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.

We won’t know until after tomorrow morning’s balloting whether Fort Worth plastic surgeon Larry Reaves, MD, wins his quest to serve on the AMA Council on Constitution and Bylaws or whether Dallas internist Lynne Kirk, MD, is elected to the Council on Medical Education. But we already have several election victories to celebrate:

• San Antonio internist Jayesh Shah, MD, is the new chair of the AMA International Medical Graduate Section.
• Jason Sharp, MD, a resident physician from Dallas, was unanimously reelected to a second term on the Council on Constitution and Bylaws.
• Ankit Shah, a second-year student from Baylor College of Medicine, was elected AMA Medical Student Section Region 3 vice chair; and Elizabeth Carroll, a third-year student at The University of Texas Southwestern Medical School, was elected Region 3 secretary-treasurer.

The strange 81st session of the Texas Legislature ended with some very good news for physicians and patients. “Thanks to patients’ champions in the House and Senate, the 2009 Texas Legislature passed bills to reform health insurance, increase access to health care, preserve the patient-physician relationship, and improve the health of all Texans,” Dr. Fleming said. Lawmakers:

• Preserved Texas’ landmark 2003 medical liability reforms (pending Governor Perry’s veto of HB 3485);
• Increased funding for graduate medical education in Texas;
• Required insurers to use accurate data and valid, recognized standards when ranking or tiering physicians in their networks;
• Expanded efforts to improve the use and reliability of health information technology in Medicaid and the health care system;
• Funded expansions of community-based obesity prevention programs;
• Directed the state to evaluate the adequacy of insurers’ physician networks in local markets to reduce the chances of out-of-network services and unexpected out-of-pocket costs for patients;
• Expanded the Texas physician loan repayment program;
• Protected funding to enhance cancer prevention and research programs in Texas;
• Enhanced funding for local mental health crisis intervention; and
• Created a lifelong immunization registry in Texas.

With sadness, I write to inform you that Charles Max Cole, MD, passed away on June 1, at the age of 95. He was the oldest living former TMA president. For many years, he was clinical professor of surgery at The University of Texas Southwestern Medical School. He led both the Dallas County Medical Society (1964) and TMA (1970) as president. TMA presented him with the Distinguished Service Award in 1984. And Dallas County Medical Society has attached Dr. Cole’s name to its own annual distinguished service award. Physicians from across the country have responded with a very consistent message. Here are a few examples.

• “He was a giant — no, ‘the giant’ — in organized medicine from our community; a true leader, yet so very humble.”
• “He was a wonderful man, a true gentleman, and the finest representative of medicine's best.”

Dr. Cole’s family has arranged a memorial service for Friday, June 12, at 11 am at Preston Hollow Presbyterian Church, 9800 Preston Rd., in Dallas. A private family funeral was held June 3.

As per our recent custom, TMA staff will bring you up-to-the-minute news, photos, and audio from the annual meeting of the American Medical Association House of Delegates via Blogged Arteries. The meeting convenes in Chicago on Saturday. Our own Jim Rohack, MD, will be installed as the new AMA president next week, and we will live blog his installation address. The Texas Delegation is also backing two Texas candidates for office and five resolutions from our House of Delegates.

We warned you that partisan politics would play a major role in the 2009 session of the Texas Legislature. The five-day House battle between Democrats and Republicans over a bill requiring voters to show a picture ID brought chaos to the legislature’s closing weeks. The 140-day session ends today with the fate of many bills still uncertain. The capitol is filled with rumors that Gov. Rick Perry will call a special session. Here’s a rundown on bills important to medicine that passed:

• The $182.3 billion state budget increases funds for graduate medical education and mental health services. It will not increase Medicaid payments to physicians. We stopped a plan to expand HMO-like Medicaid programs and cut physicians’ out-of-network Medicaid payments.
• House Bill 1888 by Rep. John Davis (R-Houston) and Sen. Robert Duncan (R-Lubbock) requires health plans to use accurate physician data in any physician ranking system, allows due process for physicians prior to the publication of their ranking, and specifies that the measurements used be reliable, evidence-based, and consistent across all health plans in the market.
• HB 2256 would provide important patient protections as well as a mediation venue to resolve disputes for out-of-network, facility-based physician claims. Senator Duncan and Rep. Kelly Hancock (R-North Richland Hills) carried the bill.
• Small physician practices could get a double benefit from HB 2154 by Rep. Al Edwards (D-Houston) and Sen. Juan Hinojosa (D-McAllen). It enhances the state’s loan repayment program to provide up to $160,000 over four years for physicians who work in a medically underserved area. The bill raises money through a new way to tax smokeless tobacco and also helps cover the cost of increasing to $1 million the exemption for businesses subject to the margins tax.
• A session-long battle over allowing hospitals to employ physicians directly ended with two bills passing: SB 1705 by Sen. Royce West (D-Dallas) for the Dallas County Hospital District and a Senator Duncan amendment to HB 3485 by Rep. Garnet Coleman bill (D-Houston) that applies to government-owned hospitals in counties of 50,000 or less. TMA won very strong protections for physicians' clinical autonomy including a Texas Medical Board-supervised certification program. The bill potentially expands liability exposure to government hospitals that use this option to employ physicians. That has drawn the governor’s attention for a possible veto.
• SB 532 by Sen. Robert Deuell, MD (R-Greenville), and Representative Coleman ensures proper oversight of physicians' delegation of prescriptive authority and other responsibilities to allied health practitioners at retail health clinics.
• No bills passed that would dilute our 2003 health care liability reforms.
• Two immunization bills by Sen. Jane Nelson (R-Lewisville) passed: SB 1328 gives state and local experts an opportunity to assess the vaccine needs of first responders before they respond to emergencies and disasters. SB 346 creates a lifelong adult immunization registry in Texas.

Our Task Force on Health System Reform met Saturday to spell out exactly what Texas physicians want to see in any reform package that Congress might pass this year. We will release the final plan for comment in a week or so, but it’s certain to include language that would:

• Eliminate Medicare’s flawed physician payment formula;
• Focus on prevention and wellness, both for individual patients and the population as a whole;
• Ensure that physicians define science-based standards of care;
• Eliminate unnecessary complexities and paperwork that add to physicians’ costs; and
• Align financing and incentives to ensure that physicians, hospitals, patients, health plans, and government agencies all are working together for the good of the patient.

The Texas Delegation to the American Medical Association House of Delegates will be a very busy bunch when the AMA meeting convenes in Chicago on June 13. In addition to celebrating the installation of Jim Rohack, MD, as the new AMA president, we are asking the house to back two Texas candidates for office and five resolutions from our own House of Delegates. They include:

• Electing Fort Worth plastic surgeon Larry Reaves, MD, to the AMA Council on Constitution and Bylaws; and Dallas internist Lynne Kirk, MD, to the Council on Medical Education;
• A resolution calling for legislation mandating clear and transparent health insurance company language so patients know their financial responsibility when receiving care out of network;
• A resolution calling for legislation requiring insurers to adopt standardized verbiage spelling out coverage for preventive care, including adequate payment for recommended vaccines;
• A resolution calling for the use of standard commercial physician payment rates in all government health care benefit programs;
• A resolution requiring all Medicare patients to register the advance directive of their choice; and
• A resolution asking AMA to help physicians and medical staffs establish transparent policies to implement and conduct Ongoing Professional Practice Evaluations.

In his first public appearance since becoming TMA president, Bill Fleming, MD, addressed the graduating class at The University of Texas Medical School at Houston. Dr. Fleming acknowledged the students’ hard work to date – and the work, fears, and excitement to come. He urged them to always put their patients first and to get involved in organized medicine. “You are embarking upon the greatest profession in the world,” he said. “Cherish it. Go forth and make us proud.”