TMA Testifies at Joint Senate Hearing on Health Reform

Testimony: Health Reform by C. Bruce Malone, MD

Joint Hearing of the Senate Committee on Health and Human Services
and State Affairs Committee 

Aug. 1, 2012 

Good morning, committee chairs and members of the committee. I’m Austin orthopedic surgeon C. Bruce Malone, MD, immediate past president of TMA. I want to thank you today for allowing me to testify on the potential impact of the Patient Protection Affordable Care Act as it relates to insurance regulations, Medicaid, and Children's Health Insurance Program, health care outcomes, health care workforce, the overall health of all Texans, and the state budget.   

We all want to do the right thing for our patients and Texas taxpayers. We all want to find cost-effective ways to ensure people who live in our communities can get the care they need when they need it.  

As TMA president, I had the opportunity to travel the state and visit with my colleagues from El Paso to Tyler, from Wichita Falls to the Valley.  

I can tell you firsthand, physicians’ practices are struggling to surmount the growing regulatory burdens of the new federal law. Physicians have had to invest in expensive health information technology, upgrade our coding and billing systems, implement e-prescribing programs, and endure the frozen fee schedule and continuous pay uncertainty from Medicare. The financial stress is hurting small practices in rural Texas, mid-size practices in the suburbs, and large practices in every urban center.  

Government regulatory burdens, red tape, payment hassles, and low pay have been eroding the physician foundation of Medicaid and Medicare for more than a decade.  

TMA’s new 2012 physician survey shows the fallout. More and more physicians are forced to reduce the number of patients they see who depend on government health care.  

The number of Texas physicians available to treat new Medicaid patients has plummeted from 42 percent in 2010 to 31 percent — an all-time low. I’m not surprised by these numbers. It makes no sense to create health insurance programs that no doctor can afford to accept.  

I am one of the 31 percent of Texas doctors who take new Medicaid patients. I do that because I believe it is my moral and ethical duty to take call in hospital emergency departments (ED). I need a Medicaid and Medicare number so I can work in the ED.   

When the Health and Human Services Commission (HHSC) says “there are plenty of physicians available to take Medicaid patients,” what it really means is that the commission has a long list of physicians with a “Medicaid number.” It doesn’t mean these physicians are available to care for patients or that they are taking new Medicaid patients.   

HHSC is running a system based on a false sense of access.  

A huge majority of Texas physicians agree that Texas Medicaid is broken. And, almost all of them believe we need to devise a system of providing care to low-income Texans with realistic payment rates and less stifling bureaucracy.  

Look, for instance, at the 20-percent payment cut for the care we provide to our most sick and vulnerable patients — dual-eligible patients. Because of their age they qualify for Medicare, and because of their income they receive Medicaid benefits.   

The cut hit particularly hard practices in rural and inner-city Texas, along the Mexico border, and many of those serving nursing homes. Those practices serve a disproportionate number of dual-eligible patients. HHSC recognized the cuts would truly harm patients on dialysis so reduced the cut for renal dialysis centers. We must take additional steps to reduce the dual-eligible cuts for other physicians who are struggling to care for these patients.  

What’s lost in the health care debate is the simple fact that patients need a doctor when they get sick. And, physicians want to take care of our patients. That is why we went to medical school. That is why I’m still studying continuing medical education when I am in my 60s, so I can provide the very best care to my patients.  

However, without an adequate network of physicians, no health care system can work, let alone be effective. The state simply cannot continue to run its Medicaid program on the backs of physicians. Instead, Texas needs to invest in a robust physician network so we can better treat chronic illnesses, and keep patients out of expensive hospital and emergency rooms.  

Texas has a shortage of both primary care and other specialists at a time when we need physicians more than ever. We rank behind all other large states in the number of physicians per capita. We can change these statistics by providing stable funding to our medical education system. We can change these statistics by providing opportunities for our Texas medical school graduates to obtain residency training without leaving the state.   

As we train the new workforce, we need to recognize that the way we deliver health care is evolving. The future for some physicians, especially primary care physicians, will be to lead teams of health care professionals. Physicians’ primary role will be to “manage care” — to direct and coordinate care for a large group of patients using a team approach. The care, however, will still be provided based on the needs of each patient.   

Health reformers keep talking about providing care to “patient populations.” But I don’t treat populations. I take care of one patient at a time, devoting my time and skills to giving you the best care possible. Doctors hear from policymakers that “practice guidelines” will solve our health care problems. Well, I should and do know those guidelines, but do not forget that your outcome depends on my skill and the skill of the hospital and professionals working there. Really good medical care will never be cheap, but prevention can be.   

If Texas wants to create a new system to serve the more than six million citizens who have no health insurance, we need realistic solutions that are going to require sacrifice and work from all segments of our society, not just the doctors and hospitals.