TMA EVPGram

Gov. Rick Perry stopped a sneak attack from the Texas Trial Lawyers Association by vetoing a bill that would have weakened Texas’ landmark 2003 health care liability reforms. “The bill’s provision regarding physician liability was neither debated nor discussed, but rather amended onto this bill late in the session,” the governor said in his veto message of House Bill 3485. “It risks unraveling the progress we made in curtailing excessive liability and ensuring that patients who need physicians will be able to find them.” TMA President Bill Fleming, MD, issued a news release, applauding Governor Perry “for recognizing that we cannot risk even the slightest dent in a new liability system that has worked exactly as promised. … We are proud that Governor Perry always has been and remains a true champion for our patients by standing tall and leading the way toward enacting and protecting the 2003 liability reforms.” TMA worked closely with Rep. Garnet Coleman (D-Houston), the bill’s author, to forge strong protections for physicians’ clinical autonomy before the legislation was sabotaged by the trial lawyers’ 11th-hour amendment.

The bill Governor Perry vetoed was intended to attract new physicians to underserved rural areas of Texas by allowing government-owned hospitals in counties with fewer than 50,000 residents to hire physicians directly. TMA is committed to helping solve rural Texas’ health care problems without jeopardizing our liability reforms. In coming months, we will work with rural physicians and hospitals to forge some solid solutions. “We will continue to work with state leaders to craft a consensus plan for the 2011 legislative session that more effectively addresses the problem of underserved areas and protects patient care and access,” Dr. Fleming said. The governor made an excellent start by signing House Bill 2154, which helps underserved counties attract new physicians by significantly strengthening the Texas Physician Loan Repayment Program. The new budget the legislature approved increases graduate medical education (GME) funding for the next biennium from $5,634 to $6,653 per year per residency slot. It also gave a 21.5-percent hike to the Higher Education Coordinating Board’s Family Practice Residency Program.

The period for the governor to veto bills from the 2009 Texas Legislature ended yesterday, so we can wrap up some of medicine’s highlights for the session (PDF). (Contact TMA Public Affairs if you want copies of that legislative report card.) Among the bills Governor Perry signed into law:

• House Bill 1888 by Rep. John Davis (R-Houston) sets standards for health plans’ schemes for ranking physicians.
• HB 2256 by Rep. Kelly Hancock (R-Fort Worth) provides important patient protections as well as a mediation venue to resolve disputes for out-of-network, facility-based physician claims by health benefit plans.
• Senate Bill 78 by Sen. Jane Nelson (R-Lewisville) creates the new Healthy Texas program to help small businesses obtain affordable health insurance for their employees.
• Senate Bill 346 by Senator Nelson establishes a lifelong adult immunization registry in Texas, and Senate Bill 347 by Senator Nelson allows states to share immunization registry records during a disaster.
• Senate Bill 870 by Sen. Eddie Lucio Jr. (D-Brownsville) directs Medicaid and the Children’s Health Insurance Program to implement pilots to help reduce childhood obesity among enrollees, and Senate Bill 282 by Senator Nelson establishes grant programs to provide nutrition education to children and to school districts for best practices in nutrition.
• House Bill 1357 by Rep. Carl Isett (R-Lubbock) requires that freestanding emergency room facilities be licensed and sets minimum standards for their construction, design, and operation.

Jim Rohack, MD, became the 164th president of the American Medical Association one day after President Barack Obama made a historic visit to the AMA, and on the eve of a long, hot summer of negotiations over health system reform. The former TMA president took his audience through a history lesson – the evolution of medicine, of organized medicine, and of Jim Rohack himself. “I can promise that our AMA is committed to offering guidance, our expertise, the benefits of our relationship with patients, and the powerful voice of our profession, to help the powers that be make the right decisions,” Dr. Rohack said to an audience of his national peers and Texas friends. “This is an effort that will define our organization, define our nation, and define each and every one of us.” Listen to Dr. Rohack’s address in a special installment of Podcast TMA.

Physician leaders from along the U.S.-Mexico border and San Antonio head to Washington, D.C., to discuss the dire health care situation along the border. Physicians representing TMA and the Border Health Caucus are meeting one-on-one with U.S. representatives and senators to support legislation that improves health care access. They also have included numerous congressional leaders in their 4th Annual Border Health Conference. El Paso surgeon Manny Acosta, MD, chair of the Border Health Caucus, is leading the delegation, which also includes Dr. Rohack. We’ll have more details in next week’s EVPGram.

We’re in for an exciting couple of days here in Chicago, and all of it is wrapped up in the future of American health care and your great profession. President Barack Obama spoke to the American Medical Association House of Delegates this morning on his plans for health system reform. “I need your help doctors,” he said. “To most Americans, you are the health care system. We just do what you tell us to do. That's what we do. We listen to you. We trust you. That's why I will listen to you and work with you to pursue reform that works for you." The president addressed all of the controversial elements of his plan:

• Mr. Obama said it is an "illegitimate concern" that "a public option is somehow a Trojan horse for a single-payer system. …I believe that it's important for our reform efforts to build on our traditions here in the United States. When you hear the naysayers claim that I'm trying to bring about government-run health care, know this: They're not telling the truth."
• In place of Medicare’s sustainable growth rate, he said, “We will ensure that you will be reimbursed in a thoughtful way that's based on patient outcome.”
• Several times, the president said he wants to keep what works in the current system and fix what’s broken. “We will make this promise to the American people: If you like your doctor, you will be able to keep your doctor, period,” he said. “If you like your health care plan, you will be able to keep your health care plan, period. No one will take it away.”
• Referring to a widely circulated New Yorker magazine article concerning Medicare spending in McAllen, Mr. Obama said, “We spend vast amounts of money on things that aren't necessarily making our people healthier.” He said he wants the government to invest in comparative effectiveness research. “Identifying what works is not about dictating what kind of care should be provided. It's about providing patients and doctors with the information they need to make the best decision. I have the assumption that if you have the information, you're going to make the best decision. I have confidence in that.” TMA disagrees with many of the conclusions in The New Yorker article because it ignores many of the stark realities of practicing medicine in the poorest metropolitan community in the country. We are working with local physician leaders to invite the president to visit the Rio Grande Valley to see the situation firsthand.

The president was warmly received by the AMA audience. Many who disagreed with his policy positions said they were impressed that he came to Chicago to speak directly to the organization. You can read the highlights of the president’s address on TMA’s Blogged Arteries.

The AMA house meeting thus far has been dominated by discussions of what health system reform physicians want for their patients and their practices. Is the so-called “public health insurance option” just a stepping stone to a single-payer system? How can we expand affordable coverage for all Americans, do away with the sustainable growth rate formula for physician Medicare payments, and bring about both antitrust reform and liability reform? Will physicians have the right to choose what plans they will join? Should the AMA demand that physicians have the right to contract privately with patients outside of Medicare? How will physicians – and it must be physicians, not government – deal with variations in the cost and quality of health care across the country? How can all the major players in health care work together for the sake of the patients? As AMA President Nancy Nielsen, MD, PhD, said, “We can’t keep on hating everyone all the time.”

Here are some additional resources you might find useful:

• TMA’s live blog of the health system reform briefing by Dr. Nielsen and Rich Deem, AMA’s senior vice president for advocacy.
• The slide deck, complete with charts and graphs, that AMA President-Elect Jim Rohack, MD, of Texas, has been using to explain health system reform to physician groups.

Stay tuned to Blogged Arteries through Wednesday for complete coverage of the AMA meeting.

Tomorrow night, Dr. Rohack takes the oath of office as AMA president. Those of us who have worked closely with him over the past few decades are excited to have a leader of Dr. Rohack’s stature and capacity at this critical juncture in American medicine. We’re excited that a physician with such a long history of service to TMA will be at the helm. TMA staff presented Dr. Rohack with a Texas tuxedo cufflink and stud set during a private dinner with him here in Chicago. The Temple cardiologist will be installed at 6 pm tomorrow. We will live blog his address on Blogged Arteries and hope to post the full speech later that night as a special edition of Podcast TMA.