Capitol Update: Budget hearings continue as payment reform pilots are filed in the Senate
The House Appropriations Committee wasted no time delving into the budget this week, splitting into subcommittees and taking invited and public testimony each day. For family physicians, the main concerns lie in Articles II and III, where funding for health and human services and graduate medical education are found, respectively.
TAFP CEO Tom Banning testified on Feb. 15 before the subcommittee on education, telling representatives that the 28 family medicine residency programs not only train the next generation of family physicians, but they provide much-needed care to Medicaid patients across the state. State support they receive through the higher education coordinating board—more than $21 million in the 2010-2011 budget—has been eliminated in the House budget and cut by almost 29 percent in the Senate. Add that loss to a 10 percent cut in Medicaid fees, and these programs are bracing for a double whammy.
“The ability for these programs to stay afloat at a time when frankly we ought to be growing these programs to ensure that we’ve got the adequate workforce we need, is not going to be sustainable,” Banning said.
The House budget also zeroes out funding for the newly-enhanced Physician Education Loan Repayment Program. “A hundred and seventy-seven physicians signed a contract to go into underserved communities and provide care for those communities, and are now being told there’s no money in this program,” he said. “When you look at five, 10 years out, and I know that’s tough when you’re dealing with a two-year budget cycle, the intense competition for physician services in the near future—simply because of the shortage we currently have, the fact we’re not producing enough doctors to meet our future growth, the fact that you’ve got a huge contingent of physicians that are entering the baby boom age, much like the rest of the baby boomers who are going to retire at some point—other states are going to be competing for those physician services. Having that loan repayment program in place would allow us to retain Texas-trained physicians and help us to import doctors from other states.”
TTHSC family medicine department chair tells Senate Finance residency programs are “running on fumes”
Mike Ragain, M.D., chair of the department of family medicine at Texas Tech University Health Sciences Center testified before the Senate Finance committee on Feb. 15, asking the panel not to cut funding to family medicine residency programs and other primary care residencies. The programs are scheduled to receive almost 29 percent less in 2012 and 2013 than their appropriations in the current budget.
“One of the challenges is that almost every revenue stream that we see in medical education is going to get cut, and that cumulative effect is tough,” he said. “We are pretty tight. You could say we’re running on fumes as far as keeping things going.”
Two bills filed in the Senate would implement a host of pilot projects in Medicaid and CHIP, and in the private insurance market to test the success of various health care payment reforms, including bundled payments, payments based on episodes of care, and quality incentives. They presented the bills at a press conference on Wednesday, Feb. 15.
"We don't have health care in America — we have sick care," Lt. Gov. David Dewhurst said. "Studies by Dartmouth Institute and others indicate that we can save money and improve medical outcomes by incentivizing doctors and hospitals to use best practices and focus on wellness and prevention, rather than the number of procedures they perform."
Sen. Jane Nelson, R-Flower Mound, filed the bills, which are modeled after similar bills she introduced last session. They passed out of the Senate but were stalled in the House.
“These bills move us toward a payment system that rewards quality outcomes rather than quantity of services, along with reducing our costs for unnecessary tests and preventable hospital readmissions,” Nelson said. "We need to refocus our payment system on the true goal: healthy outcomes for Texans.”
Senate Bill 7 introduces alternative payment systems for Medicaid and CHIP, while S.B. 8 provides a safe harbor from antitrust laws for hospitals, insurers, and physicians to experiment with various payment models. It also provides for so-called “health care collaboratives,” organizations that closely resemble the accountable care organizations outlined in the federal health reform law.
In coming weeks, TAFP will analyze these bills in depth. Stay tuned for more.
Rep. Vicki Truitt, R-Keller, filed a bill Tuesday, Feb. 15, that if passed will allow international medical student graduates to apply for a medical license after completing two years of residency. Right now, IMGs must wait until after their third year to receive a license. For IMG family medicine residents, this means finishing their residency without getting their license right away, delaying their entrance into the workforce.
To be eligible for a license under House Bill 1380, an IMG must meet a long list of standards, such as graduating from a medical school with an approved curriculum, being at least 21 years old, passing a variety of tests and examinations, holding a certificate from the Educational Commission for Foreign Medical Graduates, and being able to speak English. If the bill is passed, the law will go into effect Sept. 1.
TAFP supports this bill. Also released Feb. 15, the Academy published an issue brief that describes the many ways that delayed licensure affects IMGs and, in effect, the family physician workforce of Texas. From delayed payment and board certification, to potential employers not able to hire IMGs right out of residency, the effects of not having a license by the end of residency like graduates of U.S. medical schools can be a career roadblock for IMGs. The issue brief states that the frustrations stemming from licensure even cause many IMGs to leave Texas and go to other states that offer licenses in fewer than three years, like New Mexico or Oklahoma, both of which allow for licensure after two years.
The corresponding Senate bill is currently in the works. Stay tuned as this issue progresses. To access the full issue brief, go to TAFP’s advocacy resources page of the website, www.tafp.org/advocacy/resources.
By Monica Kortsha, TAFP publications intern - Spring 2011
Hone your advocacy skills at the TAFP Legislative Action Day on Thursday, March 10. If you are coming to Austin for Interim Session or the C. Frank Webber Lectureship, plan to arrive a day early. Free to attend, physicians will receive advocacy training, resources, and talking points during a lunch seminar with TAFP’s lobby team, then head over to the Capitol to meet with their legislators that afternoon.
The 82nd Texas Legislative Session is underway, and with a massive budget shortfall and a looming scope of practice fight, family physicians must stand together and advocate for the policies that protect your practice and your patients. We encourage you to contact your legislators ahead of time and schedule an appointment. For assistance, contact the TAFP staff at (512) 329-8666 or email@example.com.
Registration is now open; go to www.tafp.org.
Thanks to the physicians who volunteered for the Physician of the Day program this week: John Egerton, M.D., and Judith Egerton, M.D., of Austin; Francisco Barrera, M.D., of Boerne; Paul Berg, M.D., of Georgetown; and Michael Dominguez, M.D., of San Antonio.
The Physician of the Day program brings a family physician to the Capitol each day of the legislative session to provide health care to members of the Capitol community. A few dates are still available in April and May. For more information on how to sign up and to view the calendar of open dates, go to the Physician of the Day page of the TAFP website.