Healthy Vision 2020
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Healthy Vision 2020
Bringing into focus a clear and distinct view of the rest of this decade in Texas health care. Offering a sharp perception of what lies ahead and what we must change to keep us all healthy.
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The medical home requires building a better team

The medical home requires building a better team | Healthy Vision 2020 | Scoop.it
How do we get the many disparate members of our healthcare team together to provide better care in a patient-centered medical home?
Texas Medical Association's insight:

Right Care, Right Person, Right Time, Right Place

 

No one worries about the spiraling cost of U.S. health care more than physicians. Our current health care delivery system does too little to coordinate care for patients with expensive-to-manage chronic conditions. We don’t make the most effective use of allied health practitioners. We are requiring physicians to invest in high-dollar health information technology (HIT) systems without ensuring that the investment translates into better patient care. We are responding to calls to measure a physician’s effectiveness and efficiency but are concerned that the measures are not focusing on the right metrics. The way to save money in health care is not through ill-advised, random rationing of care, but rather through systems that ensure the right professional provides the right care, at the right place, and at the right time.

 

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Report: NPs, PAs won't solve primary care shortage

Report: NPs, PAs won't solve primary care shortage | Healthy Vision 2020 | Scoop.it
The industry still needs policies to solve the primary care shortage since more nurse practitioners (NPs) and physician assistants (PAs) are choosing subspecialty careers, according to new research from the American Academy of Family Physicians.
Texas Medical Association's insight:

Texas has a large, growing population that is growing sicker and needs more and better-coordinated health care services. Unfortunately, Texas — even more than most of the rest of the country — needs more physicians and other health care professionals. Although our 2003 liability reforms have brought an influx of new physicians, the current supply won’t be able to keep up with the demand, especially with expanded insurance coverage from the Patient Protection and Affordable Care Act (PPACA). We need more physicians and other health care professionals working in all parts of the state, especially in rural and border Texas. We need to invest more in our medical schools and graduate medical education training programs. We should not fool ourselves into thinking that allied health professionals — who haven’t gone to medical school — can fill the gap as independent practitioners. Instead, we need to work on building physician-led health care teams that can safely meet the diverse needs of the Texas population.

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Primary Care Doctor Shortage Set To Get Worse, USA

Primary Care Doctor Shortage Set To Get Worse, USA | Healthy Vision 2020 | Scoop.it
Too few newly qualified doctors are choosing primary care, resulting in a serious shortage of primary care physicians in America. Federal funding needs to be changed.
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Jim Landers: Texas and Mexico both face obesity and diabetes emergencies

Jim Landers: Texas and Mexico both face obesity and diabetes emergencies | Healthy Vision 2020 | Scoop.it
Good news on obesity and diabetes in Texas? Not entirely. Bad news in Mexico? Definitely.
Texas Medical Association's insight:

Encourage Texans to take personal responsibility for their own health

 

Texas needs to support our citizens in taking more responsibility for their health and health care decisions.

 

The key to maintaining health lies in helping patients assume responsibility for their own health with regular support from their physicians. Competent, compassionate medical care, delivered with professionalism, state-of-the-art clinical knowledge, and patient respect are critical components of this responsibility. Conversely, patients have a responsibility to make informed, healthy decisions.

 

Physicians must continue to emphasize the importance and power of personal responsibility in patients’ health outcomes. Over the past century, public health interventions have effectively reduced and, in some cases, eliminated illness and death. We must use education and preventive medicine measures to go further — to curb the need for the complex treatment required once a preventable condition develops. Each occurrence of preventable chronic disease is costly to Texas’ government and businesses, to our economy, and to our people.

 

Personal health and wellness depend on the behavioral decisions we make as well as the social and environmental factors to which we are exposed throughout a lifetime. Four out of 10 Texas adults report at least one factor — high cholesterol, obesity, high blood pressure, a sedentary lifestyle, or a smoking habit — that puts them at high risk of developing a chronic disease. Many adults have more than one risk factor and can develop multiple chronic conditions.

 

These chronic diseases are killers that strike down Texans before their time. Tobacco, for instance, is directly responsible for the death of 24,000 Texans each year. This is more than homicide, HIV, suicide, influenza and pneumonia, accidents, and diabetes — combined.

 

Patients and their families trust their physicians to guide and influence decisions made to protect the patient’s health. However, with the massive information and misinformation in today’s super technology-driven environment, each patient and family needs the truth. Health literacy — patients’ education and ability to read, follow instructions, and communicate verbally — also affects their health. Nine out of 10 adults struggle with fully understanding basic health information as seen in advertisements, stores, the news, and in their communities.

 

All physicians and health care providers need to educate themselves on the cross-cultural dynamics that can impact a patient’s understanding and compliance with treatment. So, too, must the government’s education efforts evolve to accommodate the diverse cultures among poorer populations to ensure materials and programs connect with our population.

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Obesity's death toll could be higher than believed, study says

Obesity's death toll could be higher than believed, study says | Healthy Vision 2020 | Scoop.it
The death toll of the nation's obesity epidemic may be close to four times higher than has been widely believed, and all that excess weight could reverse the steady trend of lengthening life spans for a generation of younger Americans, new...
Texas Medical Association's insight:

Invest in obesity control

 

Overweight and obesity contribute to diabetes, hypertension, heart disease, cancer, and stroke. Texas has an easy-to-see obesity crisis. Some 66 percent of Texas adults are overweight or obese; the United States average is 63 percent. During the past three decades, obesity rates in children have more than tripled in the country. Today, 32 percent of Texas children (ages 10-17) are obese.

 

The obesity epidemic, and the ever-younger age groups that it strikes, threatens Texas’ physical and fiscal health. Texas’ continually expanding waistline correlates to our health care cost demands. Obesity is responsible for 27 percent of the growth in health care spending. Treating obese patients costs 37 percent more than treating normal-weight patients.

 

The rise in overweight and obesity is affecting the bottom line of Texas employers. The Texas Comptroller’s Office found that in 2009, obesity cost Texas businesses an estimated $9.5 billion, due to higher employee insurance costs, absenteeism, and other effects. Left unchecked, obesity could cost employers $32.5 billion annually by 2030.

 

Improved physical health in students has been linked to academic success. Conversely, children with obesity are more prone to absences and lower grades. In the United States, students who are physically active at least 60 minutes on most days, play on at least one sports team, or watch fewer than three hours of television per day consistently have “mostly A’s.”

 

A great proportion of obese adults were overweight or obese as children. This serious risk factor is found in Texas, where more than 30 percent of children in grades 4 through 11 are overweight or obese. A child who is overweight at age 12 has a 75-percent chance of being overweight as an adult.

 

There is no single solution to preventing or addressing obesity. Multiple evidence-based approaches must be pursued for physicians, communities, schools, and workplaces, and each must identify potential barriers to implementing local programs

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State and Local Coverage Changes Under Full Implementation of the Affordable Care Act

State and Local Coverage Changes Under Full Implementation of the Affordable Care Act | Healthy Vision 2020 | Scoop.it
Medicaid Enrollment Increases Under the ACA The demographic composition of Medicaid enrollees shifts under the ACA Nationally, our model projects a 37.4 percent increase in Medicaid/CHIP enrollment under the ACA, with total enrollment rising from...
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Federal Regulator, Meet Dr. Regulated

Perhaps it’s time for federal regulators to examine themselves, because it certainly appears there’s too much oversight that inhibits phys
Texas Medical Association's insight:

After “health,” the most frequently used word in the Patient Protection and Affordable Care Act (PPACA) is neither “patient” nor “physician” nor “hospital” nor “insurance.” “Secretary,” as in “the secretary of health and human services,” is mentioned more than 2,500 times in the 2,300-page bill. And more than 700 times, the PPACA says “the secretary shall.” Each of these directives is a sign of new regulations to come on physicians and health care. Unfortunately, the PPACA was not the genesis of physician regulation, nor are these busy rulemakers limited to the federal government. “An extensive regulatory framework … arose haphazardly, with little consideration of how the pieces fit together,” the Federal Trade Commission and U.S. Department of Justice reported in 2004. The huge numbers of state and federal regulations and their haphazard nature place tremendous burdens on physicians’ practices, most of which are still small businesses. These rules insert themselves between physicians and their patients, frequently do little to improve patient care, and divert physicians’ time and energy away from the patients in the exam room. We need to repeal, reorganize, and reprioritize if we want a functional health care delivery system.

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Medicare’s Sustainable Growth Rate: Principles for Reform

Medicare’s Sustainable Growth Rate: Principles for Reform | Healthy Vision 2020 | Scoop.it
Congress will soon revisit the issue of Medicare physician reimbursement. Much of the discussion will focus on the sustainable growth rate (SGR), enacted in 1997 as a mechanism to update yearly Medicare physician payments.
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Interactive Infographic: How Physicians Use Mobile Technology

Interactive Infographic: How Physicians Use Mobile Technology | Healthy Vision 2020 | Scoop.it
Explore the rise of mobile in the clinical setting and better understand how physicians are using mobile technology and social media to improve healthcare.

Via ET Russell
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Is GME Snubbing Rural America?

Is GME Snubbing Rural America? | Healthy Vision 2020 | Scoop.it
Theories abound as to why young physicians won’t practice in rural areas. But the key reason why young medical doctors don’t fill these mu
Texas Medical Association's insight:

Key in communities large and small

 

Looking at the economic impact of physician practices by metropolitan statistical area (MSA), the Lewin Group reported that doctors’ offices in the Houston and Dallas-Fort Worth areas each accounted for more than 65,000 jobs and more than $10 billion in annual wages and benefits. In the economically stressed border region from Brownsville to Laredo and on to El Paso, physicians’ offices contribute $2.4 billion per year in economic output and support nearly 14,000 jobs.

 

The financial value of a physician’s practice has even been measured in some of Texas’ tiniest towns. Hemphill County (population 3,807) contracted to determine the value of recruiting a primary care physician to its Panhandle community.

 

The Hemphill County report concluded, “… [Primary care physicians’] economic contributions are as important to a community as their medical contributions.” Specifically, the study found:

 

One solo rural primary care physician generates approximately $1 million in revenue, $1.6 million in income (wages, salaries, benefits, and proprietor income), and creates 21 jobs in the Hemphill County economy.

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The Gulf Between Doctors and Nurse Practitioners

The Gulf Between Doctors and Nurse Practitioners | Healthy Vision 2020 | Scoop.it
Nurse practitioners believe that they can lead primary care practices and admit patients to a hospital and that they deserve to earn the same amount as doctors for the same work. Physicians disagree.
Texas Medical Association's insight:

Promote physician-led team care

 

Texas has a fast-growing population and needs to work toward a 21st century health care workforce. More than ever, caring for larger panels of patients — particularly in primary care medical homes — will involve the skills of many different practitioners. Central to this concept is that these physician-led teams will utilize a number of health care professionals, each bringing important skill sets and training to patient care. Physicians will continue to provide patient care services, but they also will be called upon to manage the team’s care for larger populations, out of necessity and for essential coordination.

 

Team care will require cooperation and collaboration among all professionals, with a focus on quality, measureable outcomes, and efficient utilization of resources. It will be essential that the patient receive the right care, at the right time, by the right professional, in the right venue.

 

The physician is the highest-trained team member. It therefore falls to the physician — as both provider of care and manager of services delivered by others on the team — to supervise, implement science-driven and objective treatment protocols, coordinate the services of other professionals as well as medical specialists, and ultimately remain accountable for each patient’s care.

 

Integrating the talents of a diverse medical team under physician leadership will be one of the key challenges in the coming decade. Without physician direction, supervision, and management (or if the system evolves to accommodate teams led by practitioners with lesser training), medical care will trend toward even more fractured care, higher-than-necessary utilization, and creeping inefficiencies. This will lead to even higher costs, duplications of services, and lower-quality patient care. These inefficiencies in turn will hamper efforts to improve access to care.

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Consensus Stirs for Medicare Reform

A U.S. House subcommittee’s review of proposals to improve the Medicare program focuses on three recommendations, but simultaneously restructuri
Texas Medical Association's insight:

Stop the Medicare Meltdown — repeal the SGR

 

Since the turn of the century, nothing has so regularly and completely vexed and frustrated physicians more than our annual game of chicken with Congress over Medicare payments.

 

Medicare patients and military families are never out of danger. Year after year, the specter of congressional action or lack of action threatens to jeopardize health care for Medicare patients. And, because TRICARE rates for military families are based on Medicare, they’re in danger, too.

 

This is because federal law requires Medicare payments to physicians to be modified annually using the Sustainable Growth Rate (SGR) formula. Because of flaws in how it was designed, the formula has mandated physician fee cuts every year for the past decade. Only short-term congressional fixes have stopped the cuts. In 2010 alone, Congress had to intervene five times to stop a 25-percent cut. It took emergency action in December 2011 and again in February 2012 to stop a 27.4-percent cut. That would have meant an annual loss of $1.71 billion to physicians for the care of elderly patients and Texans with disabilities.

 

Most commercial insurers pay physicians based on a percentage of the Medicare rate, which has changed little over the past decade. This double hit has meant a flat-lining of physician payment rates that threatens the viability of many physician practices and makes investment in new clinical equipment and health information technology increasingly more difficult and challenging.

 

Because Congress once again failed to repeal the SGR, the Congressional Budget Office projects that the next cut, scheduled for Jan. 1, 2013, will be approximately 30 percent. Without a permanent solution, the size of the cuts continues to grow.

 

Instead of fixing the flawed formula, Congress freezes the cut each year. In essence, Congress has put the SGR debt on our credit card. The 10-year cost of fixing the problem is now well over $300 billion.

 

Considering that Medicare currently pays, on average, at least 20 percent less than a physician’s cost to provide care, this decade-long and continued uncertainty is forcing some physicians to make the difficult decision to either opt out of Medicare, limit the number of patients they treat, or retire early. A recent TMA survey indicates that 50 percent of Texas physicians are considering opting out of the Medicare program altogether.

 

Medicare patients often can’t get in to see their physicians as quickly as needed. This forces Medicare patients to put off care until they are so sick they need to use a hospital’s ED, which is more expensive. Sending a Medicare patient to the ED is counterproductive to the goal set by Congress and the White House to keep health care costs down by encouraging all Americans to have a “medical home.”

 

We all recognize the value that hospitals, nursing homes, home health services, durable medical equipment, and other health care providers give to Medicare patients. Over the past decade, they have received annual payment increases, while physicians have not.

 

Medicare patients should feel anything but secure about the future of their health care. Physicians are the foundation of the Medicare program. Without a robust network of physicians to care for the millions of patients dependent on Medicare, the program will not work.

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A cautionary tale of employing doctors

A cautionary tale of employing doctors | Healthy Vision 2020 | Scoop.it

"So after taking measures to increase the cost of care and testing, it has finally dawned on them that they have incentivized the wrong entity."

Texas Medical Association's insight:

Maintain restrictions on lay control of the practice of medicine

 

In a changing and uncertain environment, many physicians will seek employment opportunities as a way to deal with unpredictable and oftentimes inadequate payment models and the increasing — and sometimes overwhelming — administrative burden of running their own practices. At the same time, hospitals and other nonphysician-owned entities will continue to seek to employ physicians.

 

Quality measures must take into account how sick patients are and what associated diseases they have. Incentives focused primarily on cost per member will reward physicians and providers for treating only the healthiest patients. The poorest and sickest likely will drag down the “efficiency” ratings so that their physicians and providers become ranked as “lower performing.”

 

Protecting the patient-physician relationship lies at the heart of Texas’ legal doctrine banning the corporate practice of medicine. Patients must be able to trust that the tests and treatments their physicians recommend are tailored to their individual medical needs and are shielded from improper lay influence. Each patient encounter must be governed by the ethics of the medical profession, the integration and application of advancing medical knowledge, and the partnership with the patient in making good decisions for that patient’s health.

 

Employment without protections is the corporate practice of medicine. Employment with protections is part of the practice of medicine, and that’s what we stand for.

 

At TMA’s urging, the 2011 Texas Legislature passed ground-breaking new laws that protect patients and their physicians’ ability to exercise independent medical judgment free from interference by a hospital administrator or corporate officer. At the same time, we preserved Texas’ ban on the corporate practice of medicine with several carefully delineated expansions for physician employment. These included strong protections for physicians employed by or associated with hospital-controlled health care corporations, rural county hospital districts, large urban hospital districts, and the newly established Texas health care collaboratives. Texas is the first state in the country to take the critical step of protecting clinical autonomy. The laws place responsibility for monitoring and enforcement with the Texas Medical Board, which is the agency responsible for upholding the standards of medical practice in the state.

 

Over the course of the coming decade, patients and physicians will see many changes in the organization and delivery of medical services. New payment models likely will drive new practice arrangements. Many physicians will continue to practice independently, some will partner in small to large groups, and others will join larger single or multispecialty groups. Payment models for physicians’ services will continue to be a mix of fee-for-service, global or capitated payments, and salary arrangements for physicians who choose employment.

 

Regardless of the applicable practice arrangement, TMA and its member physicians remain committed to protecting the clinical autonomy of physicians and the primacy of the patient-physician relationship.

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Criminally negligent physical education

Did it really take the American Medical Association to tell us this? The AMA has pronounced childhood obesity a disease — also, that boiling water scalds and wood splinters.
Texas Medical Association's insight:

Invest in obesity control

 

Overweight and obesity contribute to diabetes, hypertension, heart disease, cancer, and stroke. Texas has an easy-to-see obesity crisis. Some 66 percent of Texas adults are overweight or obese; the United States average is 63 percent. During the past three decades, obesity rates in children have more than tripled in the country. Today, 32 percent of Texas children (ages 10-17) are obese.

 

The obesity epidemic, and the ever-younger age groups that it strikes, threatens Texas’ physical and fiscal health. Texas’ continually expanding waistline correlates to our health care cost demands. Obesity is responsible for 27 percent of the growth in health care spending. Treating obese patients costs 37 percent more than treating normal-weight patients.

 

The rise in overweight and obesity is affecting the bottom line of Texas employers. The Texas Comptroller’s Office found that in 2009, obesity cost Texas businesses an estimated $9.5 billion, due to higher employee insurance costs, absenteeism, and other effects. Left unchecked, obesity could cost employers $32.5 billion annually by 2030.

 

Improved physical health in students has been linked to academic success. Conversely, children with obesity are more prone to absences and lower grades. In the United States, students who are physically active at least 60 minutes on most days, play on at least one sports team, or watch fewer than three hours of television per day consistently have “mostly A’s.”

 

A great proportion of obese adults were overweight or obese as children. This serious risk factor is found in Texas, where more than 30 percent of children in grades 4 through 11 are overweight or obese. A child who is overweight at age 12 has a 75-percent chance of being overweight as an adult.

 

There is no single solution to preventing or addressing obesity. Multiple evidence-based approaches must be pursued for physicians, communities, schools, and workplaces, and each must identify potential barriers to implementing local programs.

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This is why controlling health-care costs is almost impossible

This is why controlling health-care costs is almost impossible | Healthy Vision 2020 | Scoop.it
Americans aren't angry about health-care costs. They're angry about the small fraction of health-care costs they directly pay.
Texas Medical Association's insight:

"The health-care financing system is so fractured that it’s entirely possible for costs to fall overall even as they look like they’re rising to families. The cost control efforts in Obamacare — or in any serious replacement — will mean, among other things, higher deductibles, tighter networks and more aggressively managed care."

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Twitter / texmed: Vaccines Don't Cause Autism ...

Texas Medical Association's insight:

Not vaccinating your child against a disease like the measles is bad for your child and bad for those around you. Listen to some science, check out the video: http://youtu.be/aN0N5tTIFeI

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Regulation nation: Obama expands the regulatory state

Regulation nation: Obama expands the regulatory state | Healthy Vision 2020 | Scoop.it
The reach of the executive branch has advanced steadily under Obama, further solidifying the power of federal bureaucrats. President Obama has overseen a dramatic expansion of the regulatory state that will outlast his time in the White House.
Texas Medical Association's insight:

After “health,” the most frequently used word in the Patient Protection and Affordable Care Act (PPACA) is neither “patient” nor “physician” nor “hospital” nor “insurance.” “Secretary,” as in “the secretary of health and human services,” is mentioned more than 2,500 times in the 2,300-page bill. And more than 700 times, the PPACA says “the secretary shall.” Each of these directives is a sign of new regulations to come on physicians and health care. Unfortunately, the PPACA was not the genesis of physician regulation, nor are these busy rulemakers limited to the federal government. “An extensive regulatory framework … arose haphazardly, with little consideration of how the pieces fit together,” the Federal Trade Commission and U.S. Department of Justice reported in 2004. The huge numbers of state and federal regulations and their haphazard nature place tremendous burdens on physicians’ practices, most of which are still small businesses. These rules insert themselves between physicians and their patients, frequently do little to improve patient care, and divert physicians’ time and energy away from the patients in the exam room. We need to repeal, reorganize, and reprioritize if we want a functional health care delivery system.

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Prevention Means Business

Prevention Means Business | Healthy Vision 2020 | Scoop.it
Texas Medical Association's insight:

TMA Recommendations

 

•    Actively involve patients in the health care decisionmaking process.

•    Promote participation in smoking cessation programs, worksite wellness, and routine screenings.

•    Provide incentives via merit grants that recognize those state agencies that are promoting productive worksite wellness efforts.

•    Continue full funding for the Texas Women’s Health Program.

•    Streamline efforts to vaccinate people who work with high-risk populations.

•    Support statutory changes that allow parents of Texas schoolchildren access to data specific to the schools their children attend regarding the number of conscientious objector claims to vaccination.

•    Improve access to vaccinations, including improvements in the state’s Vaccines for Children Program and the adult safety net programs; this will ensure uninsured and low-income persons can get appropriate vaccinations.

•    Keep public health disease surveillance systems robust.

•    To address the growing obesity problem in Texas, increase funding for improving access to healthy foods; increase access to parks and recreational facilities; and promote worksite wellness policies.

•    Reduce or prevent childhood obesity by increasing physical activity and reducing barriers to student participation in safe school sport activities.

•    Promote physician participation in school health advisory committees and other public health prevention programs. Support legislation that requires inclusion of a primary care physician on all school health advisory committees.

•    Require Texans who smoke and communities that allow it in public venues to fund an increasing portion of health care costs related to smoking-related illnesses.

•    Adequately fund proven interventions to reduce tobacco use, such as Texas’ Quitline and education in schools.

•    Provide smoking cessation benefit coverage for state employees and retired teachers.

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Rural Physician Training Programs Can Inspire Future Rural Practice

After medical school students spent a summer practicing in a rural community, they were more likely to enter family practice residency training and begin their medical careers in a rural location, according to a recent study.
Texas Medical Association's insight:

Improve rural access to care

 

Physician shortages constitute a special problem in rural areas of the state. The continued urbanization of Texas exacerbates this longstanding problem. Approximately 12 percent of Texans live in rural counties, yet only 10 percent of primary care physicians practice there. In 2011, Texas had 52 primary care physicians per 100,000 population in rural areas versus 72 per 100,000 in urban areas. Physician shortages in rural areas not only hinder access to primary and other specialty care but also lead to potential losses in the local economy, difficulties attracting new businesses, and diminished quality of life for residents. A number of factors hurt physicians’ ability to open and sustain rural practices, including heavy concentration of Medicare, Medicaid, and uninsured patients; professional isolation; and high debt after medical school.

 

Physician practices in rural Texas contribute to the local economy in three critical ways.

 

• They employ administrative and clinical staff to help care for patients. On average, a solo primary care physician in a rural area will employ three staff: a registered nurse, a medical technician or licensed vocational nurse, and a receptionist/billing clerk.

• They contribute revenue to and generate additional employment at local hospitals through inpatient admissions and outpatient services.

• They generate essential tax revenues for their communities.

 

If rural physician practices and rural economies are to thrive, physicians need incentives to practice in those areas. Medical school programs with rural-focused curricula increase the supply of primary care doctors in underserved areas as do loan forgiveness programs like the National Health Service Corps and the State Physician Education Loan Repayment Program (SPELRP).

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Depression Costs U.S. Workplaces $23 Billion in Absenteeism

Depression Costs U.S. Workplaces $23 Billion in Absenteeism | Healthy Vision 2020 | Scoop.it
U.S. workers with depression miss an estimated 68 million additional days of work each year compared with those who have never been diagnosed, resulting in an estimated cost of more than $23 billion in lost productivity annually.
Texas Medical Association's insight:

Invest in mental health and substance abuse community treatment

 

Mental illness and substance abuse hurt the Texas economy through lost earning potential, treatment of coexisting conditions, disability payments, homelessness, and incarceration.

 

Mental illness is a leading cause of disability in the United States. About 13 million adults have a debilitating mental illness each year, and almost half of all adults will be affected by mental illness in their lifetime. Five percent of adults have a serious mental illness.About one in five children are affected by a mental health disorder with severe impairment in their lifetime.

 

More than 8 percent of Texas adults report current depression, and 5.2 percent report serious psychological distress. In 2011, almost 30 percent of Texas high school students reported they felt sad or hopeless almost every day for at least two weeks. Suicide is a leading cause of death among Texans under 35 years.

 

More than 66,000 Texans were cared for in state-funded substance abuse treatment programs in 2010. Substance use is common in Texas students (grades 7-12), with 62 percent reporting they had used alcohol and 17.2 reporting inhalant abuse. Despite significant legislation to curtail drinking and driving, almost 40 percent of Texas driving fatalities are still associated with alcohol use.

 

In 2009, 23 percent of the adult offenders in Texas state prisons, on parole, or on probation were current or former clients of the Texas public mental health system. A Texan with a serious mental illness is eight times more likely to be in a jail than in a hospital or treatment program, at a cost of $50,000 a year. A person in jail without a mental illness costs the state about $22,000 annually.

 

Mental illness is also strongly associated with high-risk behaviors such as alcohol, tobacco, and illicit drug use, and results in conditions such as obesity. U.S. mental health costs were estimated to be $57.5 billion in 2006 including the cost of mental health care and the indirect costs of disability caused by mental illness. One recent study estimates that Texas state dollars spent on mental health exceed $13 billion each year.

 

Mental health treatment costs in the United States totaled almost $9 billion in children in 2006; Medicaid covered more than one-third of these costs.

 

Proper care for persons with mental illnesses saves costs associated with the cycle of incarceration, homelessness, and so forth. Assessing the return on investment connected with mental health and substance abuse care is complex because there are many different diagnoses, and the disability caused by each and the treatment plans vary greatly. In 2003, depression cost U.S. employers $44 billion in lost productivity alone. One employee assistance program in California showed a return on investment of $5.17 to $6.47 for every dollar spent on employee assistance for a mental health problem.

 

While Texas has recently made significant investments in community mental health services, we still rank 50th in state public mental health funding per capita.

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Texas lawmakers increase funding for mental health

Texas lawmakers increase funding for mental health | Healthy Vision 2020 | Scoop.it
Lawmakers agreed to put $1.77 billion into mental health care, an increase of $259 million over the previous biennial budget.
Texas Medical Association's insight:

TMA's position: Invest in mental health and substance abuse community treatment

 

Mental illness and substance abuse hurt the Texas economy through lost earning potential, treatment of coexisting conditions, disability payments, homelessness, and incarceration.

 

Mental illness is a leading cause of disability in the United States. About 13 million adults have a debilitating mental illness each year, and almost half of all adults will be affected by mental illness in their lifetime. Five percent of adults have a serious mental illness.About one in five children are affected by a mental health disorder with severe impairment in their lifetime.

 

More than 8 percent of Texas adults report current depression, and 5.2 percent report serious psychological distress. In 2011, almost 30 percent of Texas high school students reported they felt sad or hopeless almost every day for at least two weeks. Suicide is a leading cause of death among Texans under 35 years.

 

More than 66,000 Texans were cared for in state-funded substance abuse treatment programs in 2010. Substance use is common in Texas students (grades 7-12), with 62 percent reporting they had used alcohol and 17.2 reporting inhalant abuse. Despite significant legislation to curtail drinking and driving, almost 40 percent of Texas driving fatalities are still associated with alcohol use.

 

In 2009, 23 percent of the adult offenders in Texas state prisons, on parole, or on probation were current or former clients of the Texas public mental health system. A Texan with a serious mental illness is eight times more likely to be in a jail than in a hospital or treatment program, at a cost of $50,000 a year. A person in jail without a mental illness costs the state about $22,000 annually.

 

Mental illness is also strongly associated with high-risk behaviors such as alcohol, tobacco, and illicit drug use, and results in conditions such as obesity. U.S. mental health costs were estimated to be $57.5 billion in 2006 including the cost of mental health care and the indirect costs of disability caused by mental illness. One recent study estimates that Texas state dollars spent on mental health exceed $13 billion each year.

 

Mental health treatment costs in the United States totaled almost $9 billion in children in 2006; Medicaid covered more than one-third of these costs.

 

Proper care for persons with mental illnesses saves costs associated with the cycle of incarceration, homelessness, and so forth. Assessing the return on investment connected with mental health and substance abuse care is complex because there are many different diagnoses, and the disability caused by each and the treatment plans vary greatly. In 2003, depression cost U.S. employers $44 billion in lost productivity alone. One employee assistance program in California showed a return on investment of $5.17 to $6.47 for every dollar spent on employee assistance for a mental health problem.

 

While Texas has recently made significant investments in community mental health services, we still rank 50th in state public mental health funding per capita.

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4 complaints of physician employees and 1 solution to fix them

4 complaints of physician employees and 1 solution to fix them | Healthy Vision 2020 | Scoop.it
Leaders have influence and power, Employees do not. So how can physicians get these features of autonomy back as employees?
Texas Medical Association's insight:

Maintain restrictions on lay control of the practice of medicine

 

In a changing and uncertain environment, many physicians will seek employment opportunities as a way to deal with unpredictable and oftentimes inadequate payment models and the increasing — and sometimes overwhelming — administrative burden of running their own practices. At the same time, hospitals and other nonphysician-owned entities will continue to seek to employ physicians.

 

Quality measures must take into account how sick patients are and what associated diseases they have. Incentives focused primarily on cost per member will reward physicians and providers for treating only the healthiest patients. The poorest and sickest likely will drag down the “efficiency” ratings so that their physicians and providers become ranked as “lower performing.”

 

Protecting the patient-physician relationship lies at the heart of Texas’ legal doctrine banning the corporate practice of medicine. Patients must be able to trust that the tests and treatments their physicians recommend are tailored to their individual medical needs and are shielded from improper lay influence. Each patient encounter must be governed by the ethics of the medical profession, the integration and application of advancing medical knowledge, and the partnership with the patient in making good decisions for that patient’s health.

 

Employment without protections is the corporate practice of medicine. Employment with protections is part of the practice of medicine, and that’s what we stand for.

 

At TMA’s urging, the 2011 Texas Legislature passed ground-breaking new laws that protect patients and their physicians’ ability to exercise independent medical judgment free from interference by a hospital administrator or corporate officer. At the same time, we preserved Texas’ ban on the corporate practice of medicine with several carefully delineated expansions for physician employment. These included strong protections for physicians employed by or associated with hospital-controlled health care corporations, rural county hospital districts, large urban hospital districts, and the newly established Texas health care collaboratives. Texas is the first state in the country to take the critical step of protecting clinical autonomy. The laws place responsibility for monitoring and enforcement with the Texas Medical Board, which is the agency responsible for upholding the standards of medical practice in the state.

 

Over the course of the coming decade, patients and physicians will see many changes in the organization and delivery of medical services. New payment models likely will drive new practice arrangements. Many physicians will continue to practice independently, some will partner in small to large groups, and others will join larger single or multispecialty groups. Payment models for physicians’ services will continue to be a mix of fee-for-service, global or capitated payments, and salary arrangements for physicians who choose employment.

 

Regardless of the applicable practice arrangement, TMA and its member physicians remain committed to protecting the clinical autonomy of physicians and the primacy of the patient-physician relationship.

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Should the American Medical Association Have Classified Obesity as a Disease?

Should the American Medical Association Have Classified Obesity as a Disease? | Healthy Vision 2020 | Scoop.it

U.S. News and World Report "Debate Club"

Texas Medical Association's insight:

Invest in Prevention

 

Three old American sayings capture the interconnections among personal responsibility, preventive medicine, and health care costs. Consider “You are what you eat,” and “An ounce of prevention is worth a pound of cure,” and “A penny saved is a penny earned.” If we as individuals take better care of ourselves, if we as a society take better care of ourselves, we’ll be not only healthier but also wealthier in the long run. Every Texan needs to have more skin in the health care game … especially those who have too much skin and fat already. We can no longer blow smoke at proven ways to stop people from smoking and exposing others to their secondhand smoke. We need a shot in the arm to stop the spread of deadly, contagious diseases. A healthy and wealthy Texas depends on a sound health care system with robust medical care and effective public health components. There is a legitimate role for limited government to play in safeguarding a sound, responsive public health infrastructure in Texas.

 

All in all, a stitch in time does indeed save nine.

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How to curb obesity: Tax calories, study says

Research suggests that raising some food prices could lower the flab.
Texas Medical Association's insight:

Invest in obesity control

 

Overweight and obesity contribute to diabetes, hypertension, heart disease, cancer, and stroke. Texas has an easy-to-see obesity crisis. Some 66 percent of Texas adults are overweight or obese; the United States average is 63 percent. During the past three decades, obesity rates in children have more than tripled in the country. Today, 32 percent of Texas children (ages 10-17) are obese.

 

The obesity epidemic, and the ever-younger age groups that it strikes, threatens Texas’ physical and fiscal health. Texas’ continually expanding waistline correlates to our health care cost demands. Obesity is responsible for 27 percent of the growth in health care spending. Treating obese patients costs 37 percent more than treating normal-weight patients.

 

The rise in overweight and obesity is affecting the bottom line of Texas employers. The Texas Comptroller’s Office found that in 2009, obesity cost Texas businesses an estimated $9.5 billion, due to higher employee insurance costs, absenteeism, and other effects. Left unchecked, obesity could cost employers $32.5 billion annually by 2030.

 

Improved physical health in students has been linked to academic success. Conversely, children with obesity are more prone to absences and lower grades. In the United States, students who are physically active at least 60 minutes on most days, play on at least one sports team, or watch fewer than three hours of television per day consistently have “mostly A’s.”

 

A great proportion of obese adults were overweight or obese as children. This serious risk factor is found in Texas, where more than 30 percent of children in grades 4 through 11 are overweight or obese. A child who is overweight at age 12 has a 75-percent chance of being overweight as an adult.

 

There is no single solution to preventing or addressing obesity. Multiple evidence-based approaches must be pursued for physicians, communities, schools, and workplaces, and each must identify potential barriers to implementing local programs.

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Healthcare Is Broken. And This Designer Thinks She Can Fix It

Healthcare Is Broken. And This Designer Thinks She Can Fix It | Healthy Vision 2020 | Scoop.it
Healthcare is notorious for being technophobic, clunky and downright ugly. No one knows this better than Gretchen Wustrack, who is trying desperately to change that.
Texas Medical Association's insight:

Interesting read

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