Becker's Hospital Review

94 THOUGHT LEADERSHIP instance — they may want to participate un- der a defined program, like MIPS, and maybe perform at the lowest level to avoid penal- ties. If it's expensive to ramp up to do MIPS in your practice, it's even more expensive to ramp up to perform as an Advanced APM. It does make sense to go that direction, if the practice has the resources, and if the physi- cian is inclined to go all in. For those who don't want to go all-in, MIPS is probably the simpler path to take. Q: Do you think we will see more physicians gravitating toward hospi- tal employment because of MACRA? DB: e AMA is very interested in providing both practice tools and resources, as well as advocating with CMS, Congress and the ad- ministration, to maintain viable alternatives for physicians who don't choose to join larg- er groups. We believe that is very important, that pluralistic approach to practice models. Whether the trend continues is less import- ant to us than making sure the environment of care will allow physicians to practice for their own professional satisfaction and for the needs of their community in whatever setting they find most appropriate. We see the trend toward consolidation, and probably much of that is being driven by programs like MIPS and various other payment-related issues. It is a harder task for small groups now than it used to be. But again, our interest is trying to preserve a path for small and independent practitioners if that's their choice of practice style. n America, We Need to Focus on Mental and Behavioral Health in the Aftermath of the Las Vegas Tragedy By Anthony R. Tersigni, EdD, FACHE, President and CEO of Ascension F ifty-nine lives. In Las Vegas, 59 lives were lost, more than 500 people are still healing and a nation seeks answers after another senseless tragedy. We continue to see these tragedies at an alarming rate because we all too often fall short of addressing the root cause. While much national discussion focus- es on the costs and benefits of additional gun regulation, we also need to have an honest conversation about how to treat the underlying disease by improving access to mental and behavioral healthcare. The American Foundation for Suicide Prevention ranks sui- cide as the 10th leading cause of death in this country. The Substance Abuse and Mental Health Services Administra- tion reports approximately 1 in 5 U.S. adults will be affect- ed by a mental illness this year alone. If I told you one-fifth of all American adults had some form of bone disease, there would be a national outcry to dramatically ramp up all research and treatment for it. Don't mental and behav- ioral disorders deserve the same attention and resources as any other pervasive disease? Of 43.8 million people affected by mental illness this year, 60 percent will not receive mental health services. Worse, nearly 40 percent of adults with a serious mental illness go without the help they so desperately need, and yet many in our nation continue to stigmatize those with mental and behavioral illness. Research suggests an inherent link between alcohol abuse and gun violence; 48 percent of homicide offenders are reportedly under the influence of alcohol at the time of the offense. Furthermore, risk of homicide, suicide and violent death significantly increases with chronic substance abuse. Addiction to alcohol, drugs and gambling is a national tragedy that often exacerbates the struggle of those suf- fering from mental illness. At Ascension, our mission calls us to provide compassion- ate, personalized care for body, mind and spirit — especial- ly for people living in poverty and those most vulnerable. Across our 2,500 sites of care, we are sharing best practic- es and learning from one another to better integrate be- havioral healthcare into more primary care settings. In fact, many of our physicians have started to add social workers and health psychologists, who focus on patients' mental and behavioral health needs, to their practices. We have begun to expand our telehealth services to in- clude telebehavioral health, serving more individuals where and when they are in need. It's an innovative be- ginning with endless possibilities. To ensure behavioral healthcare is integrated with our community health work, we are addressing social determinants of health to under- stand the conditions that have given rise to an increase of mental and behavioral health disorders. As the U.S. struggles with a mental and behavioral health crisis, it demands a national discussion that is transparent and honest. It's only when Americans begin to heal from the inside out that we can, together, more effectively re- spond to tragedies such as those in Las Vegas, Sandy Hook and Virginia Tech — along with the 121 suicides occurring each day. We need to recognize and constantly remind ourselves that our collective health — physical and mental — is one of our nation's greatest resources. It should also be one of our greatest priorities. America, we are sick. Mental health systems are failing, and we need a better, more effective treatment program. That is why Ascension advocates for a heightened focus on mental and behavioral health. I urge other healthcare organizations to join us. n

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