Lt. Gov. David Dewhurst and Sen. Jane Nelson, R-Grapevine, introduced two bills Wednesday they believe could save the state a significant amount of money and produce "healthy patient outcomes." The duo repeated those words throughout a press conference in the Capitol, flanked by stakeholders from the Texas Medical Association, the Texas Hospital Association and House Public Health Committee Chairwoman Lois Kolkhorst, R-Brenham.
"We don't have health care in America — we have sick care," said Dewhurst, who cited studies from The Dartmouth Institute for Health Policy & Clinical Practice indicating that the state could save up to one-third of its health-related costs by incentivizing doctors and hospitals to use best practices for treating patients, as opposed to paying them for the number of procedures they perform.
Nelson, a state budget writer and chairwoman of the Senate Health & Human Services Committee, said that after weeks of sobering meetings on the state's financial constraints, there needs to be a "paradigm shift" in the way Texas funds medical costs.
"If I've learned nothing else — it is unsustainable. We've got to do something differently," she said.
When asked whether the bills would cost or save the state money — and how much — Dewhurst said he is working with the Legislative Budget Board to determine exact figures. However, he is convinced there will be savings for the state. Unlike President Barack Obama's federal health care reforms, the lieutenant governor said, these two new bills do not mandate that all citizens have insurance or increase regulations for states.
"They're permissive free-market approaches, and they give our doctors a chance to be able to work with hospitals for the first time. And they change the way that we look at health care," he said.
Senate Bill 7 is focused on Medicaid and the Children's Health Insurance Program. If passed, its provisions would reduce Medicaid payments when patients are readmitted for preventable illnesses, establish co-payments for unnecessary emergency room visits, provide incentives for providers who reduce waste and improve quality of care, and begin the process of studying whether pay-for-performance is doable in long-term care.
SB 8 would change the Health Care Policy Council's name to the Texas Institute of Health Care Quality and Efficiency and alter its mission to "improving outcomes for all Texans, including state employees, teachers and others who use Texas health care programs." The plan proposes establishing a statewide system of performance payments based on improving patient care quality and finding efficiencies. In addition, the bill also calls for testing health care models that have proven to be effective, requiring public disclosure of "potentially preventable readmissions and complications," and requiring the Department of State Health Services to cooperate with hospitals to create standardized patient ID wristbands and study the possibility of reporting potentially preventable illnesses in long-term care facilities.
Dr. A. Tomas Garcia, a trustee on the board of the Texas Medical Association, stood behind the legislative leaders during the conference. So far, he says, "we are supportive of anything that'll make health care more efficient for our patients." But the TMA cautioned that the organization wants the patient-physician relationship to come first and will be watching for anything that looks like a corporation dictating care decisions.
Meanwhile, there are also some early concerns — including those voiced by the Texas Academy of Family Physicians — that SB 7 and SB 8 could conflict with lawmakers' current plans to slash Medicaid funding and loan repayment programs for family practice residents, the same doctors who would have to institute many of the reforms.