It's Academic

November 2016 

  State Projections for GME 2018–19 Funding Needs

The 2015 Texas Legislature made a hefty investment in the expansion of graduate medical education (GME), with the appropriation of $53 million for the state's two-year budget covering 2016–17. The Texas Higher Education Coordinating Board (THECB) has made a series of grant awards for this money. Here's THECB's recap of the funding commitments: 

GME Planning and Partnership Grants   $3.5M
     
GME Expansion Grant Program*   $49.5M
     
Total Funding   $53.0M

*$12 million of the GME Expansion Grant funds was specifically earmarked for primary care GME positions.  

THECB estimates these grants will support 743 residency positions during the 2016–17 biennium.  

Projected Funding Needs for 2018–19 (SB 18)
THECB’s 2018-19 appropriations request to the Legislative Budget Board asked for a total of $82.8 million to provide continued support to residency positions created from 2014 to 2017. This would require $29.8 million (a 56-percent increase) more than the $53 million funding the 2015 Texas Legislature provided. The additional monies would support existing residency positions, created through state grants. Funds would not be available to support further expansions.  

For other medical education and GME programs, THECB requested $16.78 million to provide continued funding to the Family Medicine Residency Program, $3 million to continue the Primary Care Preceptorship Program, and $2.1 million for the Primary Care Innovation Grant Program. These programs support development of the state's primary care physician workforce.   

Projected State GME Formula Funding Needs 
THECB recommended a 31.9-percent increase, for a total of $93 million in state GME formula funding in 2018–19. That's an increase of $23 million over the 2016–17 appropriation. The state allocates these funds to medical schools to offset a portion of resident teaching costs. This request does not include projected state GME formula funding for Baylor College of Medicine. Funding for Baylor is usually added during the drafting of the State Appropriations Bill. Baylor's funding amount is calculated on a per-resident basis, and the school receives the same base rate as public medical schools.    Baylor received $16 million in state GME formula funding in 2016–17.  

The 2017 Texas Legislature convenes on Jan. 10. If you would like to be part of TMA's grassroots effort to educate and inform legislators about the need for state funding of GME expansions, contact Marcia Collins at marcia.collins@texmed.org, or call (512) 370-1375. Be watching for continued updates on GME funding in It’s Academic throughout the legislative session.  

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 AMA Interim Meeting Will Tackle Medical Education-Related Policies

At its 2016 Interim Meeting, Nov. 11–14 in Orlando, the American Medical Association House of Delegates will consider 13 policy items related to medical education, residency training, and continuing medical education. This includes four resolutions seeking improvements to the American Board of Medical Specialties' maintenance of certification process; a resolution in support of leadership training for medical students and residents; policies on the use of mobile devices by residents while on duty; expanding training opportunities for residents and fellows in the medication-assisted treatment of opioid use disorders; and an extensive report by the AMA Council on Medical Education on access to confidential health services for medical students and physicians. The latter covers mental health services, as well as general preventive care.   

Visit the AMA website to read the reports and resolutions. You can also learn about positions taken by the AMA Academic Physicians Section.  

 Look for a summary of the house’s actions in the December issue of It’s Academic.  

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Texas Quality Summit Confronts the Changing Face of Medicine; Register Now    

To remain successful, practices must focus on effective population health management, especially in a post-MACRA environment. To help physicians advance quality care as a core value of their practice, with an eye toward the future of accountable care, TMA developed the interactive Texas Quality Summit

The summit begins as a pre-conference workshop on Friday, Nov. 18 with quality improvement scenarios and group exercises highlighting the tools and theories of leadership necessary for successful quality and patient safety programs. On Saturday, Nov. 19, the summit offers a series of expert physician panels for a broader audience, as well as presentations on quality, value, and payment. Programming will address population health trends in Texas, concrete steps for transitioning to value-based care, in-depth discussion of alternative payment models, and implementation of Medicare's new Quality Payment Program under the Medicare Access and CHIP Reauthorization Act (MACRA). 

The summit, co-hosted by the TMA Council on Health Care Quality and the American College of Medical Quality (ACMQ), offers continuing medical education credit on Friday, Nov. 18, for 5.25 AMA PRA Category 1 Credits™ designated as ethics and/or professional responsibility, and also on Saturday, Nov. 19, for 7.25 AMA PRA Category 1 Credits™ designated as ethics and/or professional responsibility. Seating is limited on both days, so register  now to secure your space.  

The event will be held in Austin at the TMA building in the Thompson Auditorium. Discounted room rates are available to attendees at the Doubletree, conveniently located across the street from the TMA building.  

For more information, visit the TMA website or read "Learn from the Experts" in the October issue of Texas Medicine.  

Can’t attend? Don't miss TMA's MACRA seminar series

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TMA Supports JUA's Ability to Write New Business

On Oct. 5, TMA sent a letter urging Texas Department of Insurance (TDI) Commissioner David Mattax to prevent the Texas Medical Liability Insurance Underwriting Association (JUA) from suspending the writing of new business. The JUA, established in 1975, is "critically important as a last stop gap to assure that licensed physicians and health care providers are able to continue to provide medical and dental care for their Texas patients," TMA wrote.

In the letter, TMA General Counsel Rocky Wilcox argues that the state's rapidly growing physician workforce, economic uncertainty, and regular cycles in the liability climate all demand that the JUA remain open as the insurer of last resort. "Physicians are not able to contract with a network or have privileges in a hospital without medical professional liability coverage," Mr. Wilcox wrote. "Therefore, they would not be able to effectively practice medicine." 

Commissioner Mattax conducted a hearing on the question Oct. 17. The issue arises due to a law passed last year, which TMA supported, that would use some of the JUA's reserves to finance a permanent trust fund for graduate medical education programs.

The 1975 legislation that created the JUA "enacted the right of associations such as TMA to sponsor self-insured trusts as another means of solving the insurance availability and affordability problems" of physicians at the time. Under the law, TMA sponsored the creation of Texas Medical Liability Trust, which provides coverage to qualified TMA members.  

The letter asserts TMA's strong belief that the JUA is "still necessary and its authority to write new business should not be suspended." TMA writes that uncertainty in the medical professional liability insurance market, the worldwide market, medical professional liability court decisions, the political and economic environment, and the tort legal environment could affect physicians and could "cause some insurers to be more restrictive in underwriting."   

TMA says few liability insurers offer occurrence or claims-made policies, which the JUA provides. "Occurrence policies are an attractive alternative to some physicians in some specialties where there is a 'long-tail' on claims, such as pediatricians, obstetricians, and other providers treating young children."

TMA's letter concludes by requesting TDI "find that a necessity still exists for the JUA to be able to continue to write new business."

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Save the Date: TMA Winter Conference Jan. 27–28, 2017

Mark your calendar for TMA Winter Conference, which will take place Jan. 27–28, 2017, at the Hyatt Regency Austin. The conference provides an opportunity for physicians, residents, and medical students to conduct TMA business, obtain continuing medical education, and network with peers.  

TMA's special room rate is $199 plus tax. The deadline to book your hotel reservation at the TMA rate is Jan. 5, 2017. Make your reservation early. 

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This Month in Texas Medicine

The November issue of Texas Medicine features a cover story on the Texas Medical Board's (TMB's) informal settlement conferences (ISCs), which defense attorneys who represent physicians say have become similar to administrative hearings, without the guaranteed accompanying protections. In scathing written comments TMA submitted to TMB in response to the board's proposed ISC rules, TMA said ISCs have become "more and more formal, prescriptive, and regulated," without giving physicians a fair forum to defend themselves. In the issue you'll also find coverage of HIV pre-exposure prophylaxis, which can prevent patients from getting the virus; complaints TMA has received from several physicians that three of the state's biggest health plans are taking up to eight months to credential them; and a Houston palliative care and hospice physician's account of her family's experience caring for her terminally ill father.

You can subscribe to RSS feeds for TMA Practice E-Tips, TMA news releases, Blogged Arteries, and Texas Medicine. More

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 and Advocacy page on the TMA website.

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

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