The 2016 elections brought physicians an excellent opportunity to rebuild America's health care systems, TMA officials say.
"Everything is on the table — the Affordable Care Act (ACA), Medicare, and Medicaid," said David Henkes, MD, chair of the Texas Delegation to the American Medical Association. "Today, we are crafting plans to remake the system so it truly serves our physician members and our patients."
Fortuitously, the interim meeting of the AMA House of Delegates brought dozens of TMA leaders together just four days after the Nov. 8 elections. They laid out key strategic directions that TMA staff will use to devise a detailed plan.
"We need one document for all physicians, all specialties, to take to Congress and the administration and say, ‘This is what medicine believes in,' " Houston facial plastic surgeon Russ Kridel, MD, a member of the AMA Board of Trustees, said at an hour-long health care reform conversation among members of the Texas Delegation to the AMA, who are in Orlando, Fla., for the interim meeting of the AMA House of Delegates. "We need to act now, and we need to do those things that will put us at the table."
"The ACA was a first step, now we need to take another step," said former AMA and TMA President Jim Rohack, MD.
The Texas physicians said they are looking for an approach that simplifies the health care system for physicians and patients, reduces the huge regulatory burden on physicians, and reduces the cost of U.S. health care.
"This whole system is just too complicated for most people to handle," said Dallas psychiatrist Clifford Moy, MD.
Many of the ideas in President-Elect Donald Trump's "Great Again" health care platform and the health care agenda in House Speaker Paul Ryan's "Better Way" plan are consistent with TMA policy.
TMA actively opposed passage of the ACA in 2010 but has since adopted an approach to "Keep what's good, fix what's broken, and find what's missing." Speaker Ryan echoed that approach during a Nov. 13 television interview, when he said, "We can fix what is broken in health care without breaking what is working in health care."
Six years of near absolute gridlock in Washington, DC, prevented even the tiniest ACA reforms from passing. One significant achievement — from TMA's "find what's missing" category — was the repeal of Medicare's Sustainable Growth Rate formula via the Medicare Access and CHIP Reauthorization Act (MACRA), which passed in 2015.
"Texas Solution" Gets New Life
It's important to remember that what happens in Washington not only affects Medicare, commercial health insurance, and coverage for uninsured patients, but also plays a big role in how states implement the Medicaid program.
"We are entering into a new time," U.S. Rep. Michael Burgess, MD (R-Lewisville), said at a fundraising reception TMA hosted for him in Orlando. "I would love it if the governors came to Washington and said, ‘OK, guys, you deliver the mail and secure the border, we'll take care of our sick folks.' That would be a far, far more reasonable way to approach it."
Dr. Burgess likely will be a key player in the health care debate in the next Congress.
Both the Trump and Ryan plans call for Medicaid changes that mirror the "Texas Solution" for expanded coverage that TMA has promoted since 2013. The Texas Solution calls for a comprehensive plan that:
- Improves patient care;
- Draws down all available federal dollars to expand access to health care for poor Texans;
- Gives Texas the flexibility to change the plan as our needs and circumstances change;
- Clears away Medicaid's financial, administrative, and regulatory hurdles that are driving up costs and driving Texas physicians away from the program;
- Relieves local Texas taxpayers and Texans with insurance from the unfair and unnecessary burden of paying the entire cost of caring for their uninsured neighbors; and
- Pays physicians for Medicaid services at a rate at least equal to Medicare payments.
TMA staff are preparing a white paper on "Post-Election Strategies for Health System Reform" for discussion at the TMA Advocacy Retreat, Dec. 2–3 in Austin.
The Texas Medical Board (TMB) and Teladoc are in "negotiations," as both have filed motions to put Teladoc v. TMB on hold until April 19, 2017. The previous trial date was set for February.
According to Law 360, "the move comes about two weeks after the Texas Medical Board voluntarily dismissed its appeal asking the Fifth Circuit to bar Teladoc Inc.'s antitrust challenge of the state rule requiring a face-to-face visit. U.S. District Judge Robert Pitman lifted the stay in the case on Oct. 25 and ordered the parties to submit a revised scheduling order by Nov. 8. But Teladoc and the medical board asked the court to reconsider." The court granted the stay on Nov. 4.
The Nov. 2 report of the Texas Sunset Commission on TMB does not address in any way the antitrust TMB exposure Teladoc asserted in the lawsuit. It also does not mention the Federal Trade Commission's staff position that state licensing bodies that have a majority of the licensees it regulates in control of the board are not protected from federal antitrust actions. For more information about Teladoc's antitrust claims against TMB, read "Seeking Invalidation" in the April issue of Texas Medicine.
Other states are attempting to address the antitrust issue, and some have passed remedial legislation to bolster their state action exemption argument to protect their licensure boards. The Texas Legislature may do the same next year. In addition to TMB, all of the state's professional licensing agencies are up for sunset review in the 2017 legislative session.
The Texas Society of Anesthesiologists (TSA) and TMA sent a formal letter and testified in person against a Texas Health and Human Services Commission (HHSC) plan to eliminate the "Physician-Led Anesthesia Care Team Model Billing" for Texas Medicaid. The change would cut payments to anesthesiologists who supervise certified registered nurse anesthetists and anesthesia assistants.
According to the letter, the model involves a physician anesthesiologist medially directing nurse anesthetists and/or anesthesiologist assistants. "Extremely undervalued Medicaid rates have already led to significant access issues for Medicaid patients. This proposed change will further aggravate deficiencies in access to quality anesthesia care for Medicaid patients and will discourage the maintenance of high quality physician-led Anesthesia Care Team Model. TSA believes this will lead to increased anesthesia costs due to greater utilization of emergency services," the letter states.
TMA's letter, and testimony from TSA President Deborah Plagenhoef, MD, and Austin anesthesiologist Jeff Jekot, MD, emphasized the two organizations' concerns that the proposal will increase Medicaid anesthesia costs and hinder access to care. TMA and TSA leaders will meet with HHSC officials again before the agency makes a final decision on the question.
The Centers for Medicare & Medicaid Services (CMS) has reduced the meaningful use electronic health record (EHR) incentive program reporting period from a full year to 90 days in 2016. In 2017, physicians participating in the Merit-based Incentive Payment System (MIPS) will have several reporting options, including reporting on one patient to prevent a penalty, 90 days for a potential incentive, and a full year to receive an incentive. Physicians participating in the Medicaid meaningful use program will continue reporting the meaningful use measures for 2017 and will have a 90-day reporting period.
TMA, the American Medical Association, and many other physician organizations had pushed for the change, arguing that the reporting systems are too complex and cumbersome for physicians to have to use for an entire year.
Any continuous 90-day period between Jan. 1 and Dec. 31 of the participation year constitutes the EHR reporting period. Many participants will be trying to attest via the CMS portal by next year's Feb. 28 deadline. To avoid any delays or problems, TMA encourages physicians to attest earlier than the final deadline.
If you have questions about the meaningful use program, contact TMA's Health Information Technology Department by email, or call (800) 880-5720.