Texas still ranks 41st nationally in physicians per 100,000 population. Not enough of our health care dollars are going to health care. Corporations are pressing harder to dictate patient care decisions. Insurance company abuses create unnecessary barriers to patient care. Unqualified providers are trying to make dangerous medical decisions. Behavioral health and public health need much more of our attention. Too much of our state’s population is uninsured. Infant and maternal mortality rates are alarming. We are losing our state's medical-school-trained doctors to residency programs in other states. And Medicare and Medicaid payments often don’t even cover the cost of patient care.
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The time physicians spend with their patients is the most satisfying and, obviously, the most productive part of their day. Unfortunately, research shows, most physicians spend far more precious minutes each day sitting at computer screens, filling out paperwork, or waiting on hold with insurance companies and pharmacies. This sad imbalance is one of the leading causes of medicine’s burnout epidemic.
Under tort reform, the number of physicians practicing in Texas has grown even faster than our exploding population. Tort reform, however, is a never-ending political and legislative battleground in Texas. We cannot relax our guard against direct attacks on the 2003 law.
Using narrow networks, or very limited lists of in-network physicians patients can see, is one scheme insurers use to maximize their profits; it transfers much of their financial liability to patients in the form of surprise bills. The health plans’ notoriously inaccurate network directories add to patients’ confusion.
Much of physicians’ payments are controlled by government price-fixing, and physicians have little leverage in negotiating contracts with commercial insurers. Neither Medicare nor Medicaid payment rates have come anywhere near keeping up with the cost of running a practice. Physicians need appropriate pay for the life-saving, health-preserving services they provide, and relief from archaic laws that inhibit them from providing services their patients need.
Childbirth, one of life’s greatest joys, can morph into tragedy when the infant’s mother dies. Even one death is one too many. Thankfully, most maternal deaths — 80 percent in one state study — are preventable. And for every new mother who dies in Texas, another 50 to 100 experience serious, life-threatening conditions. Building on the work of state and national maternal health experts, Texas physicians propose a clinically proven list of interventions to counter this troubling trend.
Team-based care capitalizes on the efficiencies of having the right professional providing the right services to the right patient at the right time … with overall direction and coordination in the hands of physicians. Unfortunately, nonphysician practitioners once again are asking lawmakers to expand their legal scope of practice beyond what their education, training, and skills safely allow.
Investments in public health have a proven ROI — like every dollar spent on childhood vaccination saves a minimum of $10 in direct and indirect costs. In a classic example of “penny wise, but pound foolish,” though, public health budgets are constant targets for trimming. Failing to build and maintain our public health defenses definitely will cost Texas taxpayers far more in the long run.
For more than a decade, Texas has held the title of “Uninsured Capital of the United States.” And for the first time in a decade, the number of children without health insurance increased in 2017, eroding Texas’ slow gains in coverage for children. The friction created when 17 percent of the population lacks health insurance threatens to slow our booming Texas economy.
Patients trust their physicians to do what is best for their individual circumstances; physicians know that each patient is special and unique and requires their undivided attention. But the corporations that manage the business end of health care exist to make money. That unflinching focus on the bottom line — and persecution of those who report unethical incursions — has the potential to significantly and adversely impact patient care.
TMA focuses most of its advocacy activities on the Texas Legislature and state agencies and courts. Because the federal government plays such an outsize role in health care policy and programs, however, TMA also conducts extensive advocacy with the U.S. Congress and federal regulatory agencies. As on the state level, much of TMA’s work in Washington is intended to ensure physicians receive fair payment for the medical services they provide to patients, and to win relief from onerous government regulations.
Physicians add opportunity, growth, and prosperity to the Texas economy by creating more than 670,000 jobs and generating nearly $120 billion in economic activity, according to a 2018 economic impact analysis prepared by the IQVIA consulting firm.
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