We'll be liveblogging throughout the weekend from The Texas Tribune Festival's health and human services track — which includes panels on the fight over federal health reform, whether Texas can cure cancer, what effect tort reform has had statewide, and how patient privacy is possible in the digital age.
Featured speakers include Planned Parenthood Federation of America President Cecile Richards; U.S. Rep. Michael Burgess; Texas Health and Human Services Commissioner Tom Suehs; and Doug Ulman, president and CEO of the Lance Armstrong Foundation.
Follow us here for updates from the University of Texas campus.
Burgess says in Texas, which has the highest rate of the uninsured, there is "a fairly robust safety net system."
Panelists: Howard Marcus of Texas Alliance for Patient Access, Jay Harvey of Winckler & Harvey, LLP, Michael Hull of Hull Hendricks, LLP, and David Hyman of the Epstein Program in Health Law and Policy at the University of Illinois
Law professor David Hyman says the increase is largely due to dramatic population growth. There are fewer specialists after tort reform, but when you account for population growth...there's just not much difference.
Lyman on defensive medicine: If doctors have lower costs, you’d expect that to be reflected in patient bills. But it’ll have small impact. If physicians are afraid of being sued, they’ll run extra tests, etc. The theory is that if doctors don’t have to worry about the risks of being sued, they won’t run extra tests. Harvey argues that makes no sense. Doctors don't order tests without a legitimate, rational basis for the need for that test. So if there’s an unreasonable mark-up, it’s the doctor’s fault and not the plaintiffs’ fault.
Health law expert Lyman: If you want to motivate physicians to practice in those areas, tort reform is a small piece of the puzzle because it might lower costs. The trends in Texas show increase in urban areas where there are lots of uninsured as well as insured patients. If you want to broaden access to rural areas, tort reform isn’t at the top of the list of ways to make it happen.
Dr. Hall sees progress. He says 32 Texas counties that didn’t have ER doctors now have one.
Raymond N. Dubois Jr., provost and executive vice president of the University of Texas M.D. Anderson Cancer Center and a professor of cancer biology and cancer medicine.
Doug Ulman, President and CEO of the Lance Armstrong Foundation. He’s also a three-time cancer survivor and founder of the Ulman Cancer Fund for Young Adults.
Joseph S. Bailes, vice chairman of the Cancer Prevention and Research Institute of Texas, a state-established foundation that has awarded over $455 million in grants for cancer research and prevention.
“We have actually cured some cancer,” said Dubois, citing the success of curing Lance Armstrong’s as an example. New treatments also “put the cancer into a more chronic-type condition where people can live with that.”'
Dubois adds that Texas’ funding for CPRIT ranks fifth or sixth in the world in terms of available funds for research. “It’s a major impact on worldwide cancer research," he said.
Ulman says people across the nation recognize M.D. Anderson as a leading cancer research center, but they don’t know some of the other institutions across the state, such as U.T. Southwestern, that also have strong research programs. “People are paying attention to Texas,” said Ulman, and “wondering who the next Nobel laureates are that are going to move to Texas.”
He said it is also important to keep talking about cancer research programs, especially during future legislative sessions, because the funding needs to stay consistent for the program to be successful. “These are not processes you can stop and start.”
Ulman’s response: “You can’t sit in the legislature…and say I’m in support of CPRIT, but not in support of smoke-free work places…people should not have to choose between making a living and health.”
Dubois: “It would be wise for us to think about focusing on maybe five or six particular cancers where we’re going to go all the way…If we could focus our energy in a narrower beam, clearly we’re going to have a lot more impact.”
Bailes said CPRIT funds companies that have innovative products and other sources of funding, “so commercialization is a very important part…of what CPRIT’s mission is and what CPRIT’s research efforts are. Our goal is to leverage the other funding people bring in.” He said that most grants require a 50 percent match from other funding sources.
Dubois: “We don’t typically make public policies, but we can see the benefit of some preventative effort like that.”
Panelists pause for a moment, laugh a bit, before answering. Ulman: “Probably not the right way to go about it, but people should have access to this vaccine, because it is a huge success story.” HPV is the number one cause of death by cancer for women in Africa, he said, and “we have the tool” to help.
Bailes said people need health insurance, but if reform means more people are going to be put into “financially-stressed” healthcare programs, such as Medicaid and Medicare, these programs need to “cover needed benefits for individuals with cancer.”
Dubois adds that the health care debate is usually focused on access and services. “We haven’t been talking enough about the value of the healthcare, the quality of our healthcare, and really, how we can reduce our costs,” he said.
Panelists crack up in laughter. “You’d have to go through billions of times to get cancer,” said Bailes.
The legislature also pursued a set of different waivers from the federal government. According to Suehs’ presentation, an FMAP waiver that is “based on a state’s relative income and its relative burden serving poor residents would more equitably allocate federal funds.” Another option is a benefits waiver, which would reduce the mandatory populations covered by Medicaid in order to save taxpayers' money.
The lump sum payments to hospitals are based on how much the hospitals charge for services, not the actual cost of care per Medicaid patient, said Suehs. “The more efficient system is getting out of this lump sum payment so you can diversify how you make those payments,” he said. For example, more money could be directed to primary care physicians to prevent emergency medical costs.
Leo Linbeck III, president and CEO of Aquinas Companies and vice chairman of the Health Care Compact Alliance, which seeks to limit federal government intervention in medical care.
Spencer Berthelsen, managing director of Kelsey-Sebold Clinic, a Houston-based medical clinic and past chairman of the Texas Medical Association's Council on Legislation.
Arlene Wohlgemuth, director of the Center for Health Care Policy at the Texas Public Policy Foundation.
Charles E. Begley, professor of management policy and community health at the University of Texas School of Public Health in Houston.
Linbeck: “I run a single-payer system in my family, I being the single-payer, and I know at some point that breaks down,” noting that his four-year old daughter can't be trusted to make decisions. But on the other extreme, he said, federal decision-making of healthcare reform is not better. “The direction it's going is wrong and it needs to go the other way.”
Begley responds: “One of the things that I like about ACOs is it would be a mechanism for getting healthcare providers to share information.” (ACO = Accountable Care Organization.) “You’d have a degree of centralization,” he said, which would allow healthcare providers to compare the regional costs of healthcare. It would be easier to identify efficient providers, and how to implement those savings in regions with more expensive care, he said.
Linbeck responds: “It’s a long journey to try to devolve power back to the people…it’s not going to happen overnight.” It is wrongly presumed now that federal government should make these decisions, he said.
Berthelsen: “I believe vaccination is the single best paradigm for prevention of disease…I’m in favor of having vaccines used to their maximum extent in a population.”
Linbeck: “A terrible abuse of power…hate to kick the guy when he’s down,” referencing Gov. Rick Perry’s current status in the presidential campaign. The question should be solved county-by-county, he said. “Let them debate it, weigh the pros and cons.”
Wohlgemuth: “Generally speaking, we’re opposed to mandating.” Vaccinating for HPV is beneficial, she said, “it is the mandate that is the problem.” The flu-shot is also beneficial, she said, but people should choose whether it is in their self-interest to get one.
Begley: The HPV vaccine is extremely cost-effective as a preventative measure, "but it is very controversial, because of the opposition to mandates.”
Moderated by Paul Burka, senior executive editor of Texas Monthly and featuring:
Anne Dunkelberg, associate director at the Center of Public Policy Priorities.
Rep. John Zerwas, R-Simonton, chairman of the Health and Human Services subcommittee.
Rep. Garnet Coleman, D-Houston, senior member of the House Public Health Committee.
Dianne White Delisi, former state representative, R-Temple, and senior policy adviser for Delisi Communities.
Zerwas: "When people have skin in the game... a health savings account... people are more discretionary buyers."
Moderated by Sherri Greenberg, interim director of the Center for Politics and Governance at the LBJ School of Public Affairs and featuring: J. James Rohack, the former president of the American Medical Association, Nora Belcher, the executive director of Texas e-Health Alliance, Michael Stearns, President and CEO of e-MDs, and Deborah Peel, founder and chair of Patient Privacy Rights.
Deborah Peel says we have no ability to control where our information flows. "It isn't flowing to the people we want it to." There are effective tech, "but we're in a dangerous space." Texas has $28 million to develop data exchanges, and it's going to happen before we have the right technology in place. The government is pushing ahead even though we have no idea how far and to how many third parties this information flows... this is very, very dangerous." People depend on not being judged to work and survive.
J. James Rohack says it's an ethical question. "Safeguarding the patients' privacy" is important, but it's not absolute. Must balance efficient delivery of care and availability of resources. The issue is can it be done in the electronic age? The answer is yes. What is the safeguard? It's the ethics, which drives the profession. Code of conduct is signed by all employees. If it's breached, they lose their job. It gives more safety to patients than the current system, in which patient records are on papers in rubber bands. Electronic records allow us to know who's been handling our records.
Nora Belcher says her constituents are very concerned about patient privacy. If consumer confidence isn't high, the system won't work. However, Texas leaders have set a high bar to protect patients. Texas approach is different because it makes everyone who comes into contact with patient health information accountable. They're regulated. There are consequences.
Rohack says there has to be trust between the patient and the doctor. The patient safety issue is the awareness of the drug interactions that are out there. Electronic records summarize medicines, possible reactions, etc. But if the trust factor isn't there, we're not going to be able to provide the care patients deserve and need.
Stearns citing VA experience. Records have helped them improve care for their patients. Getting patients immunized for pneumonia, for instance, helped to save millions.
Peel says we don't have a data map, so there's a massive difference between paper records and electronic world. With paperwork, one person handles it at a time. With e-records, you don't know how many people are accessing your information.
Stearns says it's not a new thing. Access to those databases has been around for a long time.
Rochack says this issue is being studied.Information can be aggregated and identity information can be stripped off. That's another way to look at population health without invading privacy. "There's always been evil people out there. Always will be."
Belcher says Peel's example of using databases isn't allowed in Texas. There is regulation here. This year, the Legislature also took steps to remove the commercial value of health information.
Dr. Stearns-- As far as cost goes, people have to invest in this or it won't take off. We need to look at privacy on a broader spectrum. It's more than health care. What privacy means for our society and within the context of health care.
Dr. Peel-- There are costs savings, but it's not totally clear or guaranteed. Saving all this data is very costly, too. Certain costs can go down and that's true, but this hasn't been fully mapped out. How do you support the cost of protecting this information? Often, it's to sell the data.
Dr. Rohack-- E-records are a tool to provide better care. Some believe it's a variant of the Internet, "a tool of Satan." But from a real standpoint, our system has shown that with appropriate safeguards, ethics and professionalism (including protecting that sacred bond between doctors and patients), we can provide better care.
Belcher-- The boundaries of social media? That's something we need to talk about as a society. She's concerned what this will do to the provider base if we DON'T help them through this transition. We won't reap any benefits if we don't support our physicians and hospitals in their efforts to transition.
Introduction by state Rep. Donna Howard, D-Austin, and featuring Cecile Richards, president of Planned Parenthood Federation of America
With federal health care reform, birth control and other preventive health care will be covered with no co-pay or cost to women. Richards says there is an "unprecedented" assault against family planning underway. Nearly 300,000 women just lost access to non-abortion health care in Texas. That includes access to cancer screenings, well woman exams, etc. She was just in Waco, where PP is the only community family planning service provider for the region. Due to budget cuts, they're turning away men and women who've been relying on PP for STD testing.
Tech age represents an opportunity to change this.
Another man at the mic says legislators like to say government should stay out of our lives, "and we should put that argument right back in their face."
Tanden acknowledges it was super-long. But she said there are so many Republican bills that are "over 1,000 words long."
Tanden: Uncompensated care will be tremendously alleviated from federal health reform.
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