Tuesday, July 31, 2012

Setting the Record Straight on Doctor Pay

The following is a response by Joseph Valenti, MD, to commentary published Friday in the Dallas Morning News by Eli Lehrer, president of R Street. In the article, Mr. Lehrer claims U.S. physicians and health care workers make too much money and are responsible for the high cost of medical care in America.

Dear Sir:

I am a physician in Denton, Texas. This morning, I sat and read your article in The Dallas Morning News titled “Your Doctor’s Big Fat Paycheck.” Frankly, I am in awe of the breadth of your ignorance.

Fact: Of the health care dollars spent in this country, physician salaries make up about 8.5 percent. That is one of the lowest percentages in the industrialized world. Germany, by contrast, is at 15 percent.

[RELATED: Dallas County Medical Society President Sets The Record Straight, Too]

Fact: The graduate level course of study for nurse practitioners (NPs) and nurses is not even close to that of physicians — we have a little something called residency. Perhaps you’ve heard of it. When I did mine in OB-Gyn from 1994 to1998, it was 90-100 hours a week for four years with a take home pay of $20,000. I was raising a family on that, as my wife had to stay home to take care of premature twins. NPs and nurses do none of that.

Fact: Private insurers are already too strong. “Weak bargaining position”? If you don’t like the contract they offer, they tell you to take a hike. Doctors are the ones with no bargaining position. I haven’t had an increase from United Healthcare for 54 months. Meanwhile, it paid its shareholders an 11-percent dividend last year. And regarding your comment about how individual plans rarely cover one-half an area — do your homework! States like Alabama have Blue Cross and Blue Shield covering 90 percent of insured lives! In any other industry, this would constitute a monopoly.

Fact: Medicare increases have been had by every segment of the health care industry except doctors. (See the charts.)

Fact: Pilots may make less than doctors. They also belong to unions and walk out when they don’t get what they want. Doctors never walk out, and the pro bono and free care we hand out can’t even be deducted from our federal taxes as charity. Then try breaking it down per hour. Pilots fly about 60 hours/month. Doctors work in the office and hospital about 60 hours/week. And that doesn’t take into account nights and weekends on call. Don’t get me wrong — pilots are vital and do a great job. But on a per-hour basis, they are clearly ahead. By the way, I don't know a single primary care doctor who makes $200,000 a year. Most of the ones I know are barely getting by, and many are closing their practices or selling them to hospitals.

A huge doctor shortage is looming. We cannot and will not attract our best and brightest students to medicine unless their pay is commensurate with the level and intensity of work and commitment needed to fund a modern medical education. The student loan burden alone, which is now often exceeding $200,000, keeps many away.

Monday, July 30, 2012

People’s Community Clinic Now Able to Help More Patients

By Celia Neavel, MD, FSAHM 
Clinical Assistant Professor, The University of Texas Southwestern Austin Pediatrics 
Director, Center for Adolescent Health 
Director, Goals People's Community Clinic

Dr. Neavel with patient
Dr. Neavel with patient
As my family and I traveled in Germany this summer, I received the good news that my clinic — People’s Community Clinic (PCC), in Austin, Texas — was awarded federally qualified health center (FQHC) status. Ironically, at the same time, I learned German reporters were in Austin visiting PCC. Our German friends who watched the story couldn’t comprehend that basic health care is not available for many in the United States. PCC has worked to provide health care to Austin’s uninsured since opening as a small nonprofit for Austin’s uninsured in the 1970s. Attaining FQHC status will provide more needed resources and benefits to help support our mission.

PCC was organized when a group of volunteer doctors and others saw the need for patient-centered, centrally located (off the “Drag” by The University of Texas) health care for the uninsured. At that time, our patients included young adults going to college and trying to establish careers. Today, like other nonprofit medical homes, PCC struggles to provide comprehensive services to the under- and uninsured patients who have increasingly complex chronic diseases and behavioral health needs.

Friday, July 27, 2012

State Progress or (NOT) on Health Reform

The new health law is changing how health care is delivered in America. Many of the changes in the law are up to individual states to implement, such as health insurance exchanges, expanding Medicaid to more low-income people, health care coordination, and implementing ways to measure quality and get public input. Some state are making progress, while others — Texas included — are resisting implementation. You can monitor each state’s progress with StateReforum.com. The new interactive website shows how each stacks up. Find out how far along your state is on health reform, and compare it with others.

Wednesday, July 25, 2012

A Steep Price: Physicians Worry About Women’s Access to Care

Dr. Neavel with a patient
Dr. Neavel with a patient
“We need to invest in prevention to ensure the health and economic future of our state,” says Celia Neavel, MD, director for the Center for Adolescent Health at People’s Community Clinic in Austin.

Unfortunately, sharp funding cuts in state family planning services and changes in the state’s Women’s Health Program threaten women’s access to vital preventive services, say Texas physicians in the July issue of Texas Medicine magazine. They say the situation is a crisis, and they want lawmakers to restore money to programs that provide low-income women recommended screenings and birth control.

Dr. Carter
Dr. Carter
The state budget for family planning services plummeted from $111.5 million last year to $37.9 million this year, including federal funds. The Texas Department of State Health Services (DSHS) can now fund only 40,000 to 60,000 women at 143 clinics, a significant decrease from serving 220,000 women at 300 clinics last year. As a result, many clinics can no longer offer contraceptives at a discount, and preventive screenings are no longer free.

Kimberly Carter, MD, an Austin obstetrician-gynecologist, says, “The most effective way of preventing unplanned pregnancy is ensuring women have access to birth control.” Sixty-two percent of pregnancies in Texas women aged 15 to 44 are unplanned, according to the National Campaign to Prevent Teen and Unplanned Pregnancy. Forty-three percent of unplanned pregnancies end in abortion nationwide.

Tuesday, July 24, 2012

To Read or Not to Read? Demystifying Dyslexia

Did you know that we are biologically wired to speak, but we must be explicitly taught to read? Imagine how hard your life would be if you just couldn't learn to read, no matter how hard you tried and despite being very intelligent. How frustrated would you become? Very much so, I imagine. Now, can you imagine yourself, a bright, capable person, struggling to read the words of this article and not being able to easily comprehend what was written? Think about the first grader who is already cheating in school, not because she is lazy or stupid, but because no matter how hard she tries, she can’t learn to read like the other kids. Picture the older student who understands concepts and is articulate, yet drops out of school as a result of continued embarrassment and frustration due to his poor reading skills and, later, tragically commits suicide or joins a gang and eventually becomes part of the prison population.

Recently, our center was contacted by a young man, 28 years old, who moved to Austin from the state of New York. He graduated from a New York high school, reading below a first-grade level. He is one of seven siblings; five have dyslexia. Struggling in the legal system since 2002, this young man was awarded three years of compensatory reading instruction by the Second Circuit District Court of New York, upholding all previous decisions by the lower courts. He found us through our website and noted that our mission at Scottish Rite Dyslexia Center of Austin (SRDC) is to offer an intensive two-year dyslexia therapy program for children in second to fifth grades, to train teachers to become dyslexia therapists, and to provide low-cost dyslexia evaluations. This gave him hope. Our therapy program is easily adaptable for adults. We were able to give him referrals for his dyslexia therapy and instruction. His goal is to achieve college reading and writing levels. We will keep you posted on his progress.

One in five people in the United States have dyslexia or a related reading disorder (dyslexia being the most common). The challenge is to train college pre-service teachers to recognize dyslexia and to provide teachers the training and tools to remediate dyslexia at an early age.

Friday, July 20, 2012

Half of Americans Say PPACA Will Hurt Doctors

While a majority of Americans believe the new Patient Protection and Affordable Care Act (PPACA) will make health care better and more accessible for the sick or uninsured, a majority also believe the law will make things worse for doctors, taxpayers, and businesses. According to the latest Gallup poll, the average American agrees with the arguments that the PPACA will cost taxpayers and businesses money and that the law’s added layers of red tape and bureaucracy will harm doctors and their practices.

Read more on the PPACA Gallup poll.

Wednesday, July 18, 2012

Patients, Doctors in Best Position to Mold Future of Medicine

Letter from McLennan County Medical Society President, Charles H. Stern, MD to his colleagues about last month's Supreme Court decision on the Patient Protection and Affordable Care Act (PPACA).

Two and half years ago, my Scott & White peers and I were charged by our University of Texas Executive MBA faculty to engage in a shared read of the Patient Protection and Affordable Care Act (PPACA). Parts of which were authored by Republicans and Democrats over the past 20 years. We had already spent weeks reviewing the status of US medical economics and factors that influence rising health care costs. Prior to reading the bill we were asked to consider the impact that such legislation would have on patients, physicians, medical education, business, insurance companies, and government entities.

Upon completion of this assignment, we spent several days presenting key aspects and highlights of the PPACA. Despite the differing political backgrounds in the class, we all felt philosophically that many of the ideas in the bill were worth consideration. We also agreed that the bill had some flaws and did not address other pertinent issues (e.g. tort reform, broken Medicare physician payment system, etc.). The biggest question we were left pondering was how would the more sensible elements be implemented with minimal bureaucracy and paid for in the most cost effective manner.

The Supreme Court decision regarding the PPACA generated a wide array of reactions ranging from anger and disappointment to satisfaction and elation. As a result the health care reform debate has accelerated.

Tuesday, July 17, 2012

Ten Things in the Health Reform Law You Didn't Know

There's more to the Patient Protection and Affordable Care Act (PPACA) than a mandate to purchase insurance. Kaiser Health News lists 10 little-known provisions of the law that are worth noting:

  1. Postpartum Depression
    Urges the National Institute of Mental Health to conduct a multi-year study into the causes and effects of postpartum depression. It authorized $3 million in 2010 and such sums as necessary in 2011 and 2012 to provide services to women at risk of postpartum depression.

  2. Abstinence Education
    Reauthorizes funding through 2014 for states to provide abstinence-only sex education programs that teach students abstinence is "the only certain way to avoid out-of-wedlock pregnancy, sexually transmitted diseases, and other associated health problems." Federal funding for these programs expired in 2003.

  3. Power-Driven Wheelchairs
    Revises Medicare payment levels for power-driven wheelchairs and makes it so that only "complex" and "rehabilitative" wheelchairs can be purchased; all others must be rented.

  4. Oral Health Care
    Instructs the Centers for Disease Control and Prevention to embark on a five-year national public education campaign to promote oral health care measures such as "community water fluoridation and dental sealants."

  5. Privacy Breaks for Nursing Mothers
    Requires employers with 50 or more employees to provide a private location at their worksites where nursing mothers "can express breast milk." Employers must also provide employees with "a reasonable break time" to do this, though employers are not required to pay their employees during these nursing breaks.

  6. Transparency on Drug Samples
    Requires pharmaceutical manufacturers that provide doctors or hospitals with samples of their drugs to submit to the Department of Health and Human Services the names and addresses of the providers that requested the samples, as well as the amount of drugs they received.

  7. Physician Visit Needed
    Changes eligibility for home health services and durable medical equipment, requiring Medicare beneficiaries to have a "face-to-face" encounter with their physician or a similarly qualified individual within six months of when the health professional writes the order for such services or equipment.

  8. Diabetes & Death Certificates
    Directs the CDC and the HHS Secretary to encourage states to adopt new standards for issuing death certificates that include information about whether the deceased had diabetes.

  9. Breast Cancer Awareness
    Instructs the CDC to conduct an education campaign to raise young women's awareness regarding "the occurrence of breast cancer and the general and specific risk factors in women who may be at high risk for breast cancer based on familial, racial, ethnic, and cultural backgrounds such as Ashkenazi Jewish populations."

  10. Assisted Suicide
    Forbids the federal government or anyone receiving federal health funds from discriminating against any health care entity that won't provide an "item or service furnished for the purpose of causing … the death of any individual, such as by assisted suicide, euthanasia, or mercy killing."

Monday, July 16, 2012

Physician Story: Taking Care of Patients is Easy... Regulations Are Not

TMA physician leader Noel Oliveira, MD, of Edinburg, says caring for patients would seem easy if there weren't so many regulatory hassles, requirements, and burdens.

Watch video at YouTube.

"If all I had to do each day was take care of the patient that woud be so easy," says Dr. Oliveira. "But instead I have to deal with regulatory issues all day."

This is one of a series of videos for TMA's Healthy Vision 2020: Caring for Patients in a Time of Change.

Friday, July 13, 2012

Editorial: Passing on Obamacare’s Medicaid Expansion and Exchanges is the Right Call for Texas

Sen. Deuell, MD
Rep. Schwertner, MD
Rep. Shelton, MD
Rep. Zerwas, MD

As the four physicians currently serving in the Texas Legislature, each of us brings firsthand experience to the challenges facing our health care system, as well as a unique perspective on the profoundly detrimental effect Obamacare will have on the citizens of Texas. That is why we stand shoulder-to-shoulder with Governor Perry and support his decision not to expand the state Medicaid program or implement a federally controlled health insurance exchange in Texas.

Medicaid is a jointly-funded state and federal program intended to provide health care to some of our most vulnerable citizens: pregnant women, children, the disabled, and the truly indigent. Over the years, this broken but well-intentioned program has drifted progressively further from its intended purpose and further still from those it was designed to assist. The unprecedented expansion of Medicaid proposed under Obamacare will not fundamentally improve patient access to care, and as a greater number of physicians withdraw from the system entirely, will only make it more difficult for these individuals to seek the medical help they need.

In 1987, Medicaid accounted for roughly 11% of the state budget. Today, this entitlement consumes over 22% of our state budget – diverting funds that could otherwise be used to support public safety, build new roads, or educate our children. State spending on Medicaid has grown two and a half times faster than the rest of the budget, and will balloon even more rapidly under the Obama Administration’s proposed eligibility standards, which would place one out of every five Texans on the rolls of Medicaid by 2014. Our present course is clearly unsustainable, and expanding Medicaid coverage to over a million new able-bodied adults does nothing to repair a broken system that’s already groaning under the weight of those it serves.

While the federal government will claim to pick up the tab for this expansion, their share of funding is designed to diminish progressively over time, creating an ever-greater burden on our own state budget. Eventually, this situation will create a substantial budgetary crisis for Texas, forcing us choose between raising taxes and diverting increased resources from other areas of government just to keep Medicaid afloat. Funding an expanded Medicaid program under even the best of circumstances will mean higher taxes, increased federal debt, and reduced government services for the citizens of Texas.

The Obama Administration has also asked Texas to implement a new health insurance exchange controlled entirely by federal rules and regulations, many of which have yet to be written. Even those among us who have supported similar proposals in the past realize that instituting a health care exchange at this point would yield little or no benefit to the state of Texas. Washington has essentially presented us with a false choice – either we can do it their way, or they will do it their way – but ultimately, they are the ones calling the shots. Any input or control on behalf of Texans is negligible and largely illusory.

The best solution to ensure the long-term viability of our state's ailing Medicaid program is to seek a federal block grant which would allocate funding to the state directly, thereby providing Texas with the freedom to design its own Medicaid system without burdensome federal regulations and one-size-fits-all mandates. Such a grant would provide us with the independence and flexibility to devise the best and most cost-effective solutions to the specific health care needs of Texas, while preserving the critical doctor-patient relationship and ensuring continued access to care.

The health care solutions proposed under Obamacare are simply wrong for Texas, and Governor Perry is right to reject them. As physicians, each of us has taken an oath which states that, first, we will do no harm. That is why we cannot in good conscience support these measures which threaten to reduce quality of care, place further barriers between doctors and patients, and do irreparable harm to the people of Texas.

State Senator Bob Deuell, MD
State Representative Charles Schwertner, MD
State Representative Mark Shelton, MD
State Representative John Zerwas, MD

Thursday, July 12, 2012

Physicians Must Be Forceful Patient Advocates

Letter from Dallas County Medical Society President, Richard W. Snyder, MD to his colleagues about Gov. Rick Perry's decision.

Earlier this week Gov. Rick Perry sent a letter to US Health and Human Services Secretary Kathleen Sebelius and stated that Texas is opposed to the expansion of Medicaid as provided in the Patient Protection and Affordable Care Act (PPACA) and to creating a state insurance exchange. This announcement came on the heels of the Supreme Court’s decision to uphold the PPACA.

Both decisions affect Texans as many Texans depending on government-funded health insurance face a crisis in access to health care. The problem is that having coverage is not the same as having access, and access to a waiting list is not access to health care. Handcuffed by stifling regulations and money-losing reimbursement levels, an accelerating number of physicians have stopped accepting new patients who have government-funded health insurance — Medicaid and Medicare. Only 31 percent of Texas physicians accept new Medicaid patients. The negative trajectory of this number is just as alarming, having been 42 percent in 2010. In Dallas County the numbers for 2012 are even more bleak — just 24 percent of physicians accept new Medicaid patients. At this rate you have to wonder when the acceptance rate for our county will fall into the teens, or if we will actually see single digits. Since 2010, the percentage of Texas physicians accepting new Medicare patients fell from 66 percent to 58 percent. In regard to dual-eligible (Medicare-Medicaid) patients, 40 percent of physicians statewide and 32 percent in Dallas County accept them. Coupled with the potential negative impact of the Medicaid 1115 Waiver on hospital reimbursement for low-income patients, we could be facing a devastating perfect storm of decreasing patient access.

This is why the proposed expansion in Texas of the Medicaid program under the PPACA by itself is not the answer for uninsured and low-income patients. Why expand coverage in an insurance plan that has shockingly limited and unacceptable access to care? This simply gives false hope to the 25 percent of our fellow citizens who are uninsured that their participation in the Medicaid program will dramatically improve their ability to access the healthcare system. We need a plan that expands coverage and access to care.

The gold standard for this access must embody timely access to quality, cost-effective care. A key ingredient of this expansion of access is the streamlining of the oppressive and progressively costly regulatory process so we physicians can devote more of our time to caring for patients and less to caring for paperwork. Paperwork never healed anyone. Improving patient access to health care also must involve increasing physician reimbursement to viable levels where we do not face the prospect of paying out of our pockets for every Medicaid patient we see. By working with our legislators and congressional representatives, we physicians can have a significant impact in improving access to the healthcare system for the uninsured of our state. We physicians must be forceful advocates for our patients. However, we should not put the cart before the horse. Instead of initially expanding coverage to the uninsured of our state to an overly flawed and ineffective insurance system, we should first concentrate our efforts on improving actual access to care through the Medicaid plan we currently have in place. Let’s get to work.

Wednesday, July 11, 2012

Representative Burgess Cites TMA Survey on House Floor

U.S. Rep. Michael Burgess, MD (R-Texas), mentioned TMA’s recent survey showing dramatic declines in physicians who accept new Medicaid and Medicare patients on the House floor today.

“The federal government, with its Medicare and Medicaid programs being structured the way they are, is actually causing the cost of health care to skyrocket in this country, and that’s something that needs to stop,” said Dr. Burgess. “It’s inexcusably hurting patients.”

Watch video:

Read More:

Monday, July 9, 2012

Alarming Drop in Physician Acceptance of Medicaid, Medicare Patients

TMA physician leaders have long predicted government regulatory burdens, red tape, payment hassles, and low pay would erode the physician foundation of both Medicaid and Medicare.

That day has come, according to TMA’s new biennial survey of Texas physicians. More physicians are forced to reduce the number of patients they see who depend on government insurance for their health care. “All the bureaucratic red tape and administrative burdens only serve to increase the cost of running a practice while diverting a physician’s attention away from patient care,” said TMA President, Michael E. Speer, MD.

Hardest hit are low-income Texans who rely on Medicaid for their care. Texas physicians available to treat new Medicaid patients have plummeted from 42 percent in 2010 to 31 percent — an all-time low.

Medicare, a federal health program that insures seniors, people with long-term disabilities, and military families, also saw a huge decline. The number of Texas physicians accepting all new Medicare patients dropped from 66 percent in 2010 to 58 percent in 2012. That’s part of a trend that’s seen the number decline steadily from 78 percent in 2000. Meanwhile, the number of Texas physicians who limit how many new Medicare patients they accept, and the number who decline all new Medicare patients each rose by 4 percent in the past year.

Dr. Speer said these are the lowest-ever new-patient acceptance rates the association has seen. He’s saddened but not surprised. “Doctors have answered the government mandate to invest in expensive health information technology, upgraded their coding and billing systems, implemented e-prescribing programs, withstood the threat of a new 60,000-item medical coding system (ICD-10), and for the past decade endured the payment uncertainty of Medicare,” he explained.

To make matters worse, in 2010 and 2011, the state cut physicians’ already-meager Medicaid payment rates another 2 percent. Then, at the start of this year, doctors who care for the state’s poorest elderly and disabled patients (dual-eligible patients) were cut another 20 to 100 percent. These cuts hit physician practices extremely hard, especially because Medicaid payments cover less than half of the average cost to provide services. “Every business has a breaking point; physicians’ practices are no different,” said Dr. Speer.

Joannie Parr, a Sugar Land accountant, manages her husband’s medical practice. Thomas J. Parr, MD, is an orthopedic surgeon. “Some years ago, we looked at expenses and income, and made the difficult decision to stop accepting Medicaid patients,” she said. “Medicaid puts up so many hurdles we found it was easier to provide free care outright than hassle with Medicaid’s bureaucracy for basically no pay.” Dr. Parr now treats low-income patients referred to him by a free clinic and volunteers his surgical services at a local hospital.

Another critical issue not addressed in the Patient Protection and Affordable Care Act (PPACA) is the faulty formula Medicare uses to pay physicians. Doctors have faced the threat of steep Medicare payment cuts every year for more than 10 years. Once again, physicians face a nearly 30-percent cut Jan. 1, 2013. Instead of addressing Medicare’s flawed payment formula, the PPACA has added even more layers of bureaucracy.

Su Zan Carpenter, MD, a family physician in Angleton, Texas, recently opted out of Medicare. “Every time you turn around someone has a new rule or a new regulation or a new audit or a new inspection or a new something,” she said. “There’s a point where enough is enough. You need to see the patient, talk to the patient, examine the patient, and actually do something with your patients for your patients. All that stuff is starting to get in the way of practicing medicine and helping people.”

Frisco family physician Chris Noyes, MD, says he had a “straw that broke the camel’s back moment” with Medicare in 2009. “I had a patient who moved from out of state to be with his kids. He had lung cancer when he came in, and he ultimately died. We wrote off a fairly large balance,” Dr. Noyes said. “Two years after he died, we got a letter from Medicare saying they had overpaid for a flu shot for him by $2 and they wanted the money back with interest and a penalty, and if I didn’t pay it all within 30 days they would prosecute me.” These stories are no longer isolated incidents but stories that are becoming more common across the state.

“What’s lost in the health care debate is the simple fact that patients need a doctor when they get sick. And physicians want to take care of patients and not push endless reams of paper around our desk,” said Dr. Speer. “At some point, state and federal leaders must realize without an adequate network of physicians, no health care system can work, let alone be effective.”

TMA recently published its strategic roadmap, titled Healthy Vision 2020. The document outlines the association’s state and federal recommendations to ensure patients have the right care, at the right place, and at an affordable price.

Survey Methodology
Since 1990, TMA has conducted a biennial survey of a representative sample of Texas physicians focusing primarily on health care practice, economic, and legislative issues. The survey findings provide a cross-sectional snapshot and a longitudinal tracking of physician opinions on key health care issues and their experiences to support the association’s policy development, political focus, and strategic planning process. The 2012 Survey of Texas Physicians was conducted by TMA as a monthly e-mail survey. Approximately 27,917 Texas physicians were e-mailed a personalized link to the first part of the survey along with an announcement outlining the purpose of the survey. Preliminary data was gathered from 1,139 physicians for a response rate of 4 percent.

Friday, July 6, 2012

Texas Dead Last for Health Care Quality in Federal Report

A new report from the U.S. Department of Health and Human Services rates Texas at the bottom of the states in health care quality. Texas scored “weak” or “very weak” ratings in 75 percent of the more than 150 measures used to determine quality care. These measures include preventive care, diabetes, respiratory diseases, and heart disease measures.

The state’s obesity and diabetes epidemic is crushing Texas’ fiscal and physical health, says Michael Speer, MD, president of the Texas Medical Association. TMA says this report stresses the need to invest in prevention to improve the quality of health care for all Texans. Unfortunately, “over the last several legislative sessions, given the budgetary constraints that the Texas Legislature has had to deal with, they’ve cut preventive care and they’ve cut public health initiatives,” Dr. Speer told KUT news.

Among the findings, Texas scored lowest in:
  • Percentage of home health care patients with improved breathing, urinary continence, and pain management when mobile; and
  • Breast cancer surgery and radiation therapy for women under 70 years of age.
Texas scored highest in maternal and child health, including:
  • Percentage of children ages 19-35 months who received three or more doses of Haemophilus influenzae type B (Hib) vaccine; and
  • Percentage of children ages 19-35 months who received all recommended vaccines.

Thursday, July 5, 2012

First Amendment Right of Physicians and Their Patients Protected

Seth D. Kaplan, M.D., F.A.A.P.

I presented a resolution to the Texas Medical Association 2012 House of Delegates on behalf of the Texas Pediatric Society (TPS) asking TMA to oppose laws limiting the type of conversations physicians can have with their patients or patients’ parents. TMA overwhelmingly supported the resolution, which now is TMA policy.

This action was in response to legislation Florida passed in 2011 prohibiting physicians, nurses, and medical staff from asking patients and their parents about firearms. Florida’s law allowed a patient to report a physician for “harassment” if the patient felt the question was unnecessary, with potential disciplinary action against the physician by the Florida Board of Medicine.

The Florida chapter of the American Academy of Pediatrics, along with other groups, sued to block the law. Recently, a federal court declared the law unconstitutional, saying it was a violation of physicians’ First Amendment rights to speak with their patients about gun safety.

Counseling patients about safety issues is one of the most important parts of my role as a primary care pediatrician. One of the main goals of working with my patients is to reduce the risk of injury to children in the environments in which they live and play. Thus, I spend time discussing potential problems related to seat belt use, tobacco exposure, storage of household chemicals, swimming, sun and playground safety, and more. Talking about firearm safety and storage is part of this conversation as well.

The answers I get to questions about firearms are fascinating. Many people say, “We don’t own guns, so we don’t worry about this.” When asked if they know if there are guns in the houses of children their kids play with and if their kids would know what to do if they saw a gun, they often answer, “I hadn’t thought about that.” Those who do have guns have a chance to talk about safe storage, and often have tips that I can pass on to other families, such as where parents can find good training courses for their kids, when appropriate.

I believe talking about gun safety and other safety-related issues is an important part of the preventive counseling I provide patients and their families. When the government tries to dictate what a physician and his or her patient can and cannot discuss in the confidential setting of an exam room, I no longer can perform the preventive aspects of pediatrics expected of me. Thus, I applaud the decision of the U.S. District Court for the Southern District of Florida.

To learn more, read the court’s decision.

Dr. Kaplan is a general pediatrician in Frisco, TX. He serves as the TPS alternate delegate to the TMA and is the incoming chair of the TPS Committee on Administration and Practice Management. Dr. Kaplan posts topics on Facebook at TLC Pediatrics of Frisco.

Tuesday, July 3, 2012

Test Your Health Reform IQ

Take this short, 10-question quiz to test your knowledge of the Patient Protection and Affordable Care Act. Then see how your score stacks up with other people taking the quiz, as represented by the findings of the Kaiser Family Foundation's monthly Health Tracking Poll.

Monday, July 2, 2012

Texas and the Future of Health Reform in America

Richard Reece, MD

A few days ago I received a handsome 64-page brochure from the Texas Medical Association. Its title was Healthy Vision 2020: Caring for Patients in a Time of Change.

Among other things, the brochure says Texas is the fastest growing state. Its population is expected to boom from 25 million to 40 million in 2040. It leads the nation in employment growth. It is desperately short of physicians. Nearly 6 million of its baby boomers will become eligible for Medicare. Of its citizens, 6.5 million lack insurance. In 2010, it spent $23 billion on Medicaid, yet it pays doctors only 50 percent of commercial payments, and many of its physicians can no longer afford to treat Medicaid patients. I will not be surprised if Texas is among the first of the states to opt out of federal funds for expanding Medicaid.

Texas physicians and their medical association impress me. Its physicians are tough, resilient, independent, and powerful politically and economically. Its medical association persuaded the Texas legislature to pass tort reform in 2003, which brought 24,600 new physicians into the state.

Yet Texas has fewer physicians per capita than the national average in 36 of 40 medical specialties. Texas is a prime example of a looming and inevitable political crisis: lack of access to physician services by Medicaid and Medicare patients as demand for medical services boom and more physicians drop out of these programs due to reimbursements so low physicians cannot sustain their practice.

Access to financing through the Patient Protection and Affordable Care Act is not the same as access to physicians. Indeed, what good is “universal coverage” without doctors to evaluate and treat patients? The brochure notes that spikes in numbers of physician assistants (+132 percent), advanced practice nurses (+114 percent), and registered nurses (+44 percent) over the last decade will not fill the physician shortage gap.

In spite of these problems, Texas may be what the future will look like in the United States. Texas has a robust, friendly, and inviting business climate. It is drawing Californians to Texas in droves. It is an energy-rich state.

Three-fourths of its physicians are from other states. Small wonder. Texas has no state income tax. Its cost of living is low. It is an unabashed proponent of physician entrepreneurship and innovation. It favors physician ownership and investment in hospitals. It insists on physician autonomy from corporations and meddlesome insurers. It is a potent economic force. In 2009, physician offices contributed $39.4 billion in direct and indirect wages and employee benefits. On average each physician supported $924,413 in total wages and benefits.

Texas physicians are a powerful economic and political force. They are critical of federal regulations that impede their practices, increase their expenses, slow productivity, and stifle innovation. They are aware of what has happened in Massachusetts: Long waits to see doctors; shortages of primary care physicians; the highest premiums in the land; and a sharp increase in ER patients.

For more information on how the Texas Medical Association and its 46.000 physicians see the future, go to www.texmed.org or call (512) 370-1300.

Dr. Reece is a pathologist, author, editor, and speaker. He is the author of the blog, Medinnovation: Where Health Reform, Medical Innovation, and Physician Practices Meet.

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