Action Special Report: July 17, 2009

TMA "Deeply Troubled" by House Health Reform Bill

The U.S. House of Representatives' proposal to reform the nation's health care system is inadequate because it doesn't permanently fix the Medicare payment system and doesn't include medical liability reform, Texas Medical Association leaders say in a letter to the Texas House delegation. TMA President William H. Fleming III, MD, President-Elect Susan Rudd Bailey, MD, and Nancy Dickey, MD, chair of the association's Health System Reform Task Force, also say they are "extremely concerned" about the impact of the bill's "public option" for insurance coverage and its ban on physicians owning health care facilities.

Emphasizing TMA's concern about Medicare payments to physicians is the Centers for Medicare & Medicaid Services' announcement just two weeks ago that it plans to cut payments by 21.5 percent next year.

The TMA leaders pledged that the association will work with Congress on health system reform, but reminded the representatives that physicians are ethically bound to work for the best interests of their patients and to provide leadership on public policy decisions.

TMA has developed guiding principles for health system reform that it will follow during the debate in Washington.

You can stay up to date on all the developments in health system reform by following TMA on  Twitter.

The text of the letter follows.

On behalf of the 44,000 physician and medical student members of the Texas Medical Association, we are writing to share our comments on H.R. 3200, the "America's Affordable Health Care Choices Act of 2009," and to ask your support for our position.

As physicians, our primary goal is to improve the health of our patients. We believe that patients and their physicians must be free to make choices that best fit their individual health care needs.

We are deeply troubled by the lack of a permanent fix for the Medicare sustainable growth rate (SGR) formula and the absence of medical liability reforms. Similarly, we are extremely concerned about the long-term consequences of the so-called "public option" and the prohibition on physician ownership of health care facilities.

Medicare Financing

H.R. 3200 is the first of several steps needed to solve the problems caused by the faulty SGR formula. We appreciate the committees’ proposal to eliminate the huge fiscal backlog that has been created by years of last-minute patches on this formula. The bill, however, falls short of replacing the SGR with a rational Medicare physician payment system that automatically keeps up with the cost of running a practice and is backed by a fair, stable funding formula. It continues the arcane provision that prevents a patient and physician from contracting privately for services outside the Medicare payment system.

Physicians want to care for our frail and elderly patients. It's ironic that the federal payment system these patients rely on for care is the same one that is forcing physicians out. The SGR formula and other Medicare restrictions are forcing physicians to choose between taking care of our patients or keeping open the doors of our practices for all patients. We will never be able to care for the medical needs of the baby boomers now entering the Medicare system with a continually shrinking network of physicians.

Health Insurance Reforms

On behalf of our members and our patients, TMA has been a leader in health insurance reform for many, many years. We understand the administrative cost burdens this huge industry creates within the health care system, and we have been dedicated to promoting administrative simplification and transparency in the Texas Legislature, the Congress, and the courts.

Health insurance exists for one reason. Employers and families pay premiums in the expectation that their insurance will cover the costs of their care when they need it. In the guise of "cost containment," the insurance industry for decades has delayed and denied care, forcing patients and their physicians to navigate an intentionally opaque system of rules and procedures.

We applaud the authors of H.R. 3200 for taking steps such as outlawing coverage denials for preexisting conditions, controlling premium increases, requiring health plans to demonstrate they are providing access to an adequate network of physicians, and addressing medical loss ratios. Until the health plans are forced to break open their secret decision-making and payment processes, however, they will maintain the leverage to find new ways to subvert the system for their own advantage. We call on you to support far-reaching reforms that would hold health insurance companies accountable to the promises they make for the premium dollars they receive.

Medical Liability Reform

The medical liability reforms adopted by the Texas Legislature and ratified by voters in 2003 have significantly enhanced access to care for sick and injured Texans. As the epidemic of lawsuit abuse has waned, Texas has enjoyed a historic influx of highly qualified physicians. Dozens of rural and medically underserved counties now enjoy the services of high-risk specialists, such as emergency physicians and obstetricians. Physicians who once turned away high-risk patients for fear of a lawsuit are now expanding their practices and offering new, lifesaving treatments.

All Americans deserve the improved access to care that would come with national medical liability reform, which must include significant caps on noneconomic damages. Defensive medicine adds billions of dollars to the cost of health care each year, translating into higher health insurance premiums for patients; liability reform would eventually reduce the costs of health care for everyone. Finally, we would insist that any action taken at the federal level preserve the effective liability reforms currently in place in states such as Texas and California.

Physician Ownership

The Stark limitations on physician ownership of hospitals and health care facilities included in H.R. 3200 would prove counterproductive to the bill's intent to reduce costs and make health care more efficient and effective. The Mayo Clinic, the Cleveland Clinic, and Texas' own Scott & White Clinic all were founded by and are now owned and/or controlled by physicians. President Obama himself regularly cites institutions such as these as examples of the kinds of efficient, coordinated care he envisions for all Americans. We believe these types of institutions fulfill the goals outlined by Accountable Care Organizations and should be encouraged to achieve efficiencies and improve outcomes for communities.

Limiting the viability of physician-owned hospitals would reduce access to high-quality health care for patients and hurt the economy in communities these hospitals serve. Studies of physician-owned hospitals have documented high levels of quality care and patient satisfaction; fewer complications, such as infections and hip fractures; and more net community benefits through uncompensated care and taxes.

The Texas Medical Association strongly supports responsible physician investment in technology, facilities, services, and equipment. The focus should be not on who owns the medical facility – a physician, a nonprofit entity, or a for-profit company – but on the quality of the facility and appropriateness of patient care.

Public Option

As physicians in the state with the highest percentage of uninsured residents in the nation, we are acutely aware of the need to expand health coverage. However, we believe the public option proposed in H.R. 3200 would induce more harm than good in that regard.

While the public option in the bill is an improvement over those discussed previously – it does not, for example, mandate physician participation – we remain gravely concerned that this "option" will soon become the controlling payer in all health care. The result would be the unworkable government price-setting scheme we now see for Medicare. Already, H.R. 3200 includes a provision that would prohibit the private sale of new, individual health insurance policies.

We will continue our review and analysis of H.R. 3200 and will continue to provide you with our comments and suggestions. We pledge to work with you, your colleagues in the House and Senate, and the Obama administration in crafting legislation that truly would improve health care – the patient-physician relationship – in the United States and Texas. As physicians, it is our ethical duty to provide leadership on these public policy decisions.

Sincerely,

William H. Fleming III, MD
President

Nancy H. Dickey, MD
Chair, Health System Reform Task Force

Susan Rudd Bailey, MD
President-Elect

Action Special Report, July 17, 2009

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