The Resource Guide to Your Medical Community
www.BestPracticesMD.com
How Does My Hospital Compare? Tools For the Educated Consumer
Diabetes: An American Epidemic Page 12
After the Concussion Page 16
Tracking Patients Page 20
PLUS Keeping Your Toddler Safe Around Pools Growing Your IRA Dollars Bay Area Houston’s Exceptional Healthcare The Power of Video
Third Quarter 2012
CONTENTS
Third Quarter 2012
Letter From the Medical Director 9 In Praise of Inspiration and Ingenuity
Physician’s Corner 18 How Does My Hospital Compare? 20 Keeping Track of Your Patients
Pediatrics 10 Keeping Your Toddler Safe Around
Business of Medicine 22 The Power of Video: Part 1
Swimming Pools
Prevention 12 What is Diabetes? An American Epidemic
Feature 14 Medical Center of the South: Bay Area Houston’s Exceptional Healthcare
Sports Medicine 16 After the Concussion: Natasha’s Law 6 |www.BestPracticesMD.com | Third Quarter 2012
Sucre’-Vail Wealth Management
23
Healthcare/Education Partnerships FDA Changes Rules on Advertising for Sunscreen Products
Financial Health 24 Growing Your IRA/Retirement
Dollars Without Cumbersome Fees
The Last Word 26 Affordable Care Act is Wrong Prescription for America
Third Quarter 2012 | www.BestPracticesMD.com|
7
Third Quarter 2012
PUBLISHER/CHAIRMAN Rick Clapp President Rob Kumar C.O.O. Santiago Mendoza Jr.
EDITORIAL Editor Rod Evans Medical Director Victor Kumar-Misir, M.D. Contributing Writers Rod Evans Doug Frazior Danny Gutknecht Stephen G. Kimmel M.D. Amanda Kuenstler Victor Kumar-Misir, M.D. Thea Lockett, Med, ATC, LAT Santiago Mendoza, Jr. Betha Merit Rep. Pete Olson Tish Wright
ART Creative Director Brandon A. Rowan Graphic Specialist Victoria Ugalde Photography/Editing Brian Stewart
ADVERTISING Director of Advertising Patty Kane Account Executives Patty Bederka Natalie Epperly Rob Kumar Santiago Mendoza Jr. Amber Sample
PHONE: 281.474.5875 FAX: 281.474.1443 www.BestPracticesMD.com Best Practices Quarterly is trademarked and produced by Medical Best Practices Group, LLC. Best Practices Quarterly is not responsible for facts as presented by authors and advertisers. All rights reserved. Material may not be reproduced in part or whole by any means whatsoever without written permission from the publisher. Advertising rates are available upon request. Best Practices Quarterly P.O. Box 1032 Seabrook, TX 77586 R.Clapp@Baygroupmedia.com
From the Medical Director
LETTER
In Praise of Inspiration and Ingenuity
By Victor Kumar-Misir, M.D.
t a recent meeting of the Harvard Medical School and UTMB, I had the opportunity to present my 1898 original copy of Sir William Osler’s “The Principles and Practice of Medicine,” which became the bible of medicine, and has inspired many of the early giants in medicine. I was amazed that, as word got around, many doctors lined up to lay their hands on this original publication, with observable reverence for Sir William’s historical work. What amazed me even more was the fact that many of the younger physicians were also quite aware, and in awe of, the profound global impact that this book had. I have always been fascinated by how one publication and one individual could so fundamentally alter the course of human history. At the time, 1898, Osler was the acclaimed Physician in Chief at Johns Hopkins Hospital, and had been professor of medicine at McGill University in Montreal, as well as at the University of Pennsylvania in Philadelphia, and dedicated the book to his alma mater, Trinity College, Toronto School of Medicine with the words: “Designed for the use of practitioners and students of medicine.” This book, which became the bible of medicine, along with his inspiring personality, was so vastly appreciated and acclaimed, that it had an historic impact on the socioeconomic, geo-medical landscape of the planet. At a momentous event in history, in 1901, the reverend Frederick Taylor Gates had a conversation with the richest man in the world at the time – John D. Rockefeller, Sr., – from whom he had secured $600,000.00 for the University of Chicago, and who was looking for some major ideas in which to invest his wealth. Reverend Gates had read Osler’s Practice of Medicine, and with unbounded admiration and enthusiasm, he rushed it to Mr. Rockefeller, and said: “I have the idea! The world isn’t getting its full share of benefit from scientific discoveries. This knowledge must be distributed in a practical way, to relieve the ills of the world.” Mr. Rockefeller immediately founded the Rockefeller Institute for Medical Research, which was chartered with a pledge of $200,000.00 for grants and aid to investigators and institutions, and later, millions were made available. Dr. Simon Flexner, Professor of Pathology at the University of Pennsylvania, became its leader, and the Rockefeller Institute developed into the outstanding research laboratory of the country. This stimulation to scientific enquiry, dedicated to the relief of medical ills worldwide, inspired the creation of many other institutions and foundations in North America, and led to America’s preeminence in medical advancements during the 20th century. Among the recipients of this largesse was Dr. William H. Welch, honored at the time as the dean of American medicine, who, endowed with a million dollars, became the director of the first modern school of hygiene in the United States. He had also pioneered the organization of the Johns Hopkins Medical School, a system which ultimately had a profound influence in shaping American medical education,
and giving it world leadership. His pupil, Dr. Simon Flexner, professor of pathology at the University of Pennsylvania, became the leader of the Rockefeller Foundation, and along with others, took part in the organization of the China Medical Board, and later the Peking Union Medical College, exporting American medical innovativeness worldwide. Interestingly, Dr. Flexner was dispatched to California to stem the spread westwards of bubonic plague that had intermittently affected residents of California. Dr. Victor Heiser, who, while a medical student, had met Dr. Welch, with whom he became lifelong friends, was responsible for pioneering public health programs to prevent and eradicate a variety of endemic and epidemic communicable diseases in over 45 countries, utilizing and promoting American medical best practices. Other great innovators at the time included Dr. Milton J. Rosenau of Harvard, whose volume on preventive medicine was a classic on the subject, and Harry Pratt Judson, president of the University of Chicago. As medical knowledge took a quantum leap, it compelled William Mayo, in addressing medical school graduates, to proclaim that medical knowledge had expanded so rapidly, and so extensively, that no one doctor could know it all, and that we had to specialize and separate ourselves into specialties, but work together in a clinic setting, for the good of the individual patient. These are just a few of the leading innovators in the principles and practice of medicine, inspired by Sir William Osler’s 1898 publication. This early momentum spawned a plurality of foundations, universities, private companies, entrepreneurs, businessmen, politicians and individuals to support and spur medical ingenuity an innovativeness that has led to America’s pre-eminence in global medical practice. Today, as a result, modern medicine is capable of incredible feats of human preservation and health promotion. The Bay Area of Texas, with NASA engineering, worldclass corporations and an international trade hub, has attracted the best experts and expertise in medical care and technology, and has led to tremendous accomplishments in the continued development of the practice of medicine, with international implications. It is indeed a privilege to be associated with this publication, which is devoted to sharing with you the many state-of-the-art capabilities of our specialists and facilities in the area, and I will be highlighting and showcasing some of the Bay Area’s best practices. Victor Kumar-Misir, M.D., is an international physician, who has spent the past 40 years integrating translingual, cross-cultural healthcare delivery with emerging information-management technologies, with the goal of delivering healthcare to all individuals, regardless of language, literacy, location or level of income. Third Quarter 2012 | www.BestPracticesMD.com|
9
Keeping Your Toddler Safe Around Swimming Pools By Stephen G. Kimmel M.D.
T
he State of Texas is blessed with long hot summers sandwiched between a warm spring and fall; perfect swimming weather for more than half the year. Swimming pools can be great fun and provide relaxation for the entire family, but pools can also be extremely dangerous for young children. According to the Centers for Disease Control, drowning is the leading cause of injury death for children under five years of age. Since toddlers’ capabilities change daily, they frequently do something unexpected. You must plan ahead for the time your child starts to crawl, or walk, or climb. Submersion incidents usually happen in familiar surroundings. Two-thirds of drownings occur in a pool owned by the child’s own family. At the time of the incidents, most victims were being supervised by one or both parents. Seventy percent of children were not expected to be at or in the pool, yet they were found in the water. Instead, they were thought to be in the house, in the yard, or on the patio or porch. As any parent knows, you cannot be sure of your child’s whereabouts at every moment of the day. Pool submersions involving children happen quickly. A child can drown in the time it takes to answer a phone. Seventy-five percent of drowning victims are missing from sight for five minutes or less. Child drowning is a silent
“Teach children to float or swim as soon as possible.”
10 |www.BestPracticesMD.com | Third Quarter 2012
death. There’s no splashing to alert anyone that the child is in trouble. Barriers to the pool include a fence or wall, door alarms for the house, and a power safety cover over the pool. Barriers also may be used to protect children from accessing hot tubs and spas. Barriers are not childproof, but they provide layers of protection for a child who strays from supervision. Barriers give parents additional time to locate a child before the unexpected becomes a reality. There should be a fence at least 48 inches high around all sides of the pool with a locked gate to keep children out when there is no supervision. It should be constructed so that there are no foot or hand holds that could help a young child to climb it. Vertical fence slats should be less than four inches apart to prevent a child from squeezing through. Fence gates should be self-closing, self-latching, and wellmaintained to close and latch easily. The latch should be out of a child’s reach. For aboveground pools, steps and ladders leading from the ground to the pool should be secured and locked, or removed when the pool is not in use. Lawn furniture, plants and bushes should not be close enough to provide a boost over the fence. Always close and lock gates and fences if you will not be near the pool. Doors leading from the house to the pool should be protected with alarms that produce an audible sound when a door is unexpectedly opened. The key pad should be placed high on all doors leading from the house to the pool. An alarm signal immediately tells a parent that a door has been opened. Power safety covers over the pool may be used as an alternative to door alarms. A power safety cover is a motor-powered barrier that can be placed over the water area. Motordriven covers easily open and close over the pool. When the power safety cover is properly in place over the pool, it provides a high level of safety for children under five years old by inhibiting their access to the water.
Never leave a child unsupervised near a pool. During social gatherings near a pool, designate an adult to watch the pool while children are playing. When adults become preoccupied, children are at risk of drowning. Always provide competent adult supervision when the pool is in use. Teach children to float or swim as soon as possible and keep rescue devices near the pool. Teach children what to do in case of emergency. If a child falls into a pool, survival depends on rescuing the child quickly and restarting the breathing process, even while the child is still in the water. Seconds count in preventing death or brain damage. Instruct babysitters about potential pool hazards to young children and about the use of protective devices, such as door alarms and latches. Emphasize the need for constant supervision. If a child is missing, check the pool first. Seconds count in preventing death or disability. Go to the edge of the pool and scan the entire pool, bottom and surface, as well as the pool area. Do not allow a young child in the pool without an adult. Remove toys from the pool when it is not in use, as toys can attract young children to the pool. While important, swimming lessons are not a substitute for careful supervision. Also, do not use flotation devices as a substitute for supervision. Learn CPR (cardiopulmonary resuscitation). Babysitters and other caretakers, such as grandparents and older siblings, should also know CPR. Be sure a telephone is poolside with emergency numbers posted nearby. Swimming pools are a fun and healthy way to spend time outdoors during the warm weather months. A certain amount of vigilance is always needed around a pool. Awareness of the risks, especially for toddlers, will ensure that your family will continue to enjoy your pool safely for years to come. Dr. Stephen G. Kimmel is a Pediatric Surgeon for Pediatric Surgery Associates of Clear Lake.
What is Diabetes? By Tish Wright
DIABETES IS AN EPIDEMIC IN AMERICA. The statistics are staggering, with the numbers of new diabetes cases in the millions; rising from 5.6 million in 1980 to 20.9 million in 2010, according to the Centers for Disease Control (CDC).
T
he numbers of diagnosed adult diabetics in the U.S. has increased from 8.7% of the population in 2002 to 11.3% in 2011. Estimates indicate that 3,600 cases of type 2 diabetes in youth (under 20 years of age) are diagnosed each year. Accurate statistics on children with diabetes and obesity have never been kept before, but the medical field has been inundated with children and youth diagnosed with the disease in recent years. There are obvious reasons why this increase in prevalence is happening. If you go to the CDC website (www.cdc.gov), you will see a plethora of information about the rise of diabetes and obesity in our country. It is beyond scary! The increase in the diagnosis of diabetes correlates with the rate of obesity. Obesity among the adult population in the U.S. has increased from 20% in 2000 to 28% in 2010 and obese persons (adults and children) now represent 35.7% of the U.S. population. In the medical field, we see a great number of people in the “pre-diabetic” category, or what we officially call “Impaired Glucose Tolerance.” And as you probably know, this can, and more often than not, lead to a diagnosis of diabetes. We hear many horror stories about how devastating diabetes can be. The loss of limbs, heart attack, kidney failure, blindness and erectile dysfunction are just a few of the complications associated with uncontrolled diabetes. I am sure you know of someone who has suffered from at least one of these outcomes. But the reality is life with diabetes does not have to follow this path. I have had type 1 diabetes for 34 years and have no complications associated with the disease, but I am here to tell you that living with diabetes is hard work. I call diabetes a self-care disease, but with the help of medical personnel and technology, living a long healthy life is a possibility! There are many types of diabetes, but in part one of this two-part series, I will explain, very simply, type 2 diabetes, followed by type 1. Diabetes is diagnosed when the fasting blood sugar level is more than 126mg/dl on two different occasions, or any random sugar is over 200mg/dl. Type 2 diabetes results from the combination of insulin resistance, glucose (sugar) release from the liver, and the decreased output of insulin that occurs when the pancreas cannot keep pace with the amount of sugar coming from carbohydrate foods. Insulin’s job is to pick up digested food (mostly sugar from carbohydrates) that has been dumped
12 |www.BestPracticesMD.com | Third Quarter 2012
into the blood stream from the gastrointestinal tract. When sugar rises in the blood stream, additional insulin is released from the pancreas, where the insulin “picks-up” the sugar and carries it to cells that are signaling they are hungry. The insulin attaches to a receptor site at the edge of the cell, allowing the sugar to be placed inside the cell for energy. In type 2 diabetes, one of the main problems is the lack of receptor sites, or what is termed insulin resistance. If sugar cannot be placed inside the cell due to the lack of receptor sites (which occurs in type 2 and in obesity) the sugar is instead stored as fat. Thus, most people with type 2 diabetes are overweight or obese. In addition to the problem of insulin resistance, the liver releases sugar into the blood stream when feeding the signaling starving cells. This process causes the pancreas to overwork in order to release the needed insulin, which can eventually wear out the organ. Type 2 is a vicious cycle that must be broken and YOU DO have the power to make a difference by doing a few simple things to reverse this physiologic cycle and delay or prevent the diagnosis of diabetes. There is no fix-it-all pill, but there are many medications available to help. Making lifestyle changes is the MOST POWERFUL tool you have to reverse the insulin resistance and give the pancreas a needed break. Here are a few simple things you can do to slow down, reverse and control blood sugars:
Eat less. Yes, just EAT LESS. If you normally eat six tacos, eat three or four. If you pour the salad dressing on, put it on the side. If you get a large order of French fries, get a small. This is so simple and it makes a big difference in the long run. Think “small, permanent changes for life.” Avoid all sweetened beverages. Do a comparison. One diet soda has 0 calories and 0 carbohydrates, while a regular one has 150-plus calories and 38 grams of carbs. A Starbucks Grande (medium size) Caffe Mocha has a whopping 370 calories compared to the non-fat, no whip serving, which has 220 calories, a deficit of 150 calories. If you consume 3,500 calories less than what you need to maintain your weight, you will lose a pound of fat. If you usually drink three sodas a day (totaling about 450 calories) and you switch to the diet variety, you have the potential to lose four pounds a month. WOW!
Move your body. Yes, I know you have heard of it. Exercise. Do simple things like “shake ‘n it” during every commercial break while watching TV. With an average of over 20 minutes of commercials during an hour-long show, think of the calories you can burn by doing leg lifts, arm circles, situps, or arm curls with dumbbells or even cans of green beans. Get up and dance for two songs and you’ve just exercised for about 10 minutes. Park at the back of the parking lot, take your dogs for a walk (they need exercise, too), or go for a walk with the kids. They may not like it at first, but they will eventually tolerate it! If pain keeps you from walking, then put on your swimsuit and walk in the water. It takes more energy to push water out of your way than air. Doing activities together is a great time to connect with your spouse or children. Being overweight is no fun and getting support from parents or loved ones can make all the difference in the world to someone’s health. So, take control and make a commitment. I have to say, of everything that is asked of those living with diabetes, getting regular EXERCISE is THE MOST POWERFUL, but, unfortunately, we don’t heed the advice. Healthy weight loss and life choices are a lifelong commitment. The research tells us that slow and steady wins the race when it comes to weight loss and the prevention and control of type 2 diabetes. I hope this article helps you understand type 2 diabetes and motivates you to make healthful choices by incorporating simple lifestyle changes. I can tell you from both personal and professional experience that these changes will help you control your diabetes and make a difference in your life. Remember, doing something is better than doing nothing! Next issue. Part two: type 1 diabetes. Tish Wright, MS,RD,LD,CDE, is a diabetes educator and a registered dietitian at Texas Children’s Hospital.
Bay Area Houston Boasts World-Class Medical and Wellness Facilities By Rod Evans
COOL BAY BREEZES, close proximity to dozens of coastal destinations and a more relaxed, casual way of life are just some of the numerous reasons why the Bay Area Houston region attracts thousands of new residents each month, making it one of the fastest growing areas in Texas.
T
he constant influx of residents, many of them baby boomers and retirees looking for a less stressful landing spot, creates a vibrant atmosphere, including a variety of restaurants, nightclubs, shopping centers and other entertainment venues, but it also raises the need for world-class health care facilities. Fortunately, Bay Area Houston is well served in that respect. Health care spending in the U.S. continues to soar. Current estimates by the Office of the Actuary (OACT) of the Centers for Medicare and Medicaid Services put health care spending at about 16% of gross domestic product (GDP), totaling more than $2.5 trillion, or $8,047 per person, in 2009. Health insurance costs are rising faster than wages or inflation, and according to the Congressional Budget Office (CBO), more than half of the growth in health care spending is due to changes in medical care made possible by advances in technology. In the Bay Area “Super Region,” which encompasses 24 cities in a 30-mile radius with a population north of 3.4 million people, health care is the fastest growing segment of the
14 |www.BestPracticesMD.com | Third Quarter 2012
economy, trailing only the commercial chemical and aerospace industries in economic impact and sheer numbers of employees. The region has developed the reputation as the “Medical Center of the South” thanks to top flight physicians and facilities in the area. “We call the region the health care corridor,” said Bob Mitchell, president of the Bay Area Houston Economic Partnership. “We have a strong health care committee in our organization of 27 local health care institutions that work together to keep dollars in the region and to tap into the resources we have here.”
“Health care is the fastest growing segment of the economy, trailing only the commercial chemical and aerospace industries.”
The Partnership works to attract new businesses to the area and to retain current industries and one of the main selling points is high quality health care services. Mitchell says industries considering either moving to the Bay Area or starting a new business here want to ensure that they will be able to attract talented employees in sufficient numbers, and having access to great health care is a top priority. “Health care is one of the top economic development tools we have. It’s a quality of life issue for any company looking to expand here. Having first rate health care is important to the success of the region,” Mitchell said. While Mitchell says the chemical production and processing industry, with 27,000 to 33,000 direct employees, is the industry responsible for the largest number of workers in the region, followed by aerospace, with approximately 13,500 post-shuttle program employees, health care, with over 2,200 physicians who provide care for more than 1.7 million patients annually, and a 4,000-plus total workforce, is the fastest growing segment of the local economy.
“They take some of the most deadly diseases and help create cures and treatments. They also create bugs that could be potentially used in terrorist attacks and work to find solutions to them,” Mitchell says.
about 500 by its third year of operation. The hospital will include three surgical/ medical floors, 10 operating rooms, endoscopy procedure rooms, emergency rooms, neonatal intensive care units and multiple floors of patient rooms. The facility, located at 200 Blossom in Webster, will be operated by Surgical Development Partners.
Staying at Home While the medical facilities in the Bay Area are unquestionably top shelf, getting that message out to area residents has not been easy for health care and economic development professionals alike. Because Houston’s TMC is, perhaps, the finest such center in the world, boasting 51 member institutions, the improvements in facilities and care provided in the Bay Area region are at times overshadowed by the dizzying pace of construction of new facilities in the TMC.
“The medical facilities in the Bay Area are unquestionably top shelf.”
First Rate Facilities Opened in 1972, Clear Lake Regional Medical Center in Webster, is the first hospital south of Houston’s Texas Medical Center (TMC) offering comprehensive pediatric services, including a Level IIIb neonatal intensive care unit, 17-bed dedicated pediatrics unit and a 10-bed pediatric intensive care unit. It’s also home to the Heart & Vascular Hospital.
Webster’s Houston Physician’s Hospital is one of the premier surgical facilities in the area, specializing in orthopedics, ear, nose and throat procedures and neurosurgery. The hospital also works to improve the patient stay experience by offering “hotel-inspired” private rooms offering a variety of amenities, such as high quality mattresses, a fold-out couch for patient family members and a low nurse-to-patient ratio. Meanwhile, Bay Area Regional Medical Center will be a 375,000-square-foot acute care facility when it opens in 2013. The hospital will initially have 104 beds, but a capacity to accommodate 175 beds on its eleven floors. The facility is expected to have a full-time staff of 152 upon its opening, but projections indicate the workforce will rise to
Other prominent, Bay Area medical institutions include Cornerstone Hospital in Clear Lake, Clear Lake Rehabilitation Hospital in Webster, Christus St. John Hospital in Nassau Bay, Memorial Hermann Southeast Hospital and Triumph Hospital-Clear Lake. Two facilities of regional, as well as national, importance are the National Bio Containment Training Center and the Galveston National Laboratory, both located on the campus of the University of Texas Medical Branch (UTMB) in Galveston. The Training Center is tasked with preparing the nation’s top infectious disease scientists to work safely in high containment An example of how researchers research labs. The work in a maximum containment lab such as Galveston National Galveston’s National Laboratory. Laboratory, one of two national labs constructed with funding awarded in 2003 by the National Institutes of Health, works to develop vaccines, therapies and diagnostic tests on naturally occurring emerging diseases such as SARS and West Nile disease.
Betsy Giusto, director of economic development for the city of Webster, says getting the word out to residents about the level of care available in their backyard is an ongoing effort. “People used to have to go to Houston for cardiovascular care, but now they can get the same high level of care here. The same with pediatric care,” Giusto says. “A lot of people still don’t realize that the care available here is as good as any place you’ll find. There’s still the perception that you have to go to Houston if you have a serious health issue. But many people are finding out that you don’t need to use a navigation system or pay high parking rates. The parking at our facilities is patient friendly.” For Mitchell, whose organization is involved in 52 different initiatives designed to recruit new businesses to the area, relaying the message of the superb Health care facilities in the Bay Area is of utmost importance. Despite the disappointment from the loss of the Space Shuttle program and its accompanying jobs, he says the region continues to thrive in large part due to increases in the health care sector. “We have everything that the Texas Medical Center has to offer,” Mitchell says. “It’s just a matter of getting people to understand and getting the information to them.” Third Quarter 2012 | www.BestPracticesMD.com|
15
New Bill Requires Texas Schools to Appoint Concussion Oversight Team By Thea Lockett, Med, ATC, LAT CHRISTUS St. John Concussion Center
L
ast summer, Texas Governor Rick Perry signed into law a new concussion bill known as “Natasha’s Law.” This bill will help make certain that athletes at Texas charter and University Interscholastic League (UIL) schools are fully recovered before returning to the playing field following a concussion. According to the National Federation of State High School Associations, about 140,000 U.S. high school students suffer a concussion each year. Under this new bill, all Texas UIL and charter high schools and middle schools will now be required to establish a written concussion protocol to protect student-athletes suffering from concussions. Natasha’s Law—named after Natasha Helmick, a student at Texas State University whose soccer career ended after sustaining five concussions in four years while in high school—will be put into effect as directed by the Commissioner of Education. Part of the protocol requires that any athlete suspected of suffering a concussion be immediately removed from practice or play. After a child is pulled from participation, these are some signs and symptoms I tell parents to watch for upon returning home: • • • • • • •
Headache Dizziness Slurring of speech Stumbling/off balance Vomiting/nausea Ringing in the ears Difficulty with memory
16 |www.BestPracticesMD.com | Third Quarter 2012
After the child goes to bed, I also recommend parents wake them every two to three hours to make sure they are responsive. If these signs or symptoms worsen or intensify, it is recommended the child be taken to the emergency room.
“About 140,000 U.S. high school students suffer a concussion each year.”
team will establish criteria, or stages of exertion, each athlete must complete before returning to play. These stages, which begin with low-level physical exercise and progress to full participation, will make certain that the student does not return to full activity before he or she is ready. It is only when the player has passed the stages of exertion, obtained physician approval and signed (along with his or her parent/guardian) a release form will they be eligible to play again. It’s important for parents and students to note that concussions have little to do with structural damage to the brain and much more to do with hormonal changes and energy deficits. It’s about function, not structure. A brain that appears completely normal upon physical exam and imaging tests may still need time to heal. Physical and mental difficulties can linger. To help with the recovery process, here are some steps parents can take at home: • •
Once a child is removed from competition or practice by their coach, athletic trainer, physician or parent/guardian, Natasha’s Law requires athletes be evaluated and cleared by a physician before he or she can return to play. Implementing this law will help prevent students from reengaging in the sport too soon. If athletes return to play before they have fully recovered, they increase their risk for a much greater injury, such as a brain hemorrhage, which can have fatal consequences. Natasha’s Law requires each school to appoint a concussion oversight team to manage the concussion program. The oversight team must consist of a physician, as well as an athletic trainer, advanced practice nurse, neuropsychologist or physician assistant. This
• •
• •
Make sure your child gets lots of rest Avoid things that make the symptoms worse, such as loud noise from music or classmates at school Delay school work and tests for a few days Make sure they avoid texting and video games, as these activities put strain on the brain Don’t allow them to watch TV or use the computer in the dark Avoid drinking caffeine and citrus products
At CHRISTUS St. John Hospital, we’ve developed a concussion management program that is available to schools throughout Texas, and we currently work with local schools to implement their concussion protocols. It has always been our standard of care to have athletes complete the stages of exertion before returning to play. This standard makes playing the sport they love safe for the athlete again. Thanks to Natasha’s Law, this will now be the standard throughout the State of Texas.
How Does My Hospital Compare? By Santiago Mendoza, Jr.
While sitting at a physician’s office the other day, I observed two ladies in the waiting room doing what we (most men) don’t do well: communicate.
T
hey were complete strangers, yet had so much in common and so much to share with each other. “I’m new to the area. Are you from around here?” said the first woman. “Yes. I’ve lived here over 15 years,” responded the second woman. I continued to listen to their interaction simply because there was nothing else for me to do. I already knew how many ceiling tiles were above me and I didn’t want to pick up one of the magazines next to me. I had already heard that Prince William had recently gotten married from my wife and daughter. Anyway, the ladies’ conversation turned into a review of anything and everything, even health care. This is when they really got my attention. “What doctor do you recommend for___?” “What’s the best hospital in this area?” “I’ve heard stories about (hospital)” “Who’s your dentist?” At this point, I couldn’t just sit there and not get involved in the conversation. Besides, this is my area of expertise. Luckily for them, I had my trusty iPad and was able to show them a website I share with everyone I meet that has questions about hospitals in the area: www. hospitalcompare.hhs.gov.
“When you are sick and have to go to the hospital, you want to know that you’re getting the highest quality care. And if you’re choosing between hospitals, you should be able to make an informed choice and compare the quality of hospitals in your area.” According to Stephanie Cutter, former assistant to the President for special projects and a blogger on the White House.gov blog, “When you are sick and have to go to the hospital, you want to know that you’re getting the highest quality care. And if you’re choosing between hospitals, you should be able to make an informed choice and compare the quality of hospitals in your area. That is where Healthcare. gov comes in.”
18 |www.BestPracticesMD.com | Third Quarter 2012
By visiting HealthCare.gov, you can quickly access the Hospital Compare tool that analyzes and compares data about the quality of care at more than 4,700 hospitals across the country. Simply type your zip code or city and state to access a wealth of information, including a review of 44 quality measures, such as how well your local hospitals handle conditions like heart attacks and diabetes. Hospital Compare has long been an important resource for patients and it’s only getting better. Since its inception, Hospital Compare has added new data on the use of medical imaging equipment like MRI machines, new information on the quality of care patients with suspected heart attacks receive and data about infection rates following outpatient surgeries. Here is a step-by-step explanation of how to compare hospitals in your area (or anywhere in the country) to help you become a better educated health care consumer: Step 1: Log onto www.hospitalcompare.hhs.gov Step 2: Enter the Zip Code you live in or city and state. I always leave the search type on “General.” The general search provides information on “Hospital Process of Care Measures,” “Hospital Outcome of Care Measures,” and “Survey of Patient’s Hospital Experience.” Step 3: Click “Find Hospitals.” Step 4: Select the top three hospitals in your area and click on “Compare” (it will only allow you to compare three hospitals at one time). Step 5: Once the data appears, I find it easier to click on “View Graphs” or “View Tables” in order to see if a hospital exceeded or fell under the Texas and/or national average. It felt great sharing information with these two women that will help them make educated decisions when selecting a hospital for their health care needs. All in all, the conversation was beneficial to all those involved, as I walked away with an allergy-free blueberry muffin recipe that I will try this weekend and a lead on a potential new hair stylist for my wife. Santiago Mendoza, Jr. is the COO, secretary and founder of Best Practices.
I WAS SITTING IN A WAITING ROOM for a doctor’s appointment recently when the outside door opened to a half full waiting area and in stepped an older man wearing a Panama hat and beige linen slacks.
H
e loudly tapped on the glass partition to get the receptionist’s attention. She reluctantly opened the glass and he blurted out, “I’m from out of town. I’m a traveling salesmen and don’t have a ‘regular’ home, but I need to see a doctor!” The receptionist asked, “Do you have an appointment?” and the man growled, “No!” She was kind enough to look for an opportunity to make him an appointment or have the physician see him, and I began to wander how do doctors’ offices keep track of “wandering salesmen” and their health care needs? How does a physician keep track of his/her consultations with other physicians? Did he ever speak to that physician or leave a message with another busy doctor’s office? It’s almost like the “Who’s on first?” skit. And who is ultimately responsible? It is no wonder it is a struggle to keep track of your patients. In today’s world of complex health care, keeping track of your patient population is not as easy as you might think even with the number of communication methods available. I recently saw two algorithms on the complexity process of a nurse making an appointment for a patient and another algorithm for refilling a prescription. The appointment process took 34 steps, starting with the phone encounter, and continuing with whether she reaches the patient or not, checking the physician’s schedule, and documenting it in the computer. The list
20 |www.BestPracticesMD.com | Third Quarter 2012
went on and on up to the finale of making the appointment. The refilling of one prescription can take up to 68 steps. The daily struggle of staying in communication with patients and keeping information close at hand presents new challenges. Which physician was consulted? Did you get in touch with Dr. X or Dr. Y about Jon’s Smith’s knee films? And to make matters worse … The American College of Obstetrics and Gynecologists (ACOG) Opinion #461 issued in 2010 does not appear to help matters. In a
By Amanda Kuenstler
otherwise would be a “breach.” This opinion, the writers state, places a great deal of responsibility on a physician to “be the patient’s keeper.” According to Opinion #461: “Failure to follow up may cause delayed or missed diagnoses, which may result in an adverse patient outcome and potential liability for the health care provider. Courts have held that the health care professional is responsible for contacting patients about laboratory, imaging or consultation results; however, patients have the responsibility to follow through on their health care provider’s
“Keeping track of your patient population is not as easy as you might think even with the number of communication methods available.” 2012 article about physician offices tracking systems in the publication AAOS Now (American Academy of Orthopaedic Surgeons) by E. Burke Giblin and Christina Scarpa, the writers quote ACOG Opinion #461 stating, “Healthcare providers’ offices should have procedures in place to track these events effectively and to enhance quality of care and patient safety.” According to Giblin and Scarpa, both attorneys, plaintiff attorneys are already planning to use this opinion to their advantage, setting the stage for absolutes and citing “standard of care” for all physicians. To do
recommendation. An Adequate tracking system can help reduce the risks and provide safe, high quality patient care.” (Committee Opinion, 2010) When writing claim summaries, a legal nurse consultant will include whether it is clear from the medical record what instructions were given to the patient. Is the patient to go to a specialist? Did they go? If they didn’t go, she can check to see if documentation is placed appropriately. If the patient chooses to not show up, documenting this information is also valuable information. Were there any calls made to see what happened to the patient? Why didn’t they show up?
ACOG Committee Opinion #461 on Tracking and Reminder Systems states: 1.
Healthcare providers must explain to the patient the need for any tests, referral or follow-up, and the risk of non-compliance and document this discussion in the patient’s chart.
2.
Open items must be promptly logged into an electronic or paper tracking or reminder system that must be reviewed frequently and regularly in accordance with established practice policies and procedures.
3.
Physicians must schedule follow-up appointments when indicated and discuss with the patient the importance of keeping the follow-up appointment.
4.
If a patient does not appear for a scheduled appointment, the fact should be noted in the chart (e.g. 3/8/11 – No show for 2 p.m. appointment). Attempts should be made to contact the patient and reschedule the appointment, and those attempts should be documented (e.g. 3/10/11 – Patient called re missed 3/8 appointment. Rescheduled for 4/2/11).
5.
If a physician refers a patient to another health care professional, the referral should be tracked in a tracking or reminder system. It should also be noted in the patient’s records whether the patient visited with the health care provider to whom the referral was made. If the consulting doctor provided a report, its receipt should be noted, and a system should be in place that ensures the report has been reviewed by a physician prior to being filed in the patient’s chart. All these components of a consultation or referral should be addressed by the practice’s tracking system.
6.
7.
If a health care provider has a patient referred to him or her by another health care provider, the physician/consultant has an obligation to notify the referring health care provider once the patient has been seen and send a consultation report that includes the consultant’s findings and recommendations. When contacting patients via a practice reminder or tracking system, HIPAA regulations must be followed: a. Postcard communication of patient information is not HIPAA-compliant. b. Physician and staff must recognize that email communication is not HIPAA-compliant unless both the provider’s and the patient’s email systems are secure. Most personal email services are not secure.
c. Physicians and members of their practice staff should limit the amount of information left on a patient’s answering machine or in messages when a person other than the patient answers the telephone. It is preferable to leave only a name and telephone number and ask that the patient return the call, without disclosing any specific patient information. 8.
9.
Reminder systems should be set up to contain specific data and dates, including dates for receipt of information and timelines for notifying the patient. For example, if a patient is referred for a test, the practice tracking or reminder system should contain a date by which time the test should have been completed and the results received (e.g., two to three weeks after referral). The length of time will vary depending upon the specific set of circumstances and the urgency of the patient’s needs. If a patient does not go for the recommended test in a timely manner, it is suggested that it is the responsibility of the physician to have a procedure in place to remind the patient either by telephone, letter, or some other form of notification. Physician practices should keep their tracking and reminder system in a physical or electronic location in the office that is readily accessible to all appropriate staff. The tracking and reminder system should not be the responsibility of only one person; several appropriate office staff members should be cross-trained in the system’s operation for maximum efficiency and reliability.
10. All printed test results should be reviewed, initialed, and dated by a health care provider who has been designated to perform this function. Only then should printed test results be filed permanently in the patient’s chart, along with a notation of what follow-up testing or procedures were recommended or required in light of the initial test results.
“Physicians can find themselves at the sharp end of a complicated claim...if special attention is not paid to tracking and reminder systems.”
11. Patients should be made aware of the office’s procedures for notification of test results; however, as a fail-safe, patients should also be instructed to call for test results if they are not received in a timely fashion or within the usual time parameters set by the practice. Physicians can find themselves at the sharp end of a complicated claim. The lack of efficiency and documentation can leave a physician unsheathed if special attention is not paid to tracking and reminder systems. Amanda Kuenstler is the owner and president of Kuenstler Consultations, Inc., a legal nurse consulting company. Third Quarter 2012 | www.BestPracticesMD.com|
21
The Power of Video (Part 1 of 2)
By Danny Gutknecht
C
isco states that by 2014 video will make up 90% of all content on the internet. As a physician, video can be tricky. Video with a heavy sales or marketing perception can quickly place your reputation in the wrong category. On the other hand video is a way to stand out as a provider in your region or perhaps nationally. It can be a very cost effective marketing tool that allows you to control your practice brand. Very few businesses have come to understand that audiences have not only become immune to traditional marketing and selling, but they want something more natural. Additionally, people need to hear things in little bytes over time. Familiarity leads to trust and ultimately action. If you are considering adding video to your site, or to use it as a tool, there are a few important things to consider. The first is content. While videos with lengthy procedures or extreme detail may be impressive; a potential patient may watch such video then opt to see another physician. Why? Well they may know that getting a hip replacement is major surgery, but they may not want to call the guy who was pounding that ball into the top of that poor man’s femur. The second factor is style. People don’t particularly like over-marketed videos with b-roll cuts showing the office and explaining why you have a great clinic. They want unscripted talk and eye-to-eye contact. They want to have confidence in you as a care provider and know that you will listen and are available. Last, tell your story! People want an emotional connection with anyone they do business with. Telling your story in a unique way will not only help connect patients to your practice but can act as a powerful word-ofmouth tool. This will give your video a chance to be sent from patient to patient and allows you to keep a clear message online. Remember video can be a powerful tool if used correctly. In part two of this series we will discuss some very simple processes you can put in place to increase patient engagement and referrals with the use of videos. Danny Gutknecht is the CEO and co-founder of Pathways Platform a video-based internet company serving the healthcare industry.
22 |www.BestPracticesMD.com | Third Quarter 2012
Sucré-Vail Offers Financial Wellness Through Wealth Management to Physicians By Betha Merit
M
anaging your own financial path can be a full time job. Add a thriving medical practice or your own business to the mix, and there are not enough hours in the day. An established expert can step in to streamline the process for you. SucréVail Wealth Advisors specializes in financial wellness and wealth accumulation. The firm offers comprehensive advice around issues unique to high net worth families and business owners so as to be your family physician of finances. They hold the MD Preferred Financial Advisor Medallion Award. You keep control of the path. Sucré-Vail Wealth Advisors’ primary objective is to take you on a journey beyond wealth. Their Interactive Wealth Management Solution provides your own personalized home page so you can access a Living Balance Sheet, all your assets, important documents and account information in one secure, convenient location. They serve as your independent advocate coordinating all aspects of your life. Their goal is to harmonize your unique situation and choices regarding Life Events, Financial Advisory, and Advisory Service and Management. The five pillars of their investment philosophy include asset allocation, portfolio construction, manager selection, and continuous monitoring and tax management. One Life Event Strategy is wealth transfer or wealth succession. How do you set up a structure to train your successors and protect wealth that will be given to them? Sucre’Vail Wealth Advisors is fee-based and can work with your accountant, broker, banker, or tax advisor to manage and design your wealth strategies. This is paperless, so in the event of a hurricane or natural disaster you can remotely access all your information and nothing is lost. Owner, Margaret Sucré-Vail, and Henry Vail II, share their mission, “To manage our busy clients’ life and wealth affairs, with outstanding strategic partners that allow us to deliver a consistent unequalled level of service
and best in class solutions, with the highest level of competence and integrity.” They offer over 60 years of investment industry experience. Happily married, they have lived almost 20 years in Bay Area Houston, raising their two children and now enjoying time with their three grandchildren. Community is important to them; they each serve in many Bay Area Houston associations and organizations. Sucré-Vail is a specialist in financial services and the principal at Sucré-Vail Wealth Advisors. She completed her certified financial planning studies at the University of Houston, and is an Investment Advisor Representative with Sucré-Vail Wealth Advisors. In 1982 she began her career in the insurance industry. “I immediately realized my passion for working with people to ensure they were protected from unnecessary risk,” says Sucré-Vail. Additionally, she received extensive, specialized training in the psychology of the financial needs of health care professionals. Henry Vail II is a wealth advisor and business partner with Sucré-Vail, he is also an Investment Advisor Representative. His experience was acquired at Wall Street investment firms as an estate planner working with affluent clients. He holds a bachelor’s degree in Business Administration/Finance from Lamar University and completed his certified financial planning studies at the University of Houston. He received specialized training in the psychology of the financial needs of health care professionals. Vail was named to the prestigious 2011 Houston Region Five Star Wealth Managers, chosen from a partnering of Five Star Professional and Texas Monthly magazine that surveyed Houston area high net worth households and then selected less than 2% of licensed wealth managers to the final list. Located at 16862 Royal Crest Drive, Houston, TX 77058, their phone is 888.286.9991, website is www.sucrevailwa.com.
Lift, Firm and Tighten Facial Skin Without Surgery
W
hen you look in the mirror, does your face look tired? As skin ages, it begins to “mature” and relax, gradually looking and feeling less firm. After age 30, one of the first signs of aging may be a lowered eyebrow line or sagging skin on the eyelids. There is now a new solution for loose, sagging skin with no facelift required. Ultherapy® is the perfect solution! If you’re a TV viewer, you’ve likely seen Ultherapy® featured on 20/20, The Today Show, Martha Stewart, Good Morning, America or The Doctors. Ultherapy® is a new, non-surgical procedure that uses tried-and-true ultrasound technology to gradually lift, strengthen, and tone the skin on the face and neck. In about 90 mins, you’ll be on your way to a fresh new look, with no downtime at all. You’ll enjoy tighter, firmer, better-fitting skin for up to three years, without
the risks of traditional surgical lifts. Ultheraphy® treats the same deep foundation of the facial soft tissue that is addressed in cosmetic procedures. This new treatment targets the collagen under the skin through the use of non-invasive, tried-and-true ultrasound. Collagen is a natural protein that gives skin its youthfulness by keeping it firmed and toned. As skin ages, collagen loses its strength and the ability to stand up to the effects of gravity on the skin. Ultherapy® jump starts a repair process that strengthens existing collagen and produces fresh, new collagen. While Ultherapy® is not a replacement for a surgical face lift, there are many patients looking for smoother, tighter skin but are not ready for surgery – mentally, financially, or logistically. Ultherapy® is even an option for younger people wanting to stay ahead of the aging game.
Area Health Care Businesses Partner With Education Foundation
Sunscreen Rules: Changes Simplify Label Language
By Doug Frazior
I
n an effort to promote excellence in the Clear Lake area workforce of the future, a variety of health care businesses are forming partnerships with the Clear Creek Education Foundation. Health care is now one of the five largest industries in the area, and medical professionals are providing resources to enhance educational opportunities in the Clear Creek Independent School District (CCISD). The Texas Gulf Coast Medical Group has partnered with the Education Foundation to help prepare CCISD students to excel and bolster the area’s 21st century workforce. Recently, Dr. Michael Lyons, the organization’s president and CEO, presented a lead gift donation to help support the Foundation’s innovative education programs. These programs, such as awarding grants to CCISD teachers to fund creative instructional projects, help enrich the learning experience in areas such as math, science and technology. Due to reductions in state funding for public education, it is more important than ever for additional resources to be generated to help maintain high academic standards throughout CCISD. Donations to the Education Foundation by health care firms, such as the Texas Gulf Coast Medical Group, will help provide opportunities to students to help them become better prepared to be a part of the growing Clear Lake area health care community. Doug Frazior is the executive director of the Clear Creek Education Foundation. He can be reached by calling 281-284-0031, or by emailing dfrazior@ ccisd.net.
UT MD Anderson experts comment on biggest upcoming FDA sunscreen changes
S
unscreen labels can be confusing and at times misleading. That’s why dermatologists at The University of Texas MD Anderson Cancer Center applaud the upcoming U.S. Food and Drug Administration (FDA) label changes that help consumers understand exactly what they’re buying. “This is good news because choosing the right sunscreen — and applying it correctly — can help protect your skin from harmful UV rays that can cause skin cancer,” said Carol Drucker, M.D., associate professor in MD Anderson’s Department of Dermatology. Starting in June, sunscreen makers will be required to use labels with simpler language. Listed below are the biggest changes consumers can expect to see. Labels force manufacturers to be honest Here’s what the new sunscreen labels must — and must not — tell consumers: • Sunblocks: No product completely shields users from the sun. So, sunscreens won’t be labeled as “sunblock” anymore. • SPF level: A sun protection factor (SPF) of 15 or more means a product lowers the risk of skin cancer and aging. Not so for SPFs from 2 to 14; they only help prevent sunburn at best. Sunscreen labels will have to be clear about how much SPF they provide — and whether they actually curb a person’s risk of skin cancer and aging, or just help prevent sunburns. • Broad spectrum: To be labeled “broad spectrum,” sunscreens must provide
The cost of Ultherapy® is about $4000, and can vary depending on geographic location, and the extent of the treatment. For a non-surgical treatment that can last for three years – with no risks, and no downtime – Ultheraphy® is an amazing value! Ultherapy® is the only FDA-approved treatment for lifting facial soft tissue, and is appropriate for both women and men. Ultherapy® is only available through physicians with expertise in facial cosmetic procedures. For more info, visit www.divinitymedspa.com. Dr. Swet Chaudhari is a fully-trained plastic surgeon whose practice, SunCoast Plastic Surgery, serves the south Houston area from the Bay Area to Pearland. He is also medical director at Divinity Med Spa & Wellness.
equal protection against the sun’s two types of radiation: UVB and UVA. Both types can lead to cancer. UVA causes more wrinkles; UVB causes sunburns. • “Waterproof ” and “sweatproof ” claims will disappear: Sunscreens can only say how long they offer water resistant protection. And, they’ve got to back up these promises with test results. • Instant protection: Sunscreens can’t say they provide “instant protection” or protect skin for more than two hours unless the FDA approves these claims for the specific sunscreen in question. Choose sunscreen by preference and apply it liberally and often “Even after these changes go into effect, the single most important factor in picking a sunscreen is finding one you like. Sunscreen comes in creams, lotions, sprays, gels, wax sticks and wipes,” Drucker said. “If you buy one with a texture you like, you’ll use it more often.” For safe fun in the sun, Drucker recommends using sunscreen that: • Provides SPF 30 or higher • Has broad-spectrum protection (UVA and UVB) • Is water-resistant Apply sunscreen at least 30 minutes before going outdoors. And, be sure to reapply liberally every two hours. “To really protect your skin, you should apply one ounce of sunscreen — the size of a golf ball — to every part of your body exposed to the sun,” Drucker said. “That includes your ears, feet and back of the neck.” For additional tips on sun safety and skin cancer prevention, visit www.mdanderson.org/focused. To learn more about the MD Anderson Regional Care Center in the Bay Area, visit www.mdanderson.org/bayarea. Third Quarter 2012 | www.BestPracticesMD.com|
23
F INA NC IA L
HEA LTH
How to Grow Your IRAs/Retirement Dollars Without Cumbersome Fees
W
e at Sucre-Vail Wealth Advisors are honored to be able to share timely, topical investment and wealth related insight with you. Each quarter our goal is to provide relevant information to help you maintain and grow your wealth. We hope you will take away practical concepts to implement within your portfolio. Today we are discussing a little known deduction – a deduction that impacts advice given on an IRA, Roth IRA or Rollover IRA. If you receive advice on your tax-sheltered account you may benefit from paying your advisory fees separately. In a world of information overload and one where we are all trying to streamline our lives you are likely asking; why in the world would I do this and create an extra step for myself? The answer is you may be able to benefit in three ways: •
•
•
You may be able to take a tax deduction on fees paid for advice. By paying the advice fee with outside funds you can help preserve the retirement account value rather than deplete it. In writing the check for advisory fees you understand the true cost of your advisor and are able to ensure you receive value for dollars spent.
By writing a check to your investment advisor using outside funds, you avoid depleting the funds in your tax-sheltered account. The fees you pay may be deducted as ‘miscellaneous expenses’. What this means is that the fees may not be deductible unless they exceed two percent of your adjusted gross income. For example, someone with a $2 million IRA paying 1% percent of assets under management to their adviser would pay $20,000 a year in fees. Secondly, using outside funds to pay for advice you preserve the account value. So that $20,000 fee isn’t being deducted from your account and your retirement nest egg is able to grow unfettered.
24 |www.BestPracticesMD.com | Third Quarter 2012
Lastly, by explicitly writing a check to your advisor you become keenly aware of exactly what fees you are paying and are better fortified to determine if you are receiving value for dollars spent. There is something important to consider before you write this check. If you are approaching the phase of life where you will take funds from your IRA to fund your lifestyle, -read on. Rather than writing a separate check it may be prudent to let your advisor take his/her fee from the account because money withdrawn from a tax-deferred IRA is subject to income tax. Therefore, paying your advisor with money in the account wouldn’t cause a taxable event; but if you take money out from the account to pay the advisor from – this would trigger a taxable event. It is important to highlight that if trade-related commissions compensate your adviser, you can’t separate them from your account and take advantage of this break. Depending upon if you pay for advice or commissions, if you are nearing a drawdown phase of life or if you are in an accumulation mode of life – this deduction may provide an efficient way to manage your account. This latest ruling from the IRS in January 28th 2011 reiterates that more informed investors are taking a serious look at how their Brokers/ Advisors are compensated and moving away from commission paid to Registered Investment Advisors who are solely compensated by fees. Next quarter our article wills exam the stark differences between a, Broker and a Registered Investment Advisor. Financial planning and registered investment advisory services are provided by Sucré-Vail, Inc. and under contract with Sucré-Vail Wealth Advisors. Sucré-Vail, Inc. its principals and or employees are not engaged in the practice of law, nor are we licensed to do so. Communications with any principals and or employees are not intended as legal or tax advice, or may they be construed or relied upon as such.
SNAPSHOTS YOUR MEDICAL COMMUNITY HARD AT WORK
Third Quarter 2012 | www.BestPracticesMD.com|
25
THE LAST WORD
Opinion
Affordable Care Act is Wrong Prescription for America
I
By United States Representative Pete Olson n a move that surprised many, the U.S. Supreme Court recently upheld most provisions included in the Patient Protection and Affordable Care Act, also known as ObamaCare. This law included an individual mandate that forces every American at certain income levels to purchase health care insurance. The Court ruled that the mandate is not constitutional under the Commerce Clause of the Constitution, but is constitutional as a tax. The Supreme Court seems to have rightly ruled that the individual mandate is not constitutional under the Commerce Clause of the Constitution. In fact, the Supreme Court confirmed what so many opponents of the law said from the beginning, that this is a tax. While the Supreme Court upheld the constitutionality of ObamaCare on the basis that it is a tax, this decision certainly does not make the law good policy. A law that raises taxes, destroys jobs and hampers economic growth, while doing nothing to rein in soaring health care costs, is simply the wrong prescription. The American public is now presented with a choice of bigger government, fewer options, and increased health care costs under ObamaCare, or a future with smaller government and affordable health care options where decisions are made by patients and their doctors, not Washington bureaucrats. The mandate also affects millions of Americans who will be forced to purchase health insurance only because the federal government is forcing them to do so through taxation. These individuals will be forced to buy a product they may not need, or want, just to comply with a bureaucratic mandate. The Congressional Budget Office analyzed this issue in April 2010 and found that more than three-quarters of individuals paying the mandate tax will have household incomes of less than $120,000 for a family of four. More than 10% of individuals paying the mandate tax will have incomes below the federal poverty level, which this year is $23,050 for a family of four. The court did strike down one section of the law, which requires states to expand their Medicaid programs. The Medicaid expansion component is of particular interest to Texas, as state officials have voiced considerable concerns about the high cost of this expansion, even though the law requires the federal government to cover a majority of the cost. The law would have forced states to expand their Medicaid programs or face losing all of their current federal funding. The Supreme Court ruled
“The people of the United States of America can decide whether it is right and wise, and we have the power to remove it through our elections.”
26 |www.BestPracticesMD.com | Third Quarter 2012
that they cannot withhold federal funds if states choose to opt out of the expansion. The traditional Medicaid program in Texas covers 3.4 million children, pregnant women, disabled adults and low income elderly people. The new law would extend Medicaid to everyone whose income falls below 133% of the federal poverty level, which is roughly $25,300 for a family of three. While it sounds noble, it will impose an enormous cost on states, even with a big portion being paid by the federal government. That will result in higher taxes and increased costs for other taxpayers. What does the broader ruling that upholds the bulk of ObamaCare mean for Texas? Small businesses will still likely be hurt the most. Many small business owners already hurting in a weak economy are deeply concerned about the long term impact of ObamaCare on their livelihood. Individuals who are underemployed and barely able to cope with skyrocketing inflation are terrified at the prospect of being compelled to pay for insurance or face a penalty. The added cost either through purchasing insurance, or paying the new tax, is a serious blow to those on a fixed income or barely making ends meet. The notion that the federal government can coerce someone to subscribe to a service and under no circumstances can one opt out unless given a waiver by the President sounds truly draconian and undemocratic. The tax credit for providing health insurance to employees only extends to businesses with 25 employees or fewer. For entrepreneurs who want to grow their businesses, this means that, once they hit 26 employees, they’ll lose their tax credit. This means forego the tax credit or forego expansion. In the two years since the new law has been implemented, small business owners have seen their health insurance premiums go up. This trend is likely to continue. Even more troubling, the greatest impact will be on the small mom and pops with less than 10 employees and no real opportunities for growth. The Supreme Court issued a ruling on the constitutionality of the individual mandate. However, they do not have the final say on this matter. The people of the United States of America can decide whether it is right and wise, and we have the power to remove it through our elections. The mandate is a tax and an unfair burden on the American people. The House again passed a bill to fully repeal this law in its entirety. True change will only come, though, if the Senate follows suit and the President signs the repeal into law. That will not happen with the current makeup of the Senate and White House. It will require action by the people who truly do hold the power in this country, the voters. If that happens in November, then, step-by-step, we can replace this onerous and overreaching law with thoughtful legislation, supported by the People, which will protect Americans’ access to the care they need, from the doctor they choose, at a lower cost. Pete Olson (R) is the U.S. representative of Texas’ 22nd congressional district.