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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Health reformers fail to hold patients accountable for health costs

Health reformers fail to hold patients accountable for health costs | Healthy Vision 2020 | Scoop.it
Patients also play a role in cost control. It’s time that health reformers acknowledge that.
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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About to topple? 20,000 pages of PPACA regulations so far

About to topple? 20,000 pages of PPACA regulations so far | Healthy Vision 2020 | Scoop.it
Texas Medical Association's insight:

This now-iconic photo of U.S. Senate Minority Leader Mitch McConnell posing with this teetering stack of federal regulations issued because of the Patient Protection and Affordable Care Act reminds us of the extreme risk of over-over-over regulation.

 

TMA says: Repeal Harmful and Onerous State and Federal Regulations

 

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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Me and My Doctor: IPAB: Unaccountable And a Risk to Medicare

Me and My Doctor: IPAB: Unaccountable And a Risk to Medicare | Healthy Vision 2020 | Scoop.it
The IPAB is a 15-member board of nonelected officials created to recommend Medicare spending reductions in order to reduce the per capita rate of growth in Medicare in years when spending exceeds a targeted growth rate. These unelected individuals will have the authority to make significant changes to Medicare and thereby influence important health care decisions. The Alliance of Specialty Medicine believes that these decisions must not be made by individuals with little or no clinical expertise, resources or the oversight required to protect seniors’ access to care. Rather, Congress should be the entity to legislate Medicare policy, not the IPAB.
Texas Medical Association's insight:
TMA says repeal the IPAB
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EHR a Money-Loser for Most Physicians

Federal meaningful use incentives alone are not adequate to ensure that the vast majority of medical practices don’t lose money on electronic h
Texas Medical Association's insight:

As physicians decide or are required to move from a paper to an electronic health record, Texas must carefully consider the impact of any new regulatory burdens placed on the physician practice, especially when many of these burdens do nothing to improve care quality.

 

Many times, government agencies and payers put demands on physicians that disrupt workflow. These demands come on top of the already extensive disruptions and intrusions physicians experience.

 

For instance, to achieve the goals of “meaningful use,” the federal government requires that physicians have a system that tracks patients’ height, weight, and blood pressure as part of “structured data.” This is required even if the physician practices a specialty where height and weight play little or no role in the medical care they provide to patients. Do patients really want to be weighed at the ophthalmologist when updating their eyeglass prescription? According to the federal government, if a physician “believes that one or two of these vital signs are relevant to their scope of practice, then they must record all three vital signs in order to meet the measure of this objective and successfully demonstrate meaningful use.” Texas should not repeat the mistakes of the federal government.

 

Texas must recognize that not every medical practice will benefit from an EHR. In fact, it could be disruptive to some and could hurt patient care. Requiring a physician to rely on a system that is counter-intuitive to his or her clinical training could result in adverse outcomes for the patient. Even expert users find that EHRs require more physician time than paper records and can interrupt the patient-physician interaction in the exam room. A sizeable portion of patients are concerned about the security of their electronic medical records. A July 2012 survey found "roughly half of Americans still say that they are concerned that their digitized health data could be lost, damaged, or corrupted."

 

In some cases, EHRs are cost-prohibitive regardless of federal incentives. Not all physicians are eligible for the Medicare or Medicaid EHR incentives. The average EHR purchase cost is about $40,000 per physician, not including productivity dips that hurt practice revenues. Some medical practices operate on such thin profit margins that the capital investment of an EHR could lead to bankruptcy.

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Executive Summary: 2013 Medical Education Consensus Statement

Executive Summary: 2013 Medical Education Consensus Statement | Healthy Vision 2020 | Scoop.it
The future health of Texans is dependent on our ability to educate and train more physicians NOW.
Texas Medical Association's insight:

Medical Education Is a Public Good and a Tremendous Economic Asset to the State  

Academic health centers generate an additional $1.30 in economic activity for every dollar spent. [18]  Texas ranks fifth among states in the total economic impact of academic health centers. These centers serve as major employers in their communities and impact 210,000 jobs. Many of these are filled by highly educated and skilled workers at higher salary levels.Academic health centers have a major financial impact in every region they are located: Houston, Dallas, Bryan/College Station, Temple, Lubbock, El Paso, Fort Worth, and Tyler.

Texas medical school graduates are projected to peak at more than 1,700 around 2015. This will mean an even greater demand for residency training positions to enable graduates to remain in the state. To achieve the 1.1-ratio goal after enrollments reach the peak, Texas would need to add an additional 400 GME positions. This growth will be even more difficult to achieve with the state legislature’s recent 41-percent reduction in overall state support for residency training.

 

Considering the significant challenges the state faces in meeting its health care workforce needs, state leaders must mandate a comprehensive health professions workforce analysis that includes all appropriate stakeholders and visualizes the needs of Texas for the near and long term.


- See more at: http://www.texmed.org/Template.aspx?id=24400#sthash.QGXmsbUJ.dpuf

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Ligon: Working toward a stronger mental health system

As the nation mourns for the lives lost and traumatized by the tragedies in Newtown, Conn., Aurora, Colo.
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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Group releases list of 90 medical ‘don’ts’

Group releases list of 90 medical ‘don’ts’ | Healthy Vision 2020 | Scoop.it
Report aims to prevent unnecessary or harmful tests and procedures.
Texas Medical Association's insight:

Support physician-led efforts to document quality and efficiency

 

The physician-led teams will be the linchpin of our future health care delivery system. Directly and indirectly, physicians will impact both health care quality and costs. Measuring their performance to identify weaknesses that warrant change creates tremendous opportunity to improve health care quality and efficiency.

 

Physician performance measurement and improvement may prove a lost opportunity for strengthening the health care system if we do not appropriately address methodological and other shortcomings of existing efforts. Too many government programs and commercial insurance companies, for example, rely on data from claims submitted for payment rather than on a close examination of the care delivered to the patient. All quality improvement programs should adopt a national set of standard, meaningful, evidence-based measures that improve both patient outcomes and patient satisfaction.

 

The primary goal of any quality program must be to promote safe and effective care across the health care delivery system. Getting the right care to the patient at the right time will reduce overall costs in the long run.

 

Fair and ethical quality programs are patient-centered and link evidence-based performance and improvement measures to financial incentives.

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Christensen, Flier and Vijayaraghavan: The Coming Failure of 'Accountable Care'

Christensen, Flier and Vijayaraghavan: The Coming Failure of 'Accountable Care' | Healthy Vision 2020 | Scoop.it
In The Wall Street Journal, Clayton Christensen, Jeffrey Flier and Vineeta Vijayaraghavan say that the Affordable Care Act's updated versions of HMOs are based on flawed assumptions about doctor and patient behavior.
Texas Medical Association's insight:

Defend physicians’ ethical responsibilities to patients

 

It will be more and more challenging for physicians to maintain professional ethics when ethics collide with economic interests.

 

Our evolving health care system structure is constantly emphasizing lowering costs. So-called “quality-based measures” may give physicians perverse incentives to dismiss patients who do not meet target measures, and they may be asked to ration health care resources in ways that place employers’ or Wall Street’s needs above those of the individual patient’s.

 

Furthermore, hospitals and other entities will continue to look toward employing physicians so they can consolidate market share and capture the payment stream for physician services. Physicians who accept employment opportunities with hospitals and other practice models not owned and controlled by physicians could find their clinical autonomy threatened.

 

The ability of physicians to act in their patients’ best interests must not be compromised by outside — and sometimes competing — economic, political, or social pressures. Yet lawmakers and other nonphysicians are ever more inclined to delineate the details of the interaction between physicians and patients. Physicians increasingly face nonphysicians’ attempts to mandate what information, tests, procedures, and treatments they must — or must not — provide to their patients.

 

The practice of medicine is founded upon ethics that arise from the imperative to alleviate suffering and to care for patients. According to the AMA Code of Medical Ethics, “The relationship between patient and physician is based on trust and gives rise to physicians’ ethical obligations to place patients’ welfare above their own self-interest and above obligations to other groups, and to advocate for their patients’ welfare.”

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MedPAC chief warns of Medicare payment crisis - The Hill's Healthwatch

MedPAC chief warns of Medicare payment crisis - The Hill's Healthwatch | Healthy Vision 2020 | Scoop.it
Medicare could find itself in crisis unless lawmakers overhaul the program's physician payment formula, a congressional adviser warned Thursday.
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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Doctors Push Back Against Health IT's Workflow Demands -- InformationWeek

Doctors Push Back Against Health IT's Workflow Demands -- InformationWeek | Healthy Vision 2020 | Scoop.it
Doctors are angry that accountable care organization workflows seem more like manufacturing, less like healthcare, say panelists at eHealth Initiative conference.
Texas Medical Association's insight:

As physicians decide or are required to move from a paper to an electronic health record, Texas must carefully consider the impact of any new regulatory burdens placed on the physician practice, especially when many of these burdens do nothing to improve care quality.

 

Many times, government agencies and payers put demands on physicians that disrupt workflow. These demands come on top of the already extensive disruptions and intrusions physicians experience.

 

For instance, to achieve the goals of “meaningful use,” the federal government requires that physicians have a system that tracks patients’ height, weight, and blood pressure as part of “structured data.” This is required even if the physician practices a specialty where height and weight play little or no role in the medical care they provide to patients. Do patients really want to be weighed at the ophthalmologist when updating their eyeglass prescription? According to the federal government, if a physician “believes that one or two of these vital signs are relevant to their scope of practice, then they must record all three vital signs in order to meet the measure of this objective and successfully demonstrate meaningful use.” Texas should not repeat the mistakes of the federal government.

 

Texas must recognize that not every medical practice will benefit from an EHR. In fact, it could be disruptive to some and could hurt patient care. Requiring a physician to rely on a system that is counter-intuitive to his or her clinical training could result in adverse outcomes for the patient. Even expert users find that EHRs require more physician time than paper records and can interrupt the patient-physician interaction in the exam room. A sizeable portion of patients are concerned about the security of their electronic medical records. A July 2012 survey found "roughly half of Americans still say that they are concerned that their digitized health data could be lost, damaged, or corrupted."

 

In some cases, EHRs are cost-prohibitive regardless of federal incentives. Not all physicians are eligible for the Medicare or Medicaid EHR incentives. The average EHR purchase cost is about $40,000 per physician,31 not including productivity dips that hurt practice revenues. Some medical practices operate on such thin profit margins that the capital investment of an EHR could lead to bankruptcy.

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Texas mental health care funding has stagnated, even as calls to boost efforts grow

Texas mental health care funding has stagnated, even as calls to boost efforts grow | Healthy Vision 2020 | Scoop.it
As the gun-control debate includes calls for expanded services, critics complain Texas hasn’t accounted for its growing population.
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.37 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.43 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.47

 

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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Health Care Spending In America, In Two Graphs : NPR

Health Care Spending In America, In Two Graphs : NPR | Healthy Vision 2020 | Scoop.it
Where do our health care dollars go? Where does the money come from? And how has the picture changed over time?
Texas Medical Association's insight:

For decades, physicians have given away their services for free to patients who could not afford to pay. However, today’s health care market makes this very difficult. Medicare and Medicaid, which now cover 35 percent of health care in America, often pay physicians less than it costs them to provide their services. Commercial insurance companies’ payment rates, computed largely as a percentage of Medicare, have followed the government-run programs into the basement. The nation’s 50 million uninsured, including 6.2 million Texans, can rarely pay the costs of their health care. The squeeze leaves many physicians struggling to keep their practices open, let alone provide charity care. State and federal leaders must realize that cutting physicians’ payments is not an effective tool for controlling health care costs, and often exacerbates the cost of care. They also must realize that without physicians, no health care delivery system can be effective.

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Specialty groups back IPAB repeal - The Hill's Healthwatch

Specialty groups back IPAB repeal - The Hill's Healthwatch | Healthy Vision 2020 | Scoop.it
A coalition of medical specialties said Tuesday that it supports a bill to repeal the controversial cost-control board in President Obama's signature healthcare law.
Texas Medical Association's insight:

Repeal the Independent Payment Advisory Board

 

Replacing the SGR will be meaningless unless Congress also repeals the Independent Payment Advisory Board (IPAB). Leaving both in place would create cruel and unusual double jeopardy for physicians who want to care for senior citizens and military families. The PPACA created a 15-member IPAB to recommend measures to reduce Medicare spending if costs exceed targeted growth rates set by the Centers for Medicare & Medicaid Services (CMS).

 

The PPACA prohibits the panel from recommending changes to eligibility, coverage, or other factors that drive utilization of health care services. This means the board will have only one option — cut payments. And through 2019, hospitals, Medicare Advantage plans, Medicare prescription drug plans, and health care professionals other than physicians are exempt.102 This means the board will have only one option — cut Medicare payments to physicians. Cuts the board recommends will automatically take effect, unless Congress acts to suspend them.

 

As we’ve seen with the SGR, it’s obvious that cuts the IPAB enacts will devastate Medicare beneficiaries’ ability to find physicians to care for them. The issue of Medicare spending for 3.8 million Texans is too important to be left in the hands of an unaccountable board that makes decisions based solely on cost.

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About to topple? 20,000 pages of PPACA regulations so far

About to topple? 20,000 pages of PPACA regulations so far | Healthy Vision 2020 | Scoop.it
Texas Medical Association's insight:

This now-iconic photo of U.S. Senate Minority Leader Mitch McConnell posing with this teetering stack of federal regulations issued because of the Patient Protection and Affordable Care Act reminds us of the extreme risk of over-over-over regulation.

 

TMA says: Repeal Harmful and Onerous State and Federal Regulations

 

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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Senate pushes for additional mental health funding

Senate pushes for additional mental health funding | Healthy Vision 2020 | Scoop.it
Senate budget writers are pushing to boost spending for mental health programs by more than $200 million, restoring care for thousands of Texans who saw service cutbacks during the past decade and easing the strain on prisons and jails that deal...
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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Religious leaders urge funding for family planning, birth control

Dozens of clergy members took to the Capitol on Monday to ask the Legislature to restore family planning funding and to counter assertions that all religious leaders support those cuts.
Texas Medical Association's insight:

Invest in preventive care for low-income women

 

Lost in the highly charged political debate is the fact that “women’s health” includes far more than abortions. Now that the federal government has withdrawn its support, the state must continue to find a way to ensure that women continue to have access to preventive services and to finance a robust Texas Women’s Health Program..

 

The Women’s Health Program, which does not provide abortions, delivers cost-effective basic health care screenings — such as for cancer, high blood pressure, and diabetes — as well as birth control. This is the only source of such preventive care for many low-income women in Texas.

 

More than 70 percent of pregnancies among single young women in Texas are unplanned.Increasing the number of women who enroll in the Women’s Health Program after a Medicaid delivery is especially important. Women who have had a Medicaid-funded delivery are at particularly high risk for subsequent pregnancy, often so soon that risks of prematurity and low birth weight are elevated. Babies born too soon or too small often have significant health problems, such as respiratory or developmental delays, contributing to higher medical costs at birth and as the child ages. In 2007, unplanned Medicaid births cost the state more than $1.2 billion.

 

If we want healthy children and adults – healthy Texans – who are not going to continue to be a burden on the social welfare system, then we should champion ways to make individuals responsible for their contraception and personal health. Texas must educate young people about contraception. Studies show educating teenagers about contraception actually delays sexual intercourse and decreases unintended pregnancies. By rebuilding Women’s Health Program, Texas can give young couples the tools to take responsibility for their future and protect their own health and their children’s.

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Medicare Patients May Lose Their Doctors Under Sequestration - Forbes

Medicare Patients May Lose Their Doctors Under Sequestration - Forbes | Healthy Vision 2020 | Scoop.it
I'm showing you a pizza because it looks delicious. (Image credit: Getty Images via @daylife) The latest budgetary shenanigans in Washington threaten Medicare.
Texas Medical Association's insight:

Provide Appropriate State and Federal Funding for Physician Services

 

For decades, physicians have given away their services for free to patients who could not afford to pay. However, today’s health care market makes this very difficult. Medicare and Medicaid, which now cover 35 percent of health care in America,often pay physicians less than it costs them to provide their services. Commercial insurance companies’ payment rates, computed largely as a percentage of Medicare, have followed the government-run programs into the basement. The nation’s 50 million uninsured, including 6.2 million Texans, can rarely pay the costs of their health care. The squeeze leaves many physicians struggling to keep their practices open, let alone provide charity care. State and federal leaders must realize that cutting physicians’ payments is not an effective tool for controlling health care costs, and often exacerbates the cost of care. They also must realize that without physicians, no health care delivery system can be effective.

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Health Care Panel, Lacking Budget, Is Left Waiting

Health Care Panel, Lacking Budget, Is Left Waiting | Healthy Vision 2020 | Scoop.it
A commission created to investigate the shortage of health care professionals has never met in two and a half years because it has no money from Congress or the administration.
Texas Medical Association's insight:

Ensure an Adequate Health Care Workforce

 

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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Motivating patients to make wise choices - amednews.com

Motivating patients to make wise choices - amednews.com | Healthy Vision 2020 | Scoop.it
Patients are often the biggest obstacle to their own health. Physicians are exploring new communication techniques to help patients make lasting changes.
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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Medicare pay cut set under federal budget sequester

Medicare pay cut set under federal budget sequester | Healthy Vision 2020 | Scoop.it

"Physicians will see a 2 percent reduction in Medicare payments beginning April 1 unless Congress can agree upon a plan to prevent the across-the-board federal budget cuts before the sequester goes into effect March 1.

 

The 2 percent Medicare cut is part of broader cuts required under the Budget Control Act of 2011, which will slash domestic and defense spending to eliminate a total of $1.2 trillion from the federal budget over the next decade. The sequestration cuts originally were scheduled to hit Jan. 1 but were delayed two months when the American Taxpayer Relief Act became law Jan. 3."

 

Texas Medical Association's insight:

Recognize and cover physicians’ cost of providing care

 

Physicians’ practice costs — like any other business’ operating costs — continue to march upward. While the rate of increase, thankfully, has slowed in the past several years, physicians face growing demands to cover the salaries and benefits of their professional and office staff, purchase new clinical and practice management equipment, buy liability insurance, and pay the rent and utilities.

 

The Medical Group Management Association’s (MGMA’s) data show that, for 2010, most physician groups were operating on razor-thin margins. MGMA each year compares physicians’ office costs and revenue in dollars per unit of service. (To simplify the accounting for the thousands of different types of services physicians provide, one unit of work is measured in relative value units or RVUs. This is a Medicare measure of the units of service produced. One unit of work is approximately the value of the simplest office visit for a new patient. Physician compensation is 30 percent of the total cost.) In 2010, physician-owned multispecialty groups brought in an average of $59 per unit of work while spending $60 to keep their clinics open, for an operating loss of $1 per unit of work. Family practice groups brought in less ($46 per unit of work) but only spent $45, for an operating profit of $1 per unit of work.

 

To stay open, any business must collect enough revenues to cover costs. Especially for patients covered by government insurance programs, this isn’t happening for physicians. MGMA data show that Medicare pays only 61 percent of physicians’ average costs. Medicaid payment per unit of work varies, but for most services, Medicaid payments cover less than half of the average cost to provide services. Faced with losses on every service delivered, physician practices are often forced to limit services to Medicare and Medicaid patients if they cannot make up the losses elsewhere. Physicians in a number of Texas communities say they have no other options but to move or retire.

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A Guide to Understanding Mental Health Systems and Services in Texas

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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GOP senators introduce bill to repeal Medicare cost-cutting panel - The Hill's Healthwatch

GOP senators introduce bill to repeal Medicare cost-cutting panel - The Hill's Healthwatch | Healthy Vision 2020 | Scoop.it
Senate Republicans reintroduced a bill Thursday to repeal the controversial cost-cutting board in President Obama's healthcare law.
Texas Medical Association's insight:

Repeal the Independent Payment Advisory Board

 

Replacing the SGR will be meaningless unless Congress also repeals the Independent Payment Advisory Board (IPAB). Leaving both in place would create cruel and unusual double jeopardy for physicians who want to care for senior citizens and military families. The PPACA created a 15-member IPAB to recommend measures to reduce Medicare spending if costs exceed targeted growth rates set by the Centers for Medicare & Medicaid Services (CMS).

 

The PPACA prohibits the panel from recommending changes to eligibility, coverage, or other factors that drive utilization of health care services. This means the board will have only one option — cut payments. And through 2019, hospitals, Medicare Advantage plans, Medicare prescription drug plans, and health care professionals other than physicians are exempt.This means the board will have only one option — cut Medicare payments to physicians. Cuts the board recommends will automatically take effect, unless Congress acts to suspend them.

 

As we’ve seen with the SGR, it’s obvious that cuts the IPAB enacts will devastate Medicare beneficiaries’ ability to find physicians to care for them. The issue of Medicare spending for 3.8 million Texans is too important to be left in the hands of an unaccountable board that makes decisions based solely on cost.

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House Republican aims to repeal Medicare doctor pay cuts

House Republican aims to repeal Medicare doctor pay cuts | Healthy Vision 2020 | Scoop.it
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To Love Medicine Again, Physicians Need to Delegate

To Love Medicine Again, Physicians Need to Delegate | Healthy Vision 2020 | Scoop.it
How one physician developed a system to deliver better quality care to more patients
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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Battles Erupt Over Filling Doctors' Shoes

Battles Erupt Over Filling Doctors' Shoes | Healthy Vision 2020 | Scoop.it
As physician assistants and other midlevel health professionals fill growing gaps in primary health care, turf battles are erupting in many states over what they can and can't do in medical practices.
Texas Medical Association's insight:

What’s your vision of scope-of-practice expansion? Better team-based care under the supervision of a physician? Or potentially unsafe independent practice for allied health practitioners? TMA supports the former and vehemently opposes the later.

 

Texas law clearly defines the practice of medicine and the educational qualifications necessary to diagnose, independently prescribe, and direct patient care — and to be held accountable for that care. Now, and in the future, physicians and other professionals will practice in teams to provide comprehensive patient care, and these patient-focused teams must be physician-led to ensure quality, continuity, and efficiency in care.

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