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TMA Ask: Maintain the PPACA provision requiring health in- Workforce/Graduate Medical Education
surers to use a consistent reporting formula for medical loss ratio. Texas medical schools are doing their part to expand medical stu-
Consumer Label for Insurance and dent enrollments. However, graduate medical education (GME)
Plain Language Explanations programs are not growing in the same fashion. As a result, many
of our newest physicians end up moving to other states for their
Purchasing health insurance coverage today is increasingly com- residency training. GME is a necessary part of a physician’s prepa-
plex. Health insurance companies offer a wide range of plans with ration for medical practice. Physicians who complete both medical
different benefits, exclusions, and costs. It is nearly impossible to school and GME in Texas are three times more likely to remain in
decipher a health insurer’s sales literature, then make a direct, prod- the state to practice.
uct-to-product comparison.
Texas’ medical schools and teaching hospitals have limited fund-
Employers and patients need accurate, current, and honest infor- ing available to expand GME. The shortage of GME slots guaran-
mation on copayments and deductibles to make decisions in today’s tees some medical students will be forced to leave the state upon
health care market. The real need for this information is not when graduation. Those leaving likely will not return to Texas. They will
patients are sick or injured but rather when Texas businesses and take with them more than $200,000 of state investment in their
their employees are shopping for health insurance coverage. medical school education. The current model for funding GME in
the United States has not changed in more than 15 years. This sig-
Standardized and reliable nutritional labeling has made it much easier nificantly hurts the ability of states like Texas to offer GME pro-
for consumers to make better food choices. Consumers can examine grams to medical students.
20 different boxes of cereal and easily compare the product benefits,
such as number of calories and percentage of fat, sodium, sugar, or TMA Ask: Maintain GME funding through Medicare and con-
protein. TMA believes the same standardized system could aid em- sider adjustments for future support based on population growth.
ployers and consumers when shopping for health insurance. The
PPACA contains an insurance label requirement, and TMA agrees that Overbearing "Fraud and Abuse" Enforcement
plain-language information (like the label) will aid our patients. Healthcare Fraud Criminal Statute
TMA Ask: Maintain the PPACA provision requiring health in- Texas physicians recognize the need to rid the health care system
surance labeling in plain language so patients can better understand of fraud. We want to work hand in hand with Congress to ensure
their insurance coverage. our health care system operates effectively and efficiently. The
PPACA includes provisions that increase funding and the govern-
Fix What’s Broken in the PPACA ment’s authority to combat fraud and abuse. Language was changed
in the Healthcare Fraud Criminal Statute that might have unforeseen
Independent Payment Advisory Board consequences. The law removed the government’s burden to show
The law creates a 15-member Independent Payment Advisory that an accused had “actual knowledge of the law or specific intent
to commit fraud.” It added this new language: ‘‘(b) With respect to
Board (IPAB) that has the authority to control Medicare spending, violations of this section, a person need not have actual knowledge
starting in 2015. IPAB can make recommendations that lead to de- of this section or specific intent to commit a violation of this sec-
creases in Medicare spending ONLY through lower payment rates to tion.” As a result, many physicians may be charged as criminals for
physicians. IPAB recommendations would become law automatically honest mistakes. Honest mistakes or errors should not result in a
unless Congress passes a law to reach the same budgetary savings. government crackdown.
The issue of Medicare spending is too important to be left in the TMA Ask: Revisit and/or remove language relating to the
hands of an unaccountable board with decisions based solely on cost. Healthcare Fraud Criminal Statue
TMA Ask: Repeal the Independent Payment Advisory Board. Keep Imaging Referrals
Congress accountable for the Medicare system. If decisions are made There also are additional written requirements regarding MRIs,
to limit funding for health care services, priorities will have to be set. It
should not be left, however, to an unelected and unaccountable IPAB.
22 San Antonio Medicine • December 2017
