Capitol Update: Family medicine residency programs face massive cut in budget agreement

posted 05.24.11

As the 82nd Texas Legislature draws to a close, a conference committee composed of five House members and five senators has struck a deal on the state budget that would spend $80.6 billion dollars in state funds over the next two years. Under the agreement, state funding administered by the Texas Higher Education Coordinating Board for family medicine residency programs will go from $21.2 million in the current biennium to $5.6 million in 2012-2013. Additional coordinating board support for the residency training of primary care physicians totaling almost $5.6 million was cut entirely. Altogether, the Legislature cut the coordinating board funding for primary care residency training by 80 percent.

TAFP CEO Tom Banning told the Texas Tribune that the cuts could likely lead to the closure of some of the state’s 26 family medicine residency programs. "We've already seen two family medicine programs close over the last four years. We will have fewer physicians caring for Texas patients at a time we need to be growing that physician base."

The conferees decided to eliminate funding for the Statewide Primary Care Preceptorship Program, which provides funding to first- and second-year medical students to spend up to four weeks in a primary care physician’s office.

The budget deal also slashes funding for the Physician Education Loan Repayment Program by 76 percent, leaving $5.6 million in the account for 2012, but zero in 2013. At this point, it is not clear why budget-writers chose to allocate money only in the first year of the biennium.

Physician fees for Medicaid and CHIP would not be cut, but the budget doesn’t account for the inevitable caseload growth in the programs, leading officials to project that Medicaid will be underfunded by about $4.8 billion in 2013. Medical schools would have about $400 million less in state funding under the budget deal, including a substantial reduction in graduate medical education formula funding.

The conference committee report must now be signed by the conferees, which should happen on Thursday, May 26, then distributed to both the House and the Senate. Debate could begin by Friday evening or Saturday, but whether lawmakers can actually pass the budget before the session ends on May 30 is still uncertain. A set of school finance measures has stalled the process, and if lawmakers can’t forge agreements on them, they may not get the necessary votes to pass the budget, meaning they’ll be back in Austin for a special session this summer.

Bills to expand scope of nurse practitioners fail

Three bills aimed at granting nurse practitioners independent diagnosis and prescriptive authority have failed to beat the deadline for debate in the House. House Bill 915 by Rep. Wayne Christian, R-Center, and H.B. 708 by Rep. Kelly Hancock, R-North Richland Hills, were never voted out of the House Public Health Committee, and H.B. 1266 by Rep. Garnet Coleman, D-Houston, and Rep. Rob Orr, R-Burleson, which would have required a legislative interim study, was not scheduled for debate by the House before the deadline for House bills to be heard on first reading.

The bills were defeated thanks in part to the hard work of several TAFP members and TAFP’s partners in organized medicine, but nurse practitioner organizations will not give up on their pursuit of independent practice in Texas. TAFP will continue to oppose such expansion during the legislative interim and when the next round of scope bills are filed in the 83rd Legislature.

Some wins, some uncertainty for public health initiatives

TAFP and the Texas Public Health Coalition are tracking bills that promote healthy eating and exercise, immunizations, tobacco cessation, and cancer prevention. As with most initiatives this session, the two sides of public health advocacy are to push through new legislation and protect gains made in previous sessions.

On the vaccine front, a bill that requires students entering colleges and universities to receive a bacterial meningitis vaccination has passed both chambers and now awaits action from the governor. The CDC identifies teens and young adults ages 16 to 21 as high-risk for contracting meningitis, and living in close quarters like dorm rooms increases their risk.

S.B. 1107 by Sen. Wendy Davis, D-Fort Worth, expands existing law that requires the vaccination of students who will live in on-campus housing. Now all students must show through vaccine certificate or immunization record that they received the vaccination dose or booster within a certain period of enrollment. The new law excludes students enrolled in online courses or those older than 30, and parents may apply for an exemption.

Also in immunizations, a bill to require health care facilities to develop and implement vaccination policies for employees was added to the Senate’s health payment reform legislation, S.B. 8, which was given tentative approval by the House today, May 24. TAFP past president Erica Swegler, M.D., of Keller, testified in support of the committee substitute for S.B. 1177 by Sen. Jane Nelson, R-Flower Mound, at the May 18 hearing of the House Public Health Committee.

Swegler said the measure can prevent health care workers from unknowingly spreading flu and other preventable diseases to patients in their care. “Numerous published medical studies show that when health care workers are immunized, patient mortality is reduced by nearly 58 percent,” she said at the hearing. “Additionally, evidence shows that preventing influenza reduces patient hospitalizations and death from heart, chronic lung, and kidney disease, and diabetes, so this is really a critical patient-safety issue.”

Once facing an uncertain future, the bill to ban smoking in restaurants, bars, and most indoor public places was added to Senate Bill 1811—one of the fiscal matters bills—and has passed the House. House Bill 670 by Rep. Myra Crownover, R-Denton, could save $31 million dollars in state Medicaid costs over the 2012-2013 biennium by reducing the public’s exposure to secondhand smoke. Exempted from the ban are charitable bingo halls in small counties, veteran social halls, pool halls, and tobacco bars.

To pass, it must survive the final negotiating process for Senate Bill 1811. For more on the smoking ban, go to the Smoke-Free Texas website, or read an article in the Texas Tribune by Emily Ramshaw and Becca Aaronson.

On the defensive side, public health advocates fought amendments to House Bill 400 by Rep. Rob Eissler, R-The Woodlands, that would have cut back the Fitnessgram annual fitness testing in grades 3-12 and other health education programs as a means to reduce spending in public schools. Opponents of the legislation feared this changes would harm the effort to curb Texas’ obesity epidemic.

Though the bill died because of House deadlines at the beginning of May, Carrie Kroll, chair of the Partnership For a Healthy Texas, says that the amendments could reappear as lawmakers work to fund public education. “There is still work to be done between now and the end of session to make sure that public health programs, which we’ve been working on for years now, don’t go backwards.”

Thanks to the Physicians of the Day

Thanks to the physicians who volunteered for the Physician of the Day program the last week of the 82nd Legislature: Harold Nachimson, M.D., of Irving; Beverly Nuckols, M.D., of New Braunfels; Elliot Trester, M.D., of Austin; Jorge Duchicela, M.D., of Weimar; James R. Brown, M.D., of Austin; and E. David Pampe, M.D., of Dripping Springs.

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. We are grateful to all of the TAFP members who volunteered their time this session to serve this important need. To put your name on the contact list for the 83rd Legislature in 2013, e-mail ajenkins@tafp.org.