Texas medical execs comment on cash-only medical practices trend
In today’s world, private medical practices can be costly, time-consuming and inconvenient for both patients and doctors alike. Underneath the mounting healthcare reform tension and never-ending healthcare insurance debates, providers are taking it upon themselves to form an alternate solution: cash-only practices.
The current change in the healthcare industry, coupled with the resentment from current insurance reform has led to the creation of new-and-improved healthcare clinics. Dr. Gustavo Villarreal, of the state of Texas, is one of these revolutionary doctors who are steering away from traditional medicine:
“It had always been affordable and possible to maintain a practice with what insurance and patients paid, but about 10 or 15 years ago, you started seeing a decline” in revenue, said Villarreal, who switched his traditional family practice to its current business model in 2012.
Texas is not the only state who has jumped on this trendy debate; it was recently surveyed that one of every four doctors in Florida was considering the move out of traditional medicine as well. However, Texas has reported extremely high-levels of uninsured residents, so both the federal and state governments are at work to get a handle of this seemingly ever-increasing number.
Executives from the TMA, THA, Texas Academy or Physicians, have all recently commented on this issue, in order to set the records straight.
“We have to find ways of stretching the current number of primary care doctors to meet that demand,” said Dr. Clare Hawkins, president of the Texas Academy of Family Physicians. “Direct primary care goes in the other direction.”
Not only is the doctor-shortage still a rampant problem throughout the healthcare industry, but with the current insurance-based or cash-based debate, what will be the next step towards healthcare reform?
One opinion is that patients need to anticipate their healthcare needs, and not abandon the traditional service, which has worked for over 100 years.
"Consumers should anticipate their medical needs," said David Gonzales, executive director of the Texas Association of Health Plans. "However, when that is not possible, consumers should have financial protection from the unexpected."
Lee Spangler, vice president of medical economics with the TMA, said “Texas is seeing an increase in practices like these because they give doctors more flexibility to determine the services they provide and to cut costs for their practices.”
“A physician has very little ability to negotiate all policies and procedures that come with insurance contracts,” Spangler said, adding that some insurance companies can even dictate the business hours during which doctors can be paid. “Basically you get rid of all those shackles in terms of having a carrier dictate to the practice how to deliver medical services.”
Moreover, it seems unclear if there really is an imbalance in the success of private cash-only practices. On the one hand, these practices allow residents the opportunity to abandon the healthcare insurance based system in lieu of a cheaper, last-minute form or care; and on the other, traditional medicine provides constant, more expensive care.
For doctors like Villarreal the answer is clear; he has more time to spend with his patients, is able to see close to 40-60 patients daily and has a new pool of clients. With pros like these, it would not be surprising to see where this trend of cash-only practices will spring up next.
NHS staff face severe impact on mental health due to COVID
The decision to drop COVID-19 restrictions in England this month alarmed doctors in the National Health Service (NHS) while hospitalisations are on the rise. At the same time, hospitals have started cancelling operations again adding to the existing backlog of operations, which estimates say could take a year to clear.
Dr James Gilleen of the University of Roehampton and his Covida Project team are warning of the ongoing risks to the mental health of NHS staff, many of whom are traumatised from the first wave of infections. “As the UK continues to see COVID-19 infection numbers rise at a similarly alarming rate as those seen during the country’s second wave, it’s combined with a renewed strain on the NHS and its staff" he said.
The Covida Project is a digital tool created to assess the psychological impact of the COVID-19 pandemic on frontline workers including NHS staff, the police and carers.
“Healthcare workers are already exhausted and burnt-out; they are traumatised from their experiences of working during the pandemic. During the first wave in May 2020, a study from the Covida Project found an unprecedented quadrupling of the number of NHS staff with high levels of anxiety, depression and post-traumatic stress disorder (PTSD) compared to before Covid-19" Gilleen said.
"Having the most severe levels of these symptoms was statistically linked to four key factors - insufficient access or pressure to reuse Personal Protective Equipment (PPE), insufficient workplace preparation, insufficient training and communications, and a higher workload. Staff aren’t just anxious, depressed and traumatised from being over-worked – it is from feeling unsafe and at risk."
The Covida Project found that almost a third of healthcare workers reported moderate to severe levels of anxiety and depression. The number reporting very high symptoms was four times higher than before the pandemic.
Gilleen adds, “With COVID-19 restrictions now fully removed in England, NHS staff face the daunting triple-threat of rising Covid-19 hospitalisations, huge backlogs of medical operations to clear, and the added expectation of large increases in winter flu, which is already being seen even now in summer.
"These difficulties are present at a time when the NHS is already under-resourced, impacted by sickness and/or staff being ‘pinged’ to self-isolate through the government’s track and trace app, and staff continuing to fear the daily risk of infecting family and friends.
"Together these are considerable psychological burdens and create a perfect storm for the mental health and well-being of NHS staff."
Gilleen says there may be worse to come, especially if new, more transmissible variants develop. "Previous research after other pandemics such as SARS has shown that residual mental health symptoms like PTSD can continue for years, so the impact of repeated waves over the long-term will be potentially catastrophic for the mental health of NHS staff.
He has some clear recommendations to protect the wellbeing of frontline healthcare workers. “To protect the mental health of NHS staff they must feel they are less at risk or in danger, have access to the required level of PPE, not be continuously over-worked, with better staffing, more opportunities for rest and space to share their stress.
"Despite this and similar findings from other studies, still not enough is being done to protect NHS staff mental health and wellbeing and we fear it will continue to suffer in the months to come. With this comes the real risk that large numbers of staff will burn out or even quit the NHS.”