disclosure statement
DESCRIPTION
- PowerPoint PPT PresentationTRANSCRIPT
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Policies and standards of the Texas medical Association, the Accreditation Council for Continuing Medical Education, and the American Medical Association require that speakers and planners for continuing medical education activities disclose any relevant
financial relationship they may have with commercial entities whose products, devices or services may be discussed in the
content of the CME activity.
The content of this material does not relate to any product of a commercial interest; therefore, there are no relevant financial
relationships to disclose.
Disclosure Statement
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Identify the unique health care challenges facing Texas physicians and their patients;
Describe TMA’s recommendations to address the health care challenges facing physicians and their patients;
Discuss the advocacy actions TMA has taken to deal with the issue(s); and
Implement steps in their community to improve health care policy and legislation.
Healthy Vision 2020 Objectives
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1. Improve Texas’ Physician Workforce
2. Protect Physician’s Independent Medical Judgment
3. Promote Efficient & Effective Models of Care
4. Repeal Harmful & Onerous Regulations
5. Invest in Prevention
6. Protect Fair Civil Justice System
7. Provide Appropriate Funding
8. Fair & Transparent Insurance Markets
Healthy Vision 2020 Issues
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Improve Physician Workforce
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Texas Needs More Physicians
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Funding Cuts Crippled Physician Pipeline
Family Practice Residency Program cut by 75%
Statewide Primary Care Preceptorship Program and the Primary Care Residency Program not funded.
State GME formula funding cut 32%
Physician loan repayment programs one eliminated; the other cut by 78%
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Expanding Scope: Not A Workforce Solution
TMA strongly supports physician-led teams, with each practitioner bringing important skill sets and training to patient
care.
Future: Physicians will become both providers AND managers of
health care.
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Restore funding cuts and programs.
Link undergraduate expansion with GME.
Encourage Texas Higher Education Coordinating Board to evaluate workforce needs and conduct research.
Incentivize physicians to practice in rural Texas.
Reinstate physician loan repayment programs.
HV 2020 Recommendations
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Support expansions of scope consistent with team care.
Strengthen the Texas Medical Board’s regulatory oversight of physician supervision of and delegation to nonphysicians.
HV 2020 Recommendations
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Protect Independent Medical Judgment
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Preserved Texas’ ban on the corporate practice of medicine.
Passed employment bills with strong protections for clinical autonomy and independent medical judgment.
First state to pass statutes specifically protecting physicians’ clinical judgment. Hospital settings include: 501(a) corporations,
rural county hospital districts, large urban hospital districts, and the newly established Texas health care collaboratives.
Physician Employment Protections
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Nonprofit health care corporations, commonly referred to as 501(a) corporations.
Physician board of directors is responsible for all clinical matters.
Physicians now have important liability protections within a 501(a) corporation. The employed physician, “retains independent medical
judgment in providing care to patients, and the health organization may not discipline the physician for reasonably advocating for patient care.”
501(a) Corporations: SB 1661
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Rural hospitals in counties of <50,000 population can employ physicians.
Guarantees physicians’ independent medical judgment.
Medical staff is responsible for all clinical matters – bylaws, credentialing, peer review, etc.
Ensures employed and independent physicians have same rights.
A CMO is selected by the Medical Staff The CMO has a duty to report instances of interference to TMB
Rural County Hospital Districts SB 894
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Multiple laws were structured to meet the hospital districts statutory mission to provide care to the indigent. Applies to Harris, Bexar, El Paso, and Tarrant
counties, and the Scottish Rite Hospital in Dallas.
Allows for physician employment with strict protections.
Ensures Medical Executive Board establishes rules for all clinical matters: credentialing, peer review, quality assurance programs, etc.
Large Urban Hospital Districts
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New law protects patients and their physicians in new health care collaboratives.
Ensures physicians have equal say and vote in a collaborative arrangement’s governing board
Allows physicians to have: Equal say and vote in a collaborative
arrangement's governing board, Due process protections, and The ability to participate in more than one
collaborative arrangement in their community
Health Care Collaboratives
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Patient-physician relationship jeopardized by new law and rules.
Department of State Health Services rules impose a “gag order” on physicians who participate in Women’s Health Program.
A physician, nor anyone else in the practice, cannot discuss elective abortion issues with patient.
Women’s Health Program
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U.S. is spending much more for older ages
Source: Fischbeck, Paul. “US-Europe Comparisons of Health Risk for Specific Gender-Age Groups.” Carnegie Mellon University; September, 2009.
Health Care Spending at End of Life
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1976 (revised 1997): 2nd state to pass a law empowering families & physicians to make medical treatment decisions near the end of life.
Remarkable success in achieving 3 major goals: Improving communication and patient choice Decreasing pain and suffering, and Providing appropriate treatment without outside legal
intrusion
Legal definitions of terminal and irreversible illness.
Created a process to guide resolution of both right-to-die and medical futility disputes.
Texas’ Advanced Directives Act
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Protect the patient/physician relationship.
Protect physician’s independent medical judgment in all employment relationships.
Strengthen new employment laws..
Respect patient’s final days (TADA, DNRs, and stop legislation to treat until transfer).
HV 2020 Recommendations
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Right Care
Right Person
Right Time and
Right Place...
Efficient/Effective Models of Care
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Pilot in Colorado, New Hampshire, and New York: 18% in admission rates vs. 18% non PCMH group. 5% drop in ER visits; 4% in non-PCMH
Oklahoma saw complaints about access to same-day or next-day care drop from 1,670 in 2007 (year before PCMH implementation) to 13 in 2009 (year after)
North Carolina saved nearly $1.5 billion in costs between 2007 and 2009
Medical Home
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Promote patient-centered medical home for every Texan. A physician led team that ensures that care is:
Accessable Coordinated Comprehensive Patient centered Culturally relevant
Support PCMH model in Medicare, Medicaid, and commercial health plans.
HV 2020 Recommendations
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Repeal Harmful & Onerous Regulations
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“Patient” not even mentioned in PPACA.
Act
Patient Protection & Affordable Care Act
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Invest in Prevention
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Texans Are Killing Themselves
Chronic diseaseChronic disease Obesity EpidemicObesity Epidemic
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Encourage Texans to take personal responsibility for their own health.
Invest in a public health-prevention infrastructure.
Increase immunization by reducing barriers for all Texans.
Invest in obesity control.
Invest in tobacco cessation.
HV 2020 Recommendations
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Protect Fair Civil Justice System
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Reforms are Working
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Preserve Texas’ landmark liability reforms.
Ensure a fair and strong Texas Medical Board.
Oppose federal preemption of state civil justice reforms.
HV 2020 Recommendations
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Dual-Eligible Cuts
Provide Appropriate Funding
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Most of PPACA ruled constitutional, including the controversial individual mandate.
Congress CANNOT require states to give up ALL of their federal Medicaid funding if they decide NOT to expand Medicaid.
States can keep federal share of Medicaid money for their existing Medicaid programs.
U.S. Supreme Court Ruling: Now What?
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$27 billion budget deficit in 2011.
HHSC forced to trim $3 billion in Medicaid (GR) for 2012-13:
$1 billion-plus, provider/health plan cuts
Medicaid HMO statewide expansion
Benefit/service reductions
Utilization management
Fraud and abuse investigations
1115 Waiver
State Medicaid Funding: A Look Back
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Women’s Health/Family Planning
Lawmakers reduced family planning funding by $75 million — 66%.
Legislative Budget Board estimated:
20,500 more Medicaid births due to limited access to birth control.
Higher cost to Medicaid, $100,000 million.
Prohibited Planned Parenthood from participating in Women’s Health Program.
State Medicaid Funding: A Look Back
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Physicians’ payments slashed more than 20-percent for care to poor and elderly patients. Dual-eligible patients, dependent on Medicare and
Medicaid.
Cuts eliminated Medicare Part B coinsurance and deductible payments (if it exceeded the Medicaid allowable). Before cut, Medicaid paid 20% of patient’s co-insurance.
Before cut, Medicaid paid patient’s Medicare deductible.
Medicaid payments traditionally much lower than Medicare.
Dual-Eligible Payment Cuts
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Medicare Meltdown Redux
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Ensure competitive Medicaid and CHIP payments for physicians.
Repeal the dual-eligible payment cut.
Stop the Medicare Meltdown – Repeal the Sustainable Growth Rate (SGR).
Repeal or modify the Independent Payment Advisory Board (IPAB).
HV 2020 Recommendations
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What Can You Do?
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November 2012
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QuestionsFor more information: Call (512) 370-1300