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Monday, June 30, 2008


Hundreds of angry Texas physicians clogged the phone lines and e-mail boxes in the offices of U.S. Sens. John Cornyn and Kay Bailey Hutchison to complain about the senators’ votes against a bill to forestall tomorrow’s 10.6-percent cut in physicians’ Medicare payments. The bill failed by one vote, and Congress promptly left Washington for the July 4 recess. “Texas physicians are deeply offended that [the senators] chose to protect insurance companies’ profits instead of protecting our patients’ health,” TMA President Josie Williams, MD, said. In a show of no confidence for Senator Cornyn, the TEXPAC Executive Committee voted unanimously to withdraw our endorsement for his reelection. “There is talk and then there is action,” said TEXPAC Board Chair Manny Acosta, MD. “We expect our elected officials to show leadership and do the right thing. Absent that, TEXPAC has rescinded our endorsement of your candidacy.” Our strong words and actions earned TMA and TEXPAC positive coverage in the New York Times and media outlets across Texas. They also brought a phone call from Senator Cornyn to Dr. Williams explaining his vote. The American Medical Association joined TMA and state and specialty medical societies around the nation in protesting the Senate’s lack of action."


Two days before the debacle in the Senate, the U.S. House voted overwhelmingly for the bill that would have averted the Medicare cuts. Republican U.S. Reps. Michael Burgess, MD (R-Lewisville), Ralph Hall (R-Rockwall), Mike McCaul (R-Austin), Ted Poe (R-Humble), and Lamar Smith (R-San Antonio) withstood party and White House pressure to stand instead with physicians and patients.

Democrats voting for the bill were Reps. Henry Cuellar (D-Laredo), Lloyd Doggett (D-Austin), Chet Edwards (D-Waco), Charlie Gonzalez (D-San Antonio), Al Green (D-Houston), Gene Green (D-Houston), and Ruben Hinojosa (D-Mercedes). Also voting “yes” were Reps. Sheila Jackson-Lee (D-Houston), Eddie Bernice Johnson (D-Dallas), Nick Lampson (D-Stafford), Solomon Ortiz (D-Corpus Christi), and Ciro Rodriguez (D-San Antonio). Please thank them."


Frankly, we’re not 100-percent sure. There’s a chance the dead Senate bill could come back up after the July 4 recess. We will join AMA and others in working with our entire delegation in Congress, including both of our senators, to seek a quick resolution. I encourage all Texas physicians to contact their senators and representative to urge them to fix the problem before it further affects patient care. We will, of course, continue to press for a long-term solution to the Medicare payment crisis, as outlined in TMA’s Texas Medicare Manifesto. For physicians, the outlook is also murky:
  • By law, claims are not paid for 14 days after receipt, so there is a short opportunity for carriers to hold up processing in the hope that Congress acts quickly to avert the cuts retroactive to July 1.
  • Physicians can opt out of Medicare for two full years (PDF); however, there is no opportunity at this point for physicians to switch their Medicare status to “nonparticipating.”"

Monday, June 23, 2008


With just one week left until the 10.6-percent cuts in physicians’ Medicare payments take effect, the U.S. House of Representatives is taking its shot at averting the cuts. Tomorrow, the House should consider H.R. 6331, which would continue current payment rates through the end of the year and add a 1.1-percent increase for 2009. The strategy requires a two-thirds vote of the House for the bill to pass. Please use the American Medical Association’s toll-free Grassroots Hotline at (800) 833-6354 to call your U.S. representative today and urge a “yes” vote on H.R. 6331. Negotiations continue among Senate Democrats, their Republican peers, and the White House on a bill that can pass and avoid a presidential veto. A Senate vote may come later this week, so be prepared for another call to action aimed at our U.S. senators.


Physicians from McAllen to El Paso join their colleagues from other border states on Capitol Hill today for a three-day lobby trip to engage Congress on border health issues. The well-timed visit gives the Border Health Caucus the opportunity to talk directly about the Medicare funding crisis. Tomorrow’s third annual Border Health Conference will cover adequate funding for Medicare and Medicaid, support for physician training, ensuring quality health care for border patients, and proper preparedness for disasters and infectious epidemics.


The 2008 annual meeting of the American Medical Association House of Delegates completed its business and closed up shop a day ahead of schedule, something even long-time delegates said they had never seen happen before. The house calmly considered and debated new AMA policies and elected a new slate of leaders. Highlights:


We are preparing materials now for the TMA Board of Trustees’ biennial strategic planning session. We need your input. Let me know what issues are critical for you and your practice and where you would like to see TMA focus during the 2009 Texas Legislature.

Monday, June 16, 2008


It was, and still is, our best bet to stop the 10.6-percent cut in physicians’ Medicare payment scheduled for July 1. But severe partisan politics in Washington prevented the U.S. Senate from moving forward with Senate Bill 3101. A vote to take up the measure failed (54 to 39), short of the three-fifths majority needed to stop debate and take action on it. “Watching Congress work its will is, more often than not, frustrating and mind-boggling when you are faced daily with the challenges of caring for your patients,” said TMA President Josie Williams, MD. The bill would have maintained current Medicare payment rates for the rest of the year, and add a 1.1-percent increase in 2009, a 2-percent bonus for e-prescribing in 2009 and 2010, and a 2-percent bonus for reporting Physician Quality Reporting Initiative measures in 2009 and 2010. The biggest stumbling block was that S 3101 would have cut Medicare Advantage plans to pay for increasing physicians’ payments. President Bush says he will veto any bill that takes money from the Medicare Advantage plans. Senate Democratic and Republican leadership have begun negotiating a bipartisan compromise that can pass muster with the White House. “We will continue to keep you apprised of progress as it occurs and will ask for your action only when it’s critical to moving the bill along,” Dr. Williams said.


What a great weekend in Chicago for TMA physicians. The big news is that Jim Rohack, MD, won an uncontested race to be president-elect of the American Medical Association. Dr. Rohack, a cardiologist from Temple, will be installed as the 164th AMA president next June. Under his leadership, Dr. Rohack pledged, AMA will be 'clear, focused, and forceful' in advocating on behalf of American physicians and their patients. In other AMA election news:

  • Fort Worth’s Sue Rudd Bailey, MD, won reelection to the AMA Council on Medical Education.
  • Dawn Buckingham, MD, of Austin, is chair-elect of the AMA Young Physicians Section.
  • Jayesh Shah, MD, of San Antonio, is vice chair of the AMA International Medical Graduate Section.
  • Reid Orth, a medical student from The University of Texas (UT) Health Science Center at San Antonio won reelection as vice chair of the AMA Medical Student Section (MSS).
  • Spencer Pruitt, a medical student from UT Health Science Center at Houston, is the new chair of AMA MSS Region 3.

Follow all the AMA action this week, including the fate of Texas’ three resolutions, in Blogged Arteries.


Congratulations to the medical students of The University of Texas-Houston in general and Spencer Pruitt in particular. The AMA MSS named UT-Houston the Chapter of the Year, and Spencer received the section’s 2008 Leadership and Excellence Award.

Monday, June 9, 2008


As usual, it takes a deadline with a big cut in physicians’ Medicare payments for Congress to act. This time, it’s the 10.6-percent cut scheduled for July 1. TMA is very engaged in the debate, and we’re working with all of our allies in Washington to stop the cut and find a way to stop this annual circus. A TMA team of physicians and county society executives will be in Washington June 23 for our annual Border Health Conference. It’s a highly charged and partisan atmosphere, but there is some movement in our direction. And thanks to Texas physicians’ hard work, most of the Texas congressional delegation supports a bigger Band-Aid than we’ve seen in recent years, and they want a permanent Medicare fix. Here’s where we are so far:

  • The most recent plan we’ve seen from Senate Finance Committee Chair Max Baucus (D-Montana) would stop the cut and institute a 1.1-percent increase for the rest of this year and all of 2009.
  • That would give Congress 18 months to devise a long-term replacement for the sustainable growth rate (SGR) financing formula. It also sets up a very steep cliffhanger: The cost of the 18-month delay would require a cut in physician Medicare payments of 20 percent or more in 2010.
  • That cut is even more incentive to replace the SGR with a system that keeps up with the cost of running a practice. The best permanent fix bills have come from Texans: Sen. John Cornyn and Rep. Michael Burgess, MD (R-Lewisville).
  • Financing the 18-month stopgap also includes money set aside to increase payments to Medicare Advantage plans. President Bush has threatened to veto any bill that cuts on Medicare Advantage.


Most versions of the Medicare fix bills we’ve seen would increase the bonus for the Physician Quality Reporting Initiative (PQRI) from the current 1.5 percent up to 2 percent of your allowed charges. Most of the bills also would give physicians a 2-percent bonus for using electronic prescribing. But that carrot would turn into a 1-percent penalty by 2011 for physicians who don’t e-prescribe.


June 15 is the deadline for paying the new state business tax, and I’m sure you’re hearing grumbling from physicians who’ve never had to pay this tax before. Remind your colleagues that TMA fought at the Texas Legislature to make sure physicians could exclude payments from Medicare, Medicaid, and other government health programs from their taxable revenue. You also can deduct the costs of uncompensated care. And we worked overtime with Comptroller Susan Combs’ office to make sure the tax rules preserved those important protections for physicians and patients.


Check out our interview with Jim Rohack, MD, the former TMA president running for American Medical Association president-elect at the AMA House of Delegates meeting, June 14-18. We won’t have an EVPGram next week, but we’ll blog about all the action.

Monday, June 2, 2008


The Texas Legislature meets in regular session for only 140 days every odd-numbered year. But House and Senate committees get much work done between sessions, and TMA is there to provide health care guidance along the way. Just last month:

  • Charlotte Smith, MD, of Austin, told the Senate State Affairs Committee why TMA strongly opposes physician-ranking schemes that are based on faulty data.
  • Suzanne Madden of the Verden Group testified before the State Affairs Committee on behalf of TMA. She shared data (PDF) showing how health plans hide how they spend insurance premium dollars.
  • Former TMA President Ladon Homer, MD, told two Senate committees why state support for graduate medical education is critical for Texas to have enough physicians to care for our growing population.


Since the May 23 deadline to submit Medicare and Medicaid claims with National Provider Identifiers (NPIs) only – no legacy numbers – state and federal officials are reporting a large number of physicians’ claims are being rejected. See this week’s Action newsletter for details. Having NPI-related claims problems? E-mail the TMA Knowledge Center, call (800) 880-7955 or (512) 370-1550 for assistance, or visit TMA's online NPI Resource Center.


See for yourself.


A pair of Texas physician leaders is running, so far unopposed, for office at this month’s meeting of the American Medical Association House of Delegates. Jim Rohack, MD, a former TMA president, is running for AMA president-elect, and Texas Delegation Chair Sue Rudd Bailey, MD, is seeking reelection to the AMA Council on Medical Education. The meeting is June 14-18 in Chicago. We’ll blog about all the action. We’re also taking three resolutions that the TMA House of Delegates passed in May. They would:
  • Ask AMA to help physicians move toward e-prescribing, such as by winning approval to remove the requirement that physicians handwrite “brand medically necessary” on Medicaid prescriptions.
  • Urge Congress to increase penalties for using health savings accounts for nonmedical purposes.
  • Have AMA hold all its meetings at completely smoke-free facilities, “within all reasonable means.”


Although the five-year term of its settlement with organized medicine expires today, Aetna has agreed to maintain most of the business practice changes it implemented because of the settlement. We urge you to file any problems with Aetna — or any other health plan — through our Hassle Factor Log.