Tuesday, December 23, 2008

Holiday Message

I know that just turning on the TV or picking up a newspaper lately can be disheartening. The U.S. and even around the world seems to be filled with coverage of a fluctuating economy, financial bail-outs, home foreclosures, a rising number of unemployed and the like.

It is in the midst of all these challenges that many of us at CHRISTUS celebrate the season of Advent, which helps us prepare for the birth of Jesus. In fact, many religions celebrate a holy season as the days grow shorter and the darkness seems to increase.

I heard someone say once that “it gets darker and darker, and then Jesus is born.” The Advent season is really about looking forward to the coming of our Savior, the true light. It is about pausing in the midst of darkness and waiting for the light to come. It is about showing up when we are needed and carrying the love of Christ to others who are hurting. It is about sharing the stories of Miracle Moments in our own lives in order to bring hope to others. It is about accepting our present challenges as opportunities for change and performance improvements.

It is no accident that Advent comes in the coldest, darkest season of the year, when we might begin to wonder if Spring will ever come again, if the challenges will ever go away. But while we sit and wait, we also have a chance to be thankful for the blessings we have received, especially our call to work in the sacred ministry of health care and being part of the CHRISTUS family.

The Advent season is one of waiting as we prepare for the birth of Christ, but it is followed by Christmas, when we take time to rejoice in the Christ’s birth and spend time with those we love while reflecting on a brighter future. It is my wish on behalf of the entire CHRISTUS Health Senior Team that blessings of Christ’s love be yours now and forever. Have a wonderful holiday season, and may the new year bring each of you much peace and happiness.

Thursday, December 18, 2008

Health Care Reform: Wellness Programs and Prevention

As you may recall, I believe that one of the building blocks of health care reform should be wellness and prevention. (You will notice that the seven determinants of health lean heavily toward wellness, especially through education.)

If the U.S. is to provide health insurance for all, wellness and prevention aspects must be covered. This will assist us in keeping Americans out of our hospitals and Emergency Departments, the most expensive ways to deliver care.

You can read more about the building blocks of health care reform here.

Health Care Reform: The Seven Determinants of Health Care

Earlier in the year, we spent some time in Canada, learning about their socialized health care system. They provide insurance to cover basic health care for all registered Canadians, which includes not only hospital and primary care, but all of the seven determinants of health.

These determinants include:
1. Primary outpatient locations
2. Schools
3. After school programs for working parents
4. Appropriate housing
5. Appropriate nutrition
6. Appropriate psychological and psychiatric services
7. Hospitals/acute care

While it is true that Canada’s health care system is not perfect, I believe they have the right idea where the seven determinants of health are concerned. If health care reform in the U.S. is to be successful, we have to address all the issues that affect overall health, not just hospitals/primary care.

You can read more about Canada and the seven determinants of health here.

Wednesday, December 10, 2008

Health Care Reform: The Primary Care Crisis

I blogged last week about the hidden barrier to U.S. health care reform: the primary care provider crisis.

We have seen this clearly displayed recently in the state of Massachusetts. Through recent reform, Massachusetts has enough money to provide care to its residents, but is lacking the primary care providers to care for the patients who now have insurance coverage. This problem is present across the U.S., and will need to be addressed if we are to provide access to health care for all Americans.

This issue does not seem to enter into many discussions pertaining to health care reform, so I wanted to address it first in my series of video posts. You can read more about the issue here.

Health Care Reform: CHRISTUS' Response to Obama

It has come to my attention that President-elect Barack Obama and Vice President-elect Joe Biden have been soliciting Americans’ thoughts on all sorts of issues on their transition website, change.gov. One of the issues receiving much attention is health care, and members of the transition team have posted video discussions on this very important topic.

We at CHRISTUS want to join in the discussion, so I thought it would be appropriate to post some video blogs for the next few weeks on my ideas regarding health care reform. I will tie these videos back to previous posts where you can gather more information on topics that interest you, and hope that my experience as a physician and health care leader will aid us in framing this very important discussion in a helpful way.

So let’s get started.

Wednesday, December 3, 2008

The Hidden Barrier to U.S. Health Care Reform

We know that because of the priorities of the incoming Obama/Biden administration, there is a great possibility that health care reform in the U.S. may be designed and (hopefully) implemented in the next several years. We also know that the major barrier that any potential reform will face is the cost and who will pay.

There is no doubt that this is a key question which must be answered. But because of the overuse of medical services, the duplication of many health care product lines and expense associated with the reworking of procedures that were not done correctly the first time, there are dollars that could be significantly saved and redirected to care for the large number of under- or uninsured. These issues must be addressed if we are to provide basic health care for all.

This undoubtedly will take a strong collaborative effort between all constituencies--including health care providers, the government and insurance companies--in order to develop an equitable source of funds for this expanded coverage.

We do know that both president-elect Obama is aware of the Massachusetts plan which, although unique, has successfully put together a multi-tiered and multi-participant funding program which is creating the dollars necessary to deliver care for all in that state. However, closer inspection of the Massachusetts plan and its results over the last 6 months uncovers a significant issue which I call “the hidden barrier” in making health care reform possible.

Although Massachusetts has enough money to provide the care, their issue now is the lack of primary care providers to see the patients who now have insurance coverage. This issue is present throughout the U.S. and will clearly come into focus to everyone who has the ability to pay for care that they either think they want or clearly need, regardless of their method of payment.

At the present time, less than 2 percent of all medical school graduates are entering family practice or internal medicine, which serve as the primary caregivers for adults in this country. For years these residency programs have been challenged to fill their open slots with American-trained medical students; therefore, the majority of those training slots in these specialties have been filled with foreign medical graduates.

We find ourselves in this situation primarily because primary care is not seen by the reimbursement bodies as significantly important in the health care continuum, and therefore these physicians have been the lowest on the reimbursement scale for many years. Their low payment rates for services provided are not only causing fewer people to enter the field, but most recently are causing family practitioners and internists who have been practicing for many years to decide that they can no longer continue as independent practitioners. This exodus from primary care is prevalent everywhere, but is mostly exaggerated in rural communities, where--in fact, if reform occurs--the needs will be greatest.

In addition, American health care has not rapidly embraced non-physician health care providers such as nurse practitioners, midwives and physicians’ assistants. This lack of support for these important professions has also been exaggerated recently because of declining reimbursement. Therefore these professionals have become very threatening to primary care physicians, who see any decline in volume as the result of treatment by others as a significant blow to their ability to survive.

I believe that our ability to increase the quantity of primary care providers to care for all of the uninsured in America might be more critical than finding ways to financially support this important undertaking.

So what are some of the possible answers to this dilemma?
1. Both federal and state governments must restructure their payment scales through the Medicare and Medicaid programs so that primary care reimbursements move closer to the payments that some specialists are receiving.
2. Medical school faculties must encourage their students to consider primary care residencies as valuable and exciting as those for surgery.
3. Incentive programs must be developed to entice medical students to enter primary care residencies. This could be done through loan forgiveness programs or providing perks and benefits which might be different than those offered to residents who will eventually go into high-paying specialties.
4. The American Medical Association must do a strong marketing/public awareness campaign to educate the public on what an important role primary care specialist play in maintaining the health of communities throughout the U.S.
5. Health systems should undertake similar awareness programs to make sure primary care physicians know that there are opportunities to enter medical groups. This would provide guaranteed salaries and opportunities to serve in multiple positions (including acting as hospitalists), which would give them the ability to not only make an adequate living, but have a better balance of their personal and professional lives.
6. Health systems, hospital associations and physician societies should understand the appropriate use for well-trained ancillary providers and create opportunities where they can be utilized appropriately to fill in the voids that are created by this low number of primary care providers. There is adequate proof, based on sound research, that midwives, physicians’ assistants and nurse practitioners can work in independent duty stations with clear guidelines that are formulated and overseen with physicians’’ input. These groups of people must be seen as adding value to rather than competing with physicians.

If health care reform is to be successful, not only will the question of affordability have to be answered, but perhaps even more importantly, the question that will need much more deliberation will be, “Who will be providing this care once we make it affordable?” The sooner we address the latter question, the greater chance we will have of being successful in creating some meaningful health care reform that will have permanent sustainability.

Discussing Health Care Reform

As President-elect Obama and his transition team prepare to take control, continue to fill important leadership positions and discuss issues of top priority to their administration, U.S. health care reform remains a significant issue to those of us who are blessed to work in health care. Therefore, I thought this would be a great opportunity to gather my blog posts about the U.S. health care system and health care reform together in one place so they are easily accessible. It is my hope that this will help us continue to dialogue about this important issue.

Health Care Reform (7.11.07)
Health Care Reform – Who Should Come to the Table? (7.18.07)
No Common Voice in Health Care (12.5.07)
Tort Reform in Texas (12.11.07)
Futures Task Force II Journeys to Canada (4.16.08)
Canada's Health System and the Determinants of Health (4.30.08)
The Importance of Advocacy (5.28.08)
Redesign of the U.S. Health Care System (7.2.08)
Could segmented health care be part of the solution? (8.6.08)
Competition and Collaboration (8.11.08)
The Hidden Barrier to U.S. Health Care Reform (12.3.08)