Capitol Update: House approves budget

posted 04.04.11

After three days of debate on proposed amendments, the Texas House passed House Bill 1, a $164.5 billion budget for 2012-2013. It spends $23 billion less than the current budget and makes cuts in every area of state government, especially the two largest—education and health and human services.

The House passed two other budget-related bills on March 31. H.B. 4 authorizes $1 billion in supplemental appropriations for the current 2010-2011 budget. H.B. 275 allows the state to use $3.1 billion of the Rainy Day Fund to help cover the budget gap in this biennium.

The budget debate now heads to the Senate where senators are actively looking for billions in non-tax revenue to alleviate some of the cuts to public education and Medicaid. The Austin American-Statesman reports that they also seem open to using additional money from the $9.4-billion Rainy Day Fund, even though Gov. Rick Perry has said repeatedly that he won’t sign a 2012-2013 budget that uses additional money from this fund.

Stay tuned as TAFP follows budget deliberations in the Senate, then as it moves to conference committee.

Senate committee approves health care payment reform bills

In a March 29 hearing of Senate Committee on Health and Human Services, Sue Bornstein, M.D., and Gregory Sheff, M.D., provided testimony in support of Senate bills 7 and 8. Bornstein is an internal medicine physician and executive director of the Texas Medical Home Initiative, and Sheff is a family physician with Austin Regional Clinic and medical director for the ARC Medical Home Program.

S.B. 7, by Sen. Jane Nelson, R-Lewisville, proposes strategies to save money in Medicaid and the Children’s Health Insurance Program. The bill creates the Medicaid and CHIP Quality-Based Payment Advisory Committee, which would work with the Commission on Health and Human Services to use quality-based measures to adjust Medicaid and CHIP reimbursement, award incentives to physicians who serve as medical homes, reduce payments to hospitals for preventable readmissions, implement co-payments for unnecessary emergency room visits, and study the feasibility of pay-for-performance expansion to long-term care services.

“No single sector of our health care economy is responsible for the high cost of health care,” Sheff said in written testimony. “I would submit that at the core of our ills is a system that does not align payments with the outcomes we desire.” He said that reforms in S.B. 7 begin to move the state toward a system that controls costs, promotes quality, and maximizes health and wellness.

S.B. 8, also by Nelson, provides two key mechanisms to help align physician and hospital incentives with society’s goals. First is the creation of health care collaboratives. These collaboratives, similar to accountable care organizations, would provide incentives for physicians and hospitals to coordinate care to improve quality and reduce costs.

Second is the creation of the Texas Institute of Health Care Quality and Efficiency. According to his testimony, the institute “would provide the structure and venue to allow the collaborative creation of alternate payment and delivery systems.”

Both bills were unanimously passed out of committee and now wait for debate before the full Senate.

House committee approves IMG licensure bill

On March 24, the House Committee on Public Health unanimously approved a bill that would allow international medical graduates to receive a medical license after two years of graduate medical education instead of three. House Bill 1380 by Rep. Vicki Truitt, R-Keller, is intended to help IMGs become eligible for board certification earlier than the current process allows.

Under current law, IMGs must complete three years of residency training before obtaining a Texas medical license. Graduates of U.S. medical schools are required to complete one year of residency training before being allowed to obtain a Texas medical license. While this law is in place to ensure all licensed doctors provide patients the highest-quality care, a “praise-worthy objective,” she said in an earlier hearing, studies show that different requirements for IMGs are unnecessary and create unintended negative consequences.

TAFP released an issue brief on the IMG licensure bill. Download it on the Advocacy Resources page of TAFP’s website, www.tafp.org/advocacy/resources.

The bill must now be scheduled for debate on the House floor. Its companion bill, Senate Bill 1022, by Rodriguez, currently waits for hearing in the Senate Committee on Health and Human Services.

TAFP past president testifies on physician employment by hospitals

At a March 28 hearing of the Senate Committee on State Affairs, TAFP Past President Douglas Curran, M.D., of Athens, testified in support of a committee substitute of Senate Bill 894 by Sen. Robert Duncan, R-Lubbock. The bill would allow critical-access hospitals, sole community hospitals, and hospitals in counties of 50,000 or fewer to employ physicians.

The committee substitute addresses concerns raised by physician advocates. It contains measures to protect physicians’ clinical autonomy. It ensures clinical decisions are made by medical staff, guarantees physicians’ independent medical judgment, allows physicians to help select their liability insurance, and requires medical staff to designate a chief medical officer to report to the Texas Medical Board.

“By doing what we’re doing, we should be allowing small hospitals in rural areas to directly employ physicians while protecting the patient-physician relationship,” Curran told the committee. “Again, I want to stress that we view this as…an opportunity to help the smallest communities with the greatest need and to level the playing field against urban and suburban communities as these areas recruit physicians.”

Curran previously testified before the House Committee on County Affairs on a similar bill to permit physician employment by a hospital. S.B. 894’s companion is House Bill 1700, by Rep. Garnett Coleman, D-Houston. Both bills have been voted out of committee; S.B. 894 could be heard before the Senate as early as tomorrow.

Thanks to the Physicians of the Day

Thanks to the physicians who volunteered for the Physician of the Day program last week: Kurtis W. Davis, M.D., of Bryan; Todd Howell, M.D., of Fredericksburg; Fred Merian, M.D., of Wimberley; Michael Dominguez, M.D., of San Antonio; and Lindsay Botsford, M.D., of Houston.

The Physician of the Day program brings a family physician to the Capitol each day of the legislative session to provide health care to members of the Capitol community. For more information on how to sign up and to view the calendar of open dates, go to the Physician of the Day page of the TAFP website, www.tafp.org/advocacy/get-involved/physician-of-the-day.