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Commentary - June 2008



Tex Med. 2008;104(6):5-6.

B y Louis J. Goodman, PhD
TMA Executive Vice President

What does a professional society founded more than 150 years ago do to retain existing members and attract new ones?

We start with our vision, "To improve the health of all Texans," through our mission of providing distinctive solutions to the problems physicians face in the care of their patients.

In 2003, the liability climate in Texas was unhealthy and, in some regions of our state, downright toxic. Physicians were retiring early, limiting the range of their practices, and being crushed by rising insurance premiums.

A coalition, led by the Texas Medical Association, passed the now-historic House Bill 4 and Proposition 12 liability reforms that profoundly reversed these negative trends. Compared to 2003, twice as many new licenses are now being issued, physicians are again expanding their practices, insurance premiums continue to decline, and more than 15 new professional liability insurance carriers have entered the state.

Nevertheless, the same forces that sought to destroy medical practice in Texas are redoubling their efforts to reverse our tort reforms. Protecting and extending the HB 4 and Prop 12 reforms - which ensure patient access to physicians and medical care - remain TMA's No. 1 priority.



Responding to Disasters

Hurricanes Katrina and Rita wreaked havoc across the Gulf Coast in 2005. TMA, in conjunction with our county medical societies and the Texas Department of State Health Services, were early responders to the refugee crisis. Thousands of physicians volunteered to help the hundreds of thousands of displaced persons. In the face of such a large-scale emergency situation, logistics moved to center stage.

TMA created, and continues to update, a compendium of physician emergency contacts by location and specialty. When the health department sends an alert for particular specialties in a specific location, TMA's reliable database is searched and the names of the physician volunteers are given to their respective county medical society for contact and deployment.

Former Health Commissioner Eduardo Sanchez, MD, said of our emergency response network, "TMA played a critical role and stepped up to the plate informing and recruiting physicians to provide medical care within the 2,000 shelters in Texas. They did an excellent job working arm in arm with the state health department to provide a much needed private sector response."



Insurance Rating

It is becoming more and more difficult to maintain a viable medical practice in the face of misleading practices by insurance carriers. Insurance company balance sheets, profit reports, and stock prices have never been higher. Unfortunately, insurance company profit comes at the cost of increased beneficiary financial responsibility - and decreased payments to physicians and providers. The latest insurance company innovations are rating systems purported to assess quality and efficiency. Our analysis is that these rating systems are inaccurate.

Unlike my previous two examples, making insurance carriers responsible is a work in progress. For the 2009 legislative session, TMA, our county medical societies, state specialty societies, and our coalition partners will take a page out of the health insurers' playbook. The page is called transparency .

Insurance carriers need to forthrightly report the percentage of their premiums that are used for medical care. The medical ratios now reported are weighed down with "review" costs and other "medically related costs." The real question is, how much is paid to doctors and hospitals for providing direct patient care? (See " Where's the Money Going? " May 2008 Texas Medicine , pages 16-22.)

Similarly, health insurers should discontinue their rating systems until the systems have been externally validated. TMA has appointed committees of practicing physicians to evaluate evidence-based indicators, as well as the insurers' rating systems.

The committee looking at evidence-based measures is a joint effort with Blue Cross and Blue Shield of Texas. The TMA committee looking at rating systems was scheduled to issue its report in May, but as this commentary was being written, committee members believed the measures used by most health plans fall far short of being valid and reliable.

The health plans tell us they need a so-called rating measure because the other health insurers have them, and the brokers - who contract with employers to select insurance plans and networks - demand them. Yet, if a measure is not respected and, in fact, is disparaged, what is its validity to the profession, to the businesses that purchase insurance, or to patients?

Of course, we have many other examples of what your association does for its members and the patients you care for. I'll report on our efforts in the months ahead.



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