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Health Care Highway — 2012 is a GPS device for today’s driver. It alerts us to detours and speed traps. It points the way toward the elusive stretches where traffic flows freely. Like any good guidebook, it draws our attention to scenic trails we abso- lutely must explore. The report offers physicians and poli-

cymakers a map of each other’s worlds. It helps us understand the forces at work on the other side of the road and the consequences of a decision to tap on the brakes, roar past the speed limit, or swerve wildly into uncharted territory. Here are the keys to the highway:

• PPACA’s goal of rapidly reducing the number of uninsured Americans is endangered. Ideological and politi- cal animus toward the law and Presi- dent Obama was fueled by the U.S.

Supreme Court’s decision allowing states to opt out of PPACA’s anticipat- ed enormous expansion of Medicaid (pages 17–23).

• The fiscal cliff and the divided fed- eral government’s inability to rein in the deficit responsibly imperil not only our expensive health care sector but also the entire national economy. Simple repeal of PPACA would add both to the deficit and to our unin- sured population (pages 24–33).

• State governments, still recovering from the recession, are overwhelmed by the growing cost of Medicaid. Even with massive federal assistance, Medicaid expansion is politically and financially costly (pages 33–39).

• The controversial Independent Pay- ment Advisory Board (IPAB) is re- quired to focus its Medicare cost- cutting activities almost exclusively

on physician practices through 2020 (pages 43–45).

• Medicare accountable care organiza- tions (ACOs) require independent practices to sacrifice business and clinical autonomy in exchange for unproven models of care that claim to reduce costs and increase quality. ACOs pose new legal and financial risks and require practices to report reams of new data (pages 45–47).

• PPACA never fixed how Medicare pays physicians. The cost to override the Sustainable Growth Rate (SGR) formula’s annual cuts grows expo- nentially. Proposed long-term replace- ments for the SGR — that use the fed- eral government’s purchasing power to cut Medicare costs and promote primary care services — do nothing to solve the looming 27-percent re- duction in physicians’ Medicare pay- ment rates (pages 47–52).


Herbert Fred, MD, professor of internal medicine at The Uni- versity of Texas Medical School at Houston, recently received the Laureate Award from the American College of Physicians (ACP), Texas Chapter. The award honors those committed to excellence in medical care, education, or research, and service to their community and the ACP.

Gov. Rick Perry appointed two physicians to state boards. How- ard R. Marcus, MD, of Austin, will serve on the Texas Council on Cardiovascular Disease and Stroke. The council coordinates activities to reduce the human and financial toll of cardiovas- cular disease and stroke. Dr. Marcus is board chair of the Texas Alliance for Patient Access. Michael Reis, MD, of Woodway, will serve on the Texas Physician Assistant Board. The board estab- lishes and maintains standards of excellence to regulate physi- cian assistants and ensure quality health care through licensing, discipline, and education. Dr. Reis is chief medical officer and chair of the Scott and White Healthcare System Department of Family Medicine in Temple.

14 TEXAS MEDICINE January 2013

• Health insurance exchanges are caught in the broad partisan dis- agreements over PPACA. Few states are ready for these new insurance marketplaces, which bring signifi- cant federal intervention in the states’ long-standing power to regulate the industry. Expect state-by-state battles over the exchanges (pages 52–55).

• Expensive and still unproven health information technologies are forcing themselves into physicians’ offices. The goals — rewarding quality care, better sharing of critical patient infor- mation -— are laudable. The costs of buying these systems and the grow- ing federal tentacles they bring into physician practices are worrisome (pages 55–59).

• Prospects for bipartisan compromise are bleak. America’s polarized elec- torate and party-bound elected offi- cials are more divided on health care issues than on anything else. There is no middle (pages 60-64).

Log on to to

read the full report. TMA Executive Vice President and

Chief Executive Officer Louis J. Good- man, PhD, is the president of The Physi- cians Foundation.

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