February’s Thoughts
Medicare: Congress has extended the SGR
problem for one year. This is good news in that we physicians don't have to
worry about a large cut in Medicare. However, it does not relieve the problem
of the draconian SGR system that was established in 1997 as part of the Balanced
Budget Act. The SGR is the
government's way of holding increases in Medicare spending to the country's
overall inflation rate. This was an accounting system flawed from the beginning
that has produced cuts in physicians’ spending since 2002. A recent survey by the American
Medical Association (AMA) shows 60% of physicians are looking at ways to opt
out of Medicare because of the potential pay cuts. This constitutes a very
serious access to care problem for the Medicare, Tricare and Medicaid
population. Delaying the current Medicare cuts is simply putting a Band-Aid on
a flawed pay system for physicians. Physicians have to deal with multiple phone
calls, e-mails and faxes in order to get clearance to treat the patient in the
manner in which they think is necessary. This adds additional time and cost
because you have to hire additional employees just to keep up with the demands
of the third-party payers. We are grossly underpaid for the efforts that it takes
to treat the patient. There's a group of physicians that seem to think that “this does not pertain to me” because they do not take Medicare.
However, if you look at your contract with the private insurance companies, it
will demonstrate that your pay is some percentage of Medicare. Therefore, a 23%
cut in Medicare is a 23% cut in all insurance companies. It is time for
Congress to fix the Medicare payment system once and for all. We must hold our
federal representatives’ feet to the fire to ensure that this is corrected in 2011.
Diabetes: There are over 3.1 million adult Texans
affected by diabetes and pre-diabetes. There are 1.7 million Texans diagnosed
with diabetes. There are 425,000 Texans that have diabetes but do not know they
have diabetes. There are over one million Texans who have pre-diabetes. Currently,
percentage wise, there are more Anglos affected by diabetes than any other
racial/ethnic group. However, with the overall demographic change in the Texas
population, the Texas
demographers project the Hispanic population will be the most affected in the
future because of the increase in population. More than two-thirds of the 1.6 million new
cases of diabetes occurring in America each year occur in Hispanic, African Americans
and Native Americans. A hereditary predisposition for diabetes, limited access
to health care delivery systems, quality of care provided by physicians and other
healthcare administrators, limited access to prevention services and healthy
food—all contribute to creating a high rate of diabetes among these populations.
Although diabetes constitutes the sixth
leading cause of death in Texans, it is the fourth leading cause of death among
Hispanics and African-Americans. Among African-Americans in Texas
aged 18 years and older, 244,590 people or 12.9% of the population have
diabetes. This is a rate higher than Hispanics. State demographers project a quadrupling of the number of
Texas adults with diabetes from the estimated 2.2 million in 2010 to almost 8
millions in 2040.
The 82nd Legislative Session: On the first Tuesday of every month
when the Texas Legislature is in session, physicians and the alliance
members participate in First Tuesdays. The physicians, wearing their white
coats, visit our legislators in Austin. This was designed to demonstrate a show
of force to our legislators on who we are and how important we are to Texas. In
the process, we are educating and bringing key issues to the legislators on how
to protect the practice of medicine in Texas and therefore protect the citizens
of Texas. With every legislative session, there have been challenges to the
practice of medicine and the scope of medical practice. My answer is simple. If
you want to practice medicine, then go to medical school. However, those days
have passed. There are physician extenders and others who treat patients who
are challenging the scope of practice of medicine. We must be vigilant in
preserving the landmark 2003 Medical Liability Reform. Each year, legislation is introduced to
try and reduce it, or nullify certain portions of the liability reform. The TMA,
through its political action arm, TEXPAC, is constantly trying to stop or
reduce the impact of these challenges. Therefore, I am asking all physicians of
Bexar County to please consider participating in the First Tuesday
visits to the legislature in February, March, April and May. Please try to make
at least one of these First Tuesday visits to Austin.
There
seems to be a little confusion about TEXPAC and the TMA. TEXPAC was organized
in 1962 and is one of the largest bipartisan lobbyists in the state of Texas. It
ranks first in size nationally among all state medical association PACs. TEXPAC
provides financial and campaign support to candidates for both state and
federal offices and is affiliated with a political action committee of the
American Medical Association (AMPAC). TEXPAC works closely with the TMA policy
and legislative components; but separate boards govern the two organizations. The
voting members of the TEXPAC Board of Directors includes 31 physicians
representing each state senatorial district, eight alliance members, a resident
physician, a medical student and a number of members from the TMA Young Physicians section. TEXPAC
promotes physicians and alliance grass root initiatives, participates in political
campaigns and generates and collects the necessary resources to support
medicine-friendly candidates. This is done by reviewing the candidates’/representatives’
philosophy and position on medical issues, recommendations from local TMA
physicians and Alliance members on the candidates/representatives.
Additional considerations include the demographics of the district and the
chances of the candidate/representative winning the election.
The 82nd session will most likely have
health system reforms as a high priority. Health reform and health care issues
will figure prominently in this legislature. Texas is facing a significant
budget shortfall for 2011 to the tune of about 28 billion dollars. Texas remains the
uninsured capital of the U.S. Texas continues to grow older, poorer,
more obese, and less educated. Texas health care spending continues to grow and
as you would expect, there is an increasing demand from the poor and
frail Texans for healthcare services.
Texas’
business tax, sales tax and other tax revenues are running behind projections
due to the national recession. Balancing the budget is going to be very
difficult. As stated earlier,
Texas is
the uninsured capital of the U.S. with estimates of 25.2% of Texans currently uninsured. Most Americans obtain their health
care coverage for themselves and their families through their employer; but 79%
of the uninsured in Texas either work or lives with a family member who works. Texas
ranks in the bottom 10 among states for employer-sponsored insurance. In Texas,
only 48% of businesses offer their employees coverage as opposed to 56.4% nationally.
For small businesses with 50 or fewer employees—the bulk of Texas employers—the
number is even worse at 32% versus 43% nationally.
The
uninsured patients are more likely than their insured counterparts to forgo or
delay treatment of acute illnesses or injuries. They go without needed
treatment for chronic conditions or illnesses and they die prematurely. A
recent study found that uninsured, working-age adults have a 40% higher
mortality rate than privately insured patients, resulting in 45,000 patients
deaths every year.(Harvard Medical School Study, 2009)
Uninsured
patients cause higher health care costs for all because the cost of their care
is shifted to the paying and insured patients. Because of Texas’ high rate of
uninsured in 2010, families will pay an extra $2,786 in premium costs for
employee base coverage for family coverage, while individuals will pay an extra
$922.(Families USA) The Healthy Texas Program would lead to a reduction in the
number of uninsured and a corresponding reduction in the uncompensated rate
cost and workers’ productivity loss. Two significant elements of the program are
that insurers cannot use health status when determining small employees premium
and the Texas Department of Insurance will review and approve premium rates.
The
average family and many employees don't realize Wall Street's influence over
the healthcare insurance coverage. It would appear that the top priority of the
healthcare insurance company CEOs is to drive up the value of the company's
stock for their investors. As the stock fluctuates on quarterly performance
reports, the investors and analysts look for top performers in terms of earnings-per-share
and medical loss ratios. The medical loss ratio is the ratio between what the
company actually pays out in medical claims and what it has left over to cover
sales, marketing, underwriting, and other administrative expenses, and of
course—profits. Currently, there is no standard way of defining medical loss
ratios. Therefore, the health insurers have the discretion to include any
expense they want. This is a red herring. A standard definition for medical
loss ratio will help employers and patients compare how insurance companies
actually spend their premium dollars. Transparency is lacking in this industry.
Sincerely Yours.
Jesse Moss Jr. MD, PA
Our Legislators’ Contact Information
U.S. Senate
John Cornyn
(202) 224-2934 (210) 224-7485
http://www.cornyn.senate.gov/
Kay Bailey Hutchison
(202) 224-5922 (210) 340-2885
http://hutchison.senate.gov/
U.S. Representatives:
Charles A. Gonzalez, District 20
(202) 225-3236 (210) 472-6195
http://www.gonzalez.house.gov/
Lamar Smith, District 21
(202) 225-4236 (210) 821-5024
http://lamarsmith.house.gov/
Francisco “Quico” Canseco, District 23
(202) 225-4511 (210) 561-8855
http://canseco.house.gov/
Henry Cuellar, District 28
(202) 225-1640 (210) 271-2851
http://cuellar.house.gov