healthcare.

This reporter first discovered this circumstance when addressing a different aspect of the need. While acting as a program manager contractor to the department of Health and Human Services, I managed a program called the Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP). That is a very long name and a lousy abbreviation, but it served this purpose:

When healthcare professionals want to volunteer their services in event of an emergency, they can register in advance and to have their credentials recognized in whatever state and jurisdiction in which they want to volunteer.

Before ESAR-VHP, doctors and nurses may show up at a disaster site, but they could not be used because it was not possible to verify their credentials in a timely manner. Until this program was initiated, there were no national credentialing standards. They were all different among various states and territories.

Think about that for a moment. That meant that doctors who practiced in one state may be of higher or lower quality depending upon the standards determined by states. For patients, that would mean you had better hope that you get sick where the standards are highest, and not lower.

Healthcare standards as reflected by credentialing varied among the states. Guess what? They still do. ESAR-VHP applies only to healthcare professionals who volunteer under this program. Nothing was done to address the variability of healthcare credentialing nationwide.

A concluding point in this story is that while Congress and the President remain dysfunctional, think about all of the necessities that we hold in common for which there is no national standard. Take education as another instance.

Don’t you think that our elected officials could find something better to do than to wait to be elected again to office?

“The Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP) is a federal program created to support states and territories in establishing standardized volunteer registration programs for disasters and public health and medical emergencies.

The program, administered on the state level, verifies health professionals' identification and credentials so that they can respond more quickly when disaster strikes. By registering through ESAR-VHP, volunteers' identities, licenses, credentials, accreditations, and hospital privileges are all verified in advance, saving valuable time in emergency situations.

Why do we need ESAR-VHP?

In the wake of disasters and public health and medical emergencies, many of our nation's health professionals are eager and willing to volunteer their services. And in these times of crisis, hospitals, clinics, and temporary shelters are dependent upon the services of health professional volunteers. However, on such short notice, taking advantage of volunteers' time and capabilities presents a major challenge to hospital, public health, and emergency response officials.

For example, immediately after the attacks on September 11, 2001, tens of thousands of people traveled to ground zero in New York City to volunteer and provide medical assistance. In most cases, authorities were unable to distinguish those who were qualified from those who were not – no matter how well intentioned.
There are significant problems associated with registering and verifying the credentials of health professional volunteers immediately following major disasters or emergencies. Specifically, hospitals and other facilities may be unable to verify basic licensing or credentialing information, including training, skills, competencies, and employment. Further, the loss of telecommunications may prevent contact with sources that provide credential or privilege information.

The goal of the ESAR-VHP program is to eliminate a number of the problems that arise when mobilizing health professional volunteers in an emergency response.”

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