President's Page

President's Page
January 2004

Looking Ahead

by Warren E. Lichliter, MD
2004 DCMS President

The New Year is upon us, the holidays have passed, and it is time to look ahead to the many challenges and opportunities facing organized medicine for 2004. Before we move forward, however, it is worthwhile to review accomplishments and lessons learned from 2003. We just completed an impressive year for the politics of medicine. The 78th Texas Legislature passed House Bill 4 with significant majorities in both the House and Senate. Importantly, voters narrowly approved the subsequent statewide constitutional amendment, Proposition 12, in September, despite an intense effort by trial lawyers, thus codifying HB4 and laying the groundwork for true malpractice reform. In addition the Legislature passed its second attempt at a prompt pay bill, and with Governor Perry’s signature, the much-needed reform became law. Lastly, the potential disaster of the cutting of Medicaid and CHIP funding to help balance the state budget at least partially was mitigated by smaller decreases in funding and participant requirements.

In addition to these legislative victories, fences were mended between TMA and Governor Perry, repairing damage done by TEXPAC’s endorsement of Tony Sanchez in the gubernatorial election after Governor Perry vetoed the initial prompt pay bill.

On a national level, Congress recently passed the Medicare Prescription Drug Bill which included elimination of the proposed 4.5 percent reduction in physician payments and an actual 1.6 percent increase in Medicare payments to physicians.

In reviewing these accomplishments, Texas Medicine—both TMA and DCMS—has been well-recognized nationally by several organizations. The lessons learned from this difficult session are three. One, the importance was demonstrated of planning well ahead to define agendas and to work with the Legislature before debate and critical votes. The TMA and county medical societies worked with lawmakers in advance of the legislative session to identify key personnel to help facilitate the political issues through the complexity of the political process. Second, the agenda was focused and simple. “This is the problem and this is what needs to be done” was an effective approach to the passage of HB4. Third, the message delivered to the Legislature and the public was common and unified from all aspects of medicine. Hospitals and multiple physician organizations, from local to national levels, worked hard to focus issues and coordinate their efforts, which has not been successful in the past.

This approach must be replicated in addressing the ongoing issues in medicine for 2004. The 79th Legislature does not begin until early 2005, but by planning ahead, identifying early in the process the message to be delivered, and coordinating this message with other constituents, we can anticipate another successful session.

However, we have several areas of concern to address during Interim Session. House Speaker Tom Craddick and Governor Perry are working with interim study groups regarding these issues, and, through physician appointments and physician involvement with representatives and senators, our input can be both early and effective.

Medicaid makes up almost 25 percent of state appropriations, and up to one third of that is allocated for nursing home care. A one-time $1.3 billion infusion from the federal government helped the 78th Legislature balance the budget and keep Medicaid funding from imploding. The 79th Legislature will have to come up with this amount simply to maintain the already insufficient budget for Medicaid services. Potential cost shifts to the local and county level are tremendous, and potential effects on the local economy and taxpayer have yet to be communicated clearly to the public and the legislators. The need for major changes also may create the environment for privatization or rationing of care, and physicians must have input on these changes. Governor Perry’s physician advisory group has some of this potential.

The Sunset Advisory Committee of the Legislature includes a few area representatives, including Burt Solomons (R-Carrollton), and will address several issues important to medicine. In the past the Sunset Committee actually has let state-created entities “die,” then recreated them by special session in order to change their direction. Such was the case with the Texas State Board of Medical Examiners in 1988 and, because the board is up for review by legislative mandate, significant changes again may occur. Certainly the TMA and county societies would like input in redefining a Texas Medical Board that would create both the reality of patient safety and public confidence, and a process of governance that respects the individual physician’s rights.

The Sunset Committee also will address the crisis in the workers’ compensation system, which is resulting in an increasing number of nonparticipating physicians, thereby eroding access to care. Again, physician input is critical in addressing these issues.

A third area that must concern physicians has been a problem in the past—the sunsetting of the Medical Practice Act. Organized Medicine needs to stand firm in the debate about defining the physicians’ role in the delivery of health care regarding the scope of practice for physicians and allied health professionals.

Lastly, a special session likely will address the restructuring of Texas public school finance. This issue has been extremely contentious, with prior efforts at resolution being unsuccessful. There is a clear indication that the Republican’s mantra of “no new taxes” will end, as it is obvious that funding for school education is inadequate and revenue enhancement will be needed. This relates to medicine because the specter of taxes on professional services again is being discussed. Although it appears that most legislators oppose taxing physician services, the structure of many physician practices and billing services makes it difficult to construct legislation that would tax other professionals, such as lawyers and accountants, but not physicians.

A common denominator of these issues is funding the programs in an era of increasing demand and limited resources. Given the crisis in the state budget, financial concerns largely will frame the discussion of the next legislative session. The TMA, DCMS, and individual physicians will need to be diligent in helping provide the framework for these debates. Physicians need to begin not only to help define the problems in the political world of medicine, but to help define the solutions, as well.

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