Race Matters for Health

Shameful record

This is truly stunning evidence of how poorly Texas does in caring for public health. Texas ranks #49 in terms of providing access to care for all of us. The only state with worse results is Georgia.

No doubt, Texas' refusal to expand Medicaid explains a huge part of this discouraging reality.  

Data is curated by healthgrove.com

Fair health care

Health disparities that break along racial lines should concern us all. I found a recent article in The New York Times most troubling. Here's just a sample of what's reported.

A troubling racial divide in breast cancer mortality continues to widen in most major cities around the country, suggesting that advances in diagnosis and treatment continue to bypass African-American women, according to new research.


Read the entire report here. 

Cause for real concern, wouldn't you say? 

At CitySquare we continue to think in terms of "hot spot" interventions in which we know we can play a useful part. Those who support our community clinic will play a huge role in helping us engage even more effectively in the future than we have in the past. 

More later. . .I believe.

Tell me your ZIP, I'll tell you about your health

Just in from the Colorado Health Foundation.  Move evidence of the interrelated complexity of poverty.  This poverty is destroying our neighborhoods. 

Health by ZIP Code

Where You Live Determines Your Health – for Good or Ill

By Sandy Graham

Opportunities for good health bypass far too many people, in Colorado and nationwide.

If you live in a poor neighborhood, chances are that you are not as healthy as someone who resides in a more affluent neighborhood. Your address reflects your health – and more.

"There's a lot of information in an address," says Anthony B. Iton, MD, JD, MPH, senior vice president of healthy communities for The California Endowment. "It tells me about your income, your education, the health amenities you have access to and employment opportunities you can access. I can pretty much predict your life expectancy by where you live."

Iton has data to back his point. Mapping life expectancy in major metro areas by census track or ZIP code finds wide ranges even a few miles apart. In Philadelphia, for example, those in the city's center live 6.4 years less on average than neighbors 21 miles away in Chester County. Life expectancy in Oakland, Calif., is less than 74.3 years compared with more than 80 years in much of the rest of the county.

Assuring the highest level of health for all Americans is a goal that many experts believe makes both humanitarian and economic sense. But achieving what some call "health equity" requires tackling social determinants of health such as income, education, nutritious food, safe housing, affordable and reliable public transit, culturally sensitive health care professionals, health insurance, and clean water and air.

A Complex Problem
"That's why health equity is so elusive," says Len Nichols, PhD, director of the Center for Health Policy Research and Ethics at George Mason University. "You can't push one button. You have to think about the totality of the social fabric of the community."

Read more here.

Good news on CitySquare pharmacy!

[CitySquare's South Dallas health clinic is a winner! Read on. . .]

CitySquare Leadership Team (and all):

 Our clinic pharmacy had a surprise visit yesterday from the Texas State Board of Pharmacy. The state inspector showed up at about 10a. m.– completely unannounced. These visits are anticipated but it is always nerve-racking when they actually happen.

 For a historical perspective:  we were officially inspected by the State Board of Pharmacy about 6-7 years ago.

 Congratulations are in order – they passed us with flying colors!

 I am so proud and pleased to report that we received 0– repeat zero –actionable items for the future. This is wonderful news.

 WAY TO GO CITYSQUARE CLINIC PHARMACY! 

 Very special thanks to: Crystal Maturino, POR pharmacy assistant, and Oneyda de la O, LVN, for doing everything right–i.e. greeting the inspector, checking his credentials, contacting our Pharmacist (Carlos Alvarez) and answering all his questions prior to Carlos arriving and retrieving all requested information during the survey.

 Sincere thanks to both of you. Carlos– thank you so much for ensuring our success with this inspection. Without your counsel and oversight we would not be where we are today. We appreciate you. Carlos told me that it is not unusual for pharmacies to receive 1 or 2 items that require a written action plan. We received no action items. Wow! Outstanding.

 I know you will all echo my sentiments to this great team for all their hard work and dedication in the CitySquare pharmacy! Congratulations to clinic team!

The essay that follows is a mind-twister for certain!  What you read may surprise you, unless you have a degree in public health.  Much food for thought on how to intervene for life and health in the really tough parts of a city like mine.  Reactions, as always, welcomed!

Why We Need to Treat America's Poorest Neighborhoods Like Developing Countries

The average life expectancy in Japan right now, home to one of the healthiest, longest-living populations in the world, is about 83 years. That's four years longer than in the United States, a decade longer than in much of North Africa, and as many as 30 years longer than some war-torn parts of the world like Sierra Leone.  

These global patterns are well-known, but we seldom look at our own communities in the same way.

"Most people appreciate at a country level that there are huge disparities in health between the U.S. and, for example, countries in Africa," says David Fleming, the public health director and health officer for Seattle and King County. "I think what is not as obvious to most people is that you don’t need to go any further than your front door, and most of us are living in communities where those same profound differences occur across much smaller geographic areas."

In fact, that area may span the distance of a stop or two on the subway, or another exit off the highway. In New Orleans, for instance, a couple of miles down Interstate 10 can mean the difference in 25 years in life expectancy. . . .click here to read more.

CitySquare health clinic listed among the best in Dallas!

[Great news for CitySquare!  Our Community Health Services clinic received recognition in the very significant award described below!  Bottom line: we dedicate ourselves to providing our low-income neighbors the very best care possible! As a result, our clinic is listed along with the very best market-rate health clinics in the DFW Metroplex!]

80 Texas Physician Practices Recognized for Improving Care through Health Information Technology

Texas Physician Practice Quality Improvement Award honors physician practices using technology to provide exceptional preventive health care 

FOR IMMEDIATE RELEASE

CONTACT: Emilie Fennell Director, Communications and External Relations 512-334-1649 Emilie.Fennell@tmf.org 1-800-725-9216 Katie Gaide Public Relations Specialist TMF Health Quality Institute 512-334-1709 kgaide@txqio.sdps.org Austin, TX – April 22, 2013 – TMF®

Health Quality Institute, Texas Medical Association and Texas Osteopathic Medical Association announced today that 80 physician practices statewide received the first Texas Physician Practice Quality Improvement Award for effectively using health information technology to improve care for patients through reliable delivery of preventive health services.

The three organizations collaborated to develop the award in 2012 to recognize high performing practices committed to improving clinical measures including cholesterol screening, tobacco cessation counseling and cancer screenings, among others. Using health information technology to drive high-quality preventive services has been designated a priority for U.S. health care by the Centers for Medicare and Medicaid Services (CMS).

Click here to read the entire report and to see the list of award winners!

CitySquare clinic scores big!

What follows is a direct, cut and paste email message that I received recently from Frances Martinez, Operations Manager for CitySquare's Community Health Services. 

Our clinic, located in South Dallas-Fair Park just off the intersection of Malcolm X and Grand Avenue, scored big in the latest Health Texas Provider Network (the Baylor Health Care System's physicians group) audit of our Adult Preventative Services. 

The translation is very simple, and most encouraging:  our clinic ranked second among all the HTPN clinics in the system!  This includes the clinic that I call my medical home out in the North Dallas suburbs! 

Great work, CitySquare health care team!  Great work! 

Our patients receive the best care possible, and evidently the best care available! 

 

____________________________________

 

Everyone,

Please see below, we are #2 in HTPN for the July-September Adult Preventative Services (APS) audit!!  Congratulations everyone!  It is definitely a team effort from scheduling WWEs, to requesting the tests, to putting in the orders, to scheduling the tests.  Please take a moment and give each other a high five!

 

Rank Practice Name

POA

1 Signature Medicine

N 278

95.41%
 

2 City Square Community Health Services

N 643

92.87%

Frances Martinez

Operations Manager

CitySquare-Community Health Services

2835 Grand Ave.

Dallas, TX 75215

214-421-1783

francema@baylorhealth.edu

Why is health care so expensive in the US?

The good folks at MedicalBillingandCoding.org created an infographic laying out many of the exact reasons why costs are so insane in the American medical industry.

To view their work cleck here.

As always, reactions welcomed.

Lazarus reprise

So, we've been looking for "Lazarus" (see yesterday's post) over the past week or so.  He was nowhere to be found. . .until late Tuesday afternoon. 

As I left the T. Boone Pickens YMCA after working out, I spotted him seated on a sidewalk bench at the corner of San Jacinto and Ervay, in the shadow of the gigantic First Baptist Church.  Immediately I contacted Lisa Ciminelli, Director of Social Work Services at CitySquare and asked her to join us for a conversation.  While waiting for her to arrive, I talked to the man I've called "Lazarus." 

In fact, his name is Eddie. 

He came to Dallas 12 years ago from a city in another part of the country. 

With pride he informed me that back home he was state Golden Gloves champ three years running. 

He's been on the street for 10 years. 

About two years ago he suffered a stroke. 

The street is mean, like a cruel machine designed to eat up and compromise life an hour at a time.

We'll keep working with our friend in a manner that seems best to him. 

To be honest, I hope he will soon be able to move into our building across the street from the corner he's been calling home for far too long. 

We need Eddie inside. 

I'll keep you posted.

Dr. Ron Anderson on state Medicaid cuts

Few, if any, know as much about public health care and its cost than Dr. Ron Anderson, the President and CEO at Parkland Health and Hospital System.  Recently, I received the following legislative update from Dr. Anderson.  When Dr. Ron writes, we all should be listening.  Hear him out. 

Last week, the Texas House Appropriations Committee passed House Bill 1, which would drastically slash funding to hospitals and doctors. Similar discussions are happening in Washington about funding cuts as well as changes in health policy to try to deal with deficits and the cost of health care. Yet some of the proposals might not truly save any money, but rather simply shift the chairs around the Titanic.


Medicaid is not the reason for the current structural deficit in Texas. A cut to Medicaid may actually cost three times as much as it saves because Medicaid is a state-federal match program. When we cut a state dollar, we lose additional federal dollars.

The growth in Medicaid relates mostly to increased enrollment during economic downturn. This is exactly how Medicaid was envisioned to work, as a "counter cyclical" safety net. Many of the state dollars that are matched are local tax dollars that hospitals like Parkland send to the state in order to achieve the federal match. Out of $8.6 billion of state match in this last biennium, only $1.7 billion was actually general revenue. In fact, Medicaid local and state dollars were matched with more than $16 billion of federal money which is divided from taxes we Texans pay to Washington. We're simply returning money to Texas to support our neediest residents.

At the same time, Medicaid is already a program that does not pay the full cost of care. Only 38 percent of Texas doctors accept new Medicaid. Many may stop caring for Medicaid patients altogether if there were additional cuts.

In turn, patients go to emergency rooms that are already crowded. These patients may wait to seek care and therefore have a more advanced illness, requiring admission that could have been avoided through early intervention, prevention and primary care. The total cost of health care will go up and many people who are not Medicaid patients will be impacted.

How does this impact Dallas County? While the state might save money, it costs money for the local government, the local health care providers and the local taxpayers. Think of the total burden of illness that must in turn be supported solely by this community. It's simply a cost shift. Consider also that local tax values have declined yearly by 3 to 4 percent for the last four years leaving little ability to absorb these costs.

Texas has been remarkably short sighted in not taking advantage of federal matches. Some of the discussions are about expanding managed care, supposedly saving the state $50 million. On the other hand, it would also minimize the ability to match federal Upper Payment Limit dollars, costing Texas $800 million to $1 billion. If we take away a significant funding opportunity, we need something to replace it.

If we create a ripple effect downstream to local government, then the budget cut doesn't accomplish what was intended. Before we balance the budget on the backs of vulnerable people - the poor, the pregnant, the children and nursing home residents - we ought to take a comprehensive look at solutions, both in terms of state revenue and expenses. Whether it's use of the Rainy Day Fund or program cuts, I don't think there are any simple answers. I'm pleased that members of the North Texas delegation are looking for answers. However, there comes a time when we have to realize that a sacrifice is going to have to be made.

Because of the wonderful Dallas County citizens and their support of the bond campaign, we have money to build a new hospital. That won't be affected. In fact, it better prepares us for the future to stay competitive in the marketplace after health reform.

Yet as we plan the Parkland 2012 budget, we are taking a serious look at savings that make minimal impact on patient care. But we've done that now for the last four years, and as painful as it is, eventually we may have to curtail services.

We must consider the ripple effects of potential "savings" and the burden it creates on others. Parkland has an open door for the vulnerable and needy. We care for those with Medicaid even if the reimbursement is low. However, that means Parkland could also be impaled by volume if the private sector disengages from Medicaid due to cuts. That's a concern that keeps me awake at night. But above all else, we will continue to advocate by putting the patients first.

Local NPR station--KERA 90.1--reports on CDM health clinic and Project Access

Yesterday, KERA 90.1 FM, our NPR station here in Dallas ran a great report on the dilemma facing uninsured people when illness strikes. 

The work being done by Central Dallas Ministries was featured prominently in Bill Zeeble's compelling report.  Both our Community Health Services clinic and our involvement in Project Access Dallas were included in the report. 

To listen to the story click here. 

After you check it out, do me a favor and pass it along!