John Flores, MD, remembers how “lengthy” the process of Texas Medical Association policymaking was before 2019, when the House of Delegates (HOD) first allowed members to submit online testimony on business items.
A few years into its inception, the vice speaker says online testimony gave members the opportunity to continue business while the COVID-19 pandemic necessitated house procedures be conducted virtually.
However, Dr. Flores says the change was needed even before the pandemic, and without options for virtual participation, TMA members wouldn’t hear testimony for and against HOD business topics until TexMed, as voting occurred. The gap would lead to hours of debate.
“It was a little chaotic,” the Little Elm internist said. “Many members frequently left feeling frustrated they didn’t have more time to voice their thoughts.”
Now, as a permanent fixture, online testimony grants reference committees the ability to develop advance reports that summarize item recommendations, and gives members the opportunity to examine those reports weeks ahead of TexMed, says Temple pediatrician John Asbury, MD.
Dr. Asbury submitted online testimony on almost every business item presented to the house this year, an allowance he says gave him the opportunity to communicate his thoughts more effectively.
Similarly, the house’s recent embracing of open meetings, which began at TMA’s October 2023 Business of Medicine conference, encourages all TexMed attendees to visit committee and council meetings, even if not members of those bodies, in anticipation of later discussion in front of the house. These updates allowed physicians like Dr. Asbury to become more engaged. “Through this process, all … TMA [members] have the chance to be involved in the shaping of policy,” he said.
The installment of online testimony also proved to be beneficial for physicians unable to travel to TexMed or who want more time to prepare their testimony before speaking to the house, Dr. Flores adds.
“In this regard, the pandemic was a blessing,” he said. “We started online testimony as a necessity, with no other way to reach each other. Now, we’ve seen the benefits of it among our colleagues.”
These changes are among several the house has approved in recent years to increase the visibility of TMA member interests, bolster member involvement in the association, and strengthen TMA and the physician practices it represents.
The changes are “among many that we [the house] believe will increase engagement among our members,” Dr. Flores said.
Meeting TMA member needs
To help ensure TMA can deliver on those goals, leaders also voted this year in favor of a phased-in dues increase to enhance overall member experience, support organizational growth, and benefit the association’s advocacy for the next two years.
“As Texas physicians work in new and increasingly varied settings, the challenge grows for TMA to provide value to the state’s diverse physician population. We must meet that challenge,” TMA Treasurer Greg Fuller, MD, shared with TexMed 2024 attendees, adding the increase will aid the association’s efforts to fight on behalf of all Texas physician practices.
“We must provide advocacy and services that meet the needs of large group and solo practitioners, of physicians who work as a part of nationwide single-specialty groups, of rural and inner-city physicians, of employed physicians, of the new breed of physician-entrepreneurs, and of those who teach the next generation of physicians while simultaneously being asked to generate practice income,” he said. “As you are asked to do more and more, often with less income, so is your association.”
The dues increase, the first in five years, will roll out in $25 increments in 2025 and 2026, for a total of $50 per active member over the next two years.
Historically, TMA has raised dues for active members every few years to keep up with inflationary costs of salaries, health insurance, and other operational expenses. Because of the COVID-19 pandemic and its impact on physicians and their practices, however, the association forewent such a raise in recent years.
Championing physician independence
In yet another move to support the diverse set of physician practices TMA represents amid challenges like economic consolidation, low and falling payment rates, and most recently, cyberattacks, the house also created a new standing Committee on Independent Physician Practice.
The new chair of the committee, Austin ophthalmologist Michelle Berger, MD, understands the complex burdens placed upon TMA members who practice independently. The long-time TMA member had to close her practice’s doors this year after the February Change Healthcare cyberattack left her without claims payments for months.
However, her experience only reinforced her desire to see TMA uplift fellow independent physicians and to share their experiences with other Texas clinicians. With the creation of the new committee, Dr. Berger is hopeful she and her colleagues now have a “strong voice” for private practice as only 34% of Texas clinicians are in independent settings, per the Physicians Advocacy Institute.
“It’s easy to pick off little practices one by one. But when we’re all together, sharing one, loud voice, we can do anything,” Dr. Berger said. “You know the old saying: When life gives you lemons, you make lemonade. This committee is my lemonade.”
Bridge City family physician Amy Townsend, MD, who will serve as the committee’s vice chair, calls the group a “beacon” to Texas doctors. She believes the creation of the committee – and the fact that it will report directly to TMA’s Board of Trustees – will attract more members.
“Other physicians, even nonmembers, will take note of a committee that actively supports those that are in practice trouble,” she said. “Imagine the connection that can form between those physicians and the future they can create for TMA. This is an important change for our membership.”
The new 15-member committee will take up the mantle of its predecessor, the Ad Hoc Committee on Independent Physician Practice, and provide information for TMA to define what it means to practice medicine independently in Texas and identify the needs of independent physicians and the related services that TMA may develop to address those needs.
The committee will:
- Identify challenges to viability of private practice in Texas; and
- Develop and recommend policies and association resources to support the viability of independent physician practices.
Engaging all practice types
Similarly, the house transitioned TMA’s Task Force on Alternative Payment Models (APMs) into a standing Committee on Alternative Payment Models to support physicians who participate or wish to participate in care delivery and payment models outside of traditional fee-for-service. This includes accountable care organizations, bundled payment, capitated payment, Medicaid managed care, Medicare Advantage, and Medicare’s Merit-Based Incentive Payment System.
In its report supporting the move, TMA’s Reference Committee on Financial and Organizational Affairs said it “understands the upcoming challenges to payment models and feels this committee will serve Texas physicians in addressing the demands of the future.”
The Centers for Medicare & Medicaid Services, for instance, has a stated goal to transition all Medicare patients from fee-for-service arrangements to value-based care models by 2023.
Waco otolaryngologist and TMA House Speaker Brad Holland, MD, says value-based care is a topic that “TMA needs to be on top of” to support all physicians the association represents.
“We want this to be the Family of Medicine, and to accomplish that, we need to think outside the box for all our members,” he said.
The APM committee is charged with helping members navigate those and other value-based care delivery models without compromising patient experience. Specifically, the group was set in motion to:
- Research, develop, and recommend association policy on APMs;
- Identify and develop TMA regulatory, legislative, and budget recommendations relating to alternative payment and care delivery models;
- Monitor and engage in, as appropriate, implementation of state and federal regulatory and legislative initiatives related to these efforts; and
- Develop and promote continuing medical education programs and resources related to APMs.
The nine-member committee will report directly to TMA’s Council on Socioeconomics, which in turn reports to the house.
At press time, TMA leaders were in the process of appointing members to the independent practice and APM committees.