President’s Page
The end and the beginning
2 Dallas Medical Journal December 2018
Ruben L. Velez, MD
B
By the time these words are printed,
we will almost be at the end of another
year. 2018 has been a fast-moving
year, especially with the midterm
political election cycle that concluded
in November. Our established and
new leaders in Congress will take us in
different directions in regard to health
care, which has been one of the main
discussion topics all year. We hope that
the many millions of dollars that were
spent in this election cycle now are
directed to more needed areas, especially
to health care and the underserved.
We are at the tip of the iceberg,
particularly regarding the mega-mergers
in health care. We have read about
the CVS-Aetna merger. The American
Medical Association has raised concern
about this merger, and the issues related
to protecting patients and services. We
also have seen the discussions in Texas,
of the merger of Baylor Scott & White
Health with Memorial Hermann Health
System in Houston. No question,
these will be game-changers in Texas
health care, and we must be cautious
of the unintended consequences of
these unions. CMS has recognized
that consolidation and decreased
competition bring about the unexpected
consequences of smaller hospital
closures, interfering with needed services
in underserved areas. Will these mergers
improve quality of care, expand services
to needed communities, control costs?
Time will tell.
The media continue to report on the
lack of or denial of services that patients
need. The current system does not
support improving needed services for
this vulnerable population. And now, we
have another potential disruptive trend:
Medicare Advantage programs. Recent
media coverage has shown that most
large insurance companies are making
billions of dollars, while limiting needed
services to patients instead of expanding
those services. In addition, the US
Justice Department is investigating some
of these MA plans. Time will tell how
this plays out, but we all need to be more
transparent and help our patients.
Some major issues remain, and we
must work on solutions. Congress,
hospital systems, payers, the medical
profession, and other healthcare workers
need to work together to move ahead.
The most important issues include
improving services to our vulnerable
population, improving the broken
Medicaid system, improving the