Personal responsibility and healthcare

Personal Responsibility and Healthcare:  Behavior can make a big difference

Part of the cost control contemplated in the Affordable Care Act (ACA) is holding physicians accountable for cost and quality. But how can physicians be held accountable for non-compliant patients or patients who do not take responsibility for their own health? personal responsibility in healthcare Personal responsibility and healthcare costs are inextricably linked. It is estimated that more than half of our health care expenditures are for self-induced medical problems. Smoking, drug and alcohol addiction, lack of exercise, noncompliance with prescribed medical treatment plans, and lack of caution to prevent potential injuries, all add billions of dollars to medical costs yearly. Obesity alone has taken on epidemic proportions, with the United States spending $174 billion a year to treat diabetes, and at least $147 billion on health problems related to overweight and obesity. Tobacco still costs this nation more than $150 billion a year. 
According to the Centers for Disease Control and Prevention (CDC), nearly 75 percent of Americans report they do not always take their medications as directed; one in three never fill their prescriptions; and proper adherence approaches only 50 to 65 percent in patients with chronic conditions, such as diabetes and hypertension An article in the New England Journal of Medicine (NEJM) reported that poor medication adherence contributes significantly to medication-related hospital admissions in the United States, at an estimated cost of at least $100 billion annually. Lifestyle behaviors are difficult to change, and solutions to effect behavioral modification have been largely unsuccessful to date, despite huge community efforts and even legislation. Some patients have developed a sense of entitlement of care, taking no responsibility for abusing their health but expecting every conceivable means of treatment be used to cure them, no matter the expense. They, in turn, blame the health care delivery system for its high costs. This is unfortunate, since there likely would be more than enough money in our health care system to help patients with illnesses that could not be prevented if the rest of our population practiced healthy living. Other patients would like to change but need to be taught what to do. Others face economic and cultural obstacles that prevent wellness, which we must address. As physicians, no matter what our specialty, we do have a strong role to play in every one of our patient encounters, because if we don’t discuss healthy living with our patients, who will? Only the individualized approach will work along with peer and affinity group influence. We physicians alone cannot accomplish this. We need the collaborative effort of community, parents, schools, hospitals, insurance companies and businesses.

Houston Facial Plastic Surgeon, Russell Kridel, MD, is currently a member of the AMA Board of Trustees and the immediate past chair of the AMA Council on Science and Public Health.

Any views expressed on this blog should be considered personal views of Dr. Kridel and are not official statements of AMA policy (which is set by the AMA House of Delegates) nor are they official descriptions of actions of the AMA Board of Trustees.

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Taking The Wheel for The Future of Medicine

Physicians Taking The Wheel for The Future of Medicine

Physicians taking the wheel

As physicians we cannot view the future of medicine and the role we have to play by looking through the rear view mirror of yesterday. The view ahead belongs to those who face the fact of change, grab the wheel and move forward to shape it. And change is here, often obstructing our progress forward and causing many detours, which frustrates physicians as we try to provide the best care for our patients and advance science.

We used to be solely in the driver’s seat, helping our patients arrive at healthy destinations. But now, the person paying for the gas is no longer the patient, having been replaced by the government and third-party payers; they used to be just back seat drivers, annoyingly telling us where to make our turns. But more recently, they have made passengers of physicians; and they are behind the wheel. Unfortunately for patients and physicians alike, they don’t have a license and haven’t even had drivers’ education. Your leaders in organized medicine will be working harder than ever to put you back in the driver’s seat to lead the health care car safely in the right direction.

As leaders in medicine, we need to engage and work with all parties in our efforts to improve our healthcare system for the greater good. However, we cannot leave our patients’ destiny and that of medicine in the hands of others. Physicians may not be able to reform our health care system overnight, but we must prevent the health care system from destroying medicine. Remember that our patients look to physicians as trusted leaders for health care solutions, not to the government.

 

Russell Kridel MD is a Houston-based Facial Plastic & Reconstructive Surgeon in private practice in the Texas Medical Center. He is also currently the Chair of the AMA Council on Science and Public Health (CSAPH) which provides information and recommendations on medical, scientific, and public health issues which are published in their entirety here.

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Government red tape

Excessive Government Red Tape Gets in the Way of Delivering Quality Patient Care

Dr. Russell Kridel in DC to meet with members of Congress

Russ Kridel, MD goes up to capital hill to meet with members of Congress

This past year, fighting the burgeoning regulatory burdens and government red tape that contract the time physicians can spend with patients, was one of the top priorities of the Harris County Medical Society during my tenure as president.

We spent substantial time educating our U.S. Congressmen and Texas Legislators about the accumulation of compliance issues that are overwhelming physicians’ offices. They all seemed receptive, but Representatives Brady and Poe have particularly embraced our causes. The opening of health insurance marketplaces and all the new rules and regulations under the Affordable Care Act (ACA) have increased our challenges. Physicians are right in the center of the paths of multiple, colliding fronts in the form of more federal and state regulatory requirements. Physicians are caring for patients and managing the piles of paperwork that the government and other healthcare organizations and executives have created for them. Doctors are now consumed with checking boxes, implementing EMRs and transitioning to a new coding system for billing—all while seeing increasing patient loads and meeting increasingly steep clinical demands.

U.S. physicians commit about 20 percent of their time to administrative tasks and the number is growing. Wouldn’t that time be better spent delivering health care?

Russell Kridel MD is a Houston-based Facial Plastic & Reconstructive Surgeon in private practice in the Texas Medical Center. He is also currently the Chair of the AMA Council on Science and Public Health (CSAPH) which provides information and recommendations on medical, scientific, and public health issues which are published in their entirety here

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The Not Sustainable Sustainable Growth Rate (SGR)

SGR: The Not “Sustainable Growth Rate”

capital hill

In 1997, Congress created the Sustainable Growth Rate (SGR), a system that pegged the amount of money budgeted for Medicare payments to projected growth of the economy. However, in just a few short years, health-care costs far outpaced economic growth, which created a multi-billion dollar shortfall in funding for Medicare payments. Since 2003, Congress has approved “doc fix” bills that appropriate more money to Medicare funding in order to avoid cuts in the Medicare reimbursement rates for doctors. Recently, Congress passed a ‘doc fix’ bill for the 17th time in 11 years.  In essence, kicking the can down the road once again.

The Medicare Sustainable Growth Rate (SGR) payment system to physicians was never sustainable, never a growth rate and always unfairly discriminatory against physicians. How physicians have been able to keep their doors open to Medicare patients for so long while under a 13-year price freeze when practice expenses have skyrocketed is only answerable by the altruism and personal commitment that doctors have for their patients.

The problem going forward with Congressional compromise and wheeler-dealer arrangements in replacing the SGR is simply that future reimbursements may be based on compliance requirements and so-called quality measures that have unproven clinical relevance and may be more costly than helpful. It is laudable that when Congress passed the Medicare Act (Title XVIII) in the 1960s, the original language specifically said: “Nothing in this title shall be construed to authorize any Federal officer or employee to exercise any supervision or control over the practice of medicine or the manner in which medical services are provided, or over the selection, tenure, or compensation of any officer or employee.” It is distressing to see the absolute disregard of that principle as Congress and the Executive Branch take every opportunity to interpose themselves between the patient and the doctor. Those who have neither a license to practice medicine nor the education to deliver medical care seem to take pleasure in the erosion of physician autonomy and medical decisions, which should be based on the individual needs of the patient rather than on a bureaucratic practice or cost parameter.

While progress has been made in reaching a bipartisan agreement to repeal the Sustainable Growth Rate (SGR), Congress must continue to work to resolve outstanding issues.  Congress needs to treat physicians fairly and stop undervaluing our needed services to patients.  And we, as physicians, need to continue to fight, to be vocal and to take a leadership role in SGR reform.

Dr. Russell Kridel is a Houston-based Facial Plastic Surgeon in private practice in the Texas Medical Center.

Click here for additional comments on SGR and government red tape from one of Dr. Kridel’s HCMS president’s editorial.

 

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Shut Out Sugar Program Addresses Obesity

Shut Out Sugar Campaign On A Roll

Shut Out Sugar brochure

HCMS sponsored Shut Out Sugar brochure

Not only is excessive sugar in the diet dangerous to overall health, it contributes immensely to the obesity epidemic we now face and has led to the huge increase in Type II diabetes we see in younger ages.  Sugar sweetened beverages have been found to make up half of the increased sugar in our diet, and drinking one less sugar sweetened beverage a day, such as a cola, would dramatically improve our health. During my tenure as president of the Harris County Medical Society (HCMS) in 2013, one of my key initiatives  was to create the Personal Responsibility Committee.  This committee developed the Shut Out Sugar program, which included a brochure and website, to increase patients’ awareness of how sugar-sweetened drinks increase their risk of diseases, as well as adding to the waistline. The brochures have been distributed Inside Shut Out Sugar Brochureto physicians, schools and many government related agencies and non-profit groups helping to battle the obesity epidemic and is available through HCMS. HCMS was fortunate to receive grant funding from the Texas Medical Association Foundation to assist with the Shut Out Sugar campaign. I am so pleased to see physicians and other members of our community embrace the Shut Out Sugar campaign.  It is gaining some great momentum. Please check out the Shut Out Sugar educational video done by Dorothy Cohen Serna, MD and North Cypress Wellness posted on YouTube.  Feel free to share the YouTube video and Shut Out Sugar website links with your entire social media Shut Out Sugar Brochure Photocommunity.  The more people that get exposed to our message, the greater the positive impact on the health of the members of our community.

We need to drink more water and not supersize sweetened beverages!

— Russ Kridel, MD

Dr. Russell Kridel is a Houston-based Facial Plastic Surgeon in private practice in the Texas Medical Center.

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Affordable Care Act Flaws Revealed in Recent Study

 Affordable Care Act Flaws Unveiled in ACEP Study

Emergency Room

As reported in the Wall Street Journal today in a front section article titled, “ER Visits Rise Despite Law“, once again the Affordable Care Act (ACA) has not lived up to promises made prior to passage.

The April 21, 2014, WSJ article discussed the recently released email survey of 1,845 American College of Emergency Physicians (ACEP) members conducted in April, 2014 which stated over half of ER doctors say they are seeing more patients since key provisions of the ACA took effect on January 1 and 86% expect visits to rise over the next 3 years.

This is in contrast to the government’s argument to help sell passage of the ACA that ER visits would go down.  Supporters had predicted that expanding insurance coverage would reduce costly emergency room visits because people would go to primary care doctors and not emergency rooms, for medical concerns that could more efficiently be delivered in a doctor’s office or other setting, especially for patients who previously were uninsured.

Based on the ACEP survey and other articles, including an Oregon study published in January, 2014 in the journal, Science, clearly Obamacare has not fulfilled the promise that ER visits, and therefore costs, would be reduced.Affordable Care Act (ACA)

The online poll follows ACEP’s 2014 State-by-State Report Card released in January, 2014, which gave the nation a dismal D+ grade for its lack of support of emergency patients.  Forty percent of emergency physicians polled say their state policymakers are doing a poor job of addressing the issues raised in their state’s recent Report Card, which looked at the issues of Access to Emergency Care, Quality and Patient Safety, Medical Liability Environment, Public Health and Injury Prevention and Disaster Preparedness.

In a separate but related article in the April 21, 2014 issue of the LA Times, the Obama administration has quietly adjusted key provisions of the ACA healthcare law to potentially make billions of additional taxpayer dollars available to the insurance industry if companies providing coverage through the Affordable Care Act lose money. The move was buried in hundreds of pages of new regulations issued late last week. But, there is no provision to assist physicians and health care providers who are overburdened by regulations, red tape and paperwork taking care of all the additional patients thus, effecting quality care and the patient physician relationship.  It is time for Congress to take action to resolve the effects of the law’s impact, including the deleterious effect on emergency rooms.

Dr. Russell Kridel is a Houston-based Facial Plastic Surgeon in private practice in the Texas Medical Center.

 

 

 

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Texas Bluebonnet Award Given To Dr Kridel

Texas Bluebonnet Award Given to Dr Kridel For Contributions to Community Health

Dr Kridel given Texas Bluebonnet Award

Texas Bluebonnet Award Given to Dr Kridel

At a ceremony in Corpus Christi at the Omni Hotel on April 25th, the Texas Academy of Nutrition and Dietetics Foundation presented Dr. Russell Kridel with the prestigious Texas Bluebonnet Award.

Dr. Kridel received the award for his contributions to health care, including his efforts to reduce obesity throught the Shut Out Sugar campaign developed during his tenure as President of the Harris County Medical Society.

Dr. Kridel created the HCMS Personal Responsibility Committee dedicated to helping address the obesity epidemic. The committee provides physicians across all specialties with tools to communicate the importance of diet and nutrition to their patients to prevent obesity, diabetes and other diseases, with emphasis on sugar sweetened beverages. Through Dr. Kridel’s leadership, the committee developed a brochure called “Shut Out Sugar” for physicians and health providers.  The brochure clearly outlines simple and easy steps people can take to reduce consumption of sugar-sweetened beverages to improve their health. He also participates in key roles at the state and national level on health care issues that positively promote the role of diet and nutrition in the ever-changing landscape of health care.

TX Academy of Nutrition and Dietetics

Texas Academy President, Carol Bradley, PhD, RDN, LD presented the Texas Bluebonnet Award to Dr. Kridel along with Jennifer Cash, MS, RDN, LD, the Texas Academy Nominating Chair.

Dr. Kridel also received the local Houston Academy of Nutrition and Dietetics Foundation Bluebonnet Award in 2013.

Dr. Russell Kridel is a Houston-based Facial Plastic Surgeon in private practice in the Texas Medical Center.

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Government Regulatory Madness: ICD-10 Transition

ICD-10 Transition is just one example of Government Regulatory Madness

Also looming over physicians’ heads is the transition of our diagnosis coding from ICD-9 (13,000 codes) to ICD-10 (68,000 codes) or face payment disruption in government and commercial payments.

ICD-9 to ICD-10 transition

Some of these codes are quite absurd  — but, the real issue is how is this ICD-10 transition making us better physicians and increasing access to care? The transition will be costly in upgrading systems and substantial physician and staff training. In February, 2014 the AMA published a report updating cost data for physicians to comply with ICD-10. The study updates costs from an earlier study done in 2008. The report showed new cost estimates for the ICD-10 transition that range from $56,639 to $226,105 for small practices; $213,364 to $824,735 for medium-sized practices; and about $2 million to more than $8 million for large practices. The new estimates include the costs associated with purchasing new software in order to accommodate the new codes.  Needless to say, these costs can be debilitating to a practice to the point of placing practice viability in danger. In addition, the focus on implementation of this ill-thought out mandate also places what should be most paramount — the patient physician relationship — in peril.

On April 1, 2014, President Obama signed into law the Protecting Access to Medicare Act of 2014.  The primary focus of the law is to provide a temporary patch to the Sustainable Growth Rate (SGR) for physician payment.  However, Section 212 of the new law establishes a delay for the implementation of ICD-10.  The language states that the Secretary of Health and Human Services (HHS) may not adopt the ICD-10 code sets prior to October 1, 2015 rather than the previous effective date of October 1, 2014.

The AMA spoke out against the proposed legislation before it was passed due to its opposition to a temporary fix for the SGR. Dr. Hoven, AMA President, stated, “The AMA and other physician organizations strongly agree that while a delay in ICD-10 implementation provides welcomed temporary relief, it does not offset the continued harm caused by keeping the SGR formula on life support and further delaying badly needed Medicare physician payment reforms. The AMA remains committed to relieving physicians of the crushing administrative burdens and practice disruptions that are anticipated during the scheduled transition to ICD-10.”

Physicians cannot leave our patients’ destiny and that of medicine in the hands of those who have neither a license to practice nor the education to deliver medical care. Physicians may not be able to reform our health care system overnight, but we must prevent the health care system from destroying medicine. Remember that our patients look to physicians as trusted leaders for health care solutions, not to the government.  

 

Dr. Russell Kridel is a Houston-based Facial Plastic Surgeon in private practice in the Texas Medical Center.

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Russell Kridel MD hosts Ted Poe reception

Russell Kridel MD hosts Ted Poe reception to support re-election campaign

Dr. Russell Kridel with Congressman Ted Poe

Congressman Ted Poe with Dr. Russell Kridel

Dr. and Mrs. Kridel recently held a reception to support the re-election campaign for Congressman Ted Poe. The campaign event was well attended by members of the medical community.  Several physicians in attendance shared their own experiences with red tape getting in the way of delivering quality care to their patients.  Congressman Poe also shared remarks including his interest standing up against regulations that are over-burdensome to physicians and detract from patient care.

“Ted is a US Congressmen with common sense.  He believes in the free enterprise system without overregulation.  He has also been a great champion of medicine and his efforts will go a long way to preserve the patient-physician relationship,” said Dr. Kridel.

Congressman Poe, Dr. Kridel, medical students and physicians at reception

Dr. Kridel, Congressman Poe, medical students and physicians at reception

Russ has worked with US Congressman Ted Poe and several key US Congressmen from Texas as they introduced bills to help resolve the SGR and ICD-10 crises and reduce over-burdensome rules that hamper the practice of medicine.

During his tenure as President of the Harris County Medical Society (HCMS) and as current Past-President, Dr. Kridel has worked with physicians across all disciplines to address critical issues affecting their ability to maintain practice viability while preserving the highest standards of patient care.

Russ is a facial plastic and reconstructive surgeon in Houston and has long been an active member of the AMA, TMA and HCMS. He is the immediate past president of the Harris County Medical Society and is currently a Member of the AMA House of Delegates and Chair of the AMA Council on Science and Public Health.

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Russell Kridel MD Meeting With Congressmen in DC

Russell Kridel MD meeting with Congressmen in DC at NAC Conference

Dr. Russell Kridel in DC to meet with members of Congress

Russ Kridel, MD goes up to capital hill to meet with members of Congress

Dr. Russ Kridel is in our national’s capital at the National Advocacy Conference (NAC) to take part in discussions that will help maintain the patient-physician relationship and improve the health of the nation.

Russ is meeting with members of Congress, political insiders and other industry experts on current efforts being made in health system reform refinement and implementation.

This year’s NAC conference is just weeks before Congress’ March 31 deadline to pass a bipartisan SGR (Sustainable Growth Rate) repeal bill that has been in the works for a year. A 24% payment cut is scheduled to take place April 1.

Dr. Kridel and other conference participants will personally call on members of Congress to co-sponsor the bill (H.R. 4015/S. 2000) and vote for repeal before the deadline.

Russ is a facial plastic and reconstructive surgeon in Houston and has long been an active member of the AMA. He is currently a Member of the AMA House of Delegates and Chair of the AMA Council on Science and Public Health.

 

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