TEXPAC GIVES TEXAS PHYSICIANS A VOICE IN HEALTH CARE POLICY
In the late 90’s, Spencer Johnson wrote the classic business fable—Who Moved My Cheese?—which forced businesspeople everywhere to think about change and how to deal with it. In recent years, no industry has experienced more change than health care. How are physicians to respond when the tried and true paths we’ve followed for years are blocked? Do we sit at the barricades complaining and motionless? Or, do we dare to be brave and explore and find ways around the detours, recognizing that our actions alone will be the biggest determinate of our potential success?
In his book, Johnson tells us that:
- Change happens – whether we like it or not
- We must let go of the old ways and adapt to change quickly
- We must change ourselves in order to keep pace with the new reality
- We should learn to enjoy changing and the advantageous position in which it puts us
Certainly, we must be more flexible and open to change. But Spencer Johnson’s view is too passive if we believe that some of the changes in our health care system should not be adopted. The problem is that we have allowed others to rearrange the maze without our leadership so that we have had to adapt to survive. We have failed as a profession to stop special interest groups—the government, hospitals, big Pharma, the device and supply industries, insurance companies, and politicians—from defining health care and practicing medicine without a license. Because we have abrogated that responsibility, others have taken control, and we have had to be subservient to their rules. So, we must not only find out how to live within these rules in the short term, but more importantly we must take back control of the system that cannot function without physicians. We can no longer be passive and wait for “the cheese” to appear magically at the whim and control of others.
With the introduction of EHRs, PQRS, the PPACA, and other rules and regulations that will not improve patient care and may destroy practice viability, health care as we knew it 10 years ago has changed dramatically, whether we like it or not. And, so the Texas Medical Association (TMA) and Harris County Medical Society (HCMS) have spent hours and many resources providing information on how to survive the maze. But that energy struggling with how to respond to these mandates is just a first step.
We need to do much more. We need to speak out when we see a threat to quality patient care and physician practices. And the first step is political advocacy. One of the great things about our system of government is that if we don’t like a law, we have the opportunity to change it. To change a law we must convince the Legislature to pass one that fixes our problem, and so we must educate not only patients but also our lawmakers. And we must continue to be proactive in designing legislation for the lawmakers as we did with the prompt pay legislation, liability reform, and physicians as leaders of the health care team laws we were successful in having adopted. Political advocacy is a two stage process, involving policy and politics. In the first stage, we develop policy through the TMA and American Medical Association (AMA) House of Delegates. Then HCMS, TMA and AMA lobbyists work to get that policy passed into law – and they do a great job of it. Your dues dollars go to support those efforts.
In the second stage, TEXPAC, which is the political arm of the TMA, works to get medicine-friendly candidates, who will support our policy, elected to office. These efforts are supported only by TEXPAC dues, not by HCMS/TMA membership dues.
We can develop all the policy we want, but if we don’t have friends in the Legislature to turn policy into bills and then pass them into law, we have wasted our time and your HCMS/TMA dues dollars. Remember, your HCMS and TMA dues dollars cover only HALF of the process.
I understand that for many physicians, politics is a dirty, unsavory process that they would just like to ignore. Well, my friends, we cannot ignore it because the political system is the root cause of the change that is affecting us. Here is where we must wake up to reality and change.
Currently, HCMS participation in TEXPAC is a paltry 13 percent. Statewide participation is only about 15 percent. With the money raised through membership, TEXPAC barely has enough money to adequately fund the physician candidates for public office and the other medicine-friendly candidates at the state level. Unfortunately, TEXPAC does not raise enough money to be a major factor in congressional and U.S. Senate races. This must change if physicians are going to play a significant role in improving the health care system of this state and this nation. We have a very strong team of lobbyists in Texas who represent us and do great work in Austin and in Washington. During this past legislative session, we were able to successfully cut red tape and paperwork hassles, stop the theft of physician services, stop unwarranted scope expansions, strengthen Texas’ physician workforce, and protect 2003 liability reforms, among other things. These are all very important accomplishments. However, in Austin we have been unable to fix our horribly broken Medicaid system, protect funding for critical health care services from the roller coaster that is the state budget, and keep the Legislature from inserting itself between us and our patients. In Washington, we have been working for more than 10 years to fix the flawed SGR formula, and the problems that are built into the Affordable Care Act (ACA) have all been mentioned earlier.
One of the reasons we can’t get the Texas Legislature and Congress to address the critical, system-wide issues is that our voice just isn’t loud enough. The reason for that is that we fall seriously short in supporting the political part of advocacy. The insurance, hospital and legal professions all out raise us when it comes to political contributions. Here’s an example of why that is important.
We recently discovered that patients who buy health insurance through the newly opened ACA Marketplaces have a 90-day grace period in which to pay their premiums. If health care is delivered to the patient who later does not pay the premium, the insurance company is responsible to pay for all charges during the first 30 days, but for the next 60 days, the health care provider will have delivered the care but will not be paid anything! How did this happen? Well, originally, the health plans were supposed to be responsible for all 90 days, but they were able to call on their friends in Congress and lobby the Administration to change the rule. We couldn’t stop this because our voice just isn’t loud enough. Now we may find ourselves not getting paid for a lot of marketplace patients.
Are you content with running around the maze in health care that others change daily without your input, so that most of your time is spent trying to navigate the changes that take you away from time with patients and increase your overhead? Are you content to let others determine the bigger issues? If not, then we need a louder voice. We need to field a strong lobby team and elect medicine friendly candidates to public office. I ask that as you fill out your 2014 HCMS/TMA dues statements this year, check the box for TEXPAC membership. The entry level is only $125 a year, and the benefits you will see by having more medicine-friendly legislators in Austin and Washington will far outweigh that contribution.
— Russell Kridel, MD
Dr. Russell Kridel is a Houston-based Facial Plastic Surgeon in private practice in the Texas Medical Center.
See all of the exciting community and physician resources available at the Harris County Medical Society.
Read this President’s Page in the November 1, 2013 issue of the HCMS Physician’s Newsletter.