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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As Clock Ticks, Chance for Medicaid Expansion Dwindles

As Clock Ticks, Chance for Medicaid Expansion Dwindles | Healthy Vision 2020 | Scoop.it
With the lower chamber’s window to approve House bills closing, the likelihood of Texas expanding Medicaid coverage — even through a private market alternative — is looking slim.
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As health-care costs slow, IPAB’s launch is delayed

As health-care costs slow, IPAB’s launch is delayed | Healthy Vision 2020 | Scoop.it
IPAB doomsayers can rest assured: The cost-cutting board has been effectively neutered for 2015, the first year in which it's spending recommendations could go into effect.
Texas Medical Association's insight:

Repeal the Independent Payment Advisory Board

 

Replacing the Sustainable Growth Rate formula 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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The problem of basing physician pay on quality indicators

The problem of basing physician pay on quality indicators | Healthy Vision 2020 | Scoop.it
The fact that bonuses will be tied to group, not individual, performance dooms the plan to failure.
Texas Medical Association's insight:

Replace harmful restrictions with realistic incentives

 

TMA believes that the patient-physician relationship must be preserved regardless of patients’ health conditions, ethnicity, economic circumstances, demographics, or treatment compliance patterns. Unfortunately, many pay-for-performance strategies intended to contain health costs could undermine this relationship. These strategies have proliferated in both commercial and government health programs. The PPACA also relies on payment based solely on outcomes and mandates pay adjustments for all physicians, which may selectively penalize physicians who treat disadvantaged patients.

 

Pay-for-performance systems that do not risk-adjust properly for patients’ health status and that rely solely on claims data for evaluation of care will likely hurt the patient-physician relationship. This is particularly true if patient risk factors, chronic conditions, compliance, health disparities, and culturally competent care are not factored into the physician’s performance profile. For example, physicians’ ratings or payments are hurt if they are measured on how many of their patients obtain mammograms at appropriate times and the patient chooses not to follow the doctor’s advice to get the mammogram. Other examples of physicians’ quality rating measurements being directly impacted by patient choice include medication compliance, routine screening exams, weight management, and tobacco counseling.

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Rep. Ted Poe says ICD-10 requires nine billing codes for turkey injuries

Rep. Ted Poe says ICD-10 requires nine billing codes for turkey injuries | Healthy Vision 2020 | Scoop.it
Doctors’ offices, already burdened by federal billing bureaucracy, will soon find themselves pecked to death by new rules, Texas congressman Ted Poe says.
Texas Medical Association's insight:

Put ICD-10 on permanent hold

 

The ICD-10 requirement is an excellent example of a costly regulation that will disrupt practice operations. ICD-10 is a 20-year-old boondoggle of a system that will help only health care researchers. Before Secretary Sebelius delayed the new coding language for an additional year, the federal government announced that all physicians, hospitals, providers, and insurance companies must shift from ICD-9 to ICD-10 no later than Oct. 1, 2013. The punishment for noncompliance is severe: no payment for any medical services provided.

 

The number of diagnostic codes that physicians would be required to use under ICD-10 would grow from 13,500 to 69,000. The number of codes for inpatient procedures also would soar from 4,000 to 71,000. For example, the new system has 480 codes for a fractured knee cap — up from a grand total of two in ICD-9. Switching to ICD-10 will mandate extensive revision of physicians’ paper and electronic systems. Transition to the new system is expected to cost solo physicians as much as $83,000 each, and group practices of up to 10 doctors as much as $250,000.

 

The ICD-10 mandate will create significant burdens on the practice of medicine with no direct benefit to individual patient care. It is a huge weight to place on physicians when they face numerous other administrative hurdles, including implementing and achieving meaningful use of electronic health records (EHRs), meeting quality measures under Medicare’s PQRS and other programs, the impending creation of accountable care organizations in Medicare, and more. The timing of the transition could not be worse, as many physicians already are spending significant time and resources implementing EHRs in their practices.

 

ICD-10 is old technology developed during the 1980s and not designed to work in the current electronic world. A new version of the diagnostic and procedure codes, ICD-11, could come as early as 2015. It is being designed for use with electronic health records and the Internet, and should be more user-friendly than ICD-10.

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IPAB Has to Go, Providers and Advocates Urge

A coalition of healthcare provider groups, drug and device manufacturers, health insurers, and patient advocates have signed a letter to Congress urgi
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Texas Senate passes bill to address state's doctor shortage

Texas Senate passes bill to address state's doctor shortage | Healthy Vision 2020 | Scoop.it
The measure would add residency slots at hospitals in the state.
Texas Medical Association's insight:

Make sure enough physicians and other health care professionals are working in all parts of Texas

 

Imagine life without access to a physician, for yourself, your aging parent, or your child. Without access to a physician, life-enhancing and lifesaving medical care is virtually impossible. Physicians are the nucleus of the formula needed to achieve the vision of the Texas Medical Association: To improve the health of all Texans. Access to health care depends on the availability of physicians with the skills to match the needs of the state’s population.

 

Texas has a shortage of both primary care physicians and other specialists. Texas ranks behind all the other most-populous states in the number of patient care physicians per capita. To evaluate this shortage across specialties, we have devised a metric that compares the number of Texas physicians per 100,000 population with the U.S. average. We call this the “Texas Specialty Ratio.” The closer this ratio is to 100 percent for a given specialty, the closer Texas is to the national average.

 

•    Texas has fewer physicians per capita than the national average for 36 out of 40 medical specialty groups.

•    Texas needs both more primary care physicians and other specialists. A number of specialties have acute shortages.

•    Psychiatry and child/adolescent psychiatry are among the specialties with the lowest Texas Specialty Ratio.

 

We also must look to the Texas of tomorrow to evaluate the kinds of physicians we will need the most. Texas ranks fourth among the six most-populous states in medical students and resident physicians per capita. Texas continues to be overly dependent on other states and countries for supplying new physicians. Last year, nearly 75 percent of newly licensed physicians graduated from medical schools outside of Texas.We are thus subject to the vagaries of external forces that influence the numbers of physicians we can recruit. To meet future physician demands, Texas needs a stable, high-quality medical education system to produce homegrown physicians. Similarly, we must provide a reasonable opportunity for Texas medical school graduates to obtain their residency training in the state without being forced to leave home. Multiple studies confirm that physicians who complete both medical school and residency training in the state are three times more likely to practice here.

 

Because the human body is complex, the mastery of medical care is correspondingly complex, requiring a lengthy educational and training pipeline. Following college, physicians traditionally complete a four-year medical school education, followed by specialty training in residency programs for three to eight additional years, depending on the specialty.

 

The United States is in the midst of a medical education building campaign. Texas is among the leaders, with plans to increase enrollments to the nationally recommended 30-percent growth level by 2015. Texas is setting records in the number of medical school graduates, reaching 1,458 in 2011, a net gain of 80 (6 percent) from the preceding year.  The number of graduates is forecasted to peak at more than 1,700 this decade. 

 

Texas needs continued and stable state support

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Texas on the Brink 2013

Texas Medical Association's insight:

From the Texas Legislative Study Group, an interesting collection of facts and statistics about Texas, many of which support the Healthy Vision 2020 recommendations to improve health care in the Lone Star State

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Texas Medical Association's curator insight, April 15, 2013 6:33 PM

From the Texas Legislative Study Group, an interesting collection of facts and statistics about Texas, many of which support the Healthy Vision 2020 recommendations to improve health care in the Lone Star State

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Obesity causing health care costs to rise, study finds | Business | NewsObserver.com

Obesity causing health care costs to rise, study finds | Business | NewsObserver.com | Healthy Vision 2020 | Scoop.it
Whether you're obese or not, obesity increases Americans' health expenditures by $1,723 a year per person.
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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Potter: Legislators should seize opportunity to restore family...

Two years ago, the Texas House cut funding for the state’s family planning program by two-thirds, from $111 million to $37.
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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House GOP releases revised proposal for replacing SGR

House GOP releases revised proposal for replacing SGR | Healthy Vision 2020 | Scoop.it
House GOP leaders released a revised proposal to replace Medicare's SGR physician payment formula with a system that includes specialty-specific performance measures.
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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Who's To Blame For Our Rising Health Care Costs? - Forbes

Who's To Blame For Our Rising Health Care Costs? - Forbes | Healthy Vision 2020 | Scoop.it

Doctors are not necessarily the principal beneficiaries of healthcare spending.

By Louis Goodman & Timothy Norbeck
The Physicians Foundation 

Texas Medical Association's insight:

Promote Efficient and Effective New Models of Care  

 

(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

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End-of-life talks lacking between doctors, patients

End-of-life talks lacking between doctors, patients | Healthy Vision 2020 | Scoop.it
NEW YORK (Reuters Health) - Although many older patients in Canada have thought about end-of-life care and discussed it with family members, a new study suggests fewer have spoken with doctors and had...
Texas Medical Association's insight:

Respect patients in their final days

 

Thanks to the advancements of medicine and science, Texans are living longer. However, these blessings bring the challenges of care and treatment decisions in life’s final stages. Advance directives allow patients to make their end-of-life treatment decisions known in the event they become incapable of communication or incompetent. Without advance directives, some of life’s most difficult decisions are being thrust upon unprepared adult children, parents, or other loved ones.

 

At each step, human beings are involved in both deciding on and providing treatment. We must respect the value of life and the moral conscience of those involved.

 

Texas physicians abide by the Code of Medical Ethics, which includes “First, do no harm.” For this reason, TMA supports the Texas Advance Directives Act (TADA). Its aim is to allow patients to make their care preferences known before they need care, and to protect patients from discomfort, pain, and suffering due to excessive medical intervention in the dying process. The time may come when all that can be done for a patient is to alleviate pain and suffering, and preserve the patient’s dignity. For physicians, this is about medical ethics and providing medically appropriate care.

 

Then-Gov. George W. Bush signed TADA into law in 1997. It had unanimous support from physicians, nurses, hospitals, nursing homes, hospice care facilities, and pro-life organizations. The law provides a balanced approach to addressing one of life’s most difficult decisions.

 

TADA allows a patient to issue an out-of-hospital do-not-resuscitate (DNR) order, a medical power of attorney, or a directive for physicians and family members regarding the person’s wishes to administer or withhold life-sustaining treatment in the event the person is in a terminal or irreversible condition and unable to make his or her wishes known. Additionally, when an attending physician morally disagrees with a health care or treatment decision made by or on behalf of a patient, the act provides for a process whereby an ethics or medical committee reviews the physician’s refusal. The patient is given life-sustaining treatment during the process. If the ethics committee decides that discontinuing lifesaving treatment is in the best interest of the patient, and the family disagrees with that decision, the hospital must continue treatment for 10 days to allow the family some time to find a different facility for the dying patient.

 

Legislation has been introduced in the past two legislative sessions that would instead require indefinite treatment.

 

TMA has opposed the proposed legislation because it would prolong unnecessary — and often painful — care. It would require physicians, nurses, and other health care professionals to provide medically inappropriate care, even if that care violates medical ethics or the standard of care. It also sets a dangerous precedent for the legislature to mandate the provision of physician services and treatments that may be medically inappropriate, outside the standard of care, or unethical.

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Comfort care goes beyond DNR orders

Comfort care goes beyond DNR orders | Healthy Vision 2020 | Scoop.it
These are difficult decisions to make as a doctor and a son. It is very challenging to be objective when the questions are about your own father.
Texas Medical Association's insight:

Respect patients in their final days

 

Thanks to the advancements of medicine and science, Texans are living longer. However, these blessings bring the challenges of care and treatment decisions in life’s final stages. Advance directives allow patients to make their end-of-life treatment decisions known in the event they become incapable of communication or incompetent. Without advance directives, some of life’s most difficult decisions are being thrust upon unprepared adult children, parents, or other loved ones.

 

At each step, human beings are involved in both deciding on and providing treatment. We must respect the value of life and the moral conscience of those involved.

 

Texas physicians abide by the Code of Medical Ethics, which includes “First, do no harm.” For this reason, TMA supports the Texas Advance Directives Act (TADA). Its aim is to allow patients to make their care preferences known before they need care, and to protect patients from discomfort, pain, and suffering due to excessive medical intervention in the dying process. The time may come when all that can be done for a patient is to alleviate pain and suffering, and preserve the patient’s dignity. For physicians, this is about medical ethics and providing medically appropriate care.

 

Then-Gov. George W. Bush signed TADA into law in 1997. It had unanimous support from physicians, nurses, hospitals, nursing homes, hospice care facilities, and pro-life organizations. The law provides a balanced approach to addressing one of life’s most difficult decisions.

 

TADA allows a patient to issue an out-of-hospital do-not-resuscitate (DNR) order, a medical power of attorney, or a directive for physicians and family members regarding the person’s wishes to administer or withhold life-sustaining treatment in the event the person is in a terminal or irreversible condition and unable to make his or her wishes known. Additionally, when an attending physician morally disagrees with a health care or treatment decision made by or on behalf of a patient, the act provides for a process whereby an ethics or medical committee reviews the physician’s refusal. The patient is given life-sustaining treatment during the process. If the ethics committee decides that discontinuing lifesaving treatment is in the best interest of the patient, and the family disagrees with that decision, the hospital must continue treatment for 10 days to allow the family some time to find a different facility for the dying patient.

 

Legislation has been introduced in the past two legislative sessions that would instead require indefinite treatment.

 

TMA has opposed the proposed legislation because it would prolong unnecessary — and often painful — care. It would require physicians, nurses, and other health care professionals to provide medically inappropriate care, even if that care violates medical ethics or the standard of care. It also sets a dangerous precedent for the legislature to mandate the provision of physician services and treatments that may be medically inappropriate, outside the standard of care, or unethical.

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The wages of recruiting rural docs

The wages of recruiting rural docs | Healthy Vision 2020 | Scoop.it
Bisbee, Ariz., is a former mining town of about 6,700 people, some 12 miles north of the Mexican border and nearly two hours southeast of Tucson.
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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Texas must restore family planning cuts

Texas must restore family planning cuts | Healthy Vision 2020 | Scoop.it
The good news is that the Texas Legislature is poised to increase funding for preventive care, which will help restore access, rebuild the safety net, and reduce Medicaid costs.
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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Fixing the Doctor Shortage

Fixing the Doctor Shortage | Healthy Vision 2020 | Scoop.it
With a growing, aging population, the demand for physicians will intensify over the coming years. According to AAMC estimates, the United States faces a shortage of more than 90,000 physicians by 202
Texas Medical Association's insight:

TMA Recommendations on Health Care Workforce:

 

•    Preserve and protect state support for undergraduate medical education and the cultivation of the future generation of Texas physicians, thus ensuring stable access to health care for all Texans.

•    Support and develop new graduate medical education programs in the specialties that best reflect the state’s health care needs. Support incentives for hospitals and other community-based agencies to develop residency programs in the specialties most needed.

•    Direct the Texas Higher Education Coordinating Board to coordinate the availability of graduate medical education training positions so that Texas can retain our graduates for residency training.

•    Sponsor research to identify and promote innovations in training primary care residents for practice in Texas, and to address the factors that influence why few U.S. medical school graduates select this training.

•    Adjust the payment system for health care services to make primary care an attractive career option for those considering a rural practice.

•    Reinstate the State Physician Education Loan Repayment Program funds that were slashed during the 2011 legislative session to encourage physicians to practice in rural and medically underserved communities.

•    Strongly oppose any efforts to expand scope of practice beyond that safely permitted by nonphysician practitioners’ education, training, and skills.

•    Support expansions of scope of practice laws that protect patient safety, are consistent with team care, are based on objective educational standards, and improve patient care services.

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Physician-owned hospitals seize their moment - amednews.com

Physician-owned hospitals seize their moment - amednews.com | Healthy Vision 2020 | Scoop.it
Supplied with government data ranking them among the best for value of care, doctors at these facilities keep fighting to lift expansion restrictions.
Texas Medical Association's insight:

Support responsible ownership of hospitals

 

Texas’ health care delivery system has changed dramatically over the past decades. Life-saving technologies and treatments, and the types of settings in which patients receive services have proliferated. Physicians, hospitals, and others have invested extensively in these technologies and settings. While physician investment in the health care system is not new, there have been considerable changes in health care coverage, financing, licensing, and regulatory environment over the past decade. These changes drive the debate over who should invest in facilities. Texas is also the uninsured capital of America, which creates competition for a dwindling supply of paying patients.

 

TMA strongly supports responsible physician investment in technology, facilities, services, or equipment. Physicians invest in facilities to improve the effectiveness, efficiency, timeliness, and quality of the care they provide to their patients. The focus should be not on who owns the medical facility — a physician, a nonprofit entity, or a for-profit company — but on the quality of the facility and appropriateness of patient care. Referrals to a physician-owned entity or an entity in which the physician has a financial relationship must be based on the patient’s medical needs, and full disclosure of financial relationships to patients is appropriate. If overutilization or deviations from quality care are the issues, legislators should address those problems regardless of ownership, rather than limiting patient choice and innovation in the marketplace.

 

One of the more egregious sections of the Patient Protection and Accountable Care Act significantly inhibits physicians’ legal right to own or invest in hospitals and other facilities that provide high-quality care to their patients. Section 6001 prohibits new doctor investment in hospitals that take Medicare patients; no physician-owned hospitals may start nor may current ones expand.

 

Federal law should not interfere with physician ownership of hospitals. Studies show physician hospitals have better health care outcomes, shorter hospital stays, and much higher patient satisfaction ratings than nonphysician-owned hospitals. In Texas, physician-owned hospitals employed 22,226 people and paid $1.2 billion in salaries in 2009.Nationally, physician-owned hospitals provide, on average, approximately 6.2-percent charity care. These hospitals pay billions in salaries, hundreds of millions in taxes, provide charity care, and deliver services in underserved or abandoned areas. TMA has filed several legal briefs that support a lawsuit seeking to overturn Section 6001 of the PPACA.

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Health reformers should learn from doctor-owned hospitals

Health reformers should learn from doctor-owned hospitals | Healthy Vision 2020 | Scoop.it
Rather than learning from what doctor-owned hospitals do right, policy experts are doing their best to discount them.
Texas Medical Association's insight:

Support responsible ownership of hospitals

 

Texas’ health care delivery system has changed dramatically over the past decades. Life-saving technologies and treatments, and the types of settings in which patients receive services have proliferated. Physicians, hospitals, and others have invested extensively in these technologies and settings. While physician investment in the health care system is not new, there have been considerable changes in health care coverage, financing, licensing, and regulatory environment over the past decade. These changes drive the debate over who should invest in facilities. Texas is also the uninsured capital of America, which creates competition for a dwindling supply of paying patients.

 

TMA strongly supports responsible physician investment in technology, facilities, services, or equipment. Physicians invest in facilities to improve the effectiveness, efficiency, timeliness, and quality of the care they provide to their patients. The focus should be not on who owns the medical facility — a physician, a nonprofit entity, or a for-profit company — but on the quality of the facility and appropriateness of patient care. Referrals to a physician-owned entity or an entity in which the physician has a financial relationship must be based on the patient’s medical needs, and full disclosure of financial relationships to patients is appropriate. If overutilization or deviations from quality care are the issues, legislators should address those problems regardless of ownership, rather than limiting patient choice and innovation in the marketplace.

 

One of the more egregious sections of the Patient Protection and Accountable Care Act significantly inhibits physicians’ legal right to own or invest in hospitals and other facilities that provide high-quality care to their patients. Section 6001 prohibits new doctor investment in hospitals that take Medicare patients; no physician-owned hospitals may start nor may current ones expand.

 

Federal law should not interfere with physician ownership of hospitals. Studies show physician hospitals have better health care outcomes, shorter hospital stays, and much higher patient satisfaction ratings than nonphysician-owned hospitals. In Texas, physician-owned hospitals employed 22,226 people and paid $1.2 billion in salaries in 2009.Nationally, physician-owned hospitals provide, on average, approximately 6.2-percent charity care. These hospitals pay billions in salaries, hundreds of millions in taxes, provide charity care, and deliver services in underserved or abandoned areas. TMA has filed several legal briefs that support a lawsuit seeking to overturn Section 6001 of the PPACA.

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Avoiding Emergency Rooms

Avoiding Emergency Rooms | Healthy Vision 2020 | Scoop.it

With experts saying that more than half the problems patients take to emergency rooms could be addressed outside a hospital, primary care physicians need to work with patients to curb unnecessary visits.

 

"... care in an emergency department for a routine medical problem can result in unnecessary hospitalization, tests and procedures that may even complicate a patient’s medical problem." 

Texas Medical Association's insight:

Promote the patient-centered medical home for every Texan

 

Consider that the costliest 1 percent of patients in the United States account for more than 20 percent of what the nation spends on health care. They are older patients with cancer, diabetes, heart disease, and other serious chronic conditions. Many have multiple health problems, and their relatives might not be helping with their care. Most have private insurance and are white and female.

 

As public and private payers look for ways to lower costs, improve patient outcomes, and ease burdens to access, they are turning to models of care that both increase economic efficiencies and enhance patient care. One of these is the patient-centered medical home (PCMH) model. A PCMH is a primary care physician or physician-led team who ensures that patient care is accessible, coordinated, comprehensive, patient-centered, and culturally relevant. The physician or team directly provide, coordinate, or arrange health care or social support services as indicated by the patient’s individual medical needs and the best available medical evidence. The model uses a team-based approach with the patient’s primary care physician leading the overall coordination of care. Trained teams and well-constructed electronic health records (EHRs) are key to a successful PCMH.

 

TMA supports the use of the PCMH model in Medicare, Texas Medicaid, and commercial insurance plans. Public and private payers have, increasingly, been looking to this model as a way to reduce fragmented care, lower costs, avoid repetitive and costly procedures, and improve patient outcomes. Given the budget constraints that Texas faces and a growing population with unique health care needs, the PCMH offers the potential for Medicaid cost savings as well as improved patient outcomes and physician and provider satisfaction.

 

In recent years, numerous states have implemented PCMH initiatives that engage both private and public payers. While each program design was unique and each measured success differently, these initiatives showed improved outcomes and reduced costs. Below are just a few examples of PCMH successes.

 

•    In a recent Blue Cross and Blue Shield pilot in Colorado, New Hampshire, and New York, the program showed an 18-percent decrease in acute inpatient admission rates compared with an 18-percent increase in the non-medical home group. Additionally, there was a 15-percent decrease in the rate of emergency department visits, compared with a 4-percent increase in the non-PCMH group.

•    Oklahoma saw complaints about access to same-day or next-day care decrease from 1,670 in 2007 (the year before PCMH implementation) to 13 in 2009 (the year after implementation). Oklahoma saw a decline in expenses of $29 per patient per year from 2008 to 2010.

•    Inpatient hospital admissions for aged, blind, and disabled Medicaid beneficiaries participating in Community Care of North Carolina decreased 2 percent between 2007 and the middle of fiscal year 2010. Inpatient hospital admissions for the unenrolled beneficiaries increased 31 percent over the same time period. Overall, Community Care of North Carolina saved nearly $1.5 billion in costs between 2007 and 2009.

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WASHINGTON, April 11, 2013: Health Coalition Supports Legislation to Curb Medical Lawsuit Abuse | PRNewswire | Rock Hill Herald Online

WASHINGTON, April 11, 2013: Health Coalition Supports Legislation to Curb Medical Lawsuit Abuse | PRNewswire | Rock Hill Herald Online | Healthy Vision 2020 | Scoop.it
/PRNewswire-USNewswire/ -- The Health Coalition on Liability and Access today endorsed legislation introduced in the House of Representatives that will curb medical lawsuit abuse and help ensure continued patient access to care.
Texas Medical Association's insight:

Oppose federal preemption of state civil justice reforms

 

For decades, even before Texas passed our landmark medical liability reforms in 2003, medicine has pushed the U.S. Congress to enact national liability reforms based on the Texas and California models. This is a highly partisan issue. Over the years, a number of bills have passed the Republican-controlled House of Representatives only to die in the Senate, where personal injury trial lawyers have heavy influence.

 

TMA supports the enactment of fair, federal medical liability reforms because we know the very positive effect of the 2003 Texas reforms: better access to care because of the growing number of physicians relocating to Texas.

 

On the other hand, TMA and other state medical societies also have been extremely diligent in ensuring that any national legislation under consideration — including pushes for federal tort reform — doesn’t reverse or supersede stronger laws already on the books in state capitals around the country. Physicians also remain vigilant about laws that would, intentionally or not, introduce new legal reasons — known as “causes of action” — for people to sue physicians.

 

Both of those issues came to play during the 2009 congressional debate over the Patient Protection and Affordable Care Act (PPACA). Several members of the Texas delegation in Washington took steps to make certain that the PPACA would neither overstep Texas’ liability reforms nor create new causes of action against physicians.

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Internists Aim to End ’Assault’ on Patient-Physician Relationship

The American College of Physicians has a two-pronged plan to continue to advance the progress being made in expanding affordable coverage, lowering co
Texas Medical Association's insight:

Protect Physicians’ Independent Medical Judgment

 

The patient-physician relationship is unique in modern American life. Patients place their lives in their physicians’ hands. Not only must they trust in their doctors’ knowledge, experience, and skill, but they also must trust that their physician is acting in their best interest — neither motivated nor distracted by competing interests. In return, the physician is responsible for recommending and applying the most appropriate, science-based treatments for the patient’s individual circumstances and medical conditions. All of these pressures are magnified during the often-emotional final days and weeks of a person’s life.

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Compromise quells potential family-planning fight

Compromise quells potential family-planning fight | Healthy Vision 2020 | Scoop.it
The Texas House avoided a protracted, potentially volatile debate Thursday when both sides of the abortion issue agreed to withdraw about a dozen family-planning amendments from consideration.
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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Independent doctors unite to fight national trend toward hospitals buying physician groups

Independent doctors unite to fight national trend toward hospitals buying physician groups | Healthy Vision 2020 | Scoop.it
Since January, at least 114 local doctors have traded their independence for steady paychecks from hospitals. The move, part of a nationwide trend, has wide implications not only for doctors but also for patients' pocketbooks.
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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Physicians have about a 5-10% chance of being audited by CMS before receiving EHR incentive payments.

CMS conducting pre-payment audits before releasing 2013 EHR Incentive Program bonuses

Via Florida Medical Association
Texas Medical Association's insight:

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.

 

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.

 

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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Florida Medical Association's curator insight, March 29, 2013 10:57 AM

Be sure to check out FMA's Health Information Technology (HIT) Resource Center for all your HealthIT questions. http://www.flmedical.org/HIT.aspx

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Legislature considers raising funding for mental health

Legislature considers raising funding for mental health | Healthy Vision 2020 | Scoop.it
AUSTIN -- Standing in a courtyard by the state Capitol, Sen.
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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