Since health reform seems mired in the mud as a potential vehicle for implementing any of the recommendations of the Institute of Medicine's report, Retooling the Healthcare Workforce for an Aging America, we are back on track for the long-haul effort we had originally assumed would be necessary.

As part of our original strategy of maintaining an active “conversation” around the report, we co-funded the 16th annual Princeton Conference organized by the Council on Health Care Economics and Policy. The meeting, led by Stuart Altman of Brandeis (a co-chair of the IOM committee), reconvened many of Retooling's participants a little more than a year after the April 2008 release of their report. Presentations from the session and a monograph are now available at http://council.brandeis.edu/.

Coincidentally, as I was reading this follow-up report, I saw a paper by Robert Wachter, one of the parents of hospitalism, in a recent issue of Health Affairs. The paper, “Patient Safety at Ten” is a national report card on health care quality and patient safety 10 years after the Crossing the Quality Chasm report by the IOM. He gives our national response an overall grade of B-, up from C+ at 5 years post report, assessed back in 2004. Given the enormous resources that the Robert Wood Johnson Foundation has poured into safety, the vibrant safety movement that grew out of the Chasm report, and the strong echoing resonance it has had for a decade, this mediocre grade gives me pause.

Ten years after the IOM Retooling report will be 2018. This is approximately when the positive balance of funds in the Medicare Trust Fund used to pay Medicare Part A expenses (e.g., hospital insurance) will be depleted and Medicare payments will be increasingly dependent upon general tax revenues. While I don't believe that there is necessarily any calamity tied to this date, it signals the point where the aging population and rising health care costs will finally require a policy response. In many ways, I see our job in improving health care for older Americans as creating more options and less urgency among policy makers in 2018 -- so when the moment comes, they can make better decisions. Where will we be in Retooling the Health Care Workforce for an Aging America in 2018 when we have had 10 years to implement solutions? Will we be able to give ourselves better than a B-?