TMA Testimony by Louis Appel, MD
House Human Services Committee
House Bill 2304
Monday, April 27, 2015
Good afternoon Chairman Raymond and committee members. Thank you for the opportunity to testify on HB 2304. I am Louis Appel, MD, a practicing pediatrician in Austin testifying on behalf of the Texas Medical Association, Texas Pediatric Society, Texas Academy of Family Physicians, Texas Association of Obstetricians and Gynecologists, the American Congress of Obstetricians and Gynecologists-Texas Chapter, and March of Dimes to urge you to retain the Perinatal Advisory Council, which the legislature created in 2013 via House Bill 15 under the leadership of then Representative Lois Kolkhorst and Senator Jane Nelson.
Over the last several legislative sessions, Texas has invested significant new resources towards improving maternal health and birth outcomes, including improving early entry into prenatal care, educating parents about the importance of optimal birth spacing, and establishing an expert review panel of maternal illness and death. But Texas still has work to do. The state’s preterm delivery rate (12.3%) is still well above the Healthy People 2020 goal (9.6%), significant racial and ethnic disparities still exist in Texas’ birth outcomes, and the maternal mortality rate is sky high.
A coordinated system of perinatal care as envisioned by HB 15 is a critical component of Texas’ continued efforts to improve the lives of mothers and babies. The bill directed the Health and Human Services Commission and Department of State Health Services to assign hospital neonatal levels of care by Sept. 1, 2017 and maternal levels of care by Sept. 1, 2019. But creating the standards requires extensive and ongoing input from an expert panel of physicians, nurses and hospital administrators with knowledge in neonatal and maternal care.
The Perinatal Advisory Council is the body created by the legislature to provide the requisite clinical and policy expertise needed to devise a high functioning perinatal system. Over the past 18 months, the council has met quarterly to draft the neonatal standards, which DSHS will soon formally publish as proposed rules. However, the public has been actively engaged throughout the PAC’s deliberations. Stakeholders of all geographic and practice locations have actively commented on each iteration of the draft standards. Not unexpectedly, there have been disagreements. But the open dialogue has resulted in a set of rules that better reflect the diverse needs of rural, suburban and urban neonatal intensive care units and the families that rely upon them.
In the next few months, the Perinatal Advisory Council will begin its work on the maternal levels of care, which complement the neonatal standards, and will become effective Sept. 1, 2019. Reducing NICU admissions and maternal mortality depends in large part upon reducing preterm delivery. Physicians and hospitals must ensure early assessment of women who are at risk of delivering prematurely and establish a process for safely transferring women, when appropriate, to facilities that can provide a higher level of care. This does not mean changing referral patterns, but rather adopting consistent and defined standards of levels of care for patient outcomes, resource utilization, and coordination and collaboration. As with the neonatal standards, the Perinatal Council will review the best available evidence and national guidelines, while also actively soliciting input from Texas stakeholders, including rural physicians and hospitals.
We understand that a goal of HB 2304 is to reduce redundant or outdated councils and committees, while also directing the HHSC executive commissioner to appoint new advisory bodies where appropriate to solicit external expertise. But the Perinatal Council’s work is too important to suspend. Its work underpins a safe, effective system of care for pregnant women and newborns and ultimately will result in better birth outcomes. We urge your continued support.
Thank you for your consideration.
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