Hot Issues Facing Higher Ed

Submitted by Thomas Skalko, PhD, LRT/CTRS, CAAHEP President

In order to keep folks abreast, it seemed logical to pitch a short blog on things that are happening in the accreditation world.  I had the privilege of attending the Association for Specialized and Professional Accreditors (ASPA). There seem to be some key issues that are confronting all accreditors. It is time to keep our eyes and ears open and ASPA is playing an important role in representing programmatic accreditors.

On the top of the agenda is the re-authorization of the Higher Education Act. There are competing options and priorities including the comprehensive bill by Senator Harkin, separate partial proposals from the House and the priorities of the Obama Administration.  Currently, there is a push by the U.S. Department of Education and the Council for Higher Education Accreditation (CHEA) that place greater demands on accreditators. Among the topics of interest include a new push for more transparency and open disclosure of accreditation actions. This transparency includes access to self-studies, accreditation team reports, and accreditation communications. While conceptually some level of transparency may not be overly alarming, the issue, however, on how far the call for transparency goes may indeed be problematic. Will the push include all materials? Will documents and decisions be misinterpreted by the public? Will there be a requirement to release documents prior to an institutions opportunity for due process and opportunity to clarify and offer additional information that may alter decisions? What are the legal implications of full disclosure? So many questions and so few answers!

When is a Doctor not a Doctor?

When I graduated from law school with my J.D. (Juris Doctor) degree, I remember getting a call from one of my smart-aleck brothers. We had another brother with a doctorate in theology, so Mr. Smart Aleck said, “Now we have two doctors in the family and neither one of you is worth a damn.” That might be a debatable point when he needs a lawyer, but he was reflecting a commonly held belief, maybe a bit old-fashioned now, that the only REAL doctors are M.D.s. But these days a whole array of health care providers attain doctorate degrees – most of which (like my J.D.) are non-research professional doctorates. So, physical therapists, pharmacists, and dentists are all “doctors.” But, especially in the field of nursing, the question of who can call themselves doctors has become an even hotter topic.

In my home state of Florida – where you can always count on the most extreme ideas to come from our state legislature – bills have been introduced that would force health care providers with doctorate degrees to explain to patients and the public that they are "not medical doctors" or face felony charges. Yes, that’s right – felony charges!!

The AMA has had a “Truth in Advertising” campaign for several years now. They have data that indicates there is a lot of confusion among consumers of health care as to who the various practitioners are. We in allied health know that this is a problem – everyone who has direct contact with patients is perceived by most patients as either a doctor or a nurse.

So, the AMA’s “model legislation” calls for all health care practitioners who come in contact with patients to wear a name tag “that clearly identifies the type of license held…” This is certainly not a bad thing and it would help promote the visibility of professions like medical assisting. The AMA’s material notes that the model bill “does not provide for criminal penalties.” But it goes on to say, “although a state may wish to pursue that course.” Really? Do we really want to further clog up our criminal courts with felony charges against a nurse practitioner who fails to clearly identify him or herself as NOT a doctor?? Will prosecutors, who are ever sensitive to political concerns, be lobbied to throw these “not real doctors” in the slammer?

For more information on the AMA’s campaign, here is the document I have cited:

http://www.ama-assn.org/resources/doc/arc/tia-campaign-resources.pdf. The AMA says this is not a “turf battle” but others disagree. Here’s an interesting article from Bloomberg that offers another perspective: http://www.bloomberg.com/news/2013-03-04/nurses-spar-with-doctors-as-30-million-insured-seek-care.html

State of the Education Union

Education and accreditation leaders were not shocked when, in his State of the Union address, President Obama said this about higher education: “Taxpayers cannot continue to subsidize higher and higher and higher costs of higher education. Colleges must do their part to keep their costs down, and it’s our job to make sure they do.” This is a theme we have been hearing repeatedly from the Administration.

But the “supplemental document,” released after the speech, did contain a very big surprise for the accreditation community. In that document the White House said: “The President will call on Congress to consider value, affordability, and student outcomes in making determinations about which colleges and universities receive access to federal student aid, either by incorporating measures of value and affordability into the existing accreditation system; or by establishing a new, alternative system of accreditation that would provide pathways for higher education models and colleges to receive federal student aid based on performance and results.”

Right now, in order for their students to receive federal financial aid, a college must have institutional accreditation from an agency recognized by the US Department of Education.  (This is different from program accreditation which is what CAAHEP does). The main purpose of the recognition by the Department is to assure that the accreditors are serving as “gatekeepers” for that federal aid. But with rising default rates on student loans and ever-escalating costs for a college degree, the Administration clearly believes that those institutional accreditors are somehow failing in their duty as gatekeepers.

There has been a lot of debate in recent years in the accreditation community about how we should balance our roles as the cop who assures certain outcomes versus promoter of quality and quality improvement. That debate will no doubt continue.

But what is of particular interest to me is that the underlying philosophy in the Administration’s position seems to be that federal money should be used only to train students for jobs. If you want to spend $40,000 on a liberal arts degree that won’t prepare you for a profession, you have that right. But not at taxpayers’ expense.

Many of us in the “Boomer” generation started out with English or philosophy degrees before we ultimately settled into a profession. But given high unemployment rates and the fear of the looming crises over student loan defaults, this would appear in the minds of many to be a “luxury” we can no longer afford.

Just So You Know..."State Authorization" Has Not Gone Away

There was a lot of publicity recently when the U.S. Department of Education announced that it would no longer enforce a requirement that had been placed in their regulations that distance education programs would have to obtain permission to operate in every state in which they enroll at least one student.

While the Department's decision was good news, the issue did not go away. In fact, it moved to the forefront in many states. As one observer said, "the genie is out of the bottle." Many states already had laws on the books that required registration or some other form of authorization but had never enforced them, while a couple of states saw a revenue opportunity and swiftly passed such laws. Most states simply do not have the manpower to enforce the laws and with the threat of federal enforcement now gone, many colleges will simply wait to get caught rather than paying the registration fees or going through whatever process the state has set up.

There is another troubling aspect to this controversy - some of the state laws also say that placing even one student in a clinical or externship site also triggers a "physical presence" in the state and requires authorization.

Just so you know, CAAHEP has assembled a chart that provides a "thumbnail" sketch of what the various states require in terms of both distance education and clinical placements.  Proceed at your own risk! 

Déjà Vu All Over Again!

It has been more than a year since I posted a blog and what’s even more remarkable than how quickly that time has passed is the fact that my topic continues to be a variation on the same theme as previous entries: unethical or questionable practices by some colleges, most of them for-profit entities.

But while there have been lots of allegations about aggressive recruiting practices, misrepresentation of job placement rates and misleading information about accreditation status, today’s topic may be the most reprehensible yet, not because the behaviors are new but, rather, because of the population being targeted: veterans and active-duty military personnel.

Most of the abuse stems from something called the “90-10” rule which requires that no more than 90% of a school’s revenue can come from federal financial aid. But for some reason, revenue from veteran’s benefits is considered “other” income and is not counted in the 90% limit. Congress has debated ways to get at this problem but no consensus has been reached on legislation. So, on June 12th, President Obama signed an executive order that will force schools to disclose more information about topics like financial aid and graduation rates. It also requires DOD to set rules for recruiting at military installations.

In addition, the order sets up a complaint system for reporting suspected institutional fraud or abuse of veterans’ benefits, and it requires institutions to abide by the same rules as schools that receive financial aid from the Education Department.

In an effort to get out ahead of the story, the Association of Private Sector Colleges and Universities (the organization that represents for-profit institutions) issued a statement on June 11th outlining “Five Tenets of Veteran Education.” Needless to say, APSCU disagrees with many elements of the Executive Order and the battles will no doubt continue.

The "War" Continues

The “For Profit Wars” continue. Senator Tom Harkin has another hearing this week and a different Senate Committee held a hearing on March 2nd at which Senator Harkin was a witness.

Senator Thomas Carper (D, DE) held a hearing that focused on a report from the GAO that found problems with the Defense Department’s oversight of its tuition assistance program and some “improper or questionable marketing practices” by for profits.

It reminded me of an early morning call to the CAAHEP office from a woman who was serving in Iraq. In preparation for her eventual discharge she wanted to get trained in an allied health profession. She told me that she was being pursued (and pressured) by an online program that she had learned was not accredited. All I could do was confirm that it was not accredited and talk to her about the consequences of graduating from a non-accredited program. Somehow, misleading and high pressure sales tactics seemed especially egregious when directed at a young person who was putting her life on the line every day in a war zone!

So, the biggest surprise for me as a result of that Senate hearing, was learning that military tuition assistance is not considered “federal aid” under the 90/10 rule. The 90/10 rule was created in the Higher Education Act reauthorization of 1992, the last time there was lots of scrutiny of “fly-by-night” for-profits and student loan defaults. It says that a school cannot get more than 90% of its funding from federal student aid or it will become ineligible for continued receipt of federal money. Many institutions operate dangerously close to that 90% limit. And apparently one of the ways some schools keep below the limit is to market and recruit heavily among active duty military personnel because those tuition benefits are not part of the 90%.

I must admit, I don’t begin to understand why money that comes from the Department of Defense would not be considered “federal money.” And the rule likely will not change in the near future because there is bound to be opposition in the Republican controlled House of Representatives – in fact, House Republicans, who look far more favorably upon the for-profit sector, are talking about raising that 90% limit.

Whatever happens with the 90/10 rule it seems to me that members of our armed forces deserve better than what that young woman in Iraq was faced with. Shame on those who would take advantage of our military personnel!

The Fight Turns Nasty

The last several blogs have been about the scrutiny - primarily from the Obama Administration and Democrats on Capitol Hill - of for profit higher education. Damaging allegations from the GAO's "secret shopper" tapes made it difficult to argue that it was a case of "just a few bad actors." But the for-profit sector is fighting back. Millions of dollars are being spent on various lobbying campaigns and the effort was successful in delaying the proposed "gainful employment" rules from the US Department of Education.

Then, just the day before the historic (and first-ever) White House Summit on Community Colleges, a report was issued claiming that community colleges engage in "unsavory recruitment practices" and offer students "poorer-than-expected academic quality, course availability, class scheduling, job placement and personal attention." The firm that produced this report (on behalf of several for-profit companies) did some of their own "secret shopping." But the value of this "research" seemed highly questionable. The sample of students surveyed, for example, was composed of people who had withdrawn or graduated from community colleges and then enrolled in a for-profit institution. The authors of the report acknowledged this might mean that "bias may be present" (!).

On another front, Inside Higher Education reported that for-profit Keiser University filed a lawsuit against Florida State College at Jacksonville, complaining that college administrators "disseminated false information about proprietary schools, including Keiser, by working through advocacy groups and 'short sellers' who profit when the price of a publicly traded stock declines in value."

There's no question that community colleges have their own set of problems, especially in these economic times of severe budget cutting. But for-profit and non-profit alike need to do a better job of improving graduation rates and helping their "non-traditional" students to succeed.

Imagine if all the money that is being spent on lobbying and litigation went, instead, to program improvement? But, of course, that's not the way our system works, especially in these highly polarized times. We just have to hope that the students who need these programs if they ever are going to have a shot at a better life, are not "collateral damage" in these ongoing battles.