Thursday, November 20, 2014

The Great American Smokeout Is Here

A week before Thanksgiving every year, millions of smokers commit to a longer, healthier future by kicking their tobacco addiction. The Great American Smokeout urges people to stay smoke-free for a day, perhaps forever.

The costs of smoking are great, both physically and economically. Smokingkills 24,500 Texans each year and costs $12.2 billion in medical care expensesand lost productivity. That is more than the number of deaths from AIDS, heroin, cocaine, alcohol, car accidents, fire, and murder combined.

The benefits of quitting are equally great. The infographic below shows the immediate and long-term benefits for people who make the decision to live tobacco-free. Quitters not only improve their own health, but the health of those around them too, since second-handsmoke causes lung cancer, heart disease, asthma, and other illnesses.

The American Cancer Society (ACS) created a quiz to help smokers who want to quit determine their level of nicotine dependence and offer tips on how to beat cravings. You can also check out ACS’s Facebook page to determine what type of Smokeout Character Quitter you are.

The habit is hard to break but not impossible. Forty-two million Americans smoke cigarettes. Make the commitment to be one less by Nov. 17. Talk to your doctor for help and resources to quit smoking.

Wednesday, November 19, 2014

Washington - For Health Care Advice, Ask Your Doctor!

By Elizabeth Torres, MD
President of the Harris County Medical Society
Internal Medicine Physician 

Editor's Note: This article was first printed in the Harris County Medical Society's Physician Newsletter.

Watching the election coverage last week, I was distressed by the fact that government gridlock is certain unless someone blinks. Reporters were surprised and excited about the new Republican majority in the House and in the Senate and their affect on President Obama and the Affordable Care Act (ACA), immigration reform, etc.  Election results reflected a discontent with the direction Washington is moving or not moving, whatever your viewpoint.  

For medicine, health care is at a crossroads and important decisions need to be made. However, it is uncertain if there is a real willingness for the President and Congress to work together. We cannot continue under our present situation. Knowing that we have been working on repealing Medicare’s SGR for over 10 years without any success, does not make me hopeful about any changes that we need for the ACA. Not wanting to feel helpless, I wanted to write a letter to Washington to tell them how we feel. I know, it’s another letter. When we have a sick patient and are unsure how to proceed, we consult with our colleagues to find answers on the best plan of care for our patient. We never give up on our patient. As our health care system needs healing, we want to be consulted by Congress on making improvements. We cannot give up here either.

Here’s my letter:  

Dear President Obama and members of Congress,  
I am writing you to express the concerns of the more than 11,700 physicians of the Harris County Medical Society. I want you to know that while we do appreciate your willingness to lead our country, we also feel great disappointment due to your inability to work together and move our country forward. There are many complicated issues that require attention. We physicians stand willing to help provide guidance in the area of health care. As physicians, we live these issues daily. We can speak of our experiences and what we have learned. Through our national, state and local medical associations, we have tried to provide alternatives to problems of the SGR and Medicare, health information technology (HIT), fraud and abuse and the Affordable Care Act (ACA), to name a few. It is not possible to legislate good medicine, but as physicians, we work fervently to practice good medicine. And, neither we nor our patients are robots willing or able to follow recommendations without question or thought. We must provide personalized medicine to our patients and do what we do best, which is to help them make decisions based on their individual health care risks and needs. We cannot force patients to change, but only do our best to educate them about their illnesses and give them tools to effect changes to their habits and lifestyles. We do not ask our patients about their political affiliation, only offer to help them with their health care needs. We ask that you set aside your political differences and focus on getting our patients the health care they need and deserve. This is not about who wins or loses in the political arena. This is about creating good public policy that helps people who are sick or injured. When a family member is ill, no one is thinking about who their senator or congressman is. All they want to know is where they can go to get medical care. We have to work together with insurance companies, hospital systems, long-term care facilities, and other allied health professionals to continue providing comprehensive medical care.  

Repeal SGR formula

Through the work of Congressman Kevin Brady and others, we came very close to repealing SGR with bicameral and bipartisan support. Don't let the last few months of this year go by without finally repealing this costly and flawed formula. We need to find ways to finance a rational Medicare physician payment system with a fair and stable funding formula. Due to our senior patient population’s rapid growth, we need to have adequate physician access. As patients’ choice of their physicians is important, increased Medicare flexibility would also improve access, especially if physicians were allowed to directly contract with Medicare patients, even when they opt out of Medicare.

ACA-Keep what works, add what's missing and fix what's broken      

The Affordable Care Act (ACA) has been a lightning rod for politicians - pro and con. After evaluating the new law, the Texas Medical Association (TMA) recommended some parts be kept, some be fixed and other things be added. That sounds like a reasonable approach to me and many of my physician colleagues. It's important that patients with pre-existing illnesses be able to get insurance coverage or that patients not lose insurance coverage due to "honest mistakes" on insurance forms. Patients should be able to understand their insurance coverage with easily readable health insurance labeling and be able to easily compare coverage options offered by different insurance companies. Finally, it is vital that health insurers use a consistent reporting formula for their medical loss ratio. Purchasers of insurance need to know how much their premium dollars are being applied to covering the cost of medical care and how much is going toward insurance company profits.    
We need to repeal the Independent Payment Advisory Board (IPAB), which is charged with reducing Medicare spending and can ONLY do this by reducing payments to physicians and a few other groups. If decisions are needed to limit funding for health care services, then Congress needs to be accountable for these decisions for the Medicare system. Also, if patient access to care is to be maintained, it is important to support expansion of graduate medical education (GME) funding through Medicare or consider alternative methods for GME funding to assure adequate physician availability.  

Overbearing fraud and abuse     
Reducing health care costs is a laudable goal, but creating laundry lists of rules and regulations does not necessarily stop fraud and abuse. It causes an undue amount of needless paperwork for physicians who are working hard to take care of sick patients. Auditing medical offices that have invested a lot of time and money achieving meaningful use (MU), only discourages others from even attempting MU, as the tedious documentation is daunting. The use of recovery audit bounty hunters further discourages physician participation in the Medicare program. We need to remove language from the ACA health care fraud statute, stating "a person need not have knowledge of the law or intent to commit a violation," meaning physicians could be charged for honest mistakes or errors.

Health information technology 
Despite the fact that many physicians have adopted electronic health records (EHRs), there remains a significant percentage of physicians who are unable to afford the systems. The cost of maintaining an EHR also remains an issue and evidence of return on investment (ROI) continues to be unproven for most physicians. The time investment for EHR is also very high and cumbersome. Additionally, meaningful use criteria are proving to be overwhelming for many physicians. While physicians do appreciate being able to have health care information readily available for review, this idea remains elusive as there is very limited health information exchange (HIE). Also, as many EHR systems are incompatible with each other, most health information remains in the silos of each physician’s office and each hospital. Until uniform standards for EHR compatibility are created, HIE will continue to be difficult. As physicians work to adopt EHRs, it is important to extend the provisions of the HITECH act to provide additional funding and monetary incentives, rather than punitive penalties, for meaningful use adoption. Slowing down time for adoption of EHRs allows time for EHR vendors to improve their product for different specialties and create compatibility standards. We need to determine which MU standards are important and contribute to improved medical care, not just useful for actuarial use or data mining.    

Whatever our political affiliations, we physicians share a commitment to advocate for our patients, to provide the best medical care possible and to foster collegial partnerships with all members of the health care team. Mr. President and members of Congress, we need you to take this same approach and work with us to address the problems in our health care system that are reducing people’s access to care. Everyone has a need for medical care at some time in his/her life. It's that common need that should drive us to foster a robust health care system for the future. As physicians, we will continue lifelong learning, improve the quality of care, and provide value for our patients. We physicians are prepared to advise you on health care issues, just as we are prepared to advise our patients on their health care needs.

E. Torres, MD 
Harris County Medical Society President

Tuesday, November 18, 2014

Bill Filed to Ban Texting on Texas Roads

Rep. Tom Craddick (R-Midland) is calling on lawmakers to ban texting while driving. The legislator filed the Alex Brown Memorial Act that, if passed, would make it illegal to text behind the wheel. The bill is named after Alex Brown, a high school senior who lost her life to texting while driving.

Read Alex Brown’s story.

"Texans who text while driving increase their crash risk by at least eight times. That is comparable to driving while intoxicated. Like driving drunk, texting while driving is a dangerous habit that is not just risking the driver's life, it is risking the lives of other drivers, passengers and pedestrians alike," Representative Craddick said. "Writing a text, updating Facebook or checking your email messages is not worth injuring yourself or someone else."

According to the Texas Department of Transportation, in 2013 distracted driving caused nearly 100,000 traffic crashes, injuring nearly 20,000 people and killing 507.

Nearly half of all Texans admit to texting while driving

Approximately 38 Texas cities already ban texting while driving, and the state passed laws banning texting while driving for minors, school bus drivers, and anyone driving through a school zone. Representative Craddick says a statewide law banning texting while driving will protect drivers, passengers, pedestrians, and bicyclists throughout Texas.

“If this law saves one life, it will be worth it,” said Representative Craddick.

Monday, November 17, 2014

Obesity Could Cost Texas Businesses $32.1 Billion by 2030

In 1990, 12.3 percent of Texans were obese. Today that number is 30.9 percent. A special report by the Texas Comptroller of Public Accounts warns this increasing obesity rate is costing Texas a pretty penny.

The Hefty Price Tag of Obesity in Texas reports in 2012 Texas businesses lost more than $11 billion due to obesity-related costs like health care spending, absenteeism from work, and disability. If the obesity rate continues to increase (as expected), Texas looks to lose $32.1 billion annually by 2030, when the obesity rate is projected to be 37 percent.

To see just how economically damaging this public health crisis can become, the comptroller’s office created an "interactive tool to gauge obesity-related costs to businesses, depending on varying levels of obesity and average annual inflation rates to 2030."

The report points out action is needed. If Texas can lower its obesity rate, even by a small amount, individuals and businesses could see large economic savings. The report outlines several ways Texas is striving to create a healthier future, including school nutrition standards and community health initiatives. Read more.

Thursday, November 13, 2014

New Website to Help Low-Income Women Find Health Services

Low-income Texas women searching for health services like birth control, breast and cervical cancer screening and treatment, prenatal care, mental health treatment, and more now have a website to turn to help them find care: HealthyTexasWomen.org.

HealthyTexasWomen.org is a bilingual web portal that helps low-income women find health care services offered by the Texas Health and Human Services Commission and Department of State Health Services through Medicaid and other programs. Women must apply for the program and be approved to get services.

“Healthy Texas Women is a one-stop site for women seeking health services," Sen. Jane Nelson (R-Flower Mound), said. "By answering a few simple questions, women will be able to determine which program is right for them, which providers in their community participate, and what services are available.” Visit the site.

Wednesday, November 12, 2014

“Hey, Doc,” who must enroll in the marketplace? What if I don’t? What are the penalties for not having health insurance?

Enrollment for the health insurance marketplace begins in three days — Nov. 15. Texas physicians want to ensure you have the information you need to start the enrollment process. They week’s “Hey, Doc” segments discuss who must enroll for health insurance and possible penalties for those who decide not to purchase insurance.

Q. Who must enroll? What if I don't?

A. As of 2014, the individual mandate of the Affordable Care Act (ACA) requires most people to have some form of health insurance coverage, or pay a penalty. (See “When Can I Sign Up?” or watch the “Hey, Doc video.”) If you have coverage in one or more of these ways, you will satisfy the mandate:
  • Government-sponsored insurance (such as Medicare, Medicaid, the Children’s Health Insurance Program, TRICARE, the veterans health program);
  • Employer-sponsored coverage;
  • Insurance bought on your own in or outside of the ACA marketplace that meets the new ACA requirements; or
  • A "grandfathered" health plan: a health plan in existence before the health reform law (March 23, 2010) that is exempt from some of the new ACA requirements. 
The Obama administration has also said that if your insurer renewed an old policy that doesn’t meet the new ACA requirements, that might still satisfy the mandate for 2015. Check with your insurance company.

If you do not have coverage, the marketplace is a place to shop for health insurance in addition to the traditional private insurance market. The marketplace also can help you determine if you can get financial assistance toward your insurance costs or if you are eligible for a state government health program.

Additionally, the ACA says certain uninsured people don’t have to pay the penalty. Generally, you may qualify for an exception if:
  • Coverage is unaffordable based on your household income;
  • You don’t earn enough income to have to file a tax return;
  • You are uninsured for less than three months in a row;  
  • You are in one of the following groups: incarcerated individuals, undocumented immigrants, American Indians and Alaska natives, participants of a health care sharing ministry, or members of a recognized religious sect opposed to having health insurance; or 
  • You experience certain hardships preventing you from obtaining coverage. 
If you don’t qualify for one of the exemptions, and you don’t have insurance coverage, you will have to pay a penalty, which increases each year.

Q. What are the penalties for not having health insurance?

A. If you didn’t have insurance in 2014, and you didn’t qualify for one of the exemptions, you will have to pay a penalty when you file your taxes at the end of the year. The penalties increase each year.
  • For 2014, you will pay either $95 per adult and $47.50 per child, or 1 percent of your family income, whichever is greater.
  • In 2015, the fines begin at $325 per adult and $162.50 per child, or 2 percent of your family income, whichever is greater.
  • In 2016, the fines increase to as much as $695 per adult and $347 per child, or 2.5 percent of family income, whichever is greater.
  • After 2016, the penalties will be adjusted based on inflation.

Tuesday, November 11, 2014

A "Bright New Day" for VA Health Care?

(DALLAS) - The issue of veterans’ access to timely health care returned to the American Medical Association House of Delegates this weekend in a far more positive light than it enjoyed five months ago.

In June, in the wake of scandals over excessive wait times in the Veterans Affairs Administration (VA) health care system, the AMA House pushed for President Barack Obama and Congress to make it easier for private practice physicians to care for VA patients. The Texas Medical Association was at the forefront of that fight, led by TMA Delegation Vice Chair Asa Lockhart, MD, of Tyler.

The president has replaced his VA secretary with former Procter & Gamble CEO Robert McDonald, and Congress passed the Veterans Access, Choice, and Accountability Act of 2014. That law will pay private health care providers $10 billion to treat veterans who cannot get VA appointments within 30 days or who live more than 40 miles from a VA health care facility. Another $5 billion will help the VA hire new doctors, nurses, and other medical staff.

The AMA House convened this weekend in Dallas for its first meeting since that debate. Secretary McDonald spent an hour telling delegates about changes in his agency and answering physicians’ questions. From May through September, he said. the agency saw a 46-percent increase in care provided by non-VA physicians; more than 1 million veterans saw doctors outside of the VA system.

The secretary also said the VA is working to reduce the hassles many community physicians have experienced in trying provide care to veterans covered by the VA.

“We need you to participate in the program,” he said. “We know you won’t if it’s too much trouble.”

We caught up with Dr. Lockhart after Secretary McDonald’s speech. He was favorably impressed. “I really see the promise of a bright new day for the veterans’ health system,” he said.



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