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Landmark Texas law requiring private insurance and Medicaid to pay for diagnostic mammogram praised by RGV lawmakers, DHR Health leaders - mammogram - Titans of the Texas Legislature

Featured, from left: Rep. Terry Canales, D-Edinburg; Rep. R.D. “Bobby” Guerra, D-McAllen; Sen. Juan “Chuy” Hinojosa, D-McAllen; Sen. Carol Alvarado, D-Houston, Ricardo Martínez, MD, DHR Health General Surgeon, and Assistant Trauma Medical Director; and Carlos García-Cantú, MD, DHR Health General Surgeon and Chairman of the Board for the Renaissance Medical Foundation. This image was taken at the Edinburg Conference Center at Renaissance on Wednesday, November 6, 2019.

Photograph By GERARDO GARMENDIA

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Landmark Texas law requiring private insurance and Medicaid to pay for diagnostic mammogram praised by RGV lawmakers, DHR Health leaders

By DAVID A. DÍAZ
[email protected]

A new Texas state law supported by Rio Grande Valley state legislators and DHR Health leaders now requires health insurance plans and Medicaid to pay for a diagnostic mammogram, which can help determine the presence of breast cancer, according to Sen. Carol Alvarado, D-Houston, Rio Grande Valley state legislators and DHR Health leaders.

The measure, which went into effect on Sunday, September 1, 2019, removes a financial burden and eliminates the delay in early treatment for many women. 

Early detection and treatment improve survival because the breast tumor can be removed before it has a chance to spread (metastasize). In addition, there are treatments that can be used to prevent cancer cells that have escaped the breast from growing in other organs.

(https://www.uptodate.com/contents/breast-cancer-guide-to-diagnosis-and-treatment-beyond-the-basics/print)

House Bill 170, authored by Rep. Diego Bernal, D-San Antonio, and sponsored by Alvarado, makes Texas only the fourth state in the U.S. with such an advancement in women’s health care.

“I think it is life-saving. When a woman is told that she has to have a more advanced screening, that’s a scary feeling. It’s very stressful. If you add the stress of ‘can I pay for this or not’ on top of that, that is not a very good feeling,” said Alvarado, who was the featured speaker about the legislation during a news conference hosted at the Edinburg Conference Center at Renaissance on Wednesday, November 6, 2019.

“Now, knowing that you don’t have to worry about that, all you have to focus on now is going and getting the exam (diagnostic mammogram), making that appointment, and not worrying about are you going to have to dip into your saving account, borrow money from family, or waiting a few months to get the exam until you save up enough money,” Alvarado emphasized.

The author is the legislator who files a bill and guides it through the legislative process (also called the primary author). The Senate allows multiple primary authors for each bill or resolution. The House of Representatives allows only one primary author, the House member whose signature appears on the original measure and on the copies filed with the chief clerk. Both chambers also have coauthors, and the House of Representatives has joint authors.

Rep. Ryan Guillén, D-Rio Grande City, was one of four joint authors of Bernal’s House Bill 170.

The sponsor is the legislator who guides a bill through the legislative process after the bill has passed the originating chamber. The sponsor is a member of the opposite chamber of the one in which the bill was filed.

Joining Alvarado at the Wednesday, November 6, 2019 news conference were: Rep. Terry Canales, D-Edinburg; Rep. R.D. “Bobby” Guerra, D-McAllen; Sen. Juan “Chuy” Hinojosa, D-McAllen; Ricardo Martínez, MD, DHR Health General Surgeon, and Assistant Trauma Medical Director; and Carlos García-Cantú, MD, DHR Health General Surgeon and Chairman of the Board for the Renaissance Medical Foundation.

“This is a momentous occasion. The fact of the matter is that Texas is not always at the forefront of women’s health. When Texas stands out, head-and-shoulders above what many other states are doing, the rest of the country should take note because we are generally not head-and-shoulders above the rest of the nation when it comes to women’s health,” said Canales. 

House Bill 170, which was signed into law on Wednesday, June 15, 2019, by Gov. Greg Abbott, amends the Insurance Code to require a health benefit plan that provides coverage for a screening mammogram to provide coverage for a diagnostic mammogram that is no less favorable than the coverage for a screening mammogram, according to the bill analyses of the legislation. The bill extends the applicability of provisions governing coverage of mammography to certain health benefit plans for governmental employees and, to the extent allowed by federal law, the state Medicaid program and the Medicaid managed care program.

“The other reality is that women shouldn’t have to look at their bank account to determine whether they need a diagnostic mammogram. That is the reality, and it is no longer a reality. We are moving forward in making sure women have access to the health care they need, life-saving health care, preventative health care,” Canales added. “This is the kind of commonsense legislation that we need. This is the kind of forward-thinking that will save our state hundreds of millions of dollars by preventing things that could have been prevented in the first place just by knowing about it, by taking commonsense measures to help not just women, but the families that surround them.”

Diagnostic mammograms are different from screening mammograms. Diagnostic mammograms focus on getting more information about a specific area (or areas) of concern – usually because of a suspicious screening mammogram or a suspicious lump. Diagnostic mammograms take more pictures than screening mammograms do. A mammography technician and a radiologist work together to get the images a doctor needs to address that concern.

(https://www.breastcancer.org/symptoms/testing/types/mammograms)

Guerra, whose House District 41 encompasses the DHR Health system of hospitals and medical offices, recalled that the legislation was first filed in 2015 by Bernal, and again in 2017, but both times failed to make it through the state legislative process.

“I was perplexed, absolutely perplexed, why folks in the House (of Representatives) didn’t get it, and there were some in the Senate who didn’t get it,” recalled Guerra, who in 2015 – along with Rep. Sergio Muñoz, Jr., D-Mission – were joint authors of the idea. “But they finally got it (in 2019), and they got it through your help, Sen. Alvarado and Sen. Hinojosa, and both of you worked very hard. In the House of Representatives, Terry, you were a big proponent of this as well.”

He also praised DHR Health leaders for their support of the measure.

“I want to thank each and every one of you for being here today, but can we not forget our doctors here, we simply cannot forget them, and thank you for what you do for bringing this issue to light for us, and to DHR Health, for making sure that indeed we were on the forefront in trying to make things better for Texans, especially here in the Rio Grande Valley,” Guerra said.

García-Cantú and Martínez are both breast surgeons at the DHR Health Breast Center of Excellence. The DHR Health Breast Center of Excellence provides a complete spectrum of collaborative services, from initial screening and diagnosis to innovative treatment plans. Its highly trained medical staff works as a multidisciplinary team to diagnose and treat breast cancer and disease. It is the only center in the Rio Grande Valley that is accredited by the National Accreditation Program for Breast Centers.

“Texas has not been on the forefront of women’s health for a long time, but I think things are changing with your help and your hard work in Austin for us,” the state lawmakers were told by Martínez. “So this is very beneficial to us, to our patients. This will definitely help us make an earlier diagnosis if the cancer is there, and it will help to prevent (cancer) and screen people earlier.”

DHR Health is a physician-owned health system and the only locally owned and operated hospital left in Hidalgo and Cameron counties. Anchored in southwest Edinburg, with a growing presence in neighboring McAllen, DHR Health offers some of the most comprehensive medical care on the U.S. southern border, with more than 1,400 nurses and 600+ physicians providing care in 70+ specialties and sub-specialties.

DHR Health is the flagship teaching hospital for the UTRGV School of Medicine and encompasses a general acute hospital with the only dedicated women’s hospital South of San Antonio, a rehabilitation hospital, a behavioral hospital, more than 60 clinics Valley-wide, advanced cancer services, the only transplant program in the Rio Grande Valley – and the only functioning 24/7 Level 1 Trauma Center south of San Antonio.

DHR Health is headquartered on a 130-acre site, with most of the facilities in southwest Edinburg but with a growing South Campus immediately across Owassa Road in northwest McAllen. 

“Every year in the U.S., we practice approximately 40 million screening mammograms. Of those, it’s about 10 percent we have to call back to do a diagnostic mammogram. One of the main obstacles for the patients to come back is to pay out-of-pocket for the performance of the diagnostic mammogram,” said García-Cantú. “Out of those, we are going to get about four to five percent breast cancer, and that is a big number. This is something that will be a great gift for all the women in Texas, and also sometimes for men in Texas. For every 100 cases of breast cancer in women, we have one in men.”

Mario Lizcano, Administrator of Community Engagement and Corporate Affairs, DHR Health, who introduced the lawmakers and DHR Health physicians in attendance at the Wednesday, November 6, 2019 news event, expressed his pride not only for the hospital system but also for Bernal.

“I think it is very important for us to hear the news, and we congratulate you for this effort,” Lizcano said. “I was given this opportunity from our organization to present today, but I am also very happy because Diego Bernal is my cousin, so it was very important for me to be here and be part of this announcement.”

Although the San Antonio lawmaker was not able to make the Valley news conference, on his Facebook, he did share some of the history leading to the legislation and state law.

According to Bernal, who posted the following comments on Sunday, September 29, 2019:

“For starters, it’s important to understand that mammograms involve a two-step process: 1) the screening mammogram, which can signal that there might be an issue, then 2) the diagnostic, which determines whether there certainly is or is not a problem. 

“In the past, most insurance plans, as well as Medicaid, covered the screening mammogram in full. The diagnostic, however, was not covered in full and required women to pay out-of-pocket. These expenses ranged from $300 to over $1000.

“For many women, especially those with dense breast tissue, a history of breast cancer in their family, or who are survivors themselves, the screening mammogram isn’t that helpful. Their physician will often bypass the screening and opt to start with the diagnostic (mammogram).

“That means for a striking number of women of color and poor women, the diagnostic mammogram is their first mammogram. It also meant that their first mammogram required out-of-pocket payment. For these women, and all those needing the diagnostic (mammogram) after a screening mammogram raised concerns, cost became a factor.

“Sadly, many of them would put off, save for, or skip it altogether – heartbreaking, and potentially deadly. House Bill 170 attempts to remedy that. House Bill 170 requires that all state-regulated insurance plans, as well as Medicaid, cover the diagnostic mammogram in full.

@komensanantonio first raised the issue with me during the 84th Legislature. I couldn’t believe what I was hearing and have been trying to pass it ever since. After three sessions, and with the masterful help of @CarolforTexas in the Senate, we passed House Bill 170. It became law on (Sunday) September 1.

“Texas is now one of only four states with this kind of insurance requirement. Breast cancer has affected my family and those of countless others. Until there’s a cure, early detection and treatment are the best weapons we have in this battle. I hope this allows us to fight back a little harder. Let’s keep pushing.”

(The video of the press conference is available online at:

(https://www.facebook.com/DHRhealth/videos/458094204912382/?tn-str=k*F)

DHR HEALTH FIRST HOSPITAL IN SOUTH TEXAS TO OFFER THE LATEST, CUTTING-EDGE HEART VALVE REPLACEMENT TECHNOLOGY

DHR Health is expanding its expertise in cardiac care through the formation of the DHR Health Structural Heart, Valve and Endovascular Institute, the first in the Rio Grande Valley to offer comprehensive treatments, including Transcatheter Aortic Valve Replacement (TAVR), Endovascular Aneurysm Repair (EVAR), Transcatheter Mitral Valve Repair (MitraClip Procedure) and the Left Atrial Appendage Closure (WATCHMAN).  

With heart disease affecting 48 percent of adults in America, Norman Ramírez, M.D., F.A.C.C., Chief Medical Officer and Physician Executive (Heart and Vascular Institute) at DHR Health, is pleased that individuals in the Rio Grande Valley who suffer from AFib, Mitral Regurgitation, Severe Aortic Stenosis, will now have a variety of options for treatment. 

“DHR Health continues to show its commitment to providing patients with the most advanced technology. We are the only hospital south of San Antonio that offers these procedures,” said Ramírez. “The impact of this new technology being utilized in the Rio Grande Valley will benefit many patients in our community who are at high risk, or even intermediate risk, for open-heart surgery.”

Focused on reducing and minimizing procedure and device-related complications and costs along with eliminating the need for open-heart surgery, DHR Health’s Structural Heart Institute provides patients a combination of medical and surgical programs that use the most minimally invasive interventions to repair and replace valves in the heart.  

Ramírez leads a team of cardiologists who work closely with referring physicians to evaluate the needs of each patient and develop a specific treatment plan. The goal is to find the best possible treatment for each patient they come in contact with and improve their quality of life. Each patient is provided with innovative, effective and comprehensive cardiovascular care in the Rio Grande Valley, without the need to leave home. 

The DHR Health Heart Institute, the largest heart hospital in the Rio Grande Valley, and DHR Health Structural Heart, Valve and Endovascular Institute have joined their teams of interventional cardiologists and cardiovascular surgeons in order to provide patients these minimally invasive treatment options that have faster recovery times.

Elizabeth Fuentes, one of Ramírez’s first patient’s in the Rio Grande Valley to undergo surgery, arrived at DHR Health on August 12, 2016, to receive treatment via the TAVR procedure. 

“I was experiencing symptoms of a heart condition– shortness of breath and dizziness. It was at that time that I was referred to Dr. Ramírez at the DHR Health Heart Institute,” she said. “I knew I was going to be the first patient undergoing this procedure, but I wasn’t hesitant, I knew I was in good hands and I knew I wouldn’t be the last.”

About the Procedures

The TAVR (Transcatheter Aortic Valve Replacement) allows for the replacement of a diseased aortic heart valve through a minimally invasive procedure without open-heart surgery and without surgical removal of the diseased valve. 

The device is typically inserted via an artery in the leg and then guided through the arteries into the heart. Once in place, the device expands and takes over the original valve’s function to enable oxygen-rich blood to flow efficiently out of the heart. The TAVR allows patients to see results right away. Patients usually see an immediate improvement in energy, breathing, and overall daily activities. 

The MitraClip (Transcatheter Mitral Valve Repair) helps restore normal blood flow through the heart for patients who have mitral regurgitation, which occurs when blood leaks backward through the mitral valve each time the left ventricle contracts.  

When the leakage is severe enough, a person may experience palpitations, shortness of breath, coughing, and swelling of the legs and feet.  To correct this, a small device is attached to the mitral valve allowing the valve to close more completely. This procedure is less invasive than traditional open-heart surgery and may vary from person-to-person. However, patients are usually released from the hospital within one-to-two days.  

Improvement is experienced immediately allowing patients to have a better quality of life soon after this procedure. If not treated, mitral regurgitation can cause other, more serious heart problems such as heart failure or death.  

With 2.7 million Americans living with Atrial Fibrillation (AFib), patients and providers are now more hopeful with the availability of WATCHMAN (Left Atrial Appendage Closure), a permanent implant that closes off an area of the left atrial appendage of the heart to keep blood clots from forming and entering the bloodstream and that can potentially cause a stroke.  

Ramírez recommends this implant for patients who suffer from AFib, a heart condition involving a quivering or irregular heartbeat (arrhythmia) that can lead to blood clots, stroke, heart failure, and other heart-related complications and who cannot tolerate long term use of a strong oral blood thinner. Once the WATCHMAN device is implanted, blood thinners can be stopped minimizing the risk of bleeding. The procedure is done under general anesthesia and takes about an hour.  Patients commonly stay in the hospital overnight and leave the next day allowing them to get back to their daily activities.  

More information on any of these procedures is available by contacting the DHR Health Structural Heart, Valve, and Endovascular Institute at (956) 362-8590. 

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R-Myna Evans contributed to this article. For more information, please contact Roberto Haddad, Vice President and Counsel for Government Affairs and Policy at DHR Health, or Jesse Ozuna, Government Affairs Officer at DHR Health, at 956/362-7165.  For more on this and other Texas legislative news stories that affect the Rio Grande Valley metropolitan region, please log on to Titans of the Texas Legislature (TitansoftheTexasLegislature.com).

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