The ongoing issue of reimbursement rates is no small matter — but it shouldn't distract Mississippi physicians from focusing on the great health challenges of their home state.

 

It's that broader focus Timothy Alford, MD, hopes to promote as the 143^rd president of the Mississippi State Medical Association. Taking office in June, Alford is deeply involved in statewide issues while also tending to his own family practice patients at Kosciusko Medical Clinic.

 

"My big interest — if we can keep from getting distracted — is to go on the offensive with regard to Mississippi's overall health status. We keep reciting our abysmal statistics, but we haven't really done any cohesive, orchestrated work on this. We're functioning in a very fragmented healthcare system, and we're easily frustrated by the things we encounter there. We don't have time to focus on preventable causes of diseases, even though a lot of our population is entrenched in adverse behaviors."

 

"One of my top goals is embracing the comprehensive school-health curriculum that the Mississippi Department of Health and the Office of Healthy Schools are implementing around the state. The Office of Healthy Schools discovered that students are performing better when certain steps are taken. Each school is to have a health council, and physicians can be part of that. From our perspective, it's one of the best bangs for your buck: We're not having to recreate the wheel; we're just trying to augment what the Department of Education is already doing."

 

"The issue of the patient-centered medical home is also something in which Mississippi has fallen behind. It's becoming more difficult for patients to see their personal physicians because of the economy, and we've got to fight back against that trend. We must make it a priority for every person in the state of Mississippi to have a relationship with his or her own doctor.

 

"That relationship is a very important part of somebody's life and that person's ability to stay healthy. It's a very simple concept. But if that relationship is intact, then people are more likely to see their doctor in an appropriate care setting and also more likely to place an emphasis on living a healthy lifestyle."

"The Mississippi Legislature in the 2010 session passed House Bill 1192, which empowers the State Department of Health to establish medical-home pilots. Dr. Luke Lampton, chair of the Mississippi State Board of Health, has appointed a blue-ribbon task force to look at implementing the principals of the patient-centered medical home, and I'm excited to be part of that.

 

"The concept includes such radical notions as open-access scheduling, communicating with patients by e-mail and enhanced accessibility — so that when somebody runs into a problem, they can actually speak to their physician, instead of just an answering service. It also includes greater efficiencies in a medical practice, such as taking a group of patients with similar problems and dealing with them in a class format.

 

"All of this is a bit forbidding, because physicians are not reimbursed for these things. But the day is not too far off when there will be rewards for these kinds of management practices."

 

"From personal experience, I know a lot of times I've been over-involved in the mundane. I do a lot of chores during the day that could be taken care of by somebody else. Sometimes it means relinquishing things that have been held sacred over the years. For example, with patients who take Coumadin, we want to hold the management of this very close to us. But if you have a Coumadin-management track in your office, that could be handled best by an allied provider.

 

"So sometimes it can be about relinquishing some authority — empowering your office staff and using physicians for the real problem-solving and diagnosis. Because right now, there are not enough of us; we do need to use our time more wisely."

 

"This effort has had mixed reviews, and many physicians have a very cynical outlook about healthcare reform. But in a big way, I think it takes some major steps toward solving our issue of uncompensated care. We're talking about more than 500,000 people who are uninsured in this state, and I believe this stands to help about two-thirds of that group. Some people frown on the fact there will be more Medicaid dollars coming into this state, but the reality is, it's going to help a lot of the rural practices here — and that's in a large part what our medical community consists of.

 

"Additionally, I've had patients who have encountered significant financial ruin because, once these people get sick, the insurance companies find a way to get them off their rolls — either by taking them off outright, or by setting their premiums at a price they could not afford. So it's good news that this effort is basically telling the insurance companies that, as far as their being able to duck a patient because of a pre-existing condition, that party is over."

 

"My pessimism is about the cost spiral of healthcare and what it's going to do to future generations of people and of physicians, if we don't get about the business of doing something about it. The effort toward fostering the patient-centered medical home is aimed at helping this problem as well — trying to keep chronic illnesses in check and to redirect a lot of these patients who find themselves in an expensive care setting like emergency rooms or hospitals.

 

"If we don't do this, we're going to rapidly price ourselves out of the market for so many of our patients. In Mississippi, our average per-capita income is the lowest in the land, which makes it increasingly difficult for patients to pay out-of-pocket or through traditional insurance means. When you realize someone will pay 20 to 25 percent of their income for health-insurance premiums, suddenly you realize how great a burden healthcare costs are on our economy."