TMA Pushes Lawmakers on Health Priorities in State Budget
Organized medicine has weighed in on its priorities as state lawmakers continue to negotiate a compromise spending plan for the next two years.
The Texas Medical Association co-wrote a letter with the Texas Pediatric Society, the Texas Academy of Family Physicians, the Texas Chapter of the American College of Physicians Services, the Texas Association of Obstetricians and Gynecologists, and the Federation of Texas Psychiatry featuring “medicine’s recommendations for crafting a biennial budget that will promote a healthier Texas.”
“…Of paramount concern to our members and the patients they care for is that Texas enact a compassionate budget that rejects deep cuts in the state’s health care safety net, and public and mental health systems, cuts that ultimately will cost Texas taxpayers more, harm physicians’ ability to care for Texans, and make our state a less advantageous place to do business,” the letter to the 10 members of the budget conference committee reads. “Furthermore, as more people make Texas their home, the backbone of the state’s health care system — the physician workforce — is straining to keep pace. Texas, thus, must preserve investments made in 2015 to expand graduate medical education (GME) capacity to ensure medical students who study here can train here, increasing the likelihood they’ll ultimately practice here too.”
The letter establishes these overarching budget priorities:
- Ensure the long-term viability of Texas Medicaid by promoting community-oriented, value-based initiatives while implementing sensible reforms to restrain costs;
- Invest in Texas’ public health system to maintain the state’s ability to detect disease outbreaks early and to better manage costly chronic diseases, such as asthma and diabetes;
- Enhance initiatives to promote early intervention and treatment of behavioral health disorders, and increase local and state mental health inpatient hospital capacity;
- Sustain preventive health and wellness programs for low-income women and boost outreach to enroll eligible women into these cost-effective programs;
- Promote a robust physician workforce to meet Texas’ diverse and growing population; and
- Devote needed resources to ensure children with developmental delays receive timely early childhood intervention services.
After the conference committee reaches an agreement, the full House and Senate must vote to approve the budget bill, Senate Bill 1, which then goes to the governor for his signature. The last day of the regular session is May 29, and the budget bill is the only bill that must be passed. The governor has the authority to call a special session should one be needed, but thus far, there has been no signal of the need to do so.
GME Funding Update
Both the Senate and the House are proposing increases to GME. When the programs are added together, the House plan would spend $194.2 million compared with the Senate’s $189.4 million. Each uses a different approach to achieve the total. Regardless of the approach, the proposed increases are extremely important for balancing expanded GME with medical school enrollment growth.
Both the Senate and House are proposing funding these programs at current levels:
- Primary Care Preceptorship: $3 million
- Joint Admission Medical Program: $10.21 million
- Mental Health Professions Loan Repayment: $2.125 million
However, the Senate’s budget makes these cuts to the following GME and physician workforce pipeline programs:
- Family Medicine Residency Program: $1 million (6 percent),
- Physician Education Loan Repayment Program: $8.45 million (25 percent),
- Primary Care (Medical School) Innovations Grant Program: $2.1 million (complete loss of funding), and
- Emergency and Trauma Training Grants: $500,000 (11 percent).
Health-Related Institutions and Undergraduate Medical Education Funding Update
The House and Senate used different methods to prepare their proposed budgets for medical student formula funding. The Senate version provides $53.4 million more than the House proposal. This increase is part of a one-time provision to soften the fiscal impact of the almost-complete elimination of special-item funding to the health-related institutions (HRIs).
The HRIs sought special-item funding in prior years for specific programs that do not fit within the state's formula-funding process. The majority of these are research programs, but some medical education and GME programs have been included as well.
HRIs have $465.5 million in special-item funding in the current budget, but the Senate would fund only $20 million in the next budget cycle. This is for two mental health-related programs: $12 million at The University of Texas Health Science Center at Houston, and $8 million at The University of Texas Health Science Center at Tyler.
To offset that drastic cut, the Senate would distribute an additional $375 million among the HRIs, allocating half through the medical-student-formula funding and half through the research-enhancement formula. The reason for adding these funds is to limit the funding cut per institution to a maximum of 2.6 percent. The Senate employs various methods to achieve this goal. As a result, the "per-medical student" amount varies across the schools. Senators, however, made clear that they intend the extra dollars to be one-time allocations and that schools should not expect that money to be included in the 2020-21 budget.
The House budget includes a 10.8-percent reduction in special-item funding for the HRIs.
- HB 2996/SB 1455, Rural Training Track Grant Program: To promote the training of physicians for rural practice, TMA initiated a bill to establish a small state grant program for rural training tracks at the Texas Higher Education Coordinating Board. The grants would help cover training costs and serve as an incentive for urban and rural hospitals to partner in the effort to increase physician supply in rural communities. HB 2996 was approved by the House Higher Education Committee and is pending a vote by the full House.
- SB 1066, Requirement to Plan GME Needs in Conjunction with Medical School Planning: Requires a new medical school that applies to the Texas Higher Education Coordinating Board to simultaneously provide a plan for ensuring there will be a sufficient number of GME positions for the expected graduates. The bill was passed by the full Senate and has been referred to the House Committee on Higher Education.
- HB 2478/SB 1139, Psychiatrist Innovations Grant Program: Establishes a state physician workforce pipeline program, similar to the current Primary Care Innovations Grant Program at the Texas Higher Education Coordinating Board. Grants are to be issued to medical schools for development of innovative programs to increase the number of physicians practicing in adult and child/adolescent psychiatry. The bill was passed by the House Higher Education Committee and is awaiting a vote by the full House.
- SB 674, Expedited Licensing for Certain Physicians Specializing in Psychiatry: Directs the Texas Medical Board to expedite the processing of medical license applications for psychiatrists who are licensed in another state and certified by the American Board of Psychiatry and Neurology or the American Osteopathic Board of Neurology and Psychiatry. This provision would not apply to residents completing training in psychiatry programs in Texas who are applying for their initial medical license. The expedited licensing process created by this bill would be in addition to the board’s current process, which is open to physicians of all specialties who are entering practice in a rural or medically underserved area. The bill passed the full Senate and has been referred to the House Committee on Public Health.
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Congress Boosts Key Medical Science Funding
A bipartisan federal spending bill for fiscal year 2017 passed by Congress and signed by President Donald Trump earlier this month contains $2 billion in additional funds for the National Institutes of Health (NIH) through Sept. 30. NIH had been targeted for a $1.2 billion cut in President Trump’s draft budget for Fiscal Year 2017. Before the spending plan was adopted, the NIH and other federal programs were operating under a continuing resolution that froze 2017 spending at 2016 levels.
The spending bill contains support for key programs, including:
- $5.7 billion for the National Cancer Institute;
- $1.39 billion for Alzheimer’s research;
- $320 billion for precision medicine;
- $463 million for research into new antibiotics for infections resistant to traditional antibiotics; and
- $110 million for the Brain Research Through Advancing Innovative Neurotechnologies program.
Potential cuts loom ahead for NIH, however, with a proposed reduction of $5.8 billion or 18 percent in the president’s draft 2018 budget. The cuts would be largely offset through reductions to the portion of grant funds provided to cover indirect costs incurred by research institutions. Stay tuned for updates.
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House of Delegates Adopts New Medical Education/Physician Workforce Policies
The TMA House of Delegates last week adopted multiple policies of potential interest to academic physicians, including medical education and physician workforce adequacy. The policies, approved at the annual meeting in Houston, included recommendations brought to the house by the Council on Medical Education and Committee on Physician Distribution and Health Care Access, and included:
- Exceptions to deadlines for setting Medicare GME funding caps;
- Building the future physician workforce;
- A long-range state health care workforce study;
- Enhancing the state’s Physician Education Loan Repayment Program; and
- Monitoring maintenance of certification reforms.
A complete listing of these new policies is available on the TMA website.
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TMA Awards 12 Minority Medical Student Scholarships
A dozen minority students entering Texas medical schools this fall each will benefit from $10,000 scholarships from TMA. TMA awarded the scholarships in Houston at TexMed, the association’s annual conference. Physicians selected the students for their academic achievement, commitment to community service, and desire to care for Texas’ increasingly diverse population.
TMA created the Minority Scholarship Program in 1998 to help diversify the physician workforce to meet the health care needs of Texans.
The TMA Educational Scholarship, Loan, and Awards Committee chose one incoming student at each Texas medical school from a competitive field of promising future physicians. This year’s field includes the University of the Incarnate Word School of Osteopathic Medicine, which will open in the fall.
TMA has awarded 124 scholarships totaling $735,000 since the program’s inception. TMA’s 2017 Minority Scholarship Program is made possible with a grant from the TMA Foundation thanks to the TMAF Trust Fund of Dr. Roberto J. and Agniela (Annie) M. Bayardo; the TMAF Patrick Y. Leung, MD, Minority Scholarship Endowment; and generous gifts from H-E-B, and physicians and their families.
The TMA website contains a list of the 2017 TMA Minority Scholarship Winners.
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TMA Academic Physicians Honored for Outstanding Work
Austin allergist/immunologist Allen Lieberman, MD, has been recognized for his efforts in improving the quality of life and health of people with food allergies.
Dr. Lieberman, who serves on the faculty at Texas A&M Health Science Center in Round Rock and at the Dell Medical School at The University of Texas in Austin, received the Health Professional Award for Volunteer Service at the Food Allergy Research & Education (FARE) Vision conference in San Antonio last month.
“(Dr. Lieberman) is a passionate advocate for the food allergy community, working to help get undesignated epinephrine auto-injectors into Texas public schools,” FARE said on its website. “He continues to collaborate with our state legislators to bring stock epinephrine to private schools and other public entities along with raising food allergy awareness by educating the media and his local community.”
U.S. Army Col. Robert E. Suter, DO, of Dallas has been awarded the Surgeon General’s Award for Military Excellence.
The award, also called the Lewis Aspey Mologne Award, is presented to an Army Medical Corps colonel who best exhibits a balance between leadership in military medicine and leadership in academics on a national level.
Dr. Suter is a professor of emergency medicine at The University of Texas Southwestern Medical Center and a colonel in the U.S. Army Reserve.
“The nominations considered by the board were a select group of senior Medical Corps officers who collectively represent the epitome of achievement in military academic medicine,” Lt. Gen. Nadia Y. West, the surgeon general of the U.S. Army and commanding general of the U.S. Army Medical Command, said in a letter to Dr. Suter. “Your selection for this award is a reflection of your achievements and contributions to the Army Medical Department as both a leader and an academician. Such a wide range of accomplishments is truly noteworthy.”
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Study Links Drug Marketing, Prescription Rates
Doctors at teaching hospitals tend to order fewer promoted brand-name drugs when their interactions with pharmaceutical sales representatives are limited, a new study suggests.
The study, conducted by Ian Larkin, an assistant professor of strategy at the University of California, Los Angeles Anderson School of Management, and others, shines new light on conflicts of interest in medicine. It was published in the Journal of the American Medical Association.
The study focused on 19 academic medical centers in five states that restrict drug reps by limiting access and gifts, or punishing those who broke the rules. It also compared more than 16 million prescriptions written by 2,126 doctors with 24,593 peers who had no marketing limits.
“The researchers found significant changes in six of the eight drug classes studied and at nine of the 19 hospitals reviewed,” ProPublica, a nonprofit investigative newsroom, said in a summary. “The policies were put in place at different times from 2006 to 2011, but changes in prescribing started immediately and lasted for 12 to 36 months afterward.”
Centers that had policies governing drug marketing had a 1.67 percentage point decrease in market share for the average promoted drug, according to the study. Before policies were put in place, those drugs had a 19.3 percent market share, researchers said.
ProPublica pointed out that the study had limitations.
“First, it did not find that the policies caused the change in prescribing, only that there was an association between the two,” ProPublica said. “Also, the study was observational, meaning that doctors were not randomly assigned to hospitals with and without policies. And the study took policies at their word, not looking at their implementation or follow-through.”
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Register Now: AMA-APS Annual Meeting, June 9-10 in Chicago
Academic physicians, register now to attend the American Medical Association Academic Physicians Section (AMA-APS) Annual Meeting, June 9-10 at the Hyatt Regency Hotel in Chicago.
Topics will include the progress of AMA’s Accelerating Change in Medical Education consortium, an update from the Accreditation Council for Graduate Medical Education, and information about the Academic Leadership Group Membership Program, which offers substantial discounts on AMA dues for medical school deans and faculty. The meeting also will feature reviews of medical education-related reports and resolutions to go before the AMA House of Delegates, educational sessions focusing on apps and other innovations in medical education, and new directions in GME.
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Dell Medical School’s Different Direction
The May issue of Texas Medicine spotlights the Dell Medical School at The University of Texas at Austin, the first medical school built from scratch by a major research university in the last 50 years.
The school has been designed to be radically different from most medical schools, and that shows in its inaugural class, which started in 2016. Many of the students are older than most fresh-out-of-college med students. Also, 22 percent of them identify with racial or ethnic groups historically underrepresented in medicine. That's way above the 13 percent national average according to the Association of American Medical Colleges.
But Dell is different in more fundamental ways. Clay Johnston, MD, Dell's inaugural dean, says the school was determined to update the creaky Flexnerian medical school model. That model called for two years of science, two years of clinical work with patients, nonstop lectures, and lots of memorization. Dell has only one lecture hall, and very few lectures actually take place there. Instead, students spend most of their time in interactive sessions with instructors and other students. They learn medicine as well as the teamwork and leadership skills they will need as physicians. Heroic feats of memorization are not required.
"It's a very different kind of experience that none of us who went to medical school 10 years ago — or even two years ago — were exposed to," Dr. Johnston says.
Under Dell's new curriculum, the normal two years of science have been packed into one, and the second year now goes to hands-on clinical experience. The third year is a "growth" year in which students can work on a dual degree or a community project. And the fourth year is devoted mostly to exploring career opportunities and interviewing for residency positions. Dell considers that experimental third year a key innovation. Many students plan to use that time to develop projects that benefit people who have been underserved medically.
Dell was built in partnership with The University of Texas and Central Health, Travis County's health care district. Much of its work involves helping those who struggle getting medical care. Dell has launched or is planning to launch about two dozen of its own programs designed to help low-income and uninsured people.
The May issue of the magazine also includes stories about the rise in locum tenens doctors taking the places of permanent physicians, the early promise seen in the trend away from
fee-for-service and toward value-based payment models in the Texas Medicaid program, and TMA’s recommendations to the legislature to address doctor-shopping and opioid diversion.
Check out our digital edition of Texas Medicine.
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