One of the strangest and most tumultuous months in Texas legislative history has thankfully come to a close. But bills rescued from the detritus of the parliamentary storms include numerous measures that will be quite beneficial to Texas patients and their physicians.
When the 80th Texas Legislature convened in January, the Texas Medical Association issued a plea for lawmakers to pass physicians' multi-point plan, Preserving Patient Care. And that's just what they did. Led by medicine's numerous champions in the House and Senate, the legislature passed bills to reduce our uninsured population, reform the health insurance industry, enhance access to care, and bolster our public health infrastructure.
The highlight reel will point out that the 2007 Texas Legislature:
• Enacted a historic 25 percent overall increase in Medicaid payments to physicians for children's care, and a 10 percent hike for adult services;
• Allowed no dilution of Proposition 12 or the landmark 2003 medical liability reforms;
• Rescinded most of the 2003 cuts made in eligibility for the Children's Health Insurance Program (CHIP), providing health insurance for more than 120,000 additional children;
• Relaxed health plans stranglehold on patient information;
• Approved the creation of a premier Cancer Prevention and Research Institute;
• Maintained physicians' tax deductions for Medicaid, Medi-care, TRICARE, workers' compensation, charity care and CHIP;
• Established lower marginal tax rates on the state's new business tax for businesses with less than $900,000 in annual gross receipts;
• Instituted changes to protect access to care for worker's compensation patients and ensure appropriate review mechanisms are instituted by the health plans;
• Took the first steps toward requiring health plans to use smart card technology for patients; and
• Put structured physical education back into Texas public schools.
Preparation
TMA's 2007 goal was to enter the 80th legislative session with strong stakeholder support and smart strategies for each top-priority item.
Two tactics were initiated in fall 2005. The first was to create special ad hoc committees to study and develop recommendations for TMA's legislative platform. These committees studied Medicaid and the uninsured, scope of practice, health insurance reform and responsible ownership.
The second was to bring together key players at three TMA Healthy Vision 2010 summits. More than 65 stakeholders attended the summits, representing medicine, business, insurance, hospitals and other health care providers, and government. The summits helped to build support among political and business leaders, and to develop legislative agendas on the uninsured and on wellness and prevention.
Sincerely,
William W. Hinchey, MD
President, Texas Medical Association
Expand All Texans' Health Coverage Options
At the onset of the 2007 legislative session, TMA argued that lawmakers could no longer ignore the growing and alarming numbers of uninsured children and adults in Texas. The cost to care for the uninsured was fast becoming a huge burden for many communities. Nor could lawmakers disregard the impending Frew vs. Hawkins lawsuit settlement that would demand they allocate more funds to children's Medicaid services.
As a result of these two forces, lawmakers were quick to support TMA's legislative agenda aimed at reducing the ranks of the uninsured. Every single item on TMA's legislative platform for the uninsured was passed. The legislature:
• Restored physician fees for Medicaid services: 25 percent for children's Medicaid services and 10 percent for adult services
• Simplified enrollment and eligibility requirements for the Children's Health Insurance Program (CHIP), including 12 months' continuous coverage for nearly all children on CHIP
• Supported measures to reform Texas' Medicaid using state and federal dollars that will:
~ Extend private coverage for low-income parents and reduce the number of uninsured children
~ Create and maintain local public-private collaborations to address the uninsured and
~ Test new initiatives such as health savings accounts
Protect Patient
Access to
Appropriate,
Quality Care
Texas' fast-growing population exacerbates the demand for medical care. Competitors in the health care marketplace had ambitious legislative agendas, using this demographic trend to secure their footing. More than 88 bills were filed that would expand the scope of practice for nonphysician practitioners. Retail health clinics sought authority for nurse practitioners to provide medical services beyond their education, training and skill.
The trial lawyers shot out of the gate early, trying to weaken the 2003 liability reforms. Despite all these obstructive forces, not a single bill passed that would put patients in harm's way. Instead, lawmakers supported TMA-backed legislation. They:
• Stopped scope-of-practice expansions for nonphysician practitioners beyond their level of training and experience
• Preserved the historic 2003 medical liability reforms and Proposition 12
• Allocated nearly $86 million to graduate medical education so more homegrown physicians can take care of
Texas patients
• Approved $81 million to expand the medical schools at Texas Tech University Health Science Center in El Paso and Texas A&M
• Allocated more than $5.2 million to the Texas Medical Board for additional staff and technology upgrades to speed up the physician licensing process
• Imposed no new limits on physicians' rights to own equipment or facilities and
• Improved injured workers' access to appropriate care, in that only a physician licensed in Texas and in the appropriate specialty now may conduct workers' compensation peer reviews
Don't Let Health Insurance
Put Profits Before Patients
Our plan to reform health insurance ... to put power back into the hands of employers and workers who buy it ... enjoyed a strong start. Important advancements were made to loosen health insurers' stranglehold on patients and physicians. Legislators sought big-picture solutions, such as health care transparency and patients' right to know what their health care dollars purchase.
The bills in this session that prohibited balance billing didn't move. Instead, landmark measures that Texas legislators passed stopped health insurance abuses that confuse and frustrate our patients. The laws:
• Instituted transparency of health care costs from hospitals, physicians, other health care professionals, and health insurers so patients can make better health care decisions
• Required health plans to report important health care information such as where they spend health insurance premium dollars and the adequacy of their physician networks
• Prevented patients from paying out-of-network costs when seeing a physician new to a medical group that already is contracted by a health plan
• Provided employers access to health insurance information so they can evaluate employee health care expenditures and
• Required a study that will explore the feasibility of health plans using smart card technology
Enhance Our Physical Health
to Preserve Our Fiscal Health
TMA physician leaders worked overtime to make certain that legislators clearly understood one thing: Texas' future is in jeopardy. They emphasized that now is the time for Texas to invest in improving our physical and fiscal health.
Organized medicine asked lawmakers to invest in public health initiatives that will reduce obesity and tobacco use and improve immunization rates. The message was heard across the rotunda; it was a banner year for public health. Legislators took steps to address many of TMA's concerns. Legislators even upped the ante by passing legislation that:
• Created a Cancer Prevention and Research Institute to the tune of $3 billion, if Texas voters agree. The institute will fund cutting-edge research as well as a statewide tobacco prevention effort
• Put physical education back into Texas public schools for middle schoolers. Students also get an annual fitness test
• Allowed health plans to advertise their health and wellness programs and benefits, as well as provide financial incentives that encourage healthy behavior
• Created a worksite wellness program for state employees
• Developed advisory councils that will oversee and guide the state's worksite wellness, obesity and type 2 diabetes programs
Health Information Technology
for the
21st Century
Health information technology (HIT) has tremendous potential to improve the quality of care, prevent medical errors and streamline the health care delivery system. Physicians look forward to the day when they can easily access their patients' clinical information electronically, find treatment protocols to help them make evidence-based clinical decisions and participate in data-based quality improvement activities.
Investment in HIT is expensive. TMA strongly encouraged legislators to create a true public-private partnership to guide Texas into an era where health care technology can be used to improve quality care and efficient care. We also urged lawmakers to actively seek public and private sources of funding to help physicians acquire HIT for their practices - particularly in underserved areas of Texas. Three bills passed supporting TMA's vision. They will:
• Create a public-private entity to explore how physicians can take advantage of linkages that will enable them to share and compare electronic data. This partnership also sets the stage for data exchanges where patient insurance verification, coverage, prescription histories, lab results, lists of physicians in-network and eventually, real-time claims adjudication become a reality
• Modernize the state's Medicaid system with health information technology
• Create a pilot program that will provide HIT, including electronic health records, to high-
volume primary care physicians who participate
in Medicaid
Sound Science
and Care at the
End of Life
The tremendous pace of modern scientific advances gives physicians amazing new potential to diagnose and cure disease. Those same advances, however, threaten to outstrip society's financial capabilities and ethical boundaries.
This debate was a focal point during the 2007 legislative session, especially as it relates to end-of-life care. Legislation changing the Texas Advanced Directives Act (TADA) was introduced and would have rewritten state law on continuing medical treatment for a terminally ill patient. TMA argued that physicians never quit caring for dying patients. At some point, however, further medical treatment does more harm than good for the patient.
TMA made good-faith efforts to achieve a compromise. Nevertheless, the bill failed in the waning days of the session, and TADA was left unchanged. TMA will continue to work on addressing concerns that were identified during the session to ensure appropriate care is provided to patients at the end of life.
Taxes and Public School Finance
During a 2006 special session, Texas legislators enacted a broad-based business activity tax on most Texas businesses, including some physician practices. Recognizing that saving lives should not be taxed like other services, lawmakers incorporated tax deductions for free and underreimbursed care that physicians provide to Medicaid, Medicare, CHIP, workers' compensation, military and charity patients. Physician practices were the only business that received these tax deductions.
Medicine's mission during the 80th legislature was to preserve the tax deductions that would help preserve patients' access to health care services. TMA reiterated this message from 2005-06: Health care is not a traditional business activity and should not be subject to a traditional business tax. Legislators listened. In the end, lawmakers protected physicians' tax deductions and instituted a graduated tax rate that reduced the business tax for companies with gross incomes from $300,000 to $900,000.
Principles for Healthy
Vision
2010 Accountability
The Texas Medical Association supports:
• The highest professional ethics in caring for patients
• Empowering patients to take more responsibility for their health
• Promoting continuous patient safety improvements
• Assuring that physicians and their patients have the sole authority to make health care decisions
• Promoting physician accountability and connectivity
Efficiency
The Texas Medical Association supports:
• Making affordable health care available to all using multiple funding sources
• Creating value in the health care of our patients
• Eliminating excess administrative costs
• Protecting the economic viability of physician practices
• Using health care information technology to improve the quality of care
Effectiveness
The Texas Medical Association supports:
• Investing in prevention
• Providing an appropriate and enduring medical home for every patient
• Providing portable and non-discriminatory basic health coverage for all Texans
• Providing clinically appropriate medical care based on sound medical science
• Promoting a team-based approach to safe and effective health care delivery
• Investing in the public health infrastructure
