Health care on the agenda for 110th Congress

On Thursday, Jan. 4, 2007, the 110th Congress convened with the new Democrat majority promising to make some major changes during the first 100 hours of the new session.

Two of the House Democrats’ top priorities, as mentioned by key leaders, involve health care: to pass legislation requiring the government to negotiate drug prices for Medicare beneficiaries and to lift restrictions on federally funded embryonic stem cell research.

Other health care issues the 110th Congress will likely address include:

• Fixing and updating the flawed Medicare physician reimbursement system,
• Expanding health insurance coverage to the 46.6 million uninsured, with an emphasis on state and federal funding for children’s health insurance programs,
• Supporting implementation of electronic health records and other health information technology,
• Improving drug safety at the Food and Drug Administration,
• Lessening restrictions on low-cost prescription drugs from Canada, and
• Improving the subsidized drug coverage for low-income Medicare beneficiaries.

“There really is a lot of excitement on our side of the aisle in Congress,” said Wendell Primus in a Washington Post article. Primus is the senior policy adviser on budget and health issues to House Speaker Nancy Pelosi (D-Calif.). “The members are ready to get down to work.”

Members of the Texas congressional delegation will fill key roles on the House and Senate committees that directly determine the success or failure of health care policy. One of these representatives, Lloyd Doggett (D-TX 25), will serve on the Health Sub-committee of the House Ways and Means Committee, which has oversight of federal health care programs such as Medicare, Medicaid and the Children’s Health Insurance Program.

Rep. Doggett sat down with his daughter, Austin family physician and TAFP member Lisa Doggett, M.D., TAFP Director of Public Affairs Tom Banning, and TMA Legislative Director Dan Finch before the holidays to discuss health care issues in the upcoming Congress.

“Among the topics we discussed was fixing the Medicare SGR, reforming ERISA and pursuing a national patients’ bill of rights, and CHIP reauthorization,” said Banning. “Congressman Doggett is committed to working with us to improve our health care delivery system and, like his colleagues, plans on making health care reform a priority for the new Congress. On the Medicare front, he mentioned he’d like to hold hearings sometime this spring on strategies to fix the flawed Medicare reimbursement system, which is a very positive step forward”

Banning is optimistic for significant gains in the 110th Congress. “We have a rare window of political opportunity to capitalize on national sentiment for health care reform and a Congress that is willing to work with us to accomplish that goal.”

Texas Legislature set to reconvene, let the political circus begin

Even before the opening day of Texas’ 80th Legislative Session on Tuesday, January 9, a heated race for Speaker of the House has captured the attention of House members and lobbyists alike. Regardless of who is voted House Speaker on opening day — Waxahachie Republican Jim Pitts, the current Chair of the House Appropriations Committee, or two-term Speaker Tom Craddick — there will likely be a significant shake up on House committees that could have significant impact for physicians and the issues important to them.

Budgetary and health care topics are sure to drive this year’s legislative agenda. A multibillion-dollar budget surplus in Texas could provide some fertile ground for reinvesting in health care programs like Medicaid and CHIP. Other issues the Legislature will be debating this session include managed care reform and transparency, public health initiatives, scope of practice expansion and improving graduate medical education.

TAFP Leadership and staff have been working over the past several months to schedule meetings with key lawmakers and to hone health care priorities. Key issues on the TAFP agenda include protecting and strengthening Medicaid and CHIP access through greater physician participation; developing a fair, transparent contract between physicians and health plans; and supporting real-time, electronic verification of benefits.

Part of TAFP’s work over the next months will be to keep Academy members informed on the goings-on of the 80th Legislative Session. Be sure to check the TAFP Web site often for the most up-to-date information on what is happening in Austin.

BlueCompare program — buyer beware

TAFP has joined forces with AAFP and the Texas Medical Association to identify physicians who have been inappropriately or unfairly designated as “poor” performers by the Blue Cross and Blue Shield of Texas’ new BlueCompare rating system. While the collective voice of medicine has caused BCBS Texas to postpone the publication of the BlueCompare results on its Web site, the data from the program are still being used to determine which physicians can participate in its preferred networks.

The BlueCompare program was developed to “enable more informed health care decisions by consumers,” according to BCBS Texas. However, the program uses enrollment and claims data to rate physicians on evidence-based medicine standards and efficiency.

“Claims data is notoriously flawed and is not a good indicator of whether a physician is providing quality care or not,” said Tom Banning, TAFP Director of Public Affairs. A preliminary analysis of the program by TMA found significant errors in how data is collected, processed and reported.

“Even more concerning, the flawed data is being used as the basis for which physicians can participate in Blue Cross BlueChoice and BlueChoice Solutions networks,” added Banning. “This is a significant threat to the clinical autonomy and economic independence of a medical practice because it is wrapped in the illusion of reasonableness and accountability. It is not hard to argue this program is nothing more than economic credentialing to control network participation and limit access to care.”

BlueChoice Solutions provider network skims a subset of physicians from the current BlueChoice network after evaluation by BCBS credentialing criteria, according to an information sheet distributed by the company. The evaluation process uses several components to determine eligibility in the network including a risk adjusted cost index based on a cost comparison with peers within a set geographic area, the number of completed episodes of care, the physician’s adherence to evidence-based medicine as measured by claims and enrollment data, and overall performance across a list of evidence-based indicators.

TAFP is concerned that BCBS may be using data that does not accurately reflect quality. Several Academy members have reported receiving letters from BCBS that tell of the “poor” designation and these members also report that their patients with BCBS have received similar letters encouraging them to find a new health care provider. If you have received similar correspondence from the insurer, TAFP encourages you to document your experience by filling out the TMA’s Blue Cross BlueCompare survey and to alert the Academy of your situation by e-mailing Tom Banning.

Join the excitement at the Capitol as Physician of the Day

Spots are still available in for TAFP members to serve as Physician of the Day during the upcoming 80th Legislative Session. Make sure to reserve your spot to participate in the program that has provided a family physician for each convening of the Texas Legislature including special sessions since 1971.

The Physician of the Day staffs the Capitol Health Services Clinic and treats legislators, their staffs and any person on the capitol grounds needing care. Physicians are introduced in the House of Representatives and the Senate by their district’s legislators and their names become part of the official legislative record. Volunteers are encouraged to bring a prescription pad and basic doctor’s bag.

This program is coordinated and organized by the Texas Academy of Family Physicians and co-sponsored by the Travis County Medical Society, Texas Medical Association, Texas Osteopathic Medical Association and Texas Department of State Health Services. Only TAFP members can serve as Physician of the Day.

Sign up today for February, March, April and May by contacting Kate McCann at TAFP headquarters or by filling out the form on the Physician of the Day page of TAFP’s Web site. Days available in February are February 2, 7, 14, 16, 19, 22, 23, 26 and 28.

Same great CME, new legislative updates at the C. Frank Webber Lectureship and TAFP Interim Session

Come hear what’s going on in Washington D.C. and Austin at the 2007 C. Frank Webber Lectureship and Interim Session March 1 through 3. Held annually in the state’s capital, attendees of this year’s conference will get an insider’s update on the goings-on in the
80th Legislative Session.

Attendees will also be able to earn valuable CME on important medical topics such as treatment updates for HIV and AIDS, diagnosis and management of autism and menopause management and osteoporosis. A complete CME schedule is now available on TAFP’s Web site.

Want to help shape Academy policy and influence the business side of the specialty? Attend a TAFP committee, commission, task force or section meeting. The complete business schedule and a description of the duties of each committee or commission can also be found on the TAFP Web site.

Check the Web site often for the most up-to-date information on the 2007 C. Frank Webber Lectureship and Interim Session held in Austin at the Hilton Austin Airport.

AHA heart disease awareness resources available

To raise awareness of heart disease and stroke—the No. 1 killer of women in America—the American Heart Association’s Go Red for Women Program provides tips and information to women on healthy eating, exercise and risk factors to decrease the number of women diagnosed with heart disease. National Wear Red Day, scheduled this year for February 2, is a national observance where participants wear red clothing in support of the cause.

Family physicians can get involved by providing information to patients on preventive measures and risk factors for heart disease. Informational resources for patients and physicians are available in the Go Red for Women Physician’s Toolkit, which contains:

• a description of the program,
• four 11-inch by 17-inch posters detailing tips to avoid heart disease and signs of a heart attack,
• a pack of 50 informational booklets on women and heart disease,
• five Go Red dress logo pins,
• appointment reminder cards,
• wallet-sized information cards,
• the AHA guidelines for heart disease prevention and
• a list of online tools.

For more information on the program, visit the AHA’s Go Red for Women Web site or order up to four physician’s toolkits by filling out toolkit order form.

Copyright 2006, Texas Academy of Family Physicians