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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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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Paying Doctors for Performance

Paying Doctors for Performance | Healthy Vision 2020 | Scoop.it
New York City’s public hospital system is moving away from cost-of-living increases.
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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Federal Reserve Paper: Geographic Variation Can’t Tell Much about Efficiency or Quality

"This paper examines the geographic variation in Medicare and non-Medicare health spending and finds little support for the view that most of the variation is attributable to differences in practice styles. Instead, I find that socioeconomic factors that affect the need for medical care, as well as interactions between the Medicare system, Medicaid, and private health spending, can account for most of the variation in Medicare health spending. Furthermore, I find that the health spending of the non-Medicare population is not well correlated with Medicare spending, suggesting that Medicare spending is not a good proxy for average health spending by state. Finally, there is a negative correlation between the level and growth of Medicare spending; lows pending states are not low-growth states and are thus unlikely to provide the key to curbing excess cost growth in Medicare."

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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HIPAA Changes Could Create New Bureaucratic Burdens -- InformationWeek

HIPAA Changes Could Create New Bureaucratic Burdens -- InformationWeek | Healthy Vision 2020 | Scoop.it
Modifications to HIPAA may take the focus off patients and pile on administrative work.
Texas Medical Association's insight:

Eliminate costs and hassles that don’t contribute to or add value to patient care

 

New compliance requirements are bombarding physician practices seemingly every day. Just in January 2012, a new electronic format for claims and other electronic transactions (called “HIPAA 5010”) added new costs to physician practices. The switch to the International Classification of Diseases and Related Health Problems version 10 (ICD-10), currently set for October 2014, will require the adoption of an entirely new coding system to record all possible diagnoses and inpatient procedures. It will add significant physician and staff training costs.

 

Medicare’s required new PQRS provides a monetary incentive at first but imposes penalties beginning in 2015. A number of new state and federal privacy laws introduce more administrative burden, and severe new penalties for noncompliance. State and federal governments are using more “fraud” detection, resulting in monumental compliance programs that further increase the cost of running a practice. TMA and dozens of other medical societies have written to CMS “about the imminent storm that is about to occur due to simultaneous implementation of multiple programs that will create extraordinary financial and administrative burden, as well as mass confusion, for physicians.” These changes have limited documented evidence they will lower fraud or improve privacy, but complete assurance they will increase the cost of doing business in medicine.

 

It’s because of the vast number of complex commercial insurance and federal and state regulations that affect physicians and their patients that TMA developed the Calendar of Doom.

 

The cost to operate a physician’s office continues to climb unabated. Unfunded mandates and hidden regulatory burdens like the ongoing hassles of annually renewing state registration to continue to prescribe needed medications for patients threaten the viability of practices and patients’ access to care. The average cost to staff and run a practice now exceeds $500,000 per physician, and that’s before the physician gets paid a dime. These excessive administrative expenses add to the escalating cost of medical care that are borne by patients, employers, and taxpayers.

 

Excessive regulations also hurt local economies, which receive nearly $1 million in wages and benefits for each physician in practice. Physician offices employ support staff and often work with nonphysician providers, increasing the total number of employees in the industry to well above the count of physicians alone. In 2009, Texas office-based physicians supported 249,010 jobs. On average, each office-based physician supported 5.8 jobs, including his or her own.

 

Texas should not burden practices with additional regulatory costs that provide no benefit to patients or their health care.

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End the 'doc fix' charade, once and for all

End the 'doc fix' charade, once and for all | Healthy Vision 2020 | Scoop.it
Doctors are breathing a collective sigh of relief because we again escaped a cut in Medicare payments. But this whole recurrent charade underscores, once again, the unresolved issue of how to pay doctors.
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.100

 

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.101

 

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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Using Shared Savings to Foster Coordinated Care for Dual Eligibles — NEJM

Using Shared Savings to Foster Coordinated Care for Dual Eligibles — NEJM | Healthy Vision 2020 | Scoop.it
Perspective from The New England Journal of Medicine — Using Shared Savings to Foster Coordinated Care for Dual Eligibles
Texas Medical Association's insight:

Repeal the dual-eligible payment cut

 

In early 2012, legislators made a funding cut without knowing its true impact, creating a medical emergency for thousands of dual-eligible Texans and the physicians who care for them. “Dual-eligible” patients are low-income seniors and people with disabilities who qualify for both Medicare and Medicaid. In Texas, there are almost 465,000 dual-eligible patients, who are among the sickest and most vulnerable people in our state.

 

When a physician provides treatment to a dual-eligible patient, Medicare pays the physician 80 percent and Medicaid the remaining 20 percent. Medicare also requires patients to pay an annual deductible — $140 in 2012 — which Medicaid pays because the patients are so poor. However, beginning on Jan. 1, 2012, Texas Medicaid implemented a new policy, limiting what it pays physicians (and other providers) to the maximum of what Medicaid pays for the same service. In most instances, the patient’s physician faces a cut of 20 percent, and potentially even more. Consider these examples:

 

•    Example 1: Established dual-eligible patient has not met any of the Medicare deductible and is seen during a routine office visit. Physician bills Medicare CPT code 99213. Maximum Medicare allowable is $66.90. Medicare pays $0 because deductible has not been met. Medicaid will pay $33.27, the Medicaid allowable for this code. Prior to policy change, physician would have been paid up to the Medicare allowable ($66.90). This is, in essence, a 50-percent payment cut.

•    Example 2: Established dual-eligible patient visits physician office for routine visit, Medicare deductible has been met. Physician bills Medicare CPT code 99213. Medicare allowable is $66.90. Medicare pays $53.52, 80 percent of the allowable. Physician bills Medicaid for the remaining 20 percent. Medicaid allowable is $33.27, so no coinsurance will be paid. Under old policy, Medicaid would have paid an additional $13.38 so that physician’s entire payment equaled Medicare’s $66.90 allowable. This is a 20-percent payment cut.

 

The dual-eligible payment cut unfairly penalizes physicians who care for the sickest and frailest Medicare patients. The policy change hit particularly hard practices in rural and inner-city Texas, along the Mexico border, and many of those serving nursing homes. Those practices serve a disproportionate number of dual-eligible Medicare patients. In addition, the cut is already causing physicians to limit how many dual-eligible patients they are willing to treat, restrict their Medicaid participation, and forego practicing in communities that most need them.

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CDC: Texans Have Poor Cardiovascular Profile « D Healthcare Daily

CDC: Texans Have Poor Cardiovascular Profile « D Healthcare Daily | Healthy Vision 2020 | Scoop.it
Texas Medical Association's insight:

The leading causes of death and disability in Texas and the United States today are preventable because they are closely associated with personal lifestyle decisions. Texans’ personal behaviors contribute to more than 60 percent of all deaths in our state every year.

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Kyle Janek: The Texas Medicine Interview

Kyle Janek: The Texas Medicine Interview | Healthy Vision 2020 | Scoop.it
New Texas Health and Human Services Executive Commissioner Kyle Janek, MD, has concerns about Medicaid - about having enough physicians to care for patients, about how to improve the health insurer, and other thoughts he shares with Texas Medicine...
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Texas Medical Association's comment, January 2, 2013 12:00 PM
Check out the video! www.texmed.org/JanekInterview
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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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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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Coordinated approach urged on preventive care

Coordinated approach urged on preventive care | Healthy Vision 2020 | Scoop.it

The not-for-profit Trust for America's Health is calling for a revamp of public health management at the federal, state and local levels in a report that urges a greater focus on preventive care.

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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Hospitals, physicians, insurers back bill for 'medical homes' in Montana

Hospitals, physicians, insurers back bill for 'medical homes' in Montana | Healthy Vision 2020 | Scoop.it
HELENA – Hospitals, physicians, health insurers and health clinics came out in force Wednesday to support a bill encouraging “patient-centered medical homes,” which are medical practices designed to offer preventive care and reduce health care costs.
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.28

•    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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Doctors praise bill to repeal Medicare cost-cutting board - The Hill's Healthwatch

Doctors praise bill to repeal Medicare cost-cutting board - The Hill's Healthwatch | Healthy Vision 2020 | Scoop.it
The American Medical Association praised the reintroduction Wednesday of a bill to repeal the controversial Medicare payments board in President Obama's healthcare law. Rep.
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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Bipartisan bill to repeal IPAB introduced in House of Representatives

Bipartisan bill to repeal IPAB introduced in House of Representatives | Healthy Vision 2020 | Scoop.it
A bipartisan bill introduced Wednesday in the U.S. House of Representatives would eliminate the Independent Payment Advisory Board (IPAB) before...
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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Medical schools need funds to train more Texas doctors

Medical schools need funds to train more Texas doctors | Healthy Vision 2020 | Scoop.it
While we share the common goal of achieving excellence in medical education, research and patient care, we also often compete for the state’s and the country’s best students, faculty and staff.
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.

 

In 2011, almost half (48 percent) of Texas medical school graduates left the state for residency training. Texas invests almost $200,000 in a medical student’s four years of education. Texas physicians are concerned about the state’s ability to protect that growing investment with enough graduate medical education positions to meet demand. For 2011, the annual National Resident Matching Program offered 1,476 entry-level GME positions in Texas. By comparison, 1,445 students graduated from Texas medical schools in 2011.  The Texas Higher Education Coordinating Board recommends a ratio of 1.1 entry-level GME positions for each Texas medical school graduate. To meet this goal, Texas would have needed 1,590 entry-level training positions in 2011, or 114 additional positions. 

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House rules aim to block controversial healthcare board's Medicare cuts - The Hill's Healthwatch

House rules aim to block controversial healthcare board's Medicare cuts - The Hill's Healthwatch | Healthy Vision 2020 | Scoop.it
House Republicans signaled Thursday they will not follow rules in President Obama's healthcare law that were designed to speed Medicare cuts through Congress. The House is set to vote Thursday afternoon on rules for the 113th Congress.
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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AAP: All Work and No Play Bad for Kids

Recess during school offers children cognitive, social, emotional, and physical benefits they don't get through academics alone, according to the American Academy of Pediatrics.

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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