Help wanted: Send us your ideas for the Primary Care Rescue Act

As a die-hard fan of the Texas Longhorns, I have no shame in telling you that after last year’s 5-7 record, I was glad the college football season was over. Even though I’m a self-admitted policy wonk and political news junkie, I was equally relieved—even somewhat jubilant—when the 82nd Texas Legislature finally closed up shop and went home. If you followed the frustrating struggle to balance the state budget without additional revenue, and witnessed the resulting cuts to higher education, public education, and health and human services, you might have been just as ready for it to end as I was. At least when they’re not in session, they can’t do any more damage, right?
Now is not the time to bury our heads in the sand. In fact, the legislative interim is perhaps our best opportunity to formulate and articulate our most effective arguments for renewed investment in Texas’ primary care infrastructure. We can document the ill effects of the drastic reduction in state support for graduate medical education, especially in family medicine residency training, and we can illustrate the broken promise of access to primary care physicians for underserved communities made manifest by the 76-percent cut to the state’s Physician Education Loan Repayment Program.

And now is the time to begin preparations for a major initiative in the next legislative session. In the late ’80s, rural medicine in Texas was in terrible need of state investment. Health care organizations and advocates rallied around a broad set of goals encompassed in what was called the Omnibus Rural Healthcare Rescue Act, which the Legislature passed in 1989. The law created the Center for Rural Health Initiatives and the Office of Rural Health Care, and it contained tort reforms, benefits for rural hospitals, several reforms to strengthen the state’s trauma care infrastructure, and new recruitment and training programs for primary care physicians. Family medicine won funding for third-year clerkships, among other valuable reforms.

As our state demographics change, and following the decision of the 82nd Legislature to withdraw almost 80 percent of its investment in programs intended to increase the state’s primary care workforce, we believe primary care in Texas is in desperate need of something like that landmark omnibus package of reforms and initiatives. Let’s call it the Primary Care Rescue Act. Obviously we would want to include the restoration of state support for GME, especially the funds that go directly to family medicine residency programs through the Texas Higher Education Coordinating Board. Also we would include full restoration of funds for the Statewide Primary Care Preceptorship Program, and the Physician Education Loan Repayment Program. But what else should we include?

We wish to engage you—the membership of TAFP—in this endeavor from the very beginning. What state reforms would make your practice easier, more efficient, and provide better care for your patients? What kind of administrative simplification requests should we make in state programs? What about managed care reforms? Would a standardized pre-authorization process help? Standardized contracts? Real-time claims adjudication? What could the state do to make primary care more attractive to medical students?

The sooner we can begin to craft a set of reforms to use during the election cycle, the more likely our success becomes. Remember, politics drives the process that sets policy. That’s why we want to hear your ideas for the Primary Care Rescue Act. Use this space, here on the blog, to comment with your ideas, and we’ll pay close attention to the discussion. If you’d rather send us your ideas individually, feel free to e-mail me, Jonathan Nelson, at Or you can e-mail Tom Banning at, or Kate Alfano at However you choose to share your ideas, we are eager to hear them. The legislative interim can be a time filled with promise and hope, and it’s the perfect time to lay the groundwork for big initiatives in the next session. Let’s take advantage of that opportunity.


7 Responses to “Help wanted: Send us your ideas for the Primary Care Rescue Act”

  • ryan morris:

    I practice in a small rural community that is greatly underserved. In the past 3 years, there are 3 young physicians that have joined the grop. Each of us qualified for the loan repayment program, and each of us has had our funding cut. We currently cover a rather busry rural ER that serves several counties, we have clinics in 2 different counties, we provide inpatient and obstetrical coverage to hospital. Despite working 70 hours in an average week, the high medicare and medicaid population makes for rather low income. To be blunt, I could work a whole lot less and make a whole lot more in suburban practice. I love doing what I do, but I’m not sure how long I can afford to keep doing it. I am a little concerned what will happen in this area if we lose three young and acvtive physicians. I am rather certain it will mean the end of obstetrical services at the very least. In the end, this has the potential to cost a whole lot more than it has cut. I am certain similar situations exist all across the state.

  • Jonathan Nelson:

    Dr. Morris, this is just the kind of case we’ve been worried about. Thanks so much for your comment.

  • Janet Chene:

    HSA’s which are funded from the taxes actually paid by the citizen (or funded by governement for the the truly indigent). This way this would get rid of the first 2-3K billing issues and bring cost down in that patients could negotiate cash discounts, wouldn’t overutilize as it would be their own funds being spent rather than someone elses, and the funds could be theirs for their retirement if they keep themselves healthy. Insurance should only be for catastrophic which would not involve the majority of the population. There would be no wasted money on insurance premiums if the government wants to pick up the tab for the catastrophic as they tend to do anyway. This would get rid of a lot of beauracracy since the first 2-3K worth of medical expense would be accounted for on our tax returns and also the doctors records which we all have to create anyway at our own expense or effort.

  • Health TXN:

    I suggest removing regulatory barriers on nurse practitioners to allow them to practice up to their education and certification.
    Instead of continuing the turf battle, physicians should work with their nurse colleagues to make things better.

  • I am not from Texas. I practice in New York. And, I am not a physician; I am a nurse practitioner. But, the problems you are facing are the same as those facing every primary health care provider in every state – federally-designated Medically Underserved Areas and Healthcare Provider Shortage Areas, increasing numbers of patients with multiple morbidities, lower reimbursing third-party payers, rising overhead; the list could go on.

    Yet, instead of addressing the serious issues of increasing access to health care while eliminating barriers to that care, precious time, money, effort, and emotion is squandered on perpetuating an unwinnable turf battle between medicine and advanced practice nursing.

    How embarrassing to learn that the American Academy of Family Practice Physicians will present an award – yes, an award – to the Texas Association of Family Physicians “in recognition of the effort to preserve physicians’ scope of practice against attacks from advanced practice registered nurses”, at their State Legislative Conference in Salt Lake City this year. Seriously? An award?

    We all know there are more than enough patients to go around. There are now 16 states which grant autonomous (plenary) authority to NPs. Organized Medicine would do well to abandon this non- issue and support its advanced practice nursing colleagues instead of wasting resources which could be far better utilized to promote public health.

  • Sandy McCoy:

    Texas ranks on the bottom regarding access to health care so it is time for all of us to look for solutions. Nurse practitioners are well educated and trained to take care of about 90% of what is seen in primary care and we have plenty of patients to go around. We need to remove the rules and regulations that prevent nurse practitioners from helping physicians take care of these patients that are in desparate need of healtcare. I know that physicians use the argument that patients safety is jeopardized when nurse practitioners take care of patients but there is no research to substantiate it. There is plenty of work here in Texas to be done so we don’t need to compete but we need to work together to take care of our citizens.
    Sandy McCoy, RN, MSN, FNP-BC
    President Texas Nurse Practitioners

  • Denis:

    It amazes me that despite volumes of research and the recent IOM/ Robert Wood Johnson’s report, that opposition to independent NP practice continues. There are no studies that link direct physician supervision/ madatory collaboration with Nurse Practitioners to better patient outcomes/ satisfaction, and nearly every stitch of opposition has been an opinion of ‘what may happen.” Remove barriers to NP independent practice, and there will be greater access to high quality primary care…

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