Apr 21, 2011

Texas Docs Pull All-Nighter at Capitol

TMA Legislative News Hotline

Thursday, April 21, 2011

Gary Floyd, MD
A big shout out to TMA’s dedicated physicians and lobbyists who stayed up until 4 am this morning to testify before the House Public Health Committee. The committee took up more than 20 bills that ranged from allowing advanced practice nurses to practice independently of a physician, to expanding the sale of raw milk, to allowing physicians and physician assistants and APNs to provide care over the Internet without first doing an in-person exam. Thanks again to:
  • Gary Floyd, MD, a Fort Worth pediatrician, executive vice president of medical affairs at John Peter Smith Health Network and member of the TMA Council on Legislation;
  • Lloyd Van Winkle, MD, a Castroville family physician and past president of the Texas Academy of Family Physicians;
  • Tricia Elliott, MD, director of the family medicine residency program at The University of Texas Medical Branch at Galveston;
  • Jeff Jekot, MD, an anesthesiologist from Austin;
  • Russell Thomas, DO, an Eagle Lake family physician who formerly served on the Texas Medical Board and currently serves on the National Federation of State Medical Boards;
  • Debra Patt, MD, an Austin oncologist;
  • Kimberly Avila Edwards, MD, an Austin pediatrician and medical director of the Texas Center for the Prevention and Treatment of Childhood Obesity at Dell Children’s Medical Center;
  • Greg Kronberg, MD, an Austin anesthesiologist and president the Texas Society of Anesthesiologists;
  • Sherid Zaafran, MD, a Houston anesthesiologist; and
  • Eddie Seade, MD, an Austin orthopedic surgeon.
We also want to thank Amy Arrant, MD, an Austin hospitalist and chief of staff of St. David’s South Austin Medical Center, and Mark Casanova, MD, a Dallas internist, for providing compelling testimony before the House Health and Human Services Committee yesterday. They testified on House Bill 3520 by Rep. Bryan Hughes (R-Mineola) that would force physicians and hospitals to provide medically unnecessary care indefinitely.

Yes, it’s still rainy over at the capitol. That’s why the chief budget writer for the Senate asked his committee today to support drawing down $3 billion from the state’s Rainy Day Fund to balance its 2012-13 budget plan. The Senate Finance Committee spent most of the week substituting parts of the House budget plan with its more generous spending. This morning the committee passed the committee substitute for House Bill 1 on an 11-4 vote, with Senators Lucio, Patrick, Whitmire, and Zaffirini voting against the bill. The legislation likely will be heard in the full Senate late next week, and then the House and Senate versions will be reconciled in conference committee. TMA will report the names of the 10 conference committee members as soon as they become available so you can be aware if your local legislator is serving on the committee. TMA staff also is preparing a side-by-side comparison of both budget bills so you can better understand what’s in play. Stay tuned. On Tuesday TMA released a letter to Finance Committee Chair Steve Ogden (R-Bryan) explaining why Texas physicians prefer the Senate budget plan over the House version.

With less than six weeks left of the session, lawmakers are moving quickly — through bills and through the budget. Yesterday was a big day under the rotunda. Here’s a brief list of legislation moving through the chambers that TMA is tracking:

Sen. Jane Nelson
R-Flower Mound
Medicaid cost savings: Senate Bill 7 by Sen. Jane Nelson (R-Flower Mound) was passed by the Senate. The measure now goes to the House. Rep. Lois Kolkhorst (R-Brenham), chair of the House Public Health Committee, will carry the legislation. SB 7 establishes a new Medicaid and Children’s Health Insurance Program (CHIP) Quality-Based Payment Advisory Committee that would:
  • Provide recommendations to the Texas Health and Human Services Commission to improve health outcomes and patient safety, and reduce the incidence of potentially preventable hospitalizations and readmissions;
  • Direct the state to test new payment and delivery systems that provide incentives to physicians and hospitals to develop more coordinated, evidence-driven, cost-effective care;
  • Tie a portion of Medicaid HMO premiums to improved health outcomes and quality; and
  • Implement copayments in Medicaid to reduce unnecessary emergency department use.
Health care collaborative: SB 8 by Senator Nelson also was passed by the Senate. It would establish a statewide plan for improving quality and increasing efficiency through performance-based measures, test collaborative models between physicians and health care providers, and require public reporting of preventable readmissions and complications. TMA was able to add these three important provisions to SB 8 to protect physicians in a collaborative arrangement:
  • Physicians would have an equal say and vote in a collaborative arrangement’s governing board.
  • Physicians would have due process protections and the ability to participate in more than one collaborative arrangement in their community.
  • The bill protects Texas’ ban on the corporate practice of medicine.

Rep. Lois Kolkhorst
 Interstate compact: HB 5 by Representative Kolkhorst was passed by the House yesterday. The measure would authorize the state to participate in a multistate compact to help fund and administer Medicaid. If passed, the compact would be submitted to Congress for its consideration. If approved, member states could pursue waivers that would relieve the state of federal mandates regarding Medicaid; CHIP; and all other health care programs, such as mental health and public health services. If successful, Texas likely would receive a block grant of around $60 billion, based on 2010 state/federal health care spending. Texas would then create its own health care program to replace Medicaid, CHIP, and all the other public health services.

TMB reform bills: SB 190 and SB 191 by Senator Nelson were approved by the Senate. Both bills now go to the House Public Health Committee. SB 190 would allow physicians to tape the proceedings of a Texas Medical Board (TMB) informal settlement conference, which eliminates the truly anonymous complaints. It would provide a physician notice if an insurance company files a complaint. It would prohibit the granting of a license to an applicant who has had a medical license suspended or revoked by another state or country (originally, the bill named only the country of Canada). SB 191 would bind TMB to the ruling of an administrative law judge in a proceeding supervised by the State Office of Administrative Hearings. SB 227 by Senator Nelson was also passed by the Senate. It now needs to be referred to a committee in the House. SB 277 would provide discretion for TMB to waive a fine in lieu of a remedial action plan for a minor administrative violation.

Health insurance: SB 822 by Sen. Kirk Watson (D-Austin) was passed by the Senate. Rep. John Zerwas, MD (R-Simonton), will sponsor the legislation in the House. The measure now goes to the House Insurance Committee for consideration. It would allow physicians who work in an academic setting to treat patients as an “in-network” physician for claims purposes while their applications for credentialing and health plan network participation are being processed.

HB 1405 by Rep. John Smithee (R-Amarillo) has passed the House and now goes to the Senate State Affairs Committee. The legislation would require plans that utilize a formulary to continue prescription benefits until the next renewal period if the formulary changes in the middle of the plan year. More importantly, HB 1405 would allow patients with individual coverage the same appeal rights as patients with small- or large-group health coverage. This means that a refusal or denial of a prescription drug by the health plan or pharmacy benefit manager would be considered an adverse determination and subject to an independent review if the physician has determined the drug is medically necessary.

Graduate medical education: HB 2908 by Rep. Dan Branch (R-Dallas) passed the House on second reading today. The bill requires the Higher Education Coordinating Board to assess the number of graduate medical education (GME) slots in the state and whether this number meets the national standards relating to the ratio of GME slots to medical student slots, to make sure the state is maximizing its investment in medical education.

Obesity prevention: HB 127 by Rep. Carol Alvarado (D-Houston) is on the House Local and Consent Calendar today. The legislation would limit the availability of sugary drinks on public school campuses.

Stanley Wang, MD
Congratulations to three TMA members who were appointed by Gov. Rick Perry to TMB. The physicians are:
  • Stanley Wang, MD, an Austin cardiologist and director of legislative affairs for Austin Heart Hospital. He also is a vice chair of the TMA Political Action Committee Board of Directors. Dr. Wang is newly appointed to the board.
  • George Willeford III, MD, an Austin gastroenterologist and founding partner of Austin Gastroenterology. He was reappointed.
  • Irvin Zeitler, DO, a family physician from San Angelo and vice president of medical affairs at Shannon Medical Center. Dr. Zeitler was reappointed to the board and will continue to be the presiding officer.
The physician of the day at the capitol is James P. McCurdy, MD, of Marble Falls. Dr. McCurdy has practiced family medicine for 29 years. He graduated from The University of Texas Southwestern Medical Center in 1979. Dr. McCurdy is a member of TMA and the Burnet-Lampasas County Medical Society.

Needed in Austin: patient advocates. Join hundreds of your colleagues and make a difference in legislation affecting you and your patients. Sign up now to attend First Tuesdays at the Capitol on May 3. Register today.

Listen to ReachMD XM 160: Sidney Ontai, MD, MBA, a Plainview, family physician and TMA physician is the first featured doctor in a new national radio franchise premiering this week. ReachMD, an award-winning network for professional medical news, information, and continuing medical education, premieres the new programming series “Voices From American Medicine.” The series features “physicians on the frontlines of medicine discussing their personal stories of triumph, tragedy, humanitarianism and innovation.” “Voices From American Medicine” is produced in cooperation with TMA and other medical associations and societies from across America.

Raw milk under scrutiny after North Texas illnesses (Dallas WFAA [ABC] 8)
Texas Tribune: El Paso Hospitals May Be Allowed to Hire Docs
(El Paso KVIA [ABC] 7)
A rainy-day fight?
(Houston Chronicle)
The good tax: We favor hiking the levy on cigarettes and banning workplace smoking. It's past time
(Houston Chronicle)

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