• TWHC wins funding for preventive health care in the 84th Texas Legislature

    Tags: texas women's healthcare coalition, preventive care, women's health, texas family planning, texas women's health program, expanded primary health care program, nelson, davis, howard, realini, 84th, legislature

    By Anna Chatillon
    Director of Policy and Advocacy for the Texas Women’s Healthcare Coalition

    In the midst of the chaos and inevitable drama of the 84th Texas Legislature, we risk overlooking one piece of news with the potential to change thousands of lives for the better. Funding for women’s preventive health care services, such as annual check-ups and contraceptive care, was increased by nearly $50 million in the state budget for the coming biennium.

    In 2011, draconian budget cuts to Texas’ Family Planning program devastated the women’s health care safety net. When the Texas Women’s Healthcare Coalition, a collaboration of 60 member organizations led by TAFP and others, was formed in 2012, its aim was to restore that funding. The Coalition’s successful advocacy restored the funding in 2013 through the Texas Women’s Health Program and the Expanded Primary Health Care program, in addition to the Family Planning program.

  • Public health efforts pay off with legislative wins in the 84th Texas Legislature

    Tags: texas public health coalition, 84th, legislature, tobacco, e-cigarettes, vaccination, immunization, cancer, hinojosa, ebola, sheffield, abbott, department of state health services, texas emergency medical task force, craddick, health and human services commission

    By Joey Berlin
    Texas Medicine

    The Texas Public Health Coalition and diligent physicians earned significant victories during the 84th Texas Legislature in their drive to reduce tobacco and electronic cigarette use.

    Lawmakers also provided the Texas Department of State Health Services with a likely bump in chronic disease prevention funding, and an effort to keep children’s immunization records in the state registry through their early adult years made its way into law.

  • First do no harm? A reflection on pain and intervention at the end of life

    Tags: perspective, mandola, end-of-life

    By Vincent J. Mandola, MD

    March 25, 2015 was a day I will never forget. It was the day I watched my mother take her last breath. She was 56 years old and had battled cancer for two years. It was a surreal time stepping into the unknown for my close family, but it’s not the moment of her passing I want to write about here. It is the days leading up to that moment, as this experience has given me a new outlook on end-of-life care.

    After surgery and nearly a year and a half of chemotherapy, mom was determined to have a couple of decent weeks before what she knew was inevitable. She had just been discharged from the hospital for uncontrolled pain and sent home under hospice care.

  • The brave new world of the SGR repeal

    Tags: ragle, president's letter, legislature, medicare, medicare access and CHIP reauthorization act, MACRA, sgr, affordable care act, direct primary care

    By Dale Ragle, MD
    TAFP President, 2014-2015

    On April 16, 2015, President Obama signed the Medicare Access and CHIP Reauthorization Act of 2015, which phases out Medicare’s flawed sustainable growth rate payment formula over the next 10 years. The so-called “doc fix” enjoyed bipartisan and bicameral support in Congress, a rare phenomenon these days, as well as support from most major medical organizations, including AAFP and the American Medical Association. In spite of broad support, the bill took more than a year of tweaking and survived innumerable negotiations between both political parties and the White House, a testament to the adage that “the devil is in the details.”

    The SGR formula tied Medicare expenditures to the gross domestic product. Since demand and utilization of health care services do not rise and fall directly with the ebbs and flows of the general economy, the SGR often threatened to cut physician fees year after year. Perennially, Congress passed special legislation to delay the fee cuts, often only finding they have to repeat the action in the following year.

  • Texas family physicians and family planning

    By Bhavik Kumar, MD, MPH

    In 2011, the Texas legislature cut its family planning budget by more than $70 million, resulting in a patchwork system of access to family planning services. Although much of this budget was restored in 2013, multiple barriers to care still exist. For example, abortion-affiliated family planning clinics that have commonly provided a significant amount of family planning and other preventive care are now specifically excluded from state funding programs like the Texas Women’s Health Program. Instead, much of the restored budget is being directed to primary care providers rather than specialized family planning providers.1 While Texas family physicians are well distributed throughout the state and provide care to a large volume of patients, it is likely a new role for many primary care providers who previously relied on family planning clinics that are now either cut off from state funds or have closed due to funding restrictions.

    The recent changes have also had an impact on Texans trying to access health care services. The restructuring has resulted in confusion and complexity for patients accessing family planning care. Notably, the decreased funding has limited coverage for preventive care, such as cervical cancer screening, as well as long-acting reversible contraception like the intrauterine device and contraceptive implant. Unfortunately, the changes have been most harmful for low-income women who rely on state-funded programs for much of their health care needs.2, 3

  • Court upholds subsidies in ACA

    Tags: texas association of community health centers, affordable care act, health care reform, medicaid, supreme court

    Health care organizations and millions of people across the country can breathe a sigh of relief. The Supreme Court has upheld the subsidies established by the Affordable Care Act that help about 6.4 million Americans purchase health insurance on the federal exchange. Had the court struck down those subsidies, more than one million Texans might have lost their coverage.

    President Obama addressed the nation from the White House shortly after the ruling was announced, saying there could be no doubt that the ACA is working and that the law is here to stay.

    “Today is a victory for hardworking Americans all across this country whose lives will continue to become more secure in a changing economy because of this law,” the president said.

  • Report from TACHC, TAFP says Supreme Court ruling could worsen growing consequences to Texas’ refusal to expand Medicaid coverage

    Tags: texas association of community health centers, affordable care act, health care reform, medicaid

    More than 1 million Texans might lose their health insurance if the Supreme Court rules against the Obama administration this month in King v. Burwell. Such a ruling would deny premium subsidies to Texans and residents of 35 other states that refused to establish state exchanges under the Affordable Care Act.

    Texas’ decision not to expand Medicaid coverage under the Affordable Care Act already leaves more than a million low-income, uninsured Texans without access to Medicaid or to federal subsidies to help them purchase insurance. A new report, “How will Texas’ Affordable Care Act Implementation Decisions Affect the Population? A Closer Look,” written by health care law and policy experts at George Washington University and commissioned by the Texas Association of Community Health Centers and TAFP examines the effects of that decision and the compounded damage to the state’s economy and health care infrastructure that would accompany a Supreme Court ruling in favor of the plaintiff.

    “The combined effects of not expanding Medicaid and the potential impact of King v. Burwell will hit Texas’ health care system hard,” according to the report. “County‐level estimates show that prior to implementation of the ACA, 38 counties experienced hospital annual uncompensated care levels of $50 million or greater, and four counties showed losses greater than $200 million. Texas’ failure to adopt the Medicaid expansion, coupled with the loss of premium subsidies as a result of a decision against the government in King would reverse the progress that has been made in reducing the number of uninsured Texans. Furthermore, hospitals could find that the demand for charity care actually rises, as thousands of previously‐insured people with serious health conditions turn to their hospitals for help.”

  • Cutting out the middle man

    Tags: ragle, president's letter, legislature, 84th, direct primary care, bonnen, hancock

    By Dale Ragle, MD
    TAFP President, 2014-2015

    Greetings colleagues. Do you remember a time when you could take care of your patients without any of the hassle and expense associated with billing insurance companies? When you could spend as much time with your patient as needed? When you simply received payment from your patients instead of some third-party payer?

    Many physicians practicing today have only heard stories of those days, but a growing number are rediscovering them by stepping off the insurance treadmill and contracting directly with their patients. Direct primary care is an innovative model for delivering and purchasing health care services that gives physicians and their patients an alternative to the third party, fee-for-service system. For a flat monthly fee, patients have unlimited access to their doctor—in person and by phone or e-mail—for a full range of comprehensive primary care services including acute and urgent care, regular checkups, preventive care, chronic disease management, and care coordination.

  • A new way to train family physicians

    Tags: young, residency, perspective, rural medicine, rural, rural physician

    By Richard Young, MD

    What is the best way to train comprehensive full-service family physicians to learn how to thrive in underserved rural Texas? How have duty hour restrictions affected residents’ training with this goal in mind?  JPS might have some answers.

    The John Peter Smith Hospital Family Medicine Residency Program was chosen to be one of 14 programs to participate in the Preparing the Personal Physician Practice (P4) experiment, which was conducted from 2007 to 2012. The leading organizations that regulate family medicine residencies allowed JPS and 13 other programs across the U.S. to blow up their curricula and start all over. JPS innovated its curriculum in two primary ways. This is a report on some of our preliminary results.

  • Missed opportunities in the 84th Texas Legislature

    Tags: legislature, legislative update, 84th, medicaid, banning, medicare, graduate medical education, nelson, zerwas, residency, family medicine residency program, higher education, primary care coalition, texas medical association, preceptorship, bonnen, hancock, direct primary care, schwrtner, crownover, prescription, drug abuse, substance abuse, darby, yogi

    By Tom Banning

    Yogi Berra famously said I hate making predictions, especially about the future. It’s particularly painful when those predictions come true as was the case for many of the predictions TAFP made at the outset of the 84th Texas Legislature on how health care issues would fare this session.

    Playing to their primary voters, the House and Senate focused attention almost solely on tax cuts, border security, transportation, when and where you can carry a gun, and a host of other mostly inconsequential partisan ideas.