At an unprecedented live virtual meeting Saturday, the Texas Medical Association House of Delegates took action on a variety of initiatives important to the health of all Texans, including adopting policy to address health care disparities specifically related to cancer; laying the foundation for the creation of an LGBTQ Health Section; and setting principles for community-based accountable care organizations (ACOs).
More than 500 people – including 300 voting delegates – participated in Saturday’s meeting, which was conducted live online from the TMA headquarters in Austin.
“This is truly a historic meeting, and our first virtual meeting. You are truly a part of making TMA history,” House Speaker Arlo Weltge, MD, told delegates. “We are making huge strides in moving the organization forward even during this pandemic.”
TMA this year had altered its governing and meeting process because of the COVID-19 pandemic, including postponing the 2020 House of Delegates meeting, originally scheduled for May. TMA leaders conducted a limited meeting focused on “essential” house business. Many agenda items were tabled until the 2021 annual meeting, scheduled for May 2021 in Austin.
Using technology that allowed for remote voting, delegates on Saturday overwhelmingly approved recommendations from four reference committees on Science and Public Health, Financial and Organizational Affairs, Socioeconomics, and Medical Education and Health Care Quality. The committees, over several weeks, were responsible for collecting written physician testimony, and studying and evaluating more than 100 proposed reports and resolutions on a range of health care topics affecting Texas patients and physicians.
Delegates also voted in contested elections for TMA and American Medical Association leadership positions.
In addition, retired Paris gastroenterologist and internist Josie R. Williams, MD – a TMA Past President – was awarded TMA’s 2020 Distinguished Service Award.
Below is a summary of several items approved Saturday based on recommendations from the four reference committees.
Science and Public Health
Based on recommendations from TMA’s Committee on Cancer, the House voted to adopt new policy to tackle racial, ethnic, socioeconomic, and geographic health disparities when it comes to cancer specifically, and took initial steps to address health care disparities overall.
The new policy:
- “Recognizes cancer disparities as public health issues that hinder effective cancer screening, diagnosis, treatment, supportive care, and survivorship;”
- Supports physician awareness initiatives and education to address cancer health disparities; and
- Encourages research “aimed at identifying effective strategies to eliminate disparities in cancer health outcomes in all at-risk populations.”
Also recognizing that TMA does not have policy on health care disparities in general, the house adopted a recommendation to form a workgroup focused on the subject.
In addition, with electric scooters growing in popularity in Texas cities since 2018, delegates voted to develop policy on the topic similar to TMA policy on bicycle helmets, while supporting measures “to reduce speeds and therefore the impact of collisions.”
Financial and Organizational Affairs
Delegates approved an amendment to TMA bylaws that describes the purpose and procedures of an LGBTQ Health Section. However, an amendment that allows for the section’s representation in the TMA House of Delegates will need to be approved at the 2021 annual meeting.
TMA currently has five sections: medical students, international medical graduates, residents and fellows, young physicians, and women physicians. Each section can provide input into TMA policy through direct access and representation within the house.
Among other directives, the LGBTQ Health Section “shall study and advance the scientific basis for the care of LGBTQ patients, and develop policy and resources on LGBTQ health,” according to the recommendations.
Delegates adopted a report on community-based accountable care organizations (ACOs) that included a detailed list of principles for these entities, including engaging local physician leaders with a mix of practice size and employment status in the design of the ACO model; establishing competitive, reasonable, and fair payment rates for physicians, and building and maintaining robust networks. The report also recommended that TMA actively promote community-based ACOs as the foundation of any future Medicaid 1115 transformation waiver.
Other approved recommendations include:
- Advocating for legislative and regulatory lessening of the negative impacts on patients resulting from prior authorization requirements by state-regulated health plans, as well as the burden those preapproval requirements place on physicians;
- Adoption of a report on the study of financial barriers for rural hospitals. That report’s recommendations include prescribing that TMA redouble its efforts to reduce the rate of uninsured in Texas during the 2021 legislative session; support elimination of Medicare physician payment cuts because of sequestration; and support increasing funding for Prospective Payment System rural hospitals under Medicare.
- Adoption of a report on electronic health record (EHR) vendors’ data migration responsibilities if one of their clients terminates a contract. The report recommends that the Texas delegation to the AMA formally request AMA’s assistance in pushing for EHR vendors to be required to deliver a patient’s complete medical record in a format that can be integrated into a new EHR, at no cost to the physician.
The House also referred for board action a resolution for TMA to advocate for a statewide ballot measure on Medicaid expansion initiatives, and to encourage a dialogue on Medicaid expansion as a vehicle to reduce the state’s high uninsured rate.
Medical Education and Health Care Quality
Delegates approved a policy amendment that opposes allowing medical schools outside of Texas to send their students to Texas for clinical training or to pay Texas medical institutions for access to clinical rotations. Previous TMA policy had opposed the displacement of Texas medical students from clerkship training in the state by medical students from Caribbean medical schools. The policy now has now been extended to include students from medical schools in other states.
In 2021, there will be about 2,300 first-year Texas medical students, and that number will rise by several hundred during the next five years as new medical schools develop their programs, according to the TMA Education Department.
Also in medical education, delegates approved:
- A measure that opposes national proposals to divert Medicare funding for graduate medical education from physicians to training programs for midlevel practitioners.
- A policy amendment that calls for TMA to support a minimum of $1 million in state funding in the 2022-23 state budget to launch a rural training track program.
- A recommendation that TMA adopt policy supporting federal legislation that would allow physicians to be eligible for interest-free deferment on student loans while they are in residency training.
After the COVID-19 pandemic was declared a national emergency, the TMA Board of Trustees voted in March to invoke a bylaws provision allowing it to function as a Disaster Board and to assume certain responsibilities of the house. That included overseeing and conducting elections and installations of TMA officers and other necessary business.
Due to the cancellation of TexMed 2020, TMA’s annual meeting, the Disaster Board in May acted on behalf of the house to conduct elections for uncontested positions, after postponing contested races.