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care we provide to our most sick and vulnerable patients — dual-eligible patients. Because of their age they qualify for Medicare and because of their income they receive Medicaid benefits.


The cut hit particularly hard practices in rural and inner-city


Texas, along the Mexico border, and many of those serving nursing homes. Those practices serve a disproportionate num- ber of dual-eligible patients. HHSC recognized the cuts would truly harm patients on dialysis, and it reduced the cut for renal dialysis centers. We must take additional steps to reduce the dual-eligible cuts for other physicians who are struggling to care for these patients. What’s lost in the health care debate is the simple fact that patients need a doctor when they get sick. And, physicians want to take care of our patients. That is why we went to medical school. That is why I’m still studying continuing medi- cal education when I am in my 60s, so I can provide the very best care to my patients. However, without an ad- equate network of physi- cians, no health care system can work, let alone be effec- tive. The state simply cannot continue to run its Medicaid program on the backs of phy- sicians.


Instead, Texas needs to invest in a robust physician network so we can better treat chronic illnesses and keep pa- tients out of expensive hospi- tal and emergency rooms. Texas has a shortage of both primary care and other specialists at a time when we need physicians more than ever. We rank behind all other large states in the number of physicians per capita. We can change these statistics by pro- viding stable funding to our medical education system. We can change these statistics by providing opportunities for our Texas medical school graduates to obtain residency training without leaving the state. As we train the new work-


force, we need to recognize that the way we deliver health care is evolving. The future for some physicians, especially pri- mary care physicians, will be to lead teams of health care pro- fessionals. Physicians’ primary role will be to “manage care” —


to direct and coordinate care for a large group of patients us- ing a team approach. The care, however, will still be provided based on the needs of each patient. Health reformers keep talking about providing care to “pa- tient populations.” But I don’t treat populations. I take care of one patient at a time, devoting my time and skills to giving you the best care possible. Doctors hear from policymakers that “practice guidelines” will solve our health care problems. Well, I should and do know those guidelines, but do not forget that your outcome depends on my skill and the skill of the hospital and profes- sionals working there. Really good medical care will never be cheap, but prevention can be. If Texas wants to create a new system to serve the morethan 6 million citizens who have no health insurance, we need real- istic solutions that are going to require sacrifice and work from all segments of our society, not just the doctors and hospitals.


STATE MEDICARE, MEDICAID CRISIS WORSENS


The share of Texas physicians who will take new Medicare or Medicaid patients has dropped to an all-time low, according to a TMA physician survey (see www.texmed.org/surveys). Low-income Texans who rely on Medicaid for their care are the hardest hit. Texas physicians available to treat new Medicaid patients plummeted


from 42 percent in 2010 to 31 percent, less than half the 67 percent who reported they would take all new Medicaid patients in 2000. The number of Texas physicians accepting all new Medicare patients dropped from 66 percent in 2010 to 58 percent in 2012. That’s part of a steady decline from 78 percent in 2000. “All the bureaucratic red tape and administrative burdens only serve


to increase the cost of running a practice, while diverting a physician’s attention away from patient care,” said TMA President Michael E. Speer, MD. “Every business has a breaking point; physicians’ practices are no different.” The survey also found that if health care reform were to increase the number of patients covered by private insurers and Medicaid, one in five doctors (and one in 10 primary care physicians) cannot serve any more patients than they do today. More than half of physicians (51 percent) report their practice could take more privately insured patients, but not more Medicaid patients.


September 2012 TEXAS MEDICINE 19


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