It's Academic: June 2013

Legislature Adds $30 Million, Including New Expansion Money, for GME 

After hearing from the Texas Medical Association and Texas medical schools that medical school enrollments are growing more rapidly in Texas than entry-level graduate medical education (GME) positions, the Texas Legislature appropriated more than $30 million in additional state support for GME in the state’s next two-year budget.

The 2014-15 state budget awaiting certification by the state comptroller and Gov. Rick Perry’s signature takes steps to reverse some of the GME funding lost in the 2011 legislative session and establishes new grant programs to stimulate GME growth. Overall GME funding was pieced together in the budget and through additional legislation. The total amount of state dollars dedicated to GME increased from $67 million in 2012-13 to $97 million for 2014-15, an increase of 45 percent. The historic peak in GME support was $106 million in 2010-11.  

GME formula funding, which took a 31-percent hit in 2011, was partially restored, with a 15.5-percent, or $8.8 million, increase over the 2012-13 biennium, increasing from a total of $57 million in 2012-13 to $66 million for 2014-15, as shown in the graph below. The per-capita amount increased by 9 percent, or $880 over the biennium, from $9,364 to $10,244 (see second graph). House Bill 1025, a supplemental appropriations bill, authorizes $9.25 million for GME expansions, and House Bill 2550 is the spending vehicle for $5 million more for growing GME placed in Senate Bill 1, for a combined $14.25 million in new monies to fund three new programs in 2014-15:

  • Hospital GME planning grants to fund one-time grants of $150,000 to hospitals not currently offering GME and not under Medicare GME funding caps;
  • Funding for accredited, unfilled, and unfunded GME positions, estimated to be about 100; and
  • Funding for newly developed GME positions, including the potential for development of new GME programs. 

This session was the first in a several years in which lawmakers took a hard look at GME in Texas and its impact on ensuring an adequate physician workforce, said Michelle Romero, associate director for advocacy for TMA. There were two major differences this session:

  1. An interest by the Texas legislature in offsetting a higher amount of the total costs for training a resident, allowing for $65,000 to be paid per resident a year in the new grant programs, and
  2. New grant money to stimulate GME growth. 

In comparison, the state GME formula dollars provide $5,122 per resident per year for the teaching side of GME costs and no monies for the hospital portion. Further, these formula dollars are allocated across the board for all eligible resident positions. The new programs for incentivizing GME growth will allocate funds through a competitive grant process.
 

State GME Formula Funding In Millions Image 

 

Per Capita State GME Formula Funding Image 

Residency programs in family medicine will receive a higher level of state support, due to a doubling of the appropriation for this program at the Texas Higher Education Coordinating Board (THECB). Funding increased from $5.6 million in 2012-13 to $12.78 million in 2014-15, an increase of 128 percent, or $7.2 million. This increase, however, falls short of the historic funding peak, which was $21.2 million in 2010-11.

The state’s Physician and Nurse Trauma Fellowship grant program received continued funding of $4.5 million for 2014-15. This program was created in 2011, with strong legislative stewardship by Rep. John Zerwas, MD (R-Simonton), an anesthesiologist who practices in Houston. The grant program is designed to expand the availability of physicians and nurses with specialized training in trauma care. THECB also administers this grant program. 

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Loan Repayment Program Funded  

Lawmakers made a strong financial endorsement of the state Physician Education Loan Repayment Program (PELRP), providing $33.8 million for 2014-15, an increase of nearly 500 percent over the $5.7 million in the 2012-2013 budget. The funds were so low for the current biennium that THECB, the administering agency, has been unable to accept new applications since 2011.

To allow the new funds to be committed as quickly as possible, the board is accepting applications for FY 2014   through Aug. 31. Physicians who agree to practice for four years in a primary care health professional shortage areas (HPSA) can receive up to $160,000 to repay medical school loans.
 
The PELRP website features a fact sheet and application for enrollment. It also has the ranking criteria used to determine which applicants will be accepted into the program.

In addition, a U.S. Department of Health and Human Services website includes a search function that allows you to find out if your practice is in a HPSA by entering your street address. 

Officials hope to sign 100 physicians for loan repayment by Aug. 31. Please help TMA spread the word about the renewed availability of these valuable funds.

“The quickest way to get physicians out to underserved areas is to offer loan repayment,” Ms. Romero said.

Under HB 2550, the PELRP will be expanded even further in FY 2014 to allow physicians who treat relatively high levels of Medicaid patients also to qualify for loan repayment, even in areas NOT designated as HPSAs. This expansion is similar to the previous Frew loan repayment program. The implementation delay for this aspect of the program is due to the need for the board to adopt new program rules and enter into a memorandum of understanding with the Texas Health and Human Services Commission. Applications from physicians practicing in HPSAs will receive priority over Medicaid, non-HPSA applications.  

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Medical Education Funding 

Medical education will get a 7-percent boost in medical student formula funding from $42,180 per student/year to $45,282 in 2014-15. TMA and its partners helped stop off-shore medical schools from potentially buying up core clinical clerkship spots in Texas hospitals, and repealed a 2011 law that forced international medical graduates (IMGs) who are not U.S. citizens or are not holders of “green cards” or employment visas to spend three years working only in medically underserved areas. It was strongly anticipated this law would have had a chilling effect on new IMGs selecting Texas for a practice location.

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New Primary Care Physician Pipeline Innovations Program 

HB 2550 establishes a new grant program to promote innovations at medical schools in the development of more primary care physicians for the state. A total of $2.1 million was appropriated for this program for 2014-15 to encourage medical schools to establish new programs with similar goals as the Family Medicine Accelerated Tract program at Texas Tech University Health Sciences Center in Lubbock, which produces new family physicians in six rather than seven years. These grant dollars are to encourage similar types of innovations at Texas medical schools to produce more primary care physicians.

Funding cuts were restored for the Joint Admission Medical Program, for a gain of $3.2 million or 46 percent, from $7 million in 2012-13 to $10.2 million in 2014-15. This program is a physician pipeline program intended to promote greater diversity in the Texas physician workforce. It provides a variety of support programs to help educate and train more physicians from economically disadvantaged backgrounds.   

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HOD Reaffirms TMA Medicaid Reform Stance 

The TMA House of Delegates adopted the Board of Trustees’ position statement on expanded health care coverage and Medicaid reform, and added a provision calling for equality in Medicaid and Medicare fees during its meeting at TexMed 2013 in San Antonio in May.

Earlier this year, trustees said political leaders in Washington and Austin must immediately develop a bipartisan solution to reform the state’s Medicaid program and expand coverage for low-income adults.

TMA leaders called on state leaders and lawmakers to “look beyond the federal government expansion solution and design a solution that works for Texas and for Texans.”

TMA officials emphasized that the association is seeking expansion of coverage for poor adults not covered by traditional Medicaid. The state, they say, has the ability to work with the Centers for Medicare & Medicaid Services on a proposal that:

  • Has patient copays and deductibles,
  • Allows the state to develop a benefit package that makes sense for this patient population, and
  • Allows the state to drop out of the program if conditions change.

TMA calls on Texans to use their ingenuity to “devise a comprehensive solution that:

  1. Draws down all available federal dollars to expand access to health care for poor Texans;
  2. Gives Texas the flexibility to change the plan as our needs and circumstances change;
  3. Clears away Medicaid’s financial, administrative, and regulatory hurdles that are driving up costs and driving Texas physicians away from the program; and
  4. Relieves local Texas taxpayers from the unfair and unnecessary burden of paying the entire cost of caring for their uninsured neighbors.”

During their debate, delegates voted to add additional points to TMA’s position. They call for a system that “provides Medicaid payments directly to physicians for patient care equal to at least those of Medicare payments” and that continues to “uphold and improve due process of law for physicians in the State of Texas as it relates to the Office of Inspector General.”

The house also voted against a resolution urging TMA to oppose Medicaid expansion, and against another resolution asking TMA to support repeal of the Patient Protection and Affordable Care Act. 

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 Join or Renew TMA Today: We Could Use Your Help! 

TMA has been a longtime advocate for academic faculty and medical schools -- monitoring legislation, determining the potential impact on patients, and lobbying for your interests.

The results from the 2013 legislative session were outstanding for academic medicine. Our efforts in this legislative session, including public testimony provided by TMA leadership at every applicable legislative committee hearing and through personal visits with legislative members and staff, paid off.   

TMA is extremely successful in Texas — for one reason only. The Texas Medical Association speaks with one strong, firm, and consistent voice, the voice of its members. Only with grassroots support … only with your support … can we continue to be successful.

Join or renew today at www.texmed.org/join and see what a difference TMA membership can make. Within your department and/or academic institution, funds may be available to cover the cost of your membership. Please check with your department administrator or chair to see if applicable. 

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New-to-Texas Physicians Can Start Here 

Are you a physician who is new to Texas? Have you recruited a physician for your school, your practice, or your community from out of state?

 TMA's New to Texas Resource Page can help new or returning Texans get their practices up and running. The page provides links that doctors need to obtain a Texas license, plus contact information for relevant state and federal agencies, and links to resources such as practice consulting for set-ups, health insurance plan contacts, and employee salary data.

TMA members can email the TMA Knowledge Center or call (800) 880-7955 for fast answers to questions about membership, TMA member benefits and services, practice management or legal information, and more.

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This Month in Texas Medicine 

The June issue of  Texas Medicine explores the benefits and the limits of telemedicine, details the Texas version of accountable care organizations, and explains TMA’s newest quality improvement tool. It also tells you why a government-hired auditor may want to examine the meaningful use fees you earned, why there is concern over the number of hours that residents work, and why physicians are concerned about health dangers posed by coal-fired power plants. 

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 on the TMA website.

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

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