TMA says:

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. Tort reform, however, is a never-ending political and legislative battleground in Texas. We cannot relax our guard against direct attacks on the 2003 law, attempts to weaken the Texas Medical Board, or cynical schemes to turn any individual’s final days into a lawyer’s playground. 

TMA Says:

Texas physicians want to ensure all Texans have access to coverage and, more important, have access to physicians and other health care providers. According to the Institute of Medicine, even when uninsured patients have access to safety net services, the lack of health insurance often results in delayed diagnoses and treatment of chronic diseases or injuries, needless suffering, and even death.

That’s why TMA supports allowing state leaders to work with the Centers for Medicare & Medicaid Services (CMS) to develop a comprehensive solution that fits Texas’ unique health care needs. Several states have taken this step with some success, including Indiana, Arkansas, Iowa, Michigan, and Pennsylvania. (See adjacent chart.) TMA believes the Texas Legislature too can create an ingenious solution that works for the state and helps Texans in the coverage gap get affordable and timely care. Any Texas-style solution expanding access must:

• Draw down all available federal dollars to expand access to health care for poor Texans;

• Give Texas the flexibility to change the plan as our needs and circumstances change;

• Clear away Medicaid’s financial, administrative, and regulatory hurdles that are driving up costs and driving Texas physicians away from the program;

• Relieve local Texas taxpayers and Texans with insurance from the unfair and unnecessary burden of paying the entire cost of caring for their uninsured neighbors;

• Provide Medicaid payments directly to physicians at least equal to those of Medicare payments; and

• Continue to improve due process of law for physicians and other providers in Texas as it relates to the Office of Inspector General. 

TMA Says:

Promote Government Efficiency and Accountability by Reducing Medicaid Red Tape 

Administrative hassles not only detract from a physician’s ability to provide needed care, they also drive up overhead costs, ultimately making the meager Medicaid payments too low for many physicians to put up with the tangle of red tape. 

Our platform:

- Standardize Medicaid managed care administrative processes 

- Improve Medicaid HMO physician networks 

- Simplify compliance with Medicaid fraud and abuse laws 

- Eliminate duplicate Medicaid audits and investigations that waste taxpayers’ money 

- Discard costly and burdensome data reporting programs 

TMA says:

✓ Enact regulation of electronic cigarettes and associated products that includes:

• Restricting their sale to minors,

• Including these in smoking prohibition legislation and local policies,

• Providing school-based education for children on the hazards of electronic cigarettes,

• Assessing the feasibility of taxing electronic cigarettes and associated products to decrease the use of these products, and

• Encourage the U.S. Food and Drug Administration to assess the marketing of electronic cigarettes to minors.

✓ Maintain funding for the Texas Quitline and the state’s smoking cessation program and require monitoring of electronic cigarette use.

✓ Make Texas smoke free and encourage cities throughout the state to adopt uniform policies for smoke-free public places, workplaces, restaurants, and bars. 

TMA says:

Repeal the Independent Payment Advisory Board

Replacing the SGR and removing administrative penalties will be meaningless unless Congress also repeals the Independent Payment Advisory Board (IPAB). Leaving both in place would create cruel and unusual double jeopardy for physicians who want to care for senior citizens and military families. The ACA created a 15-member IPAB designated to recommend measures to reduce Medicare spending if costs exceed targeted growth rates.

The ACA prohibits the panel from recommending changes to eligibility, coverage, or other factors that drive utilization of health care services. This means the board will have only one option — cut payments. And through 2019, hospitals, Medicare Advantage plans, Medicare prescription drug plans, and health care professionals other than physicians are exempt. This means the board has only one option — cut Medicare payments to physicians. Cuts the board recommends will automatically take effect, unless Congress acts to suspend them.

As we’ve seen with the SGR, it’s obvious that cuts the IPAB enacts will devastate Medicare beneficiaries’ ability to find physicians to care for them. The issue of Medicare spending for 3.2 million Texans is too important to be left in the hands of an unaccountable board that makes decisions based solely on cost. 

TMA Says:

Repeal the Independent Payment Advisory Board

Replacing the SGR and removing administrative penalties will be meaningless unless Congress also repeals the Independent Payment Advisory Board (IPAB). Leaving both in place would create cruel and unusual double jeopardy for physicians who want to care for senior citizens and military families. The ACA created a 15-member IPAB designated to recommend measures to reduce Medicare spending if costs exceed targeted growth rates.

The ACA prohibits the panel from recommending changes to eligibility, coverage, or other factors that drive utilization of health care services. This means the board will have only one option — cut payments. And through 2019, hospitals, Medicare Advantage plans, Medicare prescription drug plans, and health care professionals other than physicians are exempt. This means the board has only one option — cut Medicare payments to physicians. Cuts the board recommends will automatically take effect, unless Congress acts to suspend them.

As we’ve seen with the SGR, it’s obvious that cuts the IPAB enacts will devastate Medicare beneficiaries’ ability to find physicians to care for them. The issue of Medicare spending for 3.2 million Texans is too important to be left in the hands of an unaccountable board that makes decisions based solely on cost. 

TMA Says:

Promote the patient-centered medical home for every Texan

Consider that the costliest 1 percent of patients in the United State account for more than 20 percent of the nation’s health care spending. They are older patients with cancer, diabetes, heart disease, and other serious and chronic conditions. Many have multiple health problems and may not have relatives who can help with their care.

As public and private payers look for ways to reduce costs, improve patient outcomes, and ease barriers to access, they are turning to models of care that increase economic efficiencies and enhance patient care. One of these is the patient-centered medical home (PCMH). A PCMH is a primary care physician or physician-led team who ensures that patient care is assessable, coordinated, comprehensive, patient-centered, and culturally relevant. The physician or team directly provides, coordinates, or arranges 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 coordination of care. Trained teams and well-constructed electronic health records are keys to a successful PCMH.

TMA supports the use of the PCMH model in Medicare, Texas Medicaid, and commercial insurance plans. Given the budget constraints 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. 

TMA says:

Promote the patient-centered medical home for every Texan

Consider that the costliest 1 percent of patients in the United State account for more than 20 percent of the nation’s health care spending. They are older patients with cancer, diabetes, heart disease, and other serious and chronic conditions. Many have multiple health problems and may not have relatives who can help with their care.

As public and private payers look for ways to reduce costs, improve patient outcomes, and ease barriers to access, they are turning to models of care that increase economic efficiencies and enhance patient care. One of these is the patient-centered medical home (PCMH). A PCMH is a primary care physician or physician-led team who ensures that patient care is assessable, coordinated, comprehensive, patient-centered, and culturally relevant. The physician or team directly provides, coordinates, or arranges 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 coordination of care. Trained teams and well-constructed electronic health records are keys to a successful PCMH.

TMA supports the use of the PCMH model in Medicare, Texas Medicaid, and commercial insurance plans. Given the budget constraints 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, the evidence indicates the model improves outcomes and reduces costs.