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Scooped by Texas Medical Association onto Healthy Vision 2020 |
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HELENA – Hospitals, physicians, health insurers and health clinics came out in force Wednesday to support a bill encouraging “patient-centered medical homes,” which are medical practices designed to offer preventive care and reduce health care costs.
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SACRAMENTO -- A series of bills to expand the roles of nurse practitioners and other healthcare professionals has set off a turf war with doctors over what non-physicians can and can’t do in medical practices.
Texas Medical Association's insight:
Texas has a large, growing population that is growing sicker and needs more and better-coordinated health care services. Unfortunately, Texas — even more than most of the rest of the country — needs more physicians and other health care professionals. Although our 2003 liability reforms have brought an influx of new physicians, the current supply won’t be able to keep up with the demand, especially with expanded insurance coverage from the Patient Protection and Affordable Care Act (PPACA). We need more physicians and other health care professionals working in all parts of the state, especially in rural and border Texas. We need to invest more in our medical schools and graduate medical education training programs. We should not fool ourselves into thinking that allied health professionals — who haven’t gone to medical school — can fill the gap as independent practitioners. Instead, we need to work on building physician-led health care teams that can safely meet the diverse needs of the Texas population. Delete the scoop?
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A commission created to investigate the shortage of health care professionals has never met in two and a half years because it has no money from Congress or the administration.
Texas Medical Association's insight:
Ensure an Adequate Health Care Workforce
Texas has a large, growing population that is growing sicker and needs more and better-coordinated health care services. Unfortunately, Texas — even more than most of the rest of the country — needs more physicians and other health care professionals. Although our 2003 liability reforms have brought an influx of new physicians, the current supply won’t be able to keep up with the demand, especially with expanded insurance coverage from the Patient Protection and Affordable Care Act (PPACA). We need more physicians and other health care professionals working in all parts of the state, especially in rural and border Texas. We need to invest more in our medical schools and graduate medical education training programs. We should not fool ourselves into thinking that allied health professionals — who haven’t gone to medical school — can fill the gap as independent practitioners. Instead, we need to work on building physician-led health care teams that can safely meet the diverse needs of the Texas population. Delete the scoop?
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The one in five young doctors who still planned on a career in general medicine at the completion of their training may help to provide the answer to the current primary care shortage, a new study found.
Texas Medical Association's insight:
Make sure enough physicians and other health care professionals are working in all parts of Texas Imagine life without access to a physician, for yourself, your aging parent, or your child. Without access to a physician, life-enhancing and lifesaving medical care is virtually impossible. Physicians are the nucleus of the formula needed to achieve the vision of the Texas Medical Association: To improve the health of all Texans. Access to health care depends on the availability of physicians with the skills to match the needs of the state’s population.
Texas has a shortage of both primary care physicians and other specialists. Texas ranks behind all the other most-populous states in the number of patient care physicians per capita. To evaluate this shortage across specialties, we have devised a metric that compares the number of Texas physicians per 100,000 population with the U.S. average. We call this the “Texas Specialty Ratio.” The closer this ratio is to 100 percent for a given specialty, the closer Texas is to the national average. Texas has fewer physicians per capita than the national average for 36 out of 40 medical specialty groups.Texas needs both more primary care physicians and other specialists. A number of specialties have acute shortages.Psychiatry and child/adolescent psychiatry are among the specialties with the lowest Texas Specialty Ratios.We also must look to the Texas of tomorrow to evaluate the kinds of physicians we will need the most. Texas ranks fourth among the six most-populous states in medical students and resident physicians per capita. Texas continues to be overly dependent on other states and countries for supplying new physicians. Last year, nearly 75 percent of newly licensed physicians graduated from medical schools outside of Texas. [13]We are thus subject to the vagaries of external forces that influence the numbers of physicians we can recruit. To meet future physician demands, Texas needs a stable, high-quality medical education system to produce homegrown physicians. Similarly, we must provide a reasonable opportunity for Texas medical school graduates to obtain their residency training in the state without being forced to leave home. Multiple studies confirm that physicians who complete both medical school and residency training in the state are three times more likely to practice here. Delete the scoop?
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TMA says: Texas has a large, growing population that is growing sicker and needs more and better-coordinated health care services. Unfortunately, Texas – even more than most of the rest of the country – needs more physicians and other health care professionals. Although our 2003 liability reforms have brought an influx of new physicians, the current supply won’t be able to keep up with the demand. We need more physicians and other health care professionals working in all parts of the state, especially in rural and border Texas. We need to invest more in our medical schools and graduate medical education training programs. We should not fool ourselves into thinking that allied health professionals – who haven’t gone to medical school – can fill the gap as independent practitioners. Instead, we need to work on building physician-led health care teams that can safely meet the diverse needs of the Texas population. Delete the scoop?
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The United States is in the midst of a medical education building campaign. Texas is among the leaders, with plans to increase enrollments to the nationally recommended 30-percent growth level by 2015. Texas is setting records in the number of medical school graduates, reaching 1,458 in 2011, a net gain of 80 (6 percent) from the preceding year. The number of graduates is forecasted to peak at more than 1,700 this decade.
Texas needs continued and stable state support for both critical parts of a physician’s education and training to help cultivate future generations of Texas physicians, ensuring stable access to health care for all Texans.
In 2011, almost half (48 percent) of Texas medical school graduates left the state for residency training.Texas invests almost $200,000 in a medical student’s four years of education. Texas physicians are concerned about the state’s ability to protect that growing investment with enough graduate medical education (GME) positions to meet demand. For 2011, the annual National Resident Matching Program offered 1,476 entry-level GME positions in Texas. By comparison, 1,445 students graduated from Texas medical schools in 2011. The Texas Higher Education Coordinating Board recommends a ratio of 1.1 entry-level GME positions for each Texas medical school graduate. To meet this goal, Texas would have needed 1,590 entry-level training positions in 2011, or 114 additional positions.
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Texas has a fast-growing population and needs to work toward a 21st century health care workforce. More than ever, caring for larger panels of patients – particularly in primary care medical homes – will involve the skills of many different practitioners. Central to this concept is that these physician-led teams will utilize a number of health care professionals, each bringing important skill sets and training to patient care. Physicians will continue to provide patient care services, but they also will be called upon to manage the team’s care for larger populations, out of necessity and for essential coordination.
Team care will require cooperation and collaboration among all professionals, with a focus on quality, measureable outcomes, and efficient utilization of resources. It will be essential that the patient receive the right care, at the right time, by the right professional, in the right venue.
The physician is the highest-trained team member. It therefore falls to the physician – as both provider of care and manager of services delivered by others on the team – to supervise, implement science-driven and objective treatment protocols, coordinate the services of other professionals as well as medical specialists, and ultimately remain accountable for each patient’s care.
Integrating the talents of a diverse medical team under physician leadership will be one of the key challenges in the coming decade. Without physician direction, supervision, and management (or if the system evolves to accommodate teams led by practitioners with lesser training), medical care will trend toward even more fractured care, higher-than-necessary utilization, and creeping inefficiencies. This will lead to even higher costs, duplications of services, and lower-quality patient care. These inefficiencies in turn will hamper efforts to improve access to care.
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We need more physicians and other health care professionals working in all parts of the state, especially in rural and border Texas. We need to invest more in our medical schools and graduate medical education training programs. We should not fool ourselves into thinking that allied health professionals – who haven’t gone to medical school – can fill the gap as independent practitioners. Instead, we need to work on building physician-led health care teams that can safely meet the diverse needs of the Texas population Delete the scoop?
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Texas has a large, growing population that is growing sicker and needs more and better-coordinated health care services. Unfortunately, Texas – even more than most of the rest of the country – needs more physicians and other health care professionals. . Delete the scoop?
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Texas has a large, growing population that is growing sicker and needs more and better-coordinated health care services. Unfortunately, Texas – even more than most of the rest of the country – needs more physicians and other health care professionals. Although our 2003 liability reforms have brought an influx of new physicians, the current supply won’t be able to keep up with the demand. We need more physicians and other health care professionals working in all parts of the state, especially in rural and border Texas. We need to invest more in our medical schools and graduate medical education training programs. We should not fool ourselves into thinking that allied health professionals – who haven’t gone to medical school – can fill the gap as independent practitioners. Instead, we need to work on building physician-led health care teams that can safely meet the diverse needs of the Texas population. Delete the scoop?
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The number of medical students committing to primary care rather than specialties increased for the fourth straight year in the largest 'match program'' in history, a report says.
Texas Medical Association's insight:
Make sure enough physicians and other health care professionals are working in all parts of Texas
Imagine life without access to a physician, for yourself, your aging parent, or your child. Without access to a physician, life-enhancing and lifesaving medical care is virtually impossible. Physicians are the nucleus of the formula needed to achieve the vision of the Texas Medical Association: To improve the health of all Texans. Access to health care depends on the availability of physicians with the skills to match the needs of the state’s population.
Texas has a shortage of both primary care physicians and other specialists. Texas ranks behind all the other most-populous states in the number of patient care physicians per capita. To evaluate this shortage across specialties, we have devised a metric that compares the number of Texas physicians per 100,000 population with the U.S. average. We call this the “Texas Specialty Ratio.” The closer this ratio is to 100 percent for a given specialty, the closer Texas is to the national average.
• Texas has fewer physicians per capita than the national average for 36 out of 40 medical specialty groups. • Texas needs both more primary care physicians and other specialists. A number of specialties have acute shortages. • Psychiatry and child/adolescent psychiatry are among the specialties with the lowest Texas Specialty Ratio.
We also must look to the Texas of tomorrow to evaluate the kinds of physicians we will need the most. Texas ranks fourth among the six most-populous states in medical students and resident physicians per capita. Texas continues to be overly dependent on other states and countries for supplying new physicians. Last year, nearly 75 percent of newly licensed physicians graduated from medical schools outside of Texas.We are thus subject to the vagaries of external forces that influence the numbers of physicians we can recruit. To meet future physician demands, Texas needs a stable, high-quality medical education system to produce homegrown physicians. Similarly, we must provide a reasonable opportunity for Texas medical school graduates to obtain their residency training in the state without being forced to leave home. Multiple studies confirm that physicians who complete both medical school and residency training in the state are three times more likely to practice here.
Because the human body is complex, the mastery of medical care is correspondingly complex, requiring a lengthy educational and training pipeline. Following college, physicians traditionally complete a four-year medical school education, followed by specialty training in residency programs for three to eight additional years, depending on the specialty.
The United States is in the midst of a medical education building campaign. Texas is among the leaders, with plans to increase enrollments to the nationally recommended 30-percent growth level by 2015. Texas is setting records in the number of medical school graduates, reaching 1,458 in 2011, a net gain of 80 (6 percent) from the preceding year. The number of graduates is forecasted to peak at more than 1,700 this decade.
Texas needs continued and stable state support for both critical parts of a physician’s education and training to help cultivate future generations of Texas physicians, ensuring stable access to health care for all Texans. Delete the scoop?
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As physician assistants and other midlevel health professionals fill growing gaps in primary health care, turf battles are erupting in many states over what they can and can't do in medical practices.
Texas Medical Association's insight:
What’s your vision of scope-of-practice expansion? Better team-based care under the supervision of a physician? Or potentially unsafe independent practice for allied health practitioners? TMA supports the former and vehemently opposes the later.
Texas law clearly defines the practice of medicine and the educational qualifications necessary to diagnose, independently prescribe, and direct patient care — and to be held accountable for that care. Now, and in the future, physicians and other professionals will practice in teams to provide comprehensive patient care, and these patient-focused teams must be physician-led to ensure quality, continuity, and efficiency in care. Delete the scoop?
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TMA Says: Texas has a large, growing population that is growing sicker and needs more and better-coordinated health care services. Unfortunately, Texas – even more than most of the rest of the country – needs more physicians and other health care professionals. Although our 2003 liability reforms have brought an influx of new physicians, the current supply won’t be able to keep up with the demand, especially if the Patient Protection and Affordable Care Act (PPACA) withstands constitutional scrutiny. We need more physicians and other health care professionals working in all parts of the state, especially in rural and border Texas. We need to invest more in our medical schools and graduate medical education training programs. We should not fool ourselves into thinking that allied health professionals – who haven’t gone to medical school – can fill the gap as independent practitioners. Instead, we need to work on building physician-led health care teams that can safely meet the diverse needs of the Texas population. Delete the scoop?
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Texas continues to be overly dependent on other states and countries for supplying new physicians. Last year, nearly 75 percent of newly licensed physicians graduated from medical schools outside of Texas.[i] We are thus subject to the vagaries of external forces that influence the numbers of physicians we can recruit. To meet future physician demands, Texas needs a stable, high-quality medical education system to produce homegrown physicians. Similarly, we must provide a reasonable opportunity for Texas medical school graduates to obtain their residency training in the state without being forced to leave home. Multiple studies confirm that physicians who complete both medical school and residency training in the state are three times more likely to practice here. [i] Texas Medical Board. 2011. Available at http://www.tmb.state.tx.us/. ; Accessed April 2012.
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"Will the existing primary care workforce be able to care for the extra 50 million people who will gain access to health care..."
Texas has a fast-growing population and needs to work toward a 21st century health care workforce. More than ever, caring for larger panels of patients – particularly in primary care medical homes – will involve the skills of many different practitioners. Central to this concept is that these physician-led teams will utilize a number of health care professionals, each bringing important skill sets and training to patient care. Physicians will continue to provide patient care services, but they also will be called upon to manage the team’s care for larger populations, out of necessity and for essential coordination.
Team care will require cooperation and collaboration among all professionals, with a focus on quality, measureable outcomes, and efficient utilization of resources. It will be essential that the patient receive the right care, at the right time, by the right professional, in the right venue.
The physician is the highest-trained team member. It therefore falls to the physician – as both provider of care and manager of services delivered by others on the team – to supervise, implement science-driven and objective treatment protocols, coordinate the services of other professionals as well as medical specialists, and ultimately remain accountable for each patient’s care.
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It’s clockwork. Nine years ago this week, Texas voters approved our desperately needed medical liability reforms. Just like every other year at this time, the trial lawyers’ propaganda machine is once again trying to convince Texans to ignore the improvements they’re seeing all around them. I’m pleased to report on some new research that soundly contradicts the naysayers’ rhetoric.
In our generation, Texas has taken no more important step to strengthen our health care delivery system than passing the 2003 medical liability reforms. The 2003 law swiftly ended an epidemic of lawsuit abuse, brought thousands of sorely needed new physicians to Texas, and encouraged the state’s shell-shocked physicians to return to caring for patients with high-risk diseases and injuries. As recently reported in The New York Times,[i]however, tort reform is a never-ending political and legislative maneuver in Texas. We cannot relax our guard against direct attacks on the 2003 law, attempts to weaken the Texas Medical Board, nor cynical schemes to turn Texans’ final days into lawsuit battlegrounds [i] Ramsey, Ross. Fight Over Lawsuits Now Shapes State Politics. The Texas Tribune. March 2012 Available at. http://www.nytimes.com/2012/03/25/us/in-texas-trial-lawyers-and-a-pro-business-group-shape-politics-ross-ramsey.html. Accessed April 2012. Delete the scoop?
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TMA supports: Preserve and protect state support for undergraduate medical education and the cultivation of the future generation of Texas physicians, thus ensuring stable access to health care for all Texans. Support and develop new GME programs in the specialties that best reflect the state’s health care needs. Support incentives for hospitals and other community-based agencies to develop residency programs in the specialties most needed. Direct the Texas Higher Education Coordinating Board to coordinate the availability of graduate medical education training positions so that Texas can retain our graduates for residency training. Sponsor research to identify and promote innovations in training primary care residents for practice in Texas, and to address the factors that influence why few U.S. medical school graduates select this training.
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Physicians must be the backbone of such a complex system of care if it is to be cost-effective. Otherwise, the state’s efforts to increase preventive care, improve medically necessary treatment for the chronically ill, and reduce inappropriate emergency department utilization will falter. Physicians also play an important role in helping develop and partnering with the public health system. This partnership can enhance local coordination of care, disease surveillance, access, and health promotion. Delete the scoop?
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Although our 2003 liability reforms have brought an influx of new physicians, the current supply won’t be able to keep up with the demand, especially if the Patient Protection and Affordable Care Act (PPACA) withstands constitutional scrutiny. We need more physicians and other health care professionals working in all parts of the state, especially in rural and border Texas. We need to invest more in our medical schools and graduate medical education training programs. We should not fool ourselves into thinking that allied health professionals – who haven’t gone to medical school – can fill the gap as independent practitioners. Instead, we need to work on building physician-led Delete the scoop?
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Promote the patient-centered medical home for every Texan
Consider that the costliest 1 percent of patients in the United States account for more than 20 percent of what the nation spends on health care. They are older patients with cancer, diabetes, heart disease, and other serious chronic conditions. Many have multiple health problems, and their relatives might not be helping with their care. Most have private insurance and are white and female.
As public and private payers look for ways to lower costs, improve patient outcomes, and ease burdens to access, they are turning to models of care that both increase economic efficiencies and enhance patient care. One of these is the patient-centered medical home (PCMH) model. A PCMH is a primary care physician or physician-led team who ensures that patient care is accessible, coordinated, comprehensive, patient-centered, and culturally relevant. The physician or team directly provide, coordinate, or arrange health care or social support services as indicated by the patient’s individual medical needs and the best available medical evidence. The model uses a team-based approach with the patient’s primary care physician leading the overall coordination of care. Trained teams and well-constructed electronic health records (EHRs) are key to a successful PCMH.
TMA supports the use of the PCMH model in Medicare, Texas Medicaid, and commercial insurance plans. Public and private payers have, increasingly, been looking to this model as a way to reduce fragmented care, lower costs, avoid repetitive and costly procedures, and improve patient outcomes. Given the budget constraints that Texas faces and a growing population with unique health care needs, the PCMH offers the potential for Medicaid cost savings as well as improved patient outcomes and physician and provider satisfaction.
In recent years, numerous states have implemented PCMH initiatives that engage both private and public payers. While each program design was unique and each measured success differently, these initiatives showed improved outcomes and reduced costs. Below are just a few examples of PCMH successes.
• In a recent Blue Cross and Blue Shield pilot in Colorado, New Hampshire, and New York, the program showed an 18-percent decrease in acute inpatient admission rates compared with an 18-percent increase in the non-medical home group. Additionally, there was a 15-percent decrease in the rate of emergency department visits, compared with a 4-percent increase in the non-PCMH group.28
• Oklahoma saw complaints about access to same-day or next-day care decrease from 1,670 in 2007 (the year before PCMH implementation) to 13 in 2009 (the year after implementation). Oklahoma saw a decline in expenses of $29 per patient per year from 2008 to 2010.
• Inpatient hospital admissions for aged, blind, and disabled Medicaid beneficiaries participating in Community Care of North Carolina decreased 2 percent between 2007 and the middle of fiscal year 2010. Inpatient hospital admissions for the unenrolled beneficiaries increased 31 percent over the same time period. Overall, Community Care of North Carolina saved nearly $1.5 billion in costs between 2007 and 2009.