Meeting for the 150th time last weekend in Dallas, the Texas Medical Association House of Delegates once again proved that no realm of health care can’t benefit from improvements devised by Texas physicians.
From controversial topics like abortion and physician certification to physician payment problems and the power of language, the 450-member House plowed through almost 100 reports and resolutions, generating new TMA policy and directing the association to stand strong in its support of physicians and their patients.
Maintenance of Certification
Two years after the Texas Legislature passed a law largely prohibiting discrimination against physicians based on maintenance of certification (MOC), how that law is working generated plenty of discussion on the house floor.
Several resolutions served as follow-ups to Senate Bill 1148. That 2017 measure generally prohibits health plans from using MOC as a requirement for contracts and prevents hospitals from using MOC as a condition for credentialing or hiring.
On Saturday, the House adopted a resolution that every facility in Texas, other than those the law exempts, must conduct a vote of its medical staff “prior to including or allowing to remain in the medical staff bylaws any requirement of MOC.”
The same resolution declares MOC requirements shall be specific to a facility “regardless of the existence of any system-wide medical staff bylaws.” That resolution followed suspicion that at least one hospital system was trying to use preexisting, system-wide bylaws to skirt the MOC law.
“The purpose of this resolution is to empower physicians to define what is in our [hospital medical staff] bylaws,” said Houston urologist Ori Hampel, MD.
In another resolution, delegates voted to adopt language expressing TMA’s opposition to mandatory MOC. But the House rejected language advocating that “what constitutes life-long learning remain under the purview of state medical boards.”
Supporting the opposition to mandatory MOC, Dr. Hampel said of his own MOC experience, “I recertified. It was torture. … But I chose to do that. So it should be voluntary. The key word in this resolution is the word ‘mandatory.’”
During the debate, Fort Worth obstetrician-gynecologist Sealy Massingill, MD, expressed concern that “anytime we take any public stance that says we don’t like to be recertified, that’s what patients hear. … We as physicians have a duty to our patients to make sure that we are qualified and safe. If you don’t like what your board does, work with your board to fix it.”
All Texas health care facilities that receive federal or state funds for uncompensated care also must accept Medicare, Medicaid, TRICARE, CHIP, and federally subsidized health insurance, delegates decided in adopting an amended resolution submitted by the Lone Star Caucus.
The same measure also resolved that some of the funds hospitals receive for uncompensated care be transferred to “another part of the Texas Medicaid program and used to increase the payment rate for physicians who provide Medicaid services.”
In the Dallas area, cardiologist Rick Snyder, MD, told the House, “99.9% of the [uncompensated care] money goes to the hospitals.”
After a long debate, delegates adopted new policy designed to protect certain medical treatments from being inadvertently forbidden amid legislative efforts to limit abortion.
The discussion in both the Reference Committee on Science and Public Health and the House of Delegates focused mostly on the word "personhood." The original resolution called for TMA to "oppose any personhood measure that is unclear, confusing, ambiguous, or not based on sound scientific or medical knowledge, which threatens the safety of effective treatment of patients, and which threatens access to assisted reproductive services."
Broadly worded legislative measures designed to make abortion illegal by defining the word "personhood" could affect birth control and infertility treatments, said Sam Chantilis, MD, a Dallas reproductive endocrinologist and infertility specialist.
Members of the reference committee amended the resolution to give it a more positive tone and removed mention of "personhood," saying they feared it was unnecessarily controversial.
On the House floor, Dr. Chantilis moved to reinsert "personhood," pointing out that the original wording was based on a similar statement already adopted by the American Society for Reproductive Medicine.
"Texas needs a personhood policy," Dr. Chantilis said.
The House ultimately approved a resolution that kept most of the reference committee's wording and included "personhood." It said that TMA will, "regarding any personhood measure, advocate and inform on proposed public policy measures related to reproductive health based on evidence-based medicine, which promotes the safety and effective treatment of patients, and preserves access to comprehensive reproductive care, including assisted reproductive services."
The House also rejected a resolution that would have committed TMA to advocate for mandatory paid parental leave upon the birth or adoption of a child. The resolutionalso called on TMA to support the expansion of existing job-secured parental leave of at least 12 weeks to include monetary compensation.
The reference committee recommended against adoption of the resolution. But Alice Gong, MD, a San Antonio pediatrician and chair of the Council on Science and Public Health, spoke on her own behalf in favor of it. Paid parental leave can present problems for small businesses, like physician practices, but several states and many more foreign countries require paid parental leave in ways that avoid hurting businesses, she said.
Dr. Gong did not have parental leave when she had her own children, but she believes younger physicians will insist on it.
"If we want to help women, we need to do this," she said. "The younger generation wants that time with their children. … So we need to support this."
Dani Steininger, MD, an Allen obstetrician-gynecologist, asked that the issue be studied further to avoid hurting physicians in small, private practices.
"It's a very complex issue that as a mother and women's health advocate I support," Dr. Steininger said. "But as a small business owner, I would like us to look further into what the resources are to make it feasible for us as private practitioners."
Other physicians pointed out that TMA completed a study on parental leave in 2017, as have other organizations, making further study unnecessary.
Existing policy says TMA will "promote awareness and education for physicians, legislators, and the public on the importance of paid parental leave," and it calls for working with state agencies to study ways to remove barriers to parental leave.
The House voted against initiating another study and against adopting the resolution, keeping the current policy in place.
- Said Congress should make participation in Medicare’s Quality Payment Program “completely voluntary” for physicians;
- Adopted a resolution expressing TMA’s “disappointment” with Blue Cross and Blue Shield of Texas for contracting with a foreign-based, multinational health care firm to open 10 primary care medical centers in Dallas and Houston; and directing TMA to conduct “a comprehensive study of these market developments” and develop “enforceable protections from predatory behavior and adverse patient consequences;”
- Called for the removal of the Texas sales tax on feminine hygiene products;
- Recommended that physicians adopt the term “intellectual disability” instead of “mental retardation” in clinical settings; and
- Celebrated the accomplishments of Louis J. Goodman, PhD, who is retiring after 22 years as TMA’s CEO and executive vice president.