Senator Jane Nelson
P.O. Box 12068, State Capitol
Austin, Texas 78711
Tel. (512) 463-0112
Fax (512) 463-0923

OP-ED
FOR IMMEDIATE RELEASE

February 14, 2012
Contact: Addie Smith (512) 463-0112

TEXAS MUST ADDRESS PRIMARY CARE ACCESS

The ink may still be drying on legislation passed by the 82nd Legislature. However, preparations for the next session are already well underway, and the need for improved access to primary care is emerging as one of our state's most urgent challenges.

Texas' 25 million residents are served by approximately 18,000 primary care physicians who -- in addition to providing non-emergency medical services -- play the important role of coordinating care for their patients. These physicians serve as the gateway to preventive care, specialty providers and a wide range of services. Research has shown that care coordination like this results in higher quality, more efficient health care with better patient outcomes at a lower cost.

Without proper access to primary care services, many patients will be forced to seek basic health care services in already overcrowded emergency rooms -- the most expensive setting in which to receive care. Or they will delay treatment, allowing easily treatable conditions to become critical. Nearly half of the emergency room visits in Texas could be addressed in a lower cost primary care setting. These costs are shifted downstream at a much higher expense to employers, local hospitals and taxpayers.

A robust primary care work force is also vital in order to adequately serve Texas' burgeoning population. Over the last 10 years, our state's population increased nearly twice as fast as the rest of the country. Our elderly population is growing at a rate 5 percent faster than other age brackets and could double, or even triple, in size by 2040. If the federal Affordable Care Act holds up in the Supreme Court, an estimated 5 million more Texans will be entering the health care system.

Adding to our state's challenges, the prevalence of chronic diseases, many preventable, is growing at an alarming rate. Access to primary care is the key to early detection and prevention of these diseases.

Under SB 7, which I authored last session to rein in health costs, we made sweeping changes aimed at improving the quality and efficiency of our health care delivery system. The bill promotes improved care coordination through a new "health home" payment program. Under this initiative, primary care providers can receive incentives by providing comprehensive care coordination for Medicaid and CHIP patients. Another component rewards physicians who -- through services such as after-hours appointments or a 24-hour nurse line -- divert traffic from our emergency rooms.

Initiatives like these hold great promise. However, realizing the full potential of these reforms will require a strong primary care workforce. During this interim period, our Senate Health & Human Services Committee will emphasize strengthening our primary care infrastructure and removing underlying barriers to access.

Specifically, we need to grow our primary care residency slots. Each Texas medical school graduate represents a $200,000 investment by taxpayers. Physicians tend to practice close to where they completed their residency. Because we do not have enough residency slots for all of our medical graduates, we are losing our investment to other states.

We also need to examine how existing payment inequities between primary care physicians and specialists impact our primary care workforce. Medical school graduates routinely leave school with over $100,000 in debt. It is not surprising that they choose more lucrative specialties over primary care. We need to make primary care a more appealing path for medical students.

I am pleased that a broad coalition of physicians, employers, hospitals, health plans and others are already coming together to recommend legislative reforms. Together we can rebuild our primary care network, make more efficient use of our tax dollars and help Texas patients live longer, healthier lives.

SENATOR JANE NELSON represents District 12, including portions of Tarrant and Denton Counties. She is Chairman of the Senate Committee on Health & Human Services.

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