It's Academic

May 2015 

 

Medicine’s Bills Pick Up Speed in the Legislature

As lawmakers near the finish line in drafting a state budget for the next two years, TMA is tracking a plethora of bills on the move that could help or hurt medicine’s agenda.  

“It’s too early to determine bill outcomes. But there are some we like, some we don’t, and some that are works in progress that we are pushing to good outcomes,” TMA Vice President of Advocacy Darren Whitehurst said. 

After a marathon session, the House approved its version of the state budget in April, wading through about 300 amendments. The Senate conversely approved its budget with no amendments in mid-April. The Senate and House leadership appointed five members each to a conference committee to reconcile the differences between the two drafts.  

Despite some gaps between the two versions, TMA lobbyist Michelle Romero said each has its own strengths that increase spending in key TMA priority areas, and the final budget likely will settle in medicine’s favor.  

The House and Senate budgets stand at roughly $210 billion for 2016-17, a nearly 2-percent increase over the current budget. The House version has more money for Medicaid and mental health; the Senate plan has more money for graduate medical education (GME) and women’s health.  

The Senate budget puts $41 million into GME expansions, versus the House’s $28.6 million. The vehicle to put the GME expansion money into action, Senate Bill 18 by Senate Finance Committee Chair Jane Nelson (R-Flower Mound), passed the Senate and heads to the House. Rep. John Zerwas, MD (R-Richmond), is expected to pick it up and sponsor a House version. The House and Senate budgets also boost formula funding for medical schools’ teaching costs and for primary care programs, albeit at varying levels.  

The Senate budget does not, however, include the $460 million rider in the House to increase primary care physicians’ Medicaid payments to Medicare rates. But Ms. Romero is optimistic there is opportunity to retain the money in the final version. “In totality, both budgets do more for our issues over last session,” she said. 

Lawmakers took one step closer to holding Medicaid HMOs more accountable for their network adequacy when Senate Bill 760 by Charles Schwertner, MD (R-Georgetown), cleared the Senate and headed to the House.  

Senator Juan “Chuy” Hinojosa’s (D-McAllen) Senate Bill 207, which the full Senate has approved, sets clearer standards for Medicaid fraud investigations by the Office of Inspector General. It clarifies that a “credible allegation of fraud” does not include unintentional technical or clerical errors and requires “probable cause” for payment holds.  

Ms. Romero said, “It’s a better standard that clarifies things for all parties involved: providers, the state, and SOAH (State Office of Administrative Hearings),” which oversees these cases.  

The House Insurance Committee took up two telemedicine bills — one good for medicine, one bad. 

Raising alarm bells, House Bill 2172 by Rep. John Smithee (R-Amarillo) would skirt current Texas Medical Board regulations and permit physicians to diagnose over the telephone without an initial face-to-face visit to establish a patient-physician relationship. On the other hand, TMA is backing a measure — House Bill 2348 by Rep. Four Price (R-Amarillo) — to ensure physicians get paid fairly for services like after-hours phone or telemedical consults by requiring health plans to pay local doctors the same as they would if hiring outside telemedicine vendors for those services.  

Amy Lynn Sorrel, associate editor of Texas Medicine, prepared this special report

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Loan Repayment Available to Physicians

The Texas Higher Education Coordinating Board is accepting applications from primary care physicians and psychiatrists for the state’s Physician Education Loan Repayment Program. The program will cover up to $160,000 in loan repayment for physicians who commit to a practice in an underserved community for four years. Spread the word about this opportunity among residents and fellows who are completing their training, and let them know more information is available on the Physician Education Loan Repayment Program website. Applications for this award cycle are due to the board’s offices by May 31, 2015.

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TMB Rules: Telemedicine Requires In-Person Exam First

The Texas Medical Board (TMB) adopted rules in April that send a message that technology is no substitute for physical patient exams. By voting to require physicians to conduct a face-to-face examination before making a diagnosis or prescribing drugs, TMB took a big step to protect patients who receive telemedicine services.

TMB has been examining the practice of telemedicine for years and is involved in a lawsuit with Dallas-based company Teladoc.  

In a comment letter TMA sent to TMB on the proposed rules, the association states it “supports the use of telemedicine that can provide safe, high-quality, timely care to patients, particularly in areas of the state that have critical physician shortages. 

TMA believes, however, that Texas must maintain appropriate safeguards to protect patients and ensure telemedicine complements the efforts of local health care providers.”

According to the rules, physicians can see a patient via telemedicine for the first time — without a prior in-person visit — if the patient is at a location that allows a physician to adequately examine and communicate with the patient in real time with the assistance of technology and a patient site presenter. The new telemedicine rules also permit mental health services to be provided at a patient's home, including residential treatment facilities, nursing homes, jails, detention centers, and assisted living centers, through real-time audio and video technology. 

Despite claims to the contrary from critics, the changes do not and are not intended to interfere with traditional on-call coverage arrangements, based on the board's discussion during its April 9 meeting.

Barring a court challenge and subject to any changes during the legislative session, the rules take effect June 3. 

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Monumental Victory for Medicine: No More SGR!

Shout it from the rooftops: Success (finally)! Last month medicine achieved the biggest victory since the passage of Texas’ 2003 tort reform liability protections. Just hours before a 21-percent Medicare pay cut to physicians was set to take effect, the U.S. Senate approved the bill to repeal Medicare's fatally flawed Sustainable Growth Rate (SGR) formula, permanently and immediately.   

After 12 years and 17 temporary, cut-averting patches, both sides of the political aisle and both chambers of Congress worked together to pass the Medicare Access and CHIP Reauthorization Act. 

TMA has been strongly advocating for repeal of the SGR for years. In a statement, TMA President Austin I. King, MD, extended his “sincere thanks to the United States Senate — especially our own Sen. John Cornyn — for taking this momentous step.” 

Indeed, the bill had support from Texas Senator Cornyn, who substantially helped get the bill across the finish line. U.S. Reps. Michael Burgess, MD, and Kevin Brady did some heavy lifting for years to see the bill through to passage. Sen. Ted Cruz voted against the legislation. 

“Eliminating the constant threat of Medicare payment cuts means that we can focus our energies on improving this new law. We can focus our energies on removing the bureaucratic impediments that get in the way of good patient care. We can focus our energies on enacting substantive and fundamental Medicare reforms that will help us provide lifesaving, life-sustaining, and life-enhancing care to our senior citizens, military families, and Texans with disabilities,” Dr. King said, referring to the bill’s passage as “13 very long and arduous years in the making.” 

The bill also contains provisions that protect state liability reforms and ensures the care standards and guidelines in the Affordable Care Act, Medicare, or Medicaid statutes can't be used to create new causes of legal action against physicians. U.S. Rep. Henry Cuellar (D-Texas) worked tirelessly to insert this language into the bill. 

The bill features sweeping changes for how Medicare pays doctors. The bill directs the secretary of the U.S. Department of Health and Human Services “to establish a Merit-based Incentive Payment (MIP) system under which eligible professionals (including physicians, physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists) shall receive annual payment increases or decreases based on their performance.” It also “requires specified incentive payments to eligible participants in an alternative payment model.” 

For more about the legislation, read this section-by-section bill analysis. The American Medical Association has some helpful resources, including highlights from the bill and a chart comparing the new bill with current law.

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AAMC Debuts Overhauled MCAT

In April, more than 7,500 aspiring physicians worldwide were among the first examinees to take the new Medical College Admission Test (MCAT). Developed and administered by the Association of American Medical Colleges (AAMC), the new exam tests students on the knowledge and skills that future physicians need to practice in a changing health care system and to better serve a changing patient population.

“It’s a new day for the MCAT exam,” said AAMC President and Chief Executive Officer Darrell G. Kirch, MD. “There has been a paradigm shift in medical education to acknowledge the competencies physicians need beyond medical knowledge — skills that will allow doctors to treat the whole patient — and the new exam reflects these changes.”

In 2012, AAMC approved the new MCAT exam to align with the changing medical education landscape. In addition to updating the natural science testing concepts, the new exam includes a section on the psychological, social, and biological foundations of behavior. This section recognizes the importance of building a foundation for learning in medical school about the sociocultural and behavioral determinants of health and health outcomes.

The new MCAT exam is part of a broader effort by AAMC and the nation’s medical schools to improve the medical school admissions process and to support the holistic review of applicants, which balances experiences, attributes, and academic metrics when considering individuals as medical students and future physicians.

“The new exam asks examinees to be scientists by not only testing them on what they know but also on how well they apply what they know,” Dr. Kirch said. “This is a better test for preparing tomorrow’s doctors.”

For more information about the new MCAT exam, visit www.aamc.org/mcat.

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Community Service Recognition Award Nominations Open

The Organization of Resident Representatives is now accepting nominations for the Community Service Recognition Award. The award fosters a service ethic among residents by recognizing those who have made contributions above and beyond the rigors of residency training to improve the local communities surrounding their training institutions.

The awards will include funded travel to Learn Serve Lead 2015: The AAMC Annual Meeting and a $1,250 contribution to a community nonprofit. Nominations are due by May 31. 

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AAMC Develops Five-Year Road Map

Recognizing the convergence of forces for change in graduate medical education (GME), the Association of American Medical Colleges (AAMC) is undertaking a comprehensive five-year plan to optimize GME in the United States. This undertaking will be a joint effort among medical schools, teaching hospitals, and health systems. Consideration will be given to the proliferation of medical discovery, the greater role of patients in their health care, and innovations in medical education and in health care delivery.  

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FSMB Resource Center Helps Improve Patient-Physician Communication

State medical boards often receive complaints related to poor communication between physicians and patients. The Federation of State Medical Boards (FSMB) has developed the Physician-Patient Communications Resource Center to educate physicians about communication breakdown that can lead to patient complaints. Resources include advice from medical societies on improving patient-physician communication, as well as tools to teach medical students and residents how to improve communication with patients and avoid potential complaints. 

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This Month in Texas Medicine

The May issue of Texas Medicine features a cover story on TMA PracticeEdge, TMA’s practice management and accountable care tool for primary care and multispecialty practices. It also features articles on legislation that would expand the scope of practice for nonphysician practitioners; the American Board of Internal Medicine’s changes to maintenance of certification criteria; legislative efforts to clamp down on balance billing; and an update on graduate medical education legislation and the 2013 expansion grant programs.

Check out our digital edition.

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It's Academic is for physicians in academic settings. For more information about TMA’s efforts on behalf of medical education and academic physicians, visit the TMA Council on Medical Education’s Subcommittee for Academic Physicians page and Advocacy page on the TMA website.

Please share with your colleagues who are not TMA members and ask them to join.

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    The State legislature is unable to support the existing medical schools adequately. Another institution, no matter where it is located, would put more unnecessary strain on already stretched finances. Find the money to treat the ones you have better before straining draining resources.
    William E. Powell, M.D.

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