Letter to Dr. Gee: Need sufficient funding to provide Medicaid care
October 5, 2018Rebekah E. Gee, M.D., M.P.H.SecretaryLouisiana Department of HealthP. O. Box 629Baton Rouge, LA 70821-0629Dear Dr. Gee,Thank you for taking the time to meet with members of Orleans and Jefferson Parish Medical Society on September 13th at the LCMC Health Conference Center. Those in attendance certainly appreciated the opportunity to learn more about the state of ‘Healthcare In Louisiana’ and the challenges faced by the Medicaid program and Louisiana Department of Health and Hospitals.Your presentation opened eyes and raised concerns. We are especially grateful for the time you took to take and answer questions from the audience. As you know, physicians in the Greater New Orleans Area and throughout Louisiana are frustrated with low Medicaid reimbursement that does not cover our cost. At this time, Medicaid reimbursement for providers in Louisiana only covers 80 percent of cost – making it extremely difficult for physician practices to pay monthly bills, buy supplies and make payroll. As a result, many of us have had to lay off good employees and strip cost to the bone. This undo stress contributes to physician burnout, compromised healthcare and forced retirement for healthcare providers who can no longer meet the needs of their employees and their patients.Dr. Gee, the members of Orleans and Jefferson Parish Medical Societies are dedicated to improving healthcare throughout Louisiana for all citizens. In your next budget proposal to the Legislature, please include sufficient funding to cover the real cost of providing care to Medicaid patients.Sincerely,George S. Ellis, Jr., M.D.PresidentOrleans Parish Medical Society
Louisiana Needs to Raise the Legal Age to Purchase Tobacco Products to 21
Leadership from the Smoking Cessation Trust, Orleans Parish Medical Society and Jefferson Parish Medical Society support and endorse legislation in Louisiana to raise the legal age to purchase tobacco products to 21. Raising the age requirement has been made law in six states (Hawaii, California, New Jersey, Massachusetts, Oregon and Maine), and in at least 340 U.S. cities.As a result of numerous studies, we now know that raising the tobacco age to 21 will have a substantial positive impact on public health and save lives. We know that nicotine is addictive; tobacco companies deliberately market to young adults to recruit “replacement smokers”; that kids often turn to older friends and classmates as sources of cigarettes; about 350 kids under the age of 18 become regular smokers each day – with one in three eventually dying as result; and that smoking causes more deaths each year than murder, AIDS, suicide, drugs, car crashes, and alcohol combined. So, when do we say enough is enough?According to the Louisiana Department of Health and Hospitals, smoking accounts for 7,200 deaths in our state every year. Our 23 percent adult smoking rate (the U.S. average is 15.5 percent) contributes significantly to our state’s dismal health status. What is most concerning is that the majority of Louisiana smokers began their addiction prior to age 18.National data show that about 95 percent of adult smokers begin smoking before they turn 21. The ages of 18 to 21 are also a critical period when many smokers move from experimental smoking to regular, daily use. While less than half of adult smokers become daily smokers before age 18, four out of five do so before they turn 21.According to a recent State of Tobacco Control 2018 Report from the American Lung Association, the State of Louisiana received a failing grade (“F”) across several categories when it comes to helping Louisiana smokers quit. One of those failing grades is because we continue to allow 18-20 year olds to legally purchase tobacco products.As healthcare professionals and caring citizens, we appreciate the efforts of our elected officials to sponsor and support legislation that limits tobacco use and help to improve the overall health of Louisiana. The Smoking Cessation Trust, Orleans Parish Medical Society and Jefferson Parish Medical Society strongly advocate for increasing the tobacco purchase age in Louisiana to 21 and invite other organizations to join us.
Mike Rogers, CEOSmoking Cessation Trust
George S. Ellis, Jr., M.D., PresidentOrleans Parish Medical Society
John H. Wales, M.D., PresidentJefferson Parish Medical Society
Orleans Parish Medical Society (OPMS) and Jefferson Parish Medical Society (JPMS) continuously seek to provide added value to their members. An important aspect of their collaboration is in providing joint continuing medical education (CME) for physicians and medical students. In the next few months, the two organizations will provide CME related to: the opioid epidemic, physician burnout and social determinants in healthcare. The two organizations will also host a meeting in September with Louisiana Secretary of Health, Rebekah Gee, M.D.‘Controlled Substances For Louisiana Prescribers’ – Online Opioid CMEAt discount rates for OPMS and JPMS members, LAMMICO and Medical Interactive Community now provide 3 hours of opioid CME that meets the subject requirements specified by Act 76 of the Louisiana legislature and the LSBME rules. LAMMICO insureds and LSMS members receive complimentary access to this course.
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Mehdi Qalbani MD MSPHPsychiatristOrleans Parish Medical Society Board MemberWe serve patients with complex problems, in complicated social situations, with limited resources. In my case, I serve a patient whose diagnoses include: Schizophrenia, Substance Dependence, and Renal Failure requiring Dialysis. On top of this, his day-to-day life is burdened by unstable housing, transportation challenges, food instability, exposure to violence, and poverty. Despite these impediments, he has improved his life and gained a level of stability that seemed unlikely when we first started working together. Some things fell in his favor. He worked with a medical/renal team that understood his psychiatric symptoms and coordinated care. He was referred to the FACT (Forensic Assertive Community Treatment Team) team a community-based program that provides intensive case management and mental health treatment to individuals who have a severe mental illness and significant involvement in the corrections system. Mostly, he said yes to the limited opportunities given to him. He accepted his illness and actively participated in treatment for his mental illness and substance dependence. He trusted his renal team and their care plan. He persisted in advocating for his housing with his housing specialist (he has his own apartment) and is adherent to the budget proposed by his counselor. His challenges, though unique are common to the underserved people we treat in communities throughout the Greater New Orleans area.
His case gives me hope but it also irritates me because his success is not typical and it should be. His case and others made me realize that I (we) need to become advocates and we can do it more powerfully as a collective. As health care providers, we must begin by advocating to our legislature and work with our payor sources to bring evidence-based practice models to the complicated health crises facing the Greater New Orleans area.
As my patients’ story illustrates, access to care coupled with coordination and trust can lead to better outcomes. We have evidence-based programs that can reach some of the goals outlined by the Department of Health & Hospitals Healthy 2020 program objectives to increase access to care by providing it in the communities where people live, improve quality of care by coordinating across disciplines, and to achieve better outcomes by allowing the time and opportunity to build the trust necessary for behavioral change.
To the first objective: we can always become better advocates. As I write this the Louisiana Senate has just passed a bill that would provide funding for our safety net health care system, continue funding for substance abuse and mental health programs, and ensure that people remain eligible for Medicaid at current requirements. Hopefully, the Louisiana House follows suit ensuring continued access to vital programs that provide better access and quality while reducing the overall spending on individual care. It is imperative that we stay in contact with our representatives, both individually and through our organizations, should the Louisiana legislature resist support for these issues in the future.
To the second objective: we have a great opportunity to improve care for our patients and meet the healthcare needs of our community. Though beds for substance abuse and mental illness remain below recommended standards, we have a robust network of Federally Qualified Health Centers (FQHC) that continue to improve access to care for the underserved. According to the Data Center, there are now 12 FQHCs with over 40 locations throughout the Greater New Orleans Area where our colleagues in primary care treat most of the patients with depression, anxiety, substance dependence, and other common psychiatric disorders with impact on physical and social health.
In surveys related to primary care physician burnout, the lack of time available to care for patients with medical and psychiatrically complex problems is an increasing stress factor for physicians. To relieve this strain on our healthcare system, we should consider implementing coordinated care models which take a team-based approach and incorporate telemedicine. We should also consider expanding the use of peer counselors and technology to improve health outcomes. Ultimately, we must continue to listen and work with our payors to create an infrastructure where these models are tested and ultimately sustainable.
In Greater New Orleans Area and throughout Louisiana, we must continue to make progress in developing solutions to solve big problems such as the opioid crisis, care for mental illness, smoking cessation, obesity and others by incorporating evidence-based, innovative practice models. The FACT program is one example that incorporates care in the community. NAMI (National Alliance for Mental Illness) New Orleans’ program of integrating peer counselors and consumers in direct care are innovative, evidenced based, and cost effective. In addition, Community Psychiatric Support and Treatment teams, psychosocial rehabilitation, substance abuse programs, and drop-in centers all work in concert to meet the complex mental health needs of the Greater New Orleans Area. With all of these models, the foundation for adequate mental health in the Greater New Orleans Area remains the shared trust between patient and providers. If we, as physicians, don’t have the time or an environment where patients can tell us their concerns, we will experience poor outcomes. The relationship with the patient that I described in the first paragraph took several years to develop. It took time for him to understand that we were there for him. I see colleagues in all disciplines demonstrating this every day. As medical professionals, we must remain vigilant advocates for the privilege of providing this trusted physician-patient relationship.
I am hopeful for our city and our region. In order to have this hope, our patients need to have access. In order to have access, our programs need funding. To get funding, we as a community must advocate beyond our offices.OPMS and JPMS advocate for physicians and their patients:
Orleans Parish Medical Society (OPMS) and Jefferson Parish Medical Society (JPMS) help serve as a voice for the medical profession in the Greater New Orleans Area. Both organizations play important roles in advocating for physicians, their patients and for improving the overall health of the region. The recent partnership and commitment to collaborative efforts between the two societies make this voice even stronger.
In the medical practice environment, OPMS and JPMS have advocated for significant legislative and regulatory reform at the state and national levels to help physicians address challenges that have come with third-party insurance and governments mandates that make it difficult for patients to receive quality healthcare. Their impact has also been felt in the public health arena, as leaders in the smoking cessation and tobacco control movement, and EMS protocol development and oversight. Recently, they have advocated for adequate state funding for vital health programs and for the future funding for University Medical Center New Orleans.
Both organizations invite physicians, residents and medical students from throughout the Greater New Orleans Area to join in their missions of improving healthcare for the region. For more information about Orleans Parish Medical Society and Jefferson Parish Medical Society, follow their updates on social media (LinkedIn, Facebook and Twitter) and visit their websites: www.opms.org and www.jpms.org.
to Rep. Frank Hoffmann, chairman, Louisiana House Health & Welfare Committee:By George S. Ellis, Jr., M.D., President, Orleans Parish Medical SocietyTobacco use remains the leading cause of preventable deaths in the United States. On behalf of Orleans Parish Medical Society, I would like to express our sincere appreciation to you as House Health & Welfare committee chairman for sponsoring two House Resolutions (numbers 107 and 109) to study the impact of further limiting smoking in Louisiana. I would also like to express our thanks to the members of the House for overwhelmingly backing those resolutions on May 7th.
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