“We want to do everything we can to maintain patients’ rights at the end of life and to maintain the patient-physician relationship.”
practice of medicine, then we should try to move forward,” Ms. Rose said. Physicians recognize that end-of-life decisions often bring confusion. Dr. Callas hopes the legislation will
provide a framework to establish bal- anced and compassionate end-of-life care discussions. Without that, “the only way these decisions get made is by litigating them,” which also can be emotionally devastating for everyone involved. “We want to do everything we can to maintain patients’ rights at the end of life and to maintain the patient-physi- cian relationship,” he said.
The bill also creates similar notifica- tion and appeals processes for executing DNR orders when a patient’s death is not imminent and there is no clear directive as to his or her end-of-life wishes, and patients’ families would have access to an ethics committee hearing if they dis- agreed.
But Dr. Weltge was careful to note that unlike decisions over withdrawing futile care, which typically occur in lon- ger term care, those involving DNRs can mean deciding whether to order addi- tional aggressive interventions, often in an acute setting and without the luxury of time. “We do think pieces of the law are working and being used appropriately. But there are some tweaks that could help make the process a little more transparent and give people more time” to cope, said Denise Rose, senior director of government relations for THA. A 2012 THA survey of 200 hospitals
revealed that 46 percent began imple- menting many processes included in the health care groups’ proposed reforms after Senator Deuell introduced similar legislation in 2007. That measure, Sen- ate Bill 439, came in response to interim negotiations after Representative Hughes amended a broad Medicaid bill with a “treat until transfer” provision.
38 TEXAS MEDICINE February 2013
Senator Deuell’s legislative director, Scot Kibbe, says the goal of these re- forms is to get everyone to the table. “This is about getting a better process in place and having more safeguards so everybody is able to make informed decisions. At the same time, we have to address the fact that there are situations where treatment to transfer is just not viable,” he said.
The issue has been difficult for the
legislature in the past “and one in which every side needs to have its views re- spected,” Mr. Kibbe added. “We are hop- ing this time that happens.” The THA survey also reported that
the dispute resolution process is rarely used.
In 2012, the process was initiated 21 times, and in 18 of those instances a resolution was reached, either because the physicians or surrogates involved changed their minds, the patient was successfully transferred during the 10- day window, or the patient died while continuing to receive treatment during that timeframe. Hospitals did not report the outcomes in the remaining three cases. “We don’t think [such disputes] are happening often, but if this [legislation] is something we can do to alleviate fears or concerns without infringing on the
Specialists outline 2013 legislative priorities
Improving Medicare and Medicaid pay- ments, boosting the physician workforce through increased graduate medical education (GME) funding, and stopping scope-of-practice expansions by nonphy- sicians were among the top legislative priorities that medical specialty society representatives set at the Texas Medical Association’s 2012 Advocacy Retreat in December.
Physicians also heard from leaders of several state agencies about their goals and challenges during the 83rd Texas Legislature.
“The bottom line is, we need more doctors,” said Troy T. Feisinger, MD, a Sugar Land family physician and presi- dent of the Texas Academy of Family Physicians.
Other top legislative issues included
reversing the state budget cuts to pay- ments for care of dually eligible Medi- care and Medicaid patients; preserving physicians’ rights to own specialty hos- pitals and to participate in coordinated care models such as accountable care organizations; protecting Texas’ strong medical liability reform laws; and ad- ministrative simplification. From implementing electronic medi- cal records, to meeting state and federal
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68