Too many industry insiders, and other letters

I'm afraid I have to respectfully disagree with your Top 25 Women in Healthcare (“Beyond the glass ceiling,” April 8). While these may be the choices of the industry itself, it negates the influence of some nursing groups such as the National Nurses United, now the largest nursing organization in the country.

RoseAnn DeMoro (executive director of the CNA and now the NNU) has been selected to Modern Healthcare's 100 Most Influential People in Healthcare for 12 straight years. She continues to be influential, yet your selections are obviously industry “insiders” in many cases.

John Silver, RN, PhD

Regarding the article “Audits find organizations unaware of new data, privacy rules,” we as a group cannot keep up with anything the government(s) are injecting into our businesses without adding a full-time staff of lawyers to interpret the flood of new things to track. It's another additional cost of healthcare, intended or not.

David Davisson, business analyst, TEK Systems

After being at loggerheads for a decade over the scope of practice issue (“Stiff resistance,” April 19), the Texas Medical Association and nurse practitioners hammered out a surprisingly elegant compromise this year.

Senate Bill 406 improves access to healthcare by making it easier for physicians, advanced practice registered nurses and physician assistants to work together to deliver services. More importantly, the legislation firmly establishes a physician-led medical team. The legislation is the result of many months of discussions among the TMA, the Texas Academy of Family Physicians, APRNs and PAs.

TMA President Dr. Michael Speer said the bill establishes a more collaborative, delegated practice that allows members of the healthcare team to practice to their level of education and training. Physicians, APRNs and PAs are natural partners in the delivery of appropriate and compassionate patient care. This bill strengthens that partnership. 

It's a delegated and supervised model. Independent diagnosing and prescribing are the practice of medicine. A physician can delegate but must supervise. Ultimately, the physician is held accountable for the healthcare services provided to patients.

The bill also recognizes the reality of the importance of the practitioners, APRNs and PAs as valuable members of a physician-led team of professionals.

Steve Levine

There is nothing inherently “more sensitive” about mental health or HIV clinical information (“IT Everything” blog, April 16). In the past, it has been used to deny health insurance benefits to some patients, and was anecdotally used to create a “stigma” associated with them. Same thing for oncology diagnoses, particularly given the exorbitant cost of some drug therapies. But it has often been expanded even beyond those conditions. (Would you want to insure a diabetic or an asthmatic?) With the rules for the health insurance exchanges created by the Patient Protection and Affordable Care Act, that should hopefully not be a factor going forward.

Michael Mundorff

In the article “HCA to grow presence in behavioral health, official says” (ModernHealthcare.com, April 19), HCA shows very forward thinking regarding the comprehensive and integrated approach to behavioral healthcare that the Mental Health Parity and Addiction Equity Act has enabled. While some payers continue to drag their feet by resisting compliance with the law (see recent lawsuits in California, Connecticut and New York), many others have come to realize that failure to identify and treat mental illness and addiction problems comes at a steep price. The increased costs for chronic medical conditions attributed to poor screening and management of behavioral health conditions is up to double that for people without this comorbidity. Providing a continuum of care keeps expensive utilization and readmissions down while improving quality for patients.

Dr. Steve Daviss,