Baylor University Medical Center Proceedings July 2017 - 385

use one hand for assistance at ﬁrst. Do this 10 times a day
and you've done 10 squats without going to a gym.
9. When at a stoplight. The muscles supporting the lower
abdomen muscles may weaken over time. Tighten the
pelvic ﬂoor muscles by holding for 10 counts, then release
for 10. Repeat until the light turns green.
10. While watching TV. Lie on your side and do three sets of
15 leg lifts, then three sets of 15 leg circles-raising your
leg and rotating it in a circular motion. Switch sides.
These 10 suggestions can save a lot of gym fees and allow
more free time.
THE LARGEST NOT-FOR-PROFIT HEALTH CARE SYSTEM IN
TEXAS
Baylor Scott and White Health, the largest health care system in Texas, includes (in 2015) 48 hospitals, 1000+ patient
access points, nearly 210,000 hospital admissions, over 31,000
babies born, 5600+ licensed beds, 5500+ active physicians,
10,000+ nurses, 44,000+ employees, 4,600,000 outpatient
registrations, and 2000+ research projects and grants. These
are 2016 quick facts. The total assets are $10.8 billion, with
$8.4 billion in total operating revenue. This includes the audited
ﬁnancial statements running from July 1, 2015, through June
30, 2016. The Baylor Health Care System Foundation in ﬁscal
year 2016 distributed $43.2 million: 41% for patient-centered
programs, 24% for research, 19% for medical education, and
16% for capital and technology. Baylor Scott and White Health
was voted "One of the Best to Work for" in 2016.
REVISED PHYSICIAN-TRAINING HOURS
The Accreditation Council for Graduate Medical Education
in 2011 banned the 30-hour work shift for interns to no more
than 16-hour shifts (19). The council announced in March 2017
that ﬁrst-year training physicians will be allowed 24-hour shifts
in hospitals across the USA starting in July 2017. The council
indicated that the change to longer hours will enhance patient
safety because there would be fewer handoﬀs from physician
to physician. It also said the longer hours will improve the
doctors' training by allowing them to follow their patients for
more extended periods, especially in the critical hours after
admission. The decision ends the latest phase in a decades-old
debate over how to balance physician training with the safety
and needs of patients whose care is often handled by young
sleep-deprived physicians. Other previous work rules were retained in the council's latest review: residents are not allowed
to work >80 hours a week, must have 1 day oﬀ every 7 days,
and cannot work overnight in the hospital >1 night in 3, and
hospitals and residency programs must give residents time oﬀ
for their own physical and mental health appointments. These
rules aﬀect 125,000 physicians-in-training, including residents
and fellows, who are the backbone of staﬀs at about 800 hospitals in the USA.
HEALTH CARE COSTS IN TEXAS
Texas spent $42.9 billion, or 43.1% of the entire state budget, on health-related costs in 2015! From 2011 through 2015,
July 2017

health care spending in Texas rose 19.7% (20). In contrast,
the population increased 7.1%, and inﬂation increased 5.4%.
Spending on health care institutions in the University of Texas
(UT) system (which includes costs for providing medical care,
conducting research, and educating trainees) jumped from
$3.4 billion in 2011 to more than $5 billion in 2015, largely
due to expenses from the M. D. Anderson Cancer Center. That
institution had losses of more than $400 million in 2015 and
recently laid oﬀ 5% of its workforce. The state allocates the
following per institution (in millions): UT M. D. Anderson
Cancer Center, $2410; UT Medical Branch at Galveston,
$1065; UT Southwestern Medical Center, $926; UT Health
Science Center at Houston, $344; UT Health Science Center at
Tyler, $117; UT Health Science Center at San Antonio, $102;
and Texas Tech University Health Science Center, $76.
PREDICTING HEALTH CARE COSTS IN RETIREMENT
Although health care can be one of the biggest costs in
retirement, it is diﬃcult to estimate (21). Understanding
Medicare is extremely diﬃcult! It generally covers a lot less
than people usually think. The costs, of course, are highly
variable, a reason they are so hard to predict and averages can
be meaningless. Simply being healthy will not necessarily save
money. Longevity is the biggest driver of health care costs, and
it's the healthy retirees that end up with higher lifetime costs
simply because they live longer. Even retirees satisﬁed with
Medicare coverage will still spend an average of $260,000 on
health care from age 65 on. A third of that is for Medicare
premiums; the rest goes to copayments, deductibles, prescription drugs, and medical costs. Medicare covers the basics, but
it does not cover everything, such as costs of drugs, certain
medical equipment, or long-term care. Save your money.
COMMUNICATING COSTS OF MEDICAL CARE FROM
PHYSICIANS TO PATIENTS
Dr. Christopher Moriates, an assistant dean at the Dell
Medical School at the University of Texas at Austin, had a recent
column in The Dallas Morning News entitled "Doctors need
to talk about medical costs" (22). Dr. Moriates, however, does
not entirely fault physicians. Medical schools and residency
training programs have traditionally shied away from teaching
costs. For the most part, costs remain hidden even from many
practicing physicians. Some would argue that this is for a good
reason: physicians should be making decisions based on medical need without clouding that judgment with considerations
of potential costs. That intention, Moriates argues, is noble
but in practice it often leads to physicians inadvertently saddling patients with expensive medical bills. He recommends
that physicians and patients both need to better communicate
about the cost problem and work together to ﬁnd solutions if
the ﬁnancial burden is too much. A Monmouth University poll
recently found that paying for health care is the top concern of
American families, beating out job security and ﬁnding money
to pay household bills. Similarly, when Gallop asked Americans
"What is the most urgent health problem facing this country?"
costs consistently topped the list.

Facts and ideas from anywhere

385

Table of Contents for the Digital Edition of Baylor University Medical Center Proceedings July 2017