All hands on deck

Tags: ragle, president's letter, 84th, legislature, medicare, meaningful use, icd-10, graduate medical education, direct primary care, public health, medicaid, physician of the day, tafppac, key contacts

By Dale Ragle, MD
TAFP President, 2014-2015

Welcome colleagues to a new year, a new Congress, and a new Texas Legislature. On all fronts, health care is evolving. These changes present family physicians tremendous opportunities to shape our future health care system. It’s up to all of us as family physicians to advocate for our specialty in the halls where decisions are made that affect our patients and our practices.

In Washington, D.C., the 114th Congress is well under way and is busy on a number of health care issues. AAFP’s advocacy work is focused on fixing Medicare’s broken payment model, changing Meaningful Use requirements, delaying ICD-10, and reforming graduate medical education funding. Another area in which AAFP is concentrating efforts is in making payment for direct primary care services a qualified health benefit under IRS rules. This would enable patients to pay for direct primary care with pre-tax HSA and FLEX account dollars, a move that would aid the expansion of this emerging and promising model of practice.

Back here at home, state lawmakers are at work in the 84th Texas Legislature. According to the state constitution, the Legislature must be in session for 140 consecutive days every two years. Of course the old joke is that the framers actually intended the Legislature to be in session two days every 140 years, but someone got confused along the way.

As in all sessions of the Legislature, health care will compete with public education, tax cuts, roads, water, and energy on the state’s list of priorities, but rest assured there will be plenty of work for the TAFP advocacy team. Let’s take a look at some of the health care issues we’re likely to face.

Graduate medical education: Last session, led by state Sen. Jane Nelson, R-Flower Mound, the Legislature made significant strides in restoring funding cuts to the state’s family medicine residency programs and laid the groundwork to create new and expanded graduate medical education positions. As Texas continues to boom in population, ensuring an adequate supply of primary care physicians has been a major concern for the state. How we recruit, educate, and train our future physician workforce and how we pay for that effort is on the agenda yet again.

Direct primary care: The concept is simple: a physician and a patient enter into a contract for care that they are willing to provide and receive for an agreed upon price without the interference of a third party. However, state insurance laws and regulations are opaque when it comes to whether DPC models should be construed as insurance products. TAFP will be pursuing legislation to clarify that practices engaged in the DPC model are not treated as insurance and thus are not held to that statutory and regulatory standard.

Transparency: As your Academy has been saying for some time, value-based payment—or rewarding physicians for quality of care over volume—has arrived in the health care marketplace and it will only become more ubiquitous among payers and across contracts in the coming years. To counter the indefensible variation in price and outcomes patients experience, health plans are turning to narrow physician and hospital networks, and angry employers, patients, and politicians are calling for greater transparency in health care cost and quality.

No market, especially in health care, can function properly without complete information on price, cost, and quality of the goods and services being purchased. TAFP will advocate for true transparency in costs while protecting network adequacy.

Public health: Remember last year’s Ebola scare? State lawmakers in Austin do, too. As a result of systematic underfunding over the last decade, Texas’ public health infrastructure is frighteningly understaffed and fragmented. On this topic there seems to be bipartisan support: we must correct the lack of a coherent set of state and local guidelines for dealing with public health emergencies.

Medicaid: Some are calling for Texas to expand Medicaid coverage to poor uninsured Texans under Obamacare, but such a move is not likely in this Legislature. Few if any state lawmakers won elections on the promise to expand Medicaid, so the politics—especially in a much more conservative Texas Senate—should quash any expectation that they would contemplate a Medicaid expansion deal. Under the circumstances, this likely includes other red-state-style private-market Medicaid solutions.

To be sure, your Academy will work diligently to serve as family medicine’s voice in this legislative session, but as always, we need your help. If you have a relationship with your state representatives, please join our Key Contacts program so we can coordinate with you and strengthen our advocacy efforts.

Consider serving as Physician of the Day at the State Capitol during the session. It’s an excellent opportunity to meet your representatives and see the legislative machinery at work, all while providing an important service.

Finally, make a donation to TAFPPAC. By giving to our political action committee, you are helping to support candidates who demonstrate support for issues important to family physicians and our patients. Visit for more information.

There you have it—three things you can do during this legislative session to help your Academy and strengthen our specialty so we can all get back to caring for our patients. We need all hands on deck for this difficult legislative session. To learn more about these three actions and to participate, go to

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