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The U.S. Centers for Disease Control has declared a national public health emergency. One school district in Texas is closed, and Gov. Rick Perry has ordered nearly 1 million courses of antiviral medication. It’s not time to panic, but the Texas Department of State Health Services has guidance for physicians who encounter patients with flu-like symptoms. To keep members informed of the latest news and clinical suggestions, we’ve established a swine flu resource center on the TMA Web site. We will keep it up to date so you can stay up to date and answer your patients’ questions. DSHS has established a toll-free swine flu hotline for physicians and providers. Call (877) 623-6274. We are scheduling a special educational session on swine flu for the afternoon of Friday, May 1, at TexMed 2009. Look for details when you come to the meeting

It will be a First Tuesday on the last Thursday. TexMed 2009, TMA’s annual meeting, kicks of this week with our Lobby Day at the Capitol on Thursday morning. Thousands of physicians, medical students, and TMA Alliance members are expected in Austin for TexMed, so we’re organizing bus trips to the capitol. Join us as we discuss the hot issues with representatives and senators and deliver invitations for our Lobby Day luncheon on the capitol lawn. After that, don’t miss the more than 100 hours of free continuing medical education, our great speakers and book signings, the House of Delegates’ annual session, and the installation of TMA President Bill Fleming, MD, and TMA Alliance President D’Anna Wick. Check out TexMed’s Top 10 List (PDF) for other can’t-miss events. If you Twitter, please use the hash tag #texmed.

Three key pieces of our Patients’ Right to Know health insurance reform package won approval from the Senate State Affairs Committee. Special thanks to Dallas orthopedic surgeon John Gill, MD, and Austin ophthalmologist Dawn Buckingham, MD, for testifying before that committee last week. The three bills that now go to the full Senate are:

• Our Health Insurance Code of Conduct Act of 2007 (PDF), Senate Bill 1257 by Sen. Kip Averitt (R-Waco), which covers insurance cancellations, physician ratings, and more;
• Our Health Insurance Label Bill, SB 815 by Sen. Kirk Watson (D-Austin), which would establish standardized marketing materials for all health insurance plans; and
• Our Truth in Medical Loss Ratio Bill, SB 485 by Sen. Bob Deuell, MD (R-Greenville), which provides a standardized definition of the “medical loss ratio” and specifies exactly what insurers can include as a medical cost vs. administrative cost.

Why did the owners of a residential treatment center try to stop a physician from reporting a child sex scandal to authorities? Why did they fire her when she did report it? Watch Linda Adair, MD, an Austin child psychiatrist, tell her story. Senate Bill 1500 by Sen. Robert Duncan (R-Lubbock) would allow many hospitals across the state to hire physicians directly. The bill passed the Senate and is in the House, where TMA is working with lawmakers to add protections for physician autonomy and patient care.

Nobel Prize winner Alfred Gilman, MD, PhD, dean of The University of Texas Southwestern Medical School, has accepted the position of chief scientific officer for the Cancer Prevention and Research Institute of Texas. Dr. Gilman shared the 1994 Nobel Prize for Physiology or Medicine for “the discovery of G-proteins and the role of these proteins in signal transduction in cells.” The Cancer Prevention and Research Institute of Texas was created with voter approval in 2007 of a $3 billion constitutional amendment. Over the next 10 years, cancer research institutions can apply for a portion of $300 million annually in grants and loans. Up to 10 percent of funding, or $30 million a year, will pay for cancer prevention and control programs. TMA and the Texas Public Health Coalition, along with advocacy groups and lawmakers, championed passage of the amendment.

If you don’t get your share of lobbying at the TexMed 2009 Lobby Day at the Capitol, you still have one more chance to join the “white-coat invasion.” Our final First Tuesdays at the Capitol is May 7. Register online and watch our latest First Tuesdays video. “It’s crunch time in the Texas Legislature, when all the big decisions are made,” said TMA President Josie Williams. “And we need you – your patients need you – to be there as a lobbyist for a day.”

Check out the Doctor’s Orders video to get a more complete view of TMA’s 2009 legislative agenda. You can see all of TMA’s 2009 legislative issue briefs on the TMA Web site.

“All politics is local,” the old saying goes. That’s only true, though, when the folks back home keep reminding their elected leaders in Austin and Washington what’s important to them. By taking the time to call, write, or visit your senators and representatives, TMA physicians magnify the strength of our lobby team. Only with that kind of grassroots support can we kill off or amend the bad bills and pass the ones that are good for medicine and patients. As the 2009 Texas Legislature enters its crucial, final month (watch the video), I want to thank you for responding to TMA’s action alerts and taking the time to come to Austin for First Tuesdays at the Capitol. Keep it up — it works.

A TMA radio ad campaign and some stalwart physicians from the Lubbock-Crosby-Garza County Medical Society (LCGCMS) took on the hospitals’ push for authority to put physicians on their payrolls all over the state. LCGCMS President Jack DuBose, MD, discussed the issue live on the air with Senate Bill 1500 sponsor Sen. Robert Duncan (R-Lubbock) and hospital lobbyists. Special thanks to Lubbock gastroenterologist Priscilla Snodgrass, MD, who put her voice on the radio ad, and to LCGCMS President-Elect Juan Fitz, MD, who made a television appearance on behalf of physicians’ clinical autonomy. SB 1500 is still pending debate before the Texas Senate.

Four TMA member physicians and three lay citizens earned appointments to the Texas Medical Board from Gov. Rick Perry. The new physician members are Patrick J. Crocker, DO, chief of emergency medicine at Dell Children’s Hospital in Austin, and Dallas orthopedic surgeon Wynne M. Snoots, MD, medical director of the Baylor Sammons Bone Tumor Center at Baylor University Medical Center. The governor reappointed Brownsville obstetrician-gynecologist Manuel G. Guajardo, MD, and Dallas critical care specialist Allan N. Shulkin, MD, to new terms on the board. Jerry Hunsaker, MD, of Corpus Christi, testified in support of House Bill 4385 by Rep. Allen Vaught (D-Dallas), which would criminalize the intentional misuse of databases by health plans to either lower their part of the payment or deny payment for a patient's care.

Charlotte Smith, MD, of Austin testified before the Senate State Affairs Committee for TMA's Health Insurance Code of Conduct Act of 2009 (PDF) — Senate Bill 1257 by Sen. Kip Averitt (R-Waco). The bill is a key part of our Patients’ Right to Know campaign to hold health insurance companies accountable for the promises they make. Other TMA members testified for medicine this week:

• TMA President-Elect Bill Fleming, MD, testified before the House Public Health Committee for a strong and fair Texas Medical Board to preserve the 2003 health care tort reforms and uphold high ethical and professional standards for physicians. Dr. Fleming provided extensive testimony related to House Bill 3816 by Rep. Fred Brown (R-College Station).
• Austin psychiatrist Clifford Moy, MD, vice speaker of the TMA House of Delegates, testified for Senate Bill 2243 by Sen. Judith Zaffirini (D-Laredo), TMA’s bill to enhance the state’s physician loan repayment program. The bill won approval from the Senate Higher Education Committee.
• Joel Dunnington, MD, professor of radiology at M.D. Anderson Cancer Center in Houston, testified for Senate Bill 544 by Sen. Rodney Ellis (D-Houston), the statewide smoking ban bill.
• TMA President Josie R. Williams, MD, testified for the Texas Department of Insurance (TDI) sunset bill — House Bill 2203 by Rep. Carl Isett (R-Lubbock). Dr. Williams told House Insurance Committee members to consider broadening TDI’s authority over abusive business practices used by health insurers. Dr. Williams also testified for House Bill 3120 by Rep. Carol Alvarado (D-Houston), which would help small employers challenge large insurance premium increases.
• Gary Floyd, MD, a pediatrician from Fort Worth, testified for Senate Bill 532 by Sen. Dan Patrick (R-Houston), which would ensure physicians maintain supervision and accountability of physician assistants and/or advanced practice nurses (APNs) in retail health clinics. Dr. Floyd also testified against two bills that would dangerously expand APNs’ scope of practice.

The reports and resolutions the TMA House of Delegates will consider next month at TexMed 2009 in Austin are available for members only on the TMA Web site. The house convenes at 8 am on Friday, May 1, and at 8:30 am on Saturday, May 2, in the Austin Convention Center.

Blue Cross and Blue Shield of Texas agreed to an order from Attorney General Greg Abbott to stop using its Risk Adjusted Cost Index to rate physicians as more or less affordable in providing quality medical care. Blue Cross also agreed to stop a practice General Abbott’s investigation uncovered: terminating physicians from its networks solely for referring patients to out-of-network specialists. TMA President Josie Williams issued a statement applauding the attorney general and encouraging “all health insurance companies operating in Texas to adopt this same pro-patient approach.”

It’s time for medicine to flood the Texas capitol switchboard with phone calls. Bad bills for you and your patients are on the move – and our good bills are stuck in committee, particularly the Senate State Affairs Committee. Senate Bill 1500, which would allow hospitals across the state to employ physicians, won committee approval and is headed to the full Senate. With support from Lubbock-Crosby-Garza County Medical Society leaders, TMA is buying a full flight of radio ads in Lubbock this week, asking citizens to call Sen. Robert Duncan (R-Lubbock) – the bill’s sponsor – to oppose the bill. And, we’re pushing the YouTube video of Jim Cox, MD, explaining how a hospital fired him for not following orders to increase admissions from the hospital emergency room. Meanwhile, our health insurance reform bills in the Patients’ Right to Know campaign have not received a committee hearing, and a bill that could weaken liability protections for physicians offering emergency care could get a vote any day. Please make your calls today.

Led by Dr. Williams, numerous TMA-member physicians stood up for the profession last week by testifying at legislative committee hearings. Dr. Williams testified in support of House Bill 1932 by Rep. Senfronia Thompson (D-Houston), the standardized health insurance labeling bill, and for House Bill 1888 by Rep. John Davis (R-Houston), which would set standards for health plans’ physician ratings systems. HB 1988 won House Insurance Committee approval. Also:

• Jerry Hunsaker, MD, of Corpus Christi, testified in support of House Bill 4385 by Rep. Allen Vaught (D-Dallas), which would criminalize the intentional misuse of databases by health plans to either lower their part of the payment or deny payment for a patient's care.
• TMA Board of Trustees Chair Lyle Thorstenson, MD, of Nacogdoches testified against six bills that would allow rural hospital districts to directly employ physicians.
• Jim Merryman, MD, of Austin, testified in support of House Bill 3270 by Rep. Donna Howard (D-Austin), which would remove barriers to e-prescribing. Much of this bill came out of TMA’s 2008 E-Prescribing Summit.
• John Jackson, MD, chair of TMA's Committee on Physician Health and Rehabilitation testified in support of Senate Bill 1331 by Sen. Jane Nelson (R-Lewisville). The bill would create the Texas Physician Health Program to establish a mental health and substance abuse intervention program for physicians. The confidential program is intended to be nondisciplinary and would provide a source of help to doctors who need it.

We have another big week ahead of us at the capitol. The House of Representatives will debate the 2010-11 state budget Friday. Tomorrow, the House Public Health Committee takes up bills for advanced practice nurses to expand their scope of practice in extraordinary ways. We will oppose those and a bill that would undermine TMA's support of a strong and fair Texas Medical Board.

April's First Tuesdays at the Capitol brought more than 400 TMA physicians and medical students to Austin – the largest attendance ever. The morning began with a plea from Dr. Williams for physicians to protect their clinical autonomy – especially because the Texas Organization of Rural and Community Hospitals and the Texas Hospital Association have made it their mission to weaken it. I was especially proud of the hordes of medical students lobbying for their future by pushing for more funding for graduate medical education and loan repayment programs. Don’t miss our final white-coat lobby day on Tuesday, May 5.

TMA’s annual meeting comes to Austin this year, from April 30 to May 2 at the Austin Convention Center. We’re packing an extra day of lobbying at the capitol into the agenda. Plus, we have more than 100 hours of free continuing medical education, the House of Delegates, the TMA Foundation Gala, and the installation of Bill Fleming, MD, as TMA’s new president, and D’Anna Wick as the new leader of the TMA Alliance. Be sure to catch the General Session, Why Zebras Don't Get Ulcers, by stress expert Robert Sapolsky, PhD. You can register online for TexMed 2009. See you there.

Check out the Doctor’s Orders video to get a more complete view of TMA’s 2009 legislative agenda. You can see all of TMA’s 2009 legislative issue briefs on the TMA Web site.

Hospital administrators across Texas, led by their state associations, want to play doctor. TMA says no. The principle is simple. Only physicians are licensed to provide medical services. Administrators are not. Nearly 30 bills in the legislature would let hospitals hire physicians directly. One especially dangerous bill, Senate Bill 1500 by Sen. Robert Duncan (R-Lubbock), would allow dozens of Texas hospitals to put physicians on the payroll. The crux of the issue isn’t employment, per se, but rather physicians’ clinical autonomy to care for their patients. As TMA President Josie Williams, MD, told the Senate State Affairs Committee, “This is the cornerstone of the profession of medicine.” More bills will be heard in committee this week. TMA is calling affected physicians and sending e-mail action alerts. Please respond quickly to help douse this threat to patient care.

More than 400 physicians, alliance members, residents, and medical students have registered for tomorrow’s First Tuesdays at the Capitol. The white-coat invasion will lobby for insurance reform, and to stop the corporate practice of medicine, bolster spending on Medicaid and graduate medical education, improve public health, and protect our tort reforms. It’s not too late for you to register.

Dr. Williams testified before the House Insurance Committee on two health insurance reform bills that are part of TMA’s Patients’ Right to Know campaign. She spoke in support of House Bill 1932 by Rep. Senfronia Thompson (D-Houston), which requires a standardized health plan marketing label that allows an “apples-to-apples” comparison of health insurance coverage. Testifying on HB 1888 by Rep. John Davis (R-Houston), Dr. Williams laid out TMA’s standards for health plans’ physician ranking systems. Involve your patients in the campaign at www.MeAndMyDoctor.com.

With an outpouring of opposition from TMA members, we have been able to keep a dangerous bill from passing out of a State Senate committee. Senate Bill 152 by Sen. Rodney Ellis (D-Houston) would weaken liability protections for physicians who see patients in emergency situations.

Working from the guiding principles developed by almost a year’s worth of work, the new TMA Health System Reform Task Force holds its first meeting tonight. The task force will plan its work of evaluating reform proposals coming from the Obama administration, Congress, and elsewhere.

More than 4.3 million Texans, including 1.2 million children, live with some form of mental health disorder. Of these, 1.5 million cannot function at work, school, or in the community. Over the past decade, reduced state funding eroded Texas’ ability to care for patients with mental disorders. As the availability of services declined, these patients, insured and uninsured alike, had to seek care in hospital emergency rooms. Texas’ prison system also warehouses mentally ill patients who are waiting for a psychiatric bed or community help to become available. Mental illness costs the state and local governments more than $1.5 billion per year. Each person repeatedly jailed, hospitalized, or admitted to a detoxification center costs the state $55,000 per year.

In 2007, legislators invested $82 million to redesign the state’s mental health crisis system. Even though the new funds only represent about 5 percent of local mental health authorities’ (LMHAs’) budgets, it was a much-needed boost. LMHAs were directed to use the funds to support 24/7 crisis hotlines and mobile crisis outreach teams to respond to crises at schools, homes, or other settings. Other services that LMHAs may develop include expanded outpatient services, extended observation services (up to 48 hours), 14-day crisis stabilization units, and coverage of costs incurred by local law enforcement transporting patients with behavioral health needs. Congress passed legislation in 2008 that requires group health plans with 51 or more employees to treat mental health disorders the same as other medical conditions. Mental health parity in health coverage is an important step. However, much more is needed to ensure Texans with mental health disorders receive the care they need.

Medicine’s 2009 Agenda

• Support funding to expand the availability of community-based mental health care for adults and children, including prevention and early intervention.
• Support funding to sustain, expand state investments to redesign mental health crisis services.

Medicine’s Message

• Texas ranks 49th in the nation for per-person spending on mental health care. Inadequate state funding puts the burden on local resources, and increases rates of incarceration and use of public hospital emergency rooms, homeless shelters, and the foster care system.

Check out the Doctor’s Orders video to get a more complete view of TMA’s 2009 legislative agenda. You can see all of TMA’s 2009 legislative issue briefs on the TMA Web site.