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Monday, March 30, 2015

SGR Repeal Flies Through House, Stalls in Senate

Behind the strong leadership of Rep. Michael Burgess, MD (R-Lewisville), and the bipartisan support of our Texas congressional delegation, the bill to repeal Medicare’s hated Sustainable Growth Rate (SGR) formula won overwhelming approval in the U.S. House of Representatives. Leaders in the upper chamber promise the Senate will take up the bill quickly when Congress returns April 13 from its Easter recess. See Wednesday’s edition of TMA’s Action newsletter for details on how Medicare will handle claims for services provided after April 1.

Reps. Kevin Brady (R-The Woodlands) and Gene Green (D-Houston) also cosponsored the bill, and Rep. Henry Cuellar (D-Laredo) pushed hard to ensure it included language protecting Texas’ medical liability reforms. In addition to Reps. Burgess, Brady, Green, and Cuellar, each of the following Texas members of Congress deserve thank-you letters or calls for their “yes” votes on HR 2, the Medicare and CHIP Reauthorization Act (see the TMA Grassroots Action Center for addresses and phone numbers for your representative): Reps. Ted Poe, Jeb Hensarling, Joe Barton, John Culberson, Al Green, Michael McCaul, Mike Conaway, Kay Granger, Mac Thornberry, Randy Weber, Beto O’Rourke, Bill Flores, Sheila Jackson Lee, Randy Neugebauer, Joaquin Castro, Lamar Smith, Pete Olson, Will Hurd, Roger Williams, Blake Farenthold, Eddie Bernice Johnson, John Carter, Pete Sessions, Marc Veasey, Filemon Vela, Lloyd Doggett, and Brian Babin.

TMA also appreciates the support of Senate Majority Whip John Cornyn of Texas, and will work with him during the two-week recess to ensure the Senate passes the bill and quickly puts a stake into the SGR. I also urge you to send calls and letters of support into Sen. Ted Cruz’s office.

Another Round of Thank-Yous for TMA Members Testifying at the Legislature

Ten TMA member physicians took time away from their practice and took turns testifying for medicine in front of House and Senate committees last week. I send my wholehearted thanks and praise, and I think they deserve yours as well. In chronological order:
  • John Holcomb, MD, of San Antonio, and Frank Cho, MD, of Austin testified before the Senate Health and Human Services Committee on the sunset bills to reorganize Texas health and human services agencies. Dr. Holcomb also testified before the same panel for Senate Bill 207 by Juan “Chuy” Hinojosa (D-McAllen), which specifies that unintended billing errors or coding mistakes are decidedly not Medicaid fraud.

  • Keller pediatrician Jason Terk, MD, testified before the House Public Health Committee in support of two bills by Rep. J.D. Sheffield, DO (R-Gatesville), to improve immunizations. Dr. Terk also testified for five bills before that committee to curb minors’ access to e-cigarettes.

  • Council on Legislation Chair Dawn Buckingham, MD, and Houston anesthesiologist Sherif Zaafran, MD, testified before the Senate Business and Commerce Committee on Senate Bill 481 by Sen. Kelly Hancock (R-North Richland Hills). They expressed our serious concerns that the legislation eliminates the $1,000 threshold for mediation over bills from facility-based physicians for services provided out of network.

  • Pain management specialists C.M. Schade, MD, of Mesquite and Richard Hurley, MD, of Waco testified before the Senate Health and Human Services Committee for Senate Bill 195 by Sen. Charles Schwertner, MD (R-Georgetown), which, among other things, does away with the state’s controlled substance registration.

  • Leslie Secrest, MD, a Dallas psychiatrist, and Robert Greenberg, MD, a Temple emergency medicine physician, came before the Senate Health and Human Services Committee to urge passage of Senate Bill 359 by Sen. Royce West (D-Dallas). The bill would permit physicians to initiate a four-hour hold on patients who have voluntarily sought care at a hospital or freestanding emergency medical center but then want to leave, though the treating physician believes the patient is a danger to self or others.

  • Houston emergency medicine physician Arlo Weltge, MD, testified at the House State Affairs Committee hearing on House Bill 614 by Rep. Sarah Davis (R-West University Place), which would require the state to establish a registry in which patients could submit their advance directives.

On the Road With Dr. King

With just more than a month left in his term, TMA President Austin King, MD, continues his nonstop travels on behalf of Texas physicians. His recent stops included a legislative update to the McLennan County Medical Society; the installation of Austin gastroenterologist Pradeep Kumar, MD, as the new president of the Travis County Medical Society; and a panel discussion at the leadership meeting of the Texas Society of Clinical Oncology that also included State Rep. Stephanie Click (R-Fort Worth) and TMA Trustee Lewis Foxhall, MD.

TMA's Choosing Wisely Campaign Has Made a Difference

We’ve closed the books on a very successful two-year campaign in support of the Choosing Wisely® program. The TMA Foundation received a grant from the ABIM Foundation to promote Choosing Wisely among Texas physicians. The program encourages physicians to discuss with patients the wisdom of many common tests or treatments that national specialty societies have identified as frequently unnecessary or inappropriate. Ninety-three percent of Texas physicians surveyed said they will continue to use Choosing Wisely in their practices. More than 600 physicians earned continuing medical education credit from our free — and ongoing — Choosing Wisely CME Bundle.

Monday, March 23, 2015

Flood Capitol Hill With SGR Calls Tomorrow

Over the years, every member of the Texas Delegation in Congress has told us that he or she supports repeal of Medicare’s noxious Sustainable Growth Rate (SGR) formula. Now is the time to hold them to their promises. We have just one week to get it done before Congress goes on recess and the 22.4-percent cut kicks in on April 1. HR 1470, the SGR Repeal and Medicare Provider Payment Modernization Act of 2015, by our own U.S. Rep. Michael Burgess, MD (R-Lewisville), will be up for a vote on the House floor this week. It eliminates the SGR immediately, ensures solid — if nonspectacular — Medicare rate increases the next five years, and offers a bonus for physicians who participate in alternative payment models and meet certain thresholds. Any of us could find fault with one or more provisions in the bill, but, bottom line, it’s immensely better than the status quo. As TMA President Austin King, MD, said in his email Action Alert to all of our members, “We physicians are tired of the never-ending uncertainty; the never-ending threats to cut Medicare pay; the never-ending need to lobby Congress on the same, never-ending problem. Our patients are tired of the never-ending fear of losing their doctor. Eighteen years and 17 patches is enough.” If you didn’t already respond to the Action Alert, you have another chance to help us turn up the heat on the House. Tomorrow is National Call to Action Day on the SGR, organized by the American Medical Association, TMA, and medical societies nationwide. Contact your senators and representative and urge them to support HR 1470 (and its companion, S 810) by: 
  • Calling via AMA’s toll-free Physicians Grassroots Hotline at (800) 833-6354.
  • Using the TMA Grassroots Hotline to send an urgent email.
  • Contacting legislators directly through their own social media channels, and then sharing your message with your own Facebook friends and Twitter followers.

Legislature Gets a Healthy Dose of Health Vision

It was a busy and productive week for medicine’s priorities in the 84th Texas Legislature:
  • The Senate Finance Committee took up Senate Bill 18 by Sen. Jane Nelson (R-Flower Mound) Thursday. The measure aims to allocate an additional $60 million for graduate medical education (GME) expansions. The funding would sustain the 2013 GME expansion programs while building other programs to improve access to care.

  • San Antonio pediatrician Ryan Van Ramshorst, MD, continued his all-star work on the witness stand for TMA and the Texas Pediatric Society. He told the Senate Health and Human Services Committee that Texas physicians strongly support Senate Bill 760 by Sen. Charles Schwertner, MD (R-Georgetown), which would improve oversight and accountability of Medicaid HMOs’ physician networks. He also testified on Senate Bill 791 by Sen. Lois Kolkhorst (R-Brenham) requiring the state to develop and distribute educational materials for pregnant women or women planning a pregnancy about congenital cytomegalovirus. He explained physicians support the education and outreach components outlined in SB 791, but we have concerns with the state dictating specific medical treatments.

  • The Senate Education Committee approved Senate Bill 96 by Sen. Juan “Chuy” Hinojosa (D-McAllen), prohibiting the use of e-cigarettes on school property.

  • The House Judiciary and Civil Jurisprudence Committee took up House Bill 1433 by Rep. John Smithee (R-Amarillo) to prevent insurance company delays in adopting appropriate payment for immunizations, serums, and vaccines. The bill was negotiated by TMA to protect the basis for prompt-pay penalties and to prevent efforts to reduce the penalty to 18 percent per year.

TMA PracticeEdge Board Appoints CEO, Elects Officers

The Board of Managers of TMA PracticeEdge, our new physician services organization, met for the first time. The board chose me to be the new company’s CEO. Board officers are Don Read, MD, of Dallas, chair; Shara McClure of Dallas, vice president for network management of Blue Cross and Blue Shield of Texas, vice chair; and Doug Curran, MD, of Athens, secretary/treasurer. Drs. Read and Curran are also chair and vice chair, respectively, of the TMA Board of Trustees. The other members of the Board of Managers are TMA Trustee David Fleeger, MD, of Austin; TMA Trustee Dan McCoy, MD, of Dallas; and Rob Morrow, MD, of Houston. We will be making some important announcements about our first clients, affiliations, and services in the next few weeks.