Theory is now reality. Welcome to the future.

We all know that politicians are still fighting about health reform, but health providers (including Texas Health Resources) have made their decision: The big overhaul is coming regardless of what happens in the November elections.  There has been an acknowledgement of the inevitable - and the unsustainable.  Health spending has reached a high of 18% of GNP, up from 12% in 1990.  Accountable Care is not just a theory anymore... it's reality.

Providers are feeling the pressure of offering more consistent care at a lower price.  Accountable Care Organizations are a big part of health law - get the right treatment at the right time at the right price; and keep patients healthy by bringing together primary care doctors, specialists, hospitals, pharmacy, and more.  This is the beginning of the end of our crippling fee-for-service system.

Texas Health Resources facilities treat one in four patients in this region.  The group has already spent $200 million on electronic medical records systems and a data analysis company, Healthways.  The tracked health data will identify congruent health issues among patients and the most effective protocols; smartphone tools will record follow-up treatments, medications and several other measurable effects.

Cost control efforts are being seen across the spectrum.  Next month Medicare will enforce new policy for hospitals with high re-admission numbers to be paid less than hospitals with fewer preventable re-admissions.  A New England Journal of Medicine study shows that 20% of Medicare patients return to the hospital within 30 days of discharge - their conditions still serious and costing the U.S. about $17 billion each year.  34% of patients are re-hospitalized within 90 days of discharge.

Admittedly, many of the returning patients are high-risk; they may be frail, have chronic conditions, or are unable to get to their follow-up medical appointments.  To add another layer, hospitals tend to transfer patients to less costly settings once their conditions are stable.  Follow-up care at home or through a skilled nursing facility is an option many patients prefer, but their condition needs to be carefully managed for the best outcome.

The Affordable Care Act is expected to allow countless seniors to live longer, healthier lives.  The ACA brings lower drug costs, more free preventative health screenings and an annual consultation with a physician to create a personal health plan.  And, it should also mean an end to obscene increases in medical costs.  Senior advocate organizations have strongly supported the health care bill, and virtually all the major health care and health insurance associations have given it their full support.

New rules allowing for administrative simplification are gradually being rolled out and accepted as part of new health care law.  These changes are expected to save providers and health systems about $4.6 billion over the next 10 years.  How?  By eliminating the red tape.  Directed by Health and Human Services Secretary Kathleen Sebelius, a universally used administrative process is essential in providing cost-effective, patient-care focused treatment plans that lead to more time with the patient, less time filling out forms, and more positive patient outcomes.

And Missouri Stands Alone…

49 states have now passed legislation to electronically monitor controlled substance and

narcotic prescriptions, with the exception of Missouri.  Senator Rob Schaaf of St. Joseph, Missouri, is a first time senator and family practitioner.  Schaaf is adamant that Missouri will not adopt a prescription database, as he believes – along with other critics – that the database represents an infringement on personal liberty.  Protecting a patient’s confidentiality should be a priority, Schaaf has said, adding that citizens “shouldn’t have to give up their right to privacy just to stop people from doing bad things.”

The Texas Department of Public Safety (DPS) officially launched their secure online prescription monitoring program, called Prescription Access in Texas (PAT), in July 2012.  This database is available to a select group of practitioners, pharmacists, and law enforcement officials.  Very recently, DPS has extended program access to additional physicians and law enforcement, mid-level practitioners, medical board and nursing board investigators.

Advocates of the program contend the database allows doctors and pharmacists to better monitor patients who frequently seek prescription medications; the program is aimed at stopping “doctor shopping,” by which people get prescriptions from multiple physicians to feed an addiction or to sell.  The number of deaths as a result of prescription drug use and abuse are greater than heroin and cocaine overdose deaths combined.  The most recent year with statistics available – 2009 – shows that nearly 21,000 deaths in the U.S. were attributed to prescription drug overdoses.

The Centers for Disease Controll says overdose dealths from prescription painkillers such as hydrocodone, methadone, and oxycodone have skyrocketed in the last 10 years.  Some estimate that deaths from prescription drug overdoses exceed those from car accidents.  In Dallas County, 14.5 percent of high school students have admitted using an illegally obtained prescription drig in the last 30 days.   

It appears that online tracking of controlled drugs will, at the very least, decrease access.  Florida was once known as the “pill mill capital.”  A few years ago, more than 90 of the nation’s top 100 prescription-dispensing physicians were in Florida.  In 2009, the state instituted a tracking program and today, the number is down to 13 physicians in the top 100.  People who fail to disclose that they are receiving pain medication, controlled substances, or narcotics from other doctors could face legal consequences. 

Pharmacists have been required to send prescription information to the Texas Department of Public Safety since 1982, now called the Texas Prescription Program.  It was once an effective and efficient tool for investigation and preventing drug diversion.  The new online PAT system does not require every prescription written to be entered in the database; pharmacists are required to report each prescription they fill for narcotics.  PAT will hold physician, patient, and controlled substance information for one year, allowing law enforcement and health care professionals’ immediate access to dispensing data.

Texas has taken measures to ensure the data is secure on PAT, and that it can only be accessed by licensed practitioners and pharmacists; however the American Civil Liberties Union has reservations about the program.  The ACLU refers to the program as “government surveillance.”  Is this another example of Big Brother tracking our every move?  Does this program violate personal liberties? 

Let’s not over-think this…  I think PAT allows providers access to data that will help them make appropriate decisions for their patients.