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Monday, December 14, 2009

LAWMAKERS LOOK TO AVERT MEDICARE CUTS

As U.S. Senate Majority Leader Harry Reid (D-Nevada) searches for the magic 60 votes he needs to pass a health system reform bill, members of Congress and leaders of organized medicine are searching for a way to put off the 21.2-percent cut in physicians’ Medicare payments scheduled for Jan. 1. Senator Reid’s latest compromise does away with the controversial public option for health insurance. In its place is a plan that includes allowing individuals age 55-64 to buy in to Medicare. Given the many problems with the current Medicare program, the American Medical Association and others are encouraging physicians to tell their senators they oppose the Medicare buy-in. The latest move certainly makes it no easier for TMA to change our position: Without significant changes, we cannot support the Senate bill. We are examining details of a possible short-term patch of 30 to 60 days to freeze physicians’ Medicare payments at current rates. The measure likely would be tacked on to a budget bill that must pass by the end of the year, such as defense appropriations. The idea is to give lawmakers more time to pass a permanent replacement for Medicare’s Sustainable Growth Rate (SGR) formula. Another one- or two-year patch that digs an even larger budget hole at the end is not acceptable. TMA’s consistent message to Congress is that we need a rational Medicare physician payment system that automatically keeps up with the cost of running a practice and is backed by a fair, stable funding formula.

CONFUSED ABOUT MEDICARE PARTICIPATION? TMA WEBINAR WILL ANSWER YOUR QUESTIONS

Washington has extended physicians’ 2010 Medicare participation deadline to Jan. 31. In light of the controversy over long-term health system reform, the pending 21.2-percent payment cut, the elimination of consulting codes, and many other issues, we know that practices are thinking hard about this participation decision. While TMA can’t advise you which direction to take, we can give you detailed information about your participation options and the consequences of those choices. That’s why we’ve turned to our in-house Medicare experts to record a Webinar to help you make an informed decision. We’re moving quickly; our goal is to have this posted on the TMA Web site right after the first of the year. This will allow us to include the most current information while still giving you time to weight your options. Stay tuned for more details.

PAIR OF DOCS NOT A PARADOX FOR TEXPAC; BOTH BASALDUA AND CURLING WIN ENDORSEMENT

What do you do when two active TMA and TEXPAC members both decide to seek the same open Texas House of Representatives seat and both want your endorsement? With advice from local physician leaders, the TEXPAC Board of Directors took the Solomonic approach and came out behind both candidates. Two Kingwood physicians — anesthesiologist Susan Curling, MD, and family physician Martin Basaldua, MD — have filed to fill the North Houston seat of retiring State Rep. Joe Crabb (R-Atascocita). The TEXPAC decision came after Harris County members of the TEXPAC board recommended the dual endorsement in the race for House District 127. We urge physicians and alliance members to get behind both candidates and do what you can — financially or otherwise — to help them. With a crowded field in the March 2 Republican primary, there likely will be a runoff in April. TEXPAC is focused on electing physicians, and this race give us two great opportunities.

DR. FLEMING INSTALLS NEW LEADER IN CORPUS CHRISTI

Pediatrician Josefina Torres, MD, is the 84th president of the Nueces County Medical Society, taking over from John McKeever, MD, an orthopedic surgeon. TMA President Bill Fleming was on hand to administer the oath of office to Dr. Torres.

H1N1 FLU VACCINATIONS NOW OPEN TO ALL TEXANS

The Texas Department of State Health Services (DSHS) has lifted its restrictions on who can receive the H1N1 flu shot and is now encouraging physicians to give the H1N1 vaccine to the general public. DSHS eased its previous guidelines on reserving vaccine for members of priority groups. The state is still encouraging physicians to serve the priority groups, but an increasing supply of vaccine will allow anyone who wants to be protected against H1N1 to get vaccinated.

EVPGRAM TO TAKE A HOLIDAY BREAK:

EVPGram takes its annual late-December hiatus starting next week. We’ll be back in your in-box in early January. Of course, EVPGram and other TMA communications will be standing by to keep you apprised of any important breakthroughs in Washington on health system reform or the Medicare payment formula.

Tuesday, December 8, 2009

MEMBER SURVEY RESULTS SUPPORT TMA DECISION TO NOT BACK SENATE HEALTH REFORM BILL

Texas physicians and medical students say America’s health system is in need of reform, but they don’t prescribe radical change, and they believe the U.S. Congress’ current treatment plan will do more harm than good. Those are the primary findings of a recent TMA online poll of nearly 3,300 members. The results, along with extensive TMA policy, drove our decision to withhold support for the health system reform bill the U.S. Senate is now debating. The survey found that Texas physicians do not trust Congress and have no confidence that its deliberations are producing real solutions. Among the results:
  • Two-thirds said America's health care system has some problems and should be reformed, but only 20 percent called for a radical overhaul.
  • Nearly 70 percent said if a new health care bill becomes law, it will make the U.S. health care system worse than it is now in the long run.
  • Six out of 10 said quality of patient care will get worse, patients’ cost for care will go up, and patients’ health care coverage will go down if a new health care bill becomes law.
  • Respondents strongly oppose any outside interference in the patient-physician relationship. But by nearly a 2-1 margin, they say government interference is a bigger threat than insurance company interference.

PERRY, OTHER TOP SPEAKERS SLATED FOR TMA WINTER CONFERENCE

Gov. Rick Perry; U.S. Surgeon General Regina Benjamin, MD; American Medical Association President Jim Rohack, MD; National Medical Association President Willarda V. Edwards, MD, MBA; and a best-selling author are among the scheduled speakers for TMA 2010 Winter Conference. The event is Jan 29-30 at the new AT&T Executive Education and Conference Center on The University of Texas campus and at the TMA Building. You can learn more details about our Leadership for Changing Times conference and register on the TMA Web site.

TMA PREPARES FOR HIT OUTREACH PROJECT

In anticipation of upcoming federal grants, TMA’s physician leader on health information technology (HIT) and staff met with leaders of four organizations planning HIT Regional Extension Centers (HITRECs) for Texas. If the grants are approved, TMA would provide outreach and physician education for the HITRECs. Funded through the economic stimulus bill that passed this spring, the HITRECs would help Texas physicians “select, successfully implement, and meaningfully use certified electronic health record (EHR) technology to improve the quality and value of health care.” The governing board of each extension center would include at least 50 percent physicians. Joseph Schneider, MD, chair of TMA’s Committee on HIT, shared the results of a new TMA survey:
  • Nearly 60 percent of physicians surveyed said they will attempt to qualify for federal incentive payments for meaningful use of EHRs.
  • Forty-two percent said they already have implemented an EHR and another 41 percent said they want or plan to do so.
  • Cost is the No. 1 barrier for those who do not plan to implement an EHR.

LUBBOCK-CROSBY-GARZA COUNTY SOCIETY INSTALLS NEW LEADER

Emergency medicine specialist Juan Fitz, MD, is the new president of Lubbock-Crosby-Garza County Medical Society, taking over from Jack DuBose, MD. The society honored 78-year-old Lubbock thoracic surgeon Malcolm Thomas Jr., MD, as the winner of its 2009 Hippocratic Award. TMA President Bill Fleming, MD, was on hand for the ceremony and to provide Lubbock physicians an update on the health system reform debate in Washington. Dr. Fleming also visited Dallas, where he welcomed the Southern Medical Association Scientific Assembly. “The science of our profession is changing so quickly today, the business of our profession is changing so quickly today, the politics of our profession is changing so quickly today … the family of organized medicine is more important than ever,” he said.

Monday, November 23, 2009

TMA ANNOUNCES: “SENATE HEALTH PLAN BAD MEDICINE FOR OUR PATIENT”

With extensive input from our Task Force on Health System Reform and the Council on Legislation, the TMA Board of Trustees determined that the association will not support the U.S. Senate’s draft health reform bill (HR 3590) until it undergoes some necessary and significant changes. “We know that our patients — insured and uninsured, elderly and poor — need a much more efficient, effective, and accountable health care system,” TMA President Bill Fleming, MD, said in a news release we issued before the Senate’s initial vote on Saturday. “But, on the whole, the Senate health plan is bad medicine for our patients.” TMA based its analysis on the 17-point set of principles the House of Delegates adopted this year and on the results of an extensive survey of physician members conducted last week. Here are the pieces we like and support in HR 3590:
  • It would provide incentives for primary care,
  • It would require health insurance companies to be more accountable,
  • It would streamline insurance paperwork, and
  • It would enhance physicians’ access to information technology.
The bill, however, does nothing to correct Medicare’s flawed Sustainable Growth Rate (SGR) formula that is mandating a 21-percent cut in physician payments effective Jan. 1. It also would:
Increase the cost of health insurance for our patients and deliver even less in return;
Quadruple federal government interference, bureaucracy, and red tape for patients and physicians;
  • Create incentives for patients to pay a fine for not having insurance rather than pay an unrealistic amount for insurance coverage;
  • Neither protect Texas’ liability reforms nor expand those protections to patients and physicians in other states; and
  • Impose untested and arbitrary treatment standards that do not improve the quality of patient care.
Look for additional information and TMA action alerts to write our two U.S. senators in the coming weeks as the Senate debate continues.

A TURKEY-TIME SCORECARD ON HEALTH SYSTEM REFORM

In case you’ve lost track or haven’t been paying close attention, here’s a recap of the status of health system reform bills and the SGR fix to date, as well as TMA’s position on these bills:
  • On Oct. 21, the U.S. Senate fell short of the 60 votes necessary to debate S 1776 by Sen. Debbie Stabenow (D-Mich.) (PDF), the Medicare Physician Fairness Act of 2009. The motion failed on a vote of 47-53. The bill would have repealed the SGR payment formula. It also would have stopped the planned 21-percent cut in fees scheduled for Jan. 1, eliminated the $245 billion debt that has accumulated under the SGR, and laid the foundation for a new Medicare payment update system. TMA supported S 1776 even though it fell short of our call for a rational Medicare physician payment system that automatically keeps up with the cost of running a practice and is backed by a stable funding source.
  • On Nov. 7, the U.S. House of Representatives voted 220-215 to pass HR 3962, a comprehensive health reform package.TMA neither supported nor opposed the bill, but offered suggestions to “Fix What’s Wrong, Keep What Works” in the health care system.
  • On Nov. 20, the House passed HR 3961 on a 243-183 vote. The bill would stop the 21-percent cut scheduled for Jan. 1. It would replace the SGR with a formula that is still based on growth in the gross domestic product. It would set future payment rate changes separately for evaluation and management services and for procedural codes. House passage of HR 3961 was critical for a permanent SGR fix to be included in Congress’ final health reform package. Rep. Michael Burgess, MD (R-Lewisville), was the only GOP House member to vote for the bill. TMA supported the measure (PDF) even though it, too, does not meet our criteria for a permanent fix.
  • The Senate has just begun debate on HR 3590, its version of comprehensive health system legislation. On Nov. 21, just before leaving for Thanksgiving recess, senators voted 60-39 to bring the matter up for discussion. Debate is expected to last several weeks. As noted above, TMA has announced that it cannot support HR 3590 without substantial change.

Do you need more of our Fix What’s Wrong, Keep What Works posters, stickers, and postcards for your office? Order them online or call the TMA Knowledge Center at (800) 880-7955.

MEDICARE ENROLLMENT DEADLINE EXTENDED TO JAN. 31

With all the uncertainty in Washington and the 21-percent cut in physicians’ Medicare payments set to take effect the first of the year, the Centers for Medicare & Medicaid Services have given you an extra month to make up your mind on participating in Medicare next year. Physicians have until Jan. 31 to decide if they want to change their participation status in the Medicare program for 2010. The effective date for any status change, however, remains Jan. 1, and it will be in force for the entire year. You can find the Medicare participation agreement form on the Web site of TrailBlazer Health Enterprises, the Texas Medicare carrier. Your Medicare participation options are spelled out in an excellent document on the American Medical Association Web site (PDF), but note that it has not yet been revised to reflect the new deadline.

HAPPY THANKSGIVING; EVPGRAM TAKES A BREAK

I hope you enjoy the holiday with friends and family, and remember everything for which you are thankful. Your EVPGram will take a one-week holiday and be back in your in-box on Dec. 7.

Friday, November 20, 2009

House Passes SGR Fix Bill; Burgess Is Lone Republican to Vote “AYE”

The U.S. House of Representatives today (Nov. 19, 2009) passed HR 3961 on a 243-183 vote. The bill would stop the 21-percent cut in physicians' Medicare payments scheduled for Jan. 1. It would replace the Medicare Sustainable Growth Rate (SGR) with a new formula that is still based on growth in the gross domestic product. It also would set future payment rate changes separately for evaluation and management services and for procedural codes. House passage of HR 3961 is critical if a permanent SGR fix is going to be included in Congress' final health reform package.

Unfortunately, Capitol Hill partisan politics is complicating what already is a terribly complicated problem of health system reform. Rep. Michael Burgess, MD (R-Lewisville), was the only Republican to vote for HR 3961. I am terribly proud of Dr. Burgess for his courageous stance, which might expose him to some intraparty consequences. As the most knowledgeable member of Congress on Medicare, he introduces bills year after year to replace the SGR with a formula that is based on physicians' cost of caring for patients. He took the time early this morning to consult with TMA leaders about today's vote and what it means to Texas physicians and your patients.

"This bill is not the best way to fix the long-standing physician reimbursement problem," Dr. Burgess said after the vote. "The appropriate resolution is HR 3693, the Ensuring the Future Physician Workforce Act, which would finally make things right for our nation's doctors. I also do not think it is right to continue to pass massive spending bills that add to our country's record deficit with no rational payment plan in place. However, I think it is very unlikely that today's bill will ever become law, since the Senate has already soundly rejected a similar plan. Because of this, today's vote is largely symbolic, and with my 'yes' vote, I stand committed to America's doctors, the millions of seniors they care for, and TRICARE recipients, to fix this problem."

I also want to thank these Texas Democrats who voted for the bill: Reps. Henry Cuellar of Laredo, Lloyd Doggett of Austin, Charlie Gonzalez of San Antonio, Al Green of Houston, Gene Green of Houston, Rubén Hinojosa of Mercedes, Sheila Jackson Lee of Houston, Eddie Bernice Johnson of Dallas, Solomon Ortiz of Corpus Christi, Silvestre Reyes of El Paso, and Ciro Rodriguez of San Antonio.

(From TMA EVPGram, special issue, Nov. 19, 2009)

Thursday, November 19, 2009

AMA HOUSE STICKS TO PRO-REFORM POSITION

Despite calls from a vocal minority to the contrary, the American Medical Association House of Delegates backed the organization’s position in support of health system reform. “The time to make health system reform a reality is now,” said AMA President Jim Rohack, MD. The house adopted language requiring AMA to “actively and publicly” oppose or support certain details of reform legislation (PDF), pushing AMA leaders to stay true to existing association policy. “We shouldn’t have to move around in secret in the halls of Capitol Hill,” said Peter Levine, MD, a delegate from Washington, D.C. We should be leading and not hiding behind the shadows of people in Washington.” During extensive debate, the delegates:
  • Adopted language directly from TMA’s Texas Medicare Manifesto stating that “health care reform must include replacing the Sustainable Growth Rate (SGR) with a Medicare physician payment system that automatically keeps pace with the cost of running a practice, and is backed by a fair, stable funding formula;”
  • Included strong support for effective medical liability reform; and
  • Opposed unscientific measurements of physicians’ clinical outcomes and the establishment of a new Medicare bureaucracy that could set payment rates without congressional approval.
But a call for AMA to “actively and publicly oppose any new public health insurance option” failed 315 to 199. “It is bad tactics to give away all of your positions when you are playing a poker game such as we are with Congress,” said Barbara McAneny, MD, chair of the AMA Council on Medical Service. And, in the most telling action, the delegates defeated 350 to 167 language stating that AMA did not endorse HR 3962, the broad reform bill that the U.S. House of Representatives approved just days earlier with AMA support. Read complete coverage of the AMA house debate on TMA’s Blogged Arteries. We’ll also have our usual wrap-up of the full meeting in Texas Medicine.

HUGE HEALTH SYSTEM REFORM WEEK AHEAD ON CAPITOL HILL

Congress returns tomorrow from its Veterans Day recess with two big health system reform items on its pre-Thanksgiving plate. TMA joined AMA and more than 100 national specialty and state societies (PDF) in calling on the House to pass HR 3961. The bill would stop the 21-percent cut in physicians’ Medicare payments scheduled for Jan. 1. It would replace the SGR with a new formula that is still based on general inflation rates. It also would set future payment rate changes separately for evaluation and management services and for procedural codes. House passage of HR 3961 is critical if a permanent SGR fix is going to be included in Congress’ final health reform package. Across the rotunda, U.S. Senate leaders are scheduled to unveil their new comprehensive reform bill and begin what many expect will be a long and protracted debate. Be on the lookout for a TMA call to contact Texas Sens. John Cornyn and Kay Bailey Hutchison about that bill.

HAVE YOU COMPLETED TMA'S HEALTH REFORM SURVEY?

More than 2,100 TMA members have answered our online survey on health system reform. Have you? Please take about five minutes to respond to the e-mail invitation to take the survey. “TMA’s strength flows directly from our grassroots — our members,” said TMA President Bill Fleming, MD. “That’s why we need your feedback.” The deadline is 11 am Central Standard Time Thursday. We will publish the results soon after that.

MORE H1N1 VACCINE COMING TO TEXAS

Texas has ordered more than 3 million doses of the H1N1 influenza vaccine. State health officials urge physicians to continue to focus on immunizing priority populations such as pregnant women, children under 4, and health care workers. Read TMA’s weekly Flu Fighters’ Hotline to keep up with the latest on the spread of H1N1, how to administer and bill for the vaccine, answers to patients’ commonly asked questions, and other tips for your practice.

Wednesday, November 11, 2009

HOUSE PASSES HEALTH REFORM BILL WITHOUT SGR FIX OR LIABILITY REFORMS

By a five-vote margin, the U.S. House of Representatives late Saturday night passed HR 3962, Speaker Nancy Pelosi’s health system reform bill. It was mostly a party-line vote. Among Texans, all Republican representatives and Rep. Chet Edwards (D-Waco) voted against it; all the other Democrats voted for it. The bill won the American Medical Association’s support two days before the vote. A separate bill, HR 3961 — which won’t be considered until next week — eliminates the Medicare Sustainable Growth Rate (SGR) formula for physician payments with a new system that is still based on general inflation rates. It also would set future payment rate changes separately for evaluation and management services and for procedural codes. House passage of HR 3961 is, however, critical if a permanent SGR fix is going to be included in Congress’ final health reform package. HR 3962 includes a public insurance option with negotiable payment rates, a Medicare bonus for primary care practices, quite a few administrative simplifications for physicians’ dealings with insurance companies, and fines for most employers who do not offer health insurance benefits and for individuals who do not obtain insurance. It would create more than 100 new independent federal agencies to regulate health care. It would virtually prohibit the opening of any new physician-owned hospitals or growth of existing ones. HR 3962 does not include strong medical liability reforms. Thanks to an amendment from Rep. Henry Cuellar (D-Laredo), it does include some protections against federal preemption of Texas’ cap on noneconomic damages in health care liability cases. But experts from the Texas Medical Liability Trust caution that those protections are not broad enough.

AMA HOUSE OF DELEGATES PONDERS NEXT MOVES ON HEALTH SYSTEM REFORM

With large numbers of delegates incensed that AMA supported HR 3962, the AMA House of Delegates convened this weekend in Houston. Debate in a reference committee dealing with legislative matters stretched on for more than eight hours Sunday as delegates from various state and specialty societies both praised and lambasted AMA for supporting the bill. (See our live blog of the reference committee debate.) Much of the most constructive discussion focused on making sure that AMA spells out specifically what it does and does not like in the bill, on what to do with it next in the Senate, and on how medicine can make sure that HR 3961 or some other permanent Medicare payment fix is passed before the 21-percent cuts in physician payments take effect Jan. 1. The just-released recommendation from the reference committee (PDF) does not deal with the question of AMA’s support for the bill, but sticks to guiding principles, positions that AMA supports, and issues of concern. Among specific items of interest from the committee report:
  • The language on replacing the SGR copies TMA’s Texas Medicare Manifesto: “National health care reform must include replacing the SGR with a Medicare physician payment system that automatically keeps pace with the cost of running a practice, and is backed by a fair, stable funding formula.”
  • “A single payer, government-run health care system is not in the best interest of the country and must not be part of national health system reform.”
  • Health reform legislation must not expose physicians to new legal liability, and “failure to follow each and every clinical practice guideline should not be used to create a presumption of negligence.”
House of Delegates debate on the recommendations is scheduled for this afternoon. Once again TMA will cover the proceedings live via Blogged Arteries. Tune in.

THREE YOUNG TEXANS WIN AMA LEADERSHIP ROLES

The pipeline of future AMA leaders from Texas continues to flow. Congratulations to:

  • Meredith Williams, medical student at Baylor College of Medicine, who won election as the student member of the AMA Board of Trustees. Her term on the board will begin in June. Meredith is a former student member of the TMA Board of Trustees.
  • Travis Bias, DO, who is in his second year at the Memorial Family Medicine Residency Program in Houston, and was elected as one of two residents to sit in the AMA House of Delegates.
  • Erin Dunnigan, MD, a fellow in endocrinology at Parkland Hospital in Dallas, who was elected alternate delegate to the AMA House of Delegates from the Resident and Fellow Section.

TMA EVP LOU GOODMAN HONORED FOR LIFETIME OF SERVICE TO PHYSICIANS

(Editors’ note: Lou Goodman did not write, edit, or approve this news item.) AMA this weekend recognized the tremendous service that TMA EVP Lou Goodman, PhD, has provided to the profession of medicine. Dr. Goodman was the 2009 recipient of AMA’s Medical Executive Lifetime Achievement Award for his 12 years at the helm of TMA. He also was director of TMA’s Division of Medical Economics and a legendary researcher on the AMA staff. In presenting the award to Dr. Goodman, AMA President Jim Rohack, MD, cited Lou’s leadership in the passage of Texas’ 2003 health care liability reforms and Medical Economics magazine’s citation of TMA as “America’s Best Medical Society.” Please join your TMA staff in extending hearty and well-deserved congratulations and thanks to Lou for his lifetime of service to physicians.

Monday, November 2, 2009

TEXPAC ENDORSES GOV. RICK PERRY FOR REELECTION

At a joint news conference at the TMA building this morning, TEXPAC announced its endorsement of Gov. Rick Perry for reelection in 2010. “The TEXPAC Board of Directors endorsed Governor Perry because of his unwavering support and defense of Texas’ medical liability reforms and his efforts to protect the sacred patient-physician bond,” TMA President Bill Fleming, MD, said. “We appreciate his guidance to ensure prompt payment by health insurance companies, and his strong support to provide physicians meaningful and real opportunities to serve in rural and underserved areas.” Other legislative, congressional, and judicial endorsements the TEXPAC Board made last month will be announced in coming weeks in conjunction with the candidates’ campaigns.

STIFF DEBATE ON HEALTH SYSTEM REFORM EXPECTED AS AMA HOUSE CONVENES IN HOUSTON

At the end of a week in which we expect the U.S. House of Representatives to debate the immense Affordable Health Care for America Act and a separate bill (PDF) to repeal Medicare’s Sustainable Growth Rate (SGR) formula, the American Medical Association House of Delegates meets in Houston. On the delegates’ agenda are four pivotal resolutions (PDF) that could enhance or reverse AMA’s positions on health system reform legislation. In numerical order, they are:
  • Resolution 203, which calls on AMA to “promote to the fullest, at each and every opportunity,” AMA’s ruling policies on health system reform, which led the association to support an earlier version of the Affordable Health Care Act this summer;
  • Resolution 206, which directs AMA to promote Texas-style health care liability reforms and ensure that any health system reform legislation not preempt existing strong state laws;
  • Resolution 208, which calls on AMA to maintain its “unwavering and bold efforts to promote health care reform” in this country; and
  • Resolution 209, which would have AMA “actively oppose” any legislation that contains — among other things — a public option health insurance program or a short-term patch for the SGR, or that does not include “proven medical liability reforms.”

The Texas Delegation to the AMA is reviewing closely these and all other items of business before the AMA house and will take its positions based on TMA policy. You can follow all the action — including live coverage of key events such as the health system reform update at 4 pm on Saturday, Nov. 7 — on TMA’s Blogged Arteries.

WATCH REPLAY OF TMA'S U.S. SENATE CANDIDATES FORUM

The video of the forum for all six of the candidates seeking to replace U.S. Sen. Kay Bailey Hutchison has been a big hit on YouTube, with more than 300 hits. You can watch a replay of the two-hour event — broken into 13 bite-size chunks — on the TMA Web site.

WITHOUT CONGRESSIONAL ACTION, 21.2-PERCENT MEDICARE CUT SET FOR JAN. 1

The Centers for Medicare & Medicaid Services (CMS) made it official. Unless the U.S. Congress takes action — as part of global health system reform or in a separate bill — physicians’ Medicare and TriCare payments will be cut by 21.2 percent starting Jan. 1, 2010. The cuts are mandated by the SGR formula in current law. “Access to care and choice of physician for seniors, baby boomers, and military families is at serious risk — and Congress must fix the payment formula once and for all this year,” said AMA President Jim Rohack, MD. CMS published the final rule, which also includes changes in the Physicians Quality Reporting Initiative and formalizes bonuses and penalties for meaningful use of electronic medical record systems. Here’s the status of legislation to repeal the SGR:
  • After the U.S. Senate refused to take up S 1776 last month, Senate Majority Leader Harry Reid (D-Nev.) announced that senators will consider new Medicare payment legislation after passage of a health system reform bill.
  • On the House side, Speaker Nancy Pelosi (D-Calif.) unveiled a separate bill to replace the SGR with a new formula based in part on physicians’ cost of providing Medicare services. The speaker has not announced whether the House will combine the bill with the Affordable Health Care Act or take it up as separate legislation.

TMA FLU FIGHTERS SAY GET BOTH H1N1 AND SEASONAL FLU SHOTS

Most people in good health who get the seasonal or H1N1 flu will be sick for several days but will recover. However, the TMA Flu Fighters say that should not prevent people from getting vaccinated for the flu. Deaths, severe disease, and hospitalizations have occurred in previously healthy persons of all ages. Stay up to date on all the latest through the TMA Flu Fighters’ Hotline.

Tuesday, October 27, 2009

U.S. SENATE CANDIDATES KEEP THE GLOVES ON AT TEXPAC FORUM

Very little mudslinging, a good bit of humor, and plenty of respect for physicians marked the first forum for all six prospective candidates for the 2010 U.S. Senate race in Texas. Hosted by TEXPAC and moderated by former Lt. Gov. Bill Ratliff, the forum gave the four men and two women the chance to share their views on health system reform, Washington politics, and other key issues. The race will be to replace Sen. Kay Bailey Hutchison, who is expected to resign soon to campaign full-time for governor. All six told the packed audience at the TMA/TEXPAC/specialty society legislative retreat in Frisco that Congress ought to heed the advice of physicians on health system reform. The six candidates are Texas Railroad Commissioner Elizabeth Ames Jones, State Sen. Florence Shapiro (R-Plano), former Texas Comptroller John Sharp, Texas Railroad Commissioner Michael Williams, former Texas Secretary of State Roger Williams, and Houston Mayor Bill White. Couldn’t be there? You can watch video of the entire event online.

LEADERS CHART TMA'S 2011 LEGISLATIVE PRIORITIES

More than 100 physician and TMA Alliance leaders at the TMA/TEXPAC/specialty society legislative retreat began laying the groundwork for medicine’s strategic priorities in the 2011 session of the Texas Legislature. Among their recommendations, we need to:
  • Push for transparency and accountability in health insurers’ medical loss ratio reporting and prescription drug formulary tiering;
  • Require regulation of silent PPOs;
  • Provide real-time benefit information from health insurance companies;
  • Continue to defend the 2003 medical liability reforms;
  • Advocate strongly to preserve existing Medicaid and Children’s Health Insurance Program eligibility in light of an expected multibillion-dollar budget deficit in the 2011 session;
  • Push lifestyle changes to battle obesity and cancer, improve immunizations, and promote wellness and safety;
  • Work for an adequately funded, strong and fair Texas Medical Board (TMB), with due process protections for physicians under investigation;
  • Help rural physicians maintain their practices while protecting physicians’ clinical autonomy;
  • Restore Medicaid funding for graduate medical education;
  • Put advanced practice nurses and physician assistants under the supervision of TMB; and
  • Educate the public and lawmakers that, regardless of what happens in national health system reform, millions of newly insured patients will have difficulty finding a physician if physicians are not compensated adequately.
Specialty society representatives also laid out their priorities for the 2011 Texas Legislature. The family of medicine must continue to work together in promoting issues on which we agree and finding common ground when specialties have different points of view.

PICKING UP THE PIECES AFTER SGR REPEAL FAILS

As we explained in a special letter to all members from TMA President Bill Fleming, MD, the U.S. Senate failed miserably in a vote to consider legislation to repeal the failed formula that’s been driving physicians’ Medicare payments into the ground. So where do we go from here? There’s no question that the Sustainable Growth Rate (SGR) formula must go, and we need comprehensive reform of how Medicare pays physicians. Congress needs to include this issue as part of any larger health system reform bill because you can’t have health reform if patients can’t find a physician to treat them. One lesson we learned from the defeat of S 1776 is that many senators from both parties believe we must find a way to pay off the $245 billion debt the SGR has racked up over the past decade. Fixing the Medicare payment system is in the best interest of both Republicans and Democrats, but we cannot let either party use physicians or patients as political footballs in the highly partisan health reform battles. As TMA Council on Legislation Chair Dan McCoy, MD, said at the TMA/TEXPAC/specialty society legislative retreat, “Health system reform is a train moving at lightning speed and going nowhere.” U.S. Rep. Michael Burgess, MD (R-Lewisville), urged physicians to remain involved and engaged in the debate. “You hold the key to the future of professionalism in our profession, and I don't want you to give it away too easily,” he said.

TMA MEMBER TO LEAD ACIP

Congratulations to Carol J. Baker, MD, of Houston, the new chair of the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention. Dr. Baker is a professor of pediatrics and of molecular virology and microbiology at Baylor College of Medicine. U.S. Secretary of Health and Human Services Kathleen Sebelius made the appointment.

Wednesday, October 21, 2009

CRITICAL MEDICARE VOTES LOOM ON S 1776; CONTACT SENATORS CORNYN AND HUTCHISON

All TMA leaders need to make a pair of phone calls or send a pair of e-mails to Washington today. And then you need to ask your colleagues to do the same. Vote “YES” on S 1776 is the message that Sens. Kay Bailey Hutchison (R-Texas) and John Cornyn (R-Texas) need to hear from their constituents. The bill would repeal the unsustainable sustainable growth rate (SGR) formula (PDF) that drives down physicians’ Medicare payments year after year. It also would stop the planned 21-percent cut in fees scheduled for Jan. 1, eliminate the $245 billion debt (PDF) that has accumulated under the SGR, and lay the foundation for a new Medicare payment update system. The bill basically zeroes out the SGR formula. Under this bill, physicians over the next decade are getting a zero percent update, but it is the first step in the process of working to get a fair payment system. Until we can eliminate the SGR, we have no hope of getting a positive update system. One or more of the votes on S 1776 – including the decision to waive the constraints of the budget act – will require the votes of at least 60 senators. “Conventional pundits think it won't happen,” American Medical Association President Jim Rohack, MD, wrote in his latest blog entry. “But if that was the spirit of the American physician, then mortality rates for acute myocardial infarctions would still be 40 percent rather than 3 percent, and polio would still be managed with iron lungs rather than vaccines.” Use the TMA Grassroots Action Center for an easy way to e-mail Senators Cornyn and Hutchison, or call the AMA grassroots hotline at (800) 833-6354.

TEXANS TAKE THE HELM

Congratulations to Roland Goertz, MD, of Waco. The Congress of Delegates of the American Academy of Family Physicians (AAFP) made a wise decision when it chose Dr. Goertz to be AAFP’s president-elect. He will serve as AAFP president in 2010-2011. The Congress of Delegates also reelected Leah Raye Mabry, MD, of San Antonio as speaker of the congress. Both physicians have served TMA and Texas well over the years and continue to do a great job representing their patients and their profession on the national scene. Back home in Texas, Bohn Allen, MD, of Arlington, the former TMA president, was elected president of the Texas Surgical Society for 2010-2011. For a general surgeon in Texas, this is the ultimate recognition by your peers.

TMA TO HOST FIRST CANDIDATES' FORUM FOR 2010 U.S. SENATE RACE

Former Lt. Gov. Bill Ratliff will serve as moderator Saturday night, when six candidates who want to be your next U.S. senator make their case at the TMA/TEXPAC/specialty society legislative retreat (PDF) at the Westin Stonebriar in Frisco. This will be the first forum for all prospective candidates in the 2010 race for the Senate. Incumbent Sen. Kay Bailey Hutchison is running for governor. The six candidates are: Texas Railroad Commissioner Elizabeth Ames Jones, State Sen. Florence Shapiro (R-Plano), former Texas Comptroller John Sharp, Texas Railroad Commissioner Michael Williams, former Texas Secretary of State Roger Williams, and Houston Mayor Bill White. Each candidate has been asked to present his or her qualifications and positions on health care reform and other key federal issues of interest to Texas voters. If you can’t make it to Frisco for the event, you can watch it live on the Internet.

FINAL HOUSE CALL SET FOR THURSDAY NIGHT IN EL PASO

The last TMA House Call on health system reform will be in El Paso on Thursday from 6:30 to 8:30 pm at Cathedral High School at 1309 N. Stanton. Leading the event will be Cliff Moy, MD, TMA House of Delegates vice speaker, and Luis Urrea II, MD, El Paso County Medical Society president. More than 3,000 Texas patients and physicians have participated in the 17 House Calls we’ve conducted to date to hear what Texans think about our health care system and plans for reform.

Monday, October 12, 2009

ARE YOU READY FOR A MEDICARE AUDIT? TMA CAN HELP

Medicare will launch its Recovery Audit Contractor (RAC) program in March, and any physician who bills Medicare is fair game for an audit. RACs will mine Part B claims data to find underpayments and overpayments, looking for physicians whose Medicare billings are higher or lower than those of their peers. To help you prevent an audit – and prepare for one if it happens – TMA is starting a new seminar series this month. The half-day class will address common billing and coding errors, frequently asked questions on Medicare payment policies, and how to appeal claim denials. You can register for the seminars online and earn up to 5 AMA PRA Category 1 CreditsTM.

TELL SENATOR CORNYN TO KEEP UP THE GOOD WORK ON HEALTH SYSTEM REFORM

With a report card from government scorekeepers (PDF) saying its draft bill would save the U.S. Treasury a net $81 billion over the next 10 years, the U.S. Senate Finance Committee is set to vote on the plan tomorrow. TMA is asking Texas physicians to contact Sen. John Cornyn immediately and ask him to continue to fight to “fix what’s wrong and keep what’s good” in the country’s health care system. “Senate Cornyn has been a stalwart for patients and physicians on the Finance Committee,” said TMA President Bill Fleming, MD. “We have noticed, and appreciate, his work on liability reform, Medicare payments to physicians, and the independent Medicare commission. We urge the senator to continue to push for bipartisan solutions to these terribly complex problems.” In addition to those issues, TMA is asking the senator to work for real health insurance company reform, to push for workable options for the uninsured, and to stop the harsh limits on physician ownership of hospitals and health care facilities. Please call Senator Cornyn today or use the TMA’s Grassroots Action Center to craft and write a personal e-mail to him in less than two minutes total. Need more of our “Fix What’s Wrong, Keep What Works” posters, stickers, and postcards for your office? Order them online or call the TMA Knowledge Center at (800) 880-7955.

MCALLEN HOUSE CALL DRAWS 150 PATIENTS AND PHYSICIANS

TMA Trustee Lewis Foxhall, MD, and Hidalgo-Starr County Medical Society leaders hosted the latest in our physician-patient listening sessions in the Lower Rio Grande Valley. You can watch the video of the event online. We also have posted a summary of the patient feedback on the state of our health care system that we received from our first 16 House Calls. We’re using these comments, plus our House-of-Delegates approved principles to guide our advocacy on health system reform. Our final House Call is scheduled for next Thursday in El Paso.

LOOK FOR WEEKLY HOTLINE FROM TMA FLU FIGHTERS

Whether its H1N1 influenza or the seasonal flu, a subcommittee of the TMA Committee on Infectious Diseases has the answers to your questions. The TMA Flu Fighters are sending a weekly e-mail newsletter on how to prepare your practice for the rush of flu patients, how to recognize and treat them, and how to obtain and bill for H1N1 and seasonal flu vaccine. All actively practicing TMA member-physicians have been subscribed automatically to the Flu Fighters Hotline.

TMLT AMENDMENT WILL PROTECT PHYSICIANS FROM LIABILITY SUITS

Texas Medical Liability Trust (TMLT) leaders are working with the American Medical Association, state medical associations, and liability carriers around the country to prevent health care system reform from opening new avenues for lawsuits against physicians. TMLT sent its proposed amendment to U.S. Rep. Henry Waxman (D-Calif.), who chairs the House Energy and Commerce Committee, and to U.S. Sens. Blanche Lincoln (D-Ark.) and Thomas Carper (D-Del.). Without the amendment, physicians who do not follow federal standards of care could face much higher burdens of proof in liability cases, which would in turn increase liability claims and payouts and drive significant rate increases in the future. AMA also sent a strong letter to Representative Waxman (PDF) on this issue.

FED HIT CHIEF HAS BILLIONS FOR PHYSICIANS' OFFICES

I joined other Texas leaders in health information technology (HIT) for a private meeting with David Blumenthal, MD, the National Coordinator for HIT in the Obama administration. Dr. Blumenthal told us about how his office plans to distribute $2 billion in federal stimulus funds to bring electronic health record (EHR) systems to physicians’ offices, starting with primary care physicians. As we reported in last week’s EVPGram, the U.S. Department of Health and Human Services notified us that our grant application to help physicians become meaningful users of EHRs has passed the first hurdle. We are working with county medical societies and other stakeholders in Texas to plan our next step in the grant process.

Monday, October 5, 2009

TMA BID FOR HIT EXTENSION CENTER GRANT MOVES FORWARD

The U.S. Department of Health and Human Services notified us that our grant application to help physicians become meaningful users of electronic health records (EHRs) has passed its first hurdle. Funded through the economic stimulus bill that passed this spring, the grants pay for organizations to set up and run health information technology regional extension centers (HITRECs). If we are successful, our HITREC will help Texas physicians “select, successfully implement, and meaningfully use certified EHR technology to improve the quality and value of health care.”

DR. BURROSS WAS A HEALTH CARE LION

I am truly saddened to report that Texas has lost one of its most dedicated and visionary health care leaders with the passing of Cliff Burross, MD. He spent more than 45 years caring for patients in his native Wichita Falls and teaching at the Wichita Falls Family Practice Residency Program. Not only was Dr. Burross a past president of TMA and winner of the TMA Distinguished Service Award, but also he served as president of the Texas Medical Foundation, as a member of the Texas Medical Board and National Board of Medical Examiners, and as a Wichita Falls city alderman. All of us who worked with Dr. Burross will miss his passion for Texas, for patients, and for his profession.

SPANGLER PROMOTED TO TMA VP, MEDICAL ECONOMICS

I am pleased to announce the promotion of Lee Spangler, JD, to the position of vice president, Medical Economics. Lee has demonstrated tremendous value to TMA members and our legal advocacy activities through his work here for the past nine years as a member of the Office of the General Counsel. Because of Lee’s wealth of knowledge and experience in health care policy and law, I am extremely confident he will do an excellent job in his new role, which is critical to the association’s success. Lee is a graduate of the University of Dayton School of Law and St. Edward’s University. Prior to his tenure with TMA, Lee worked with the Texas Department of Insurance and the Texas State Board of Medical Examiners.

DR. BURGESS FILES BILL FOR PERMANENT MEDICARE FINANCING FIX

U.S. Rep. Michael Burgess, MD (R-Lewisville), filed legislation to eliminate the Medicare Sustainable Growth Rate (SGR) formula and link physicians’ Medicare payments to the cost of running a practice. “Medicare’s physician fee schedule will pay doctors less next year for the same patients and services they are currently providing, and this flawed formula needs a permanent fix,” he said. If Congress takes no action this year, the SGR formula will force a 21-percent cut in physicians’ Medicare payments on Jan. 1. That cut alone will cost Texas physicians $200 million.

GEORGETOWN PHYSICIAN JOINS HOUSE RACE

You can never have too many doctors in the house. TEXPAC Board Member Charles Schwertner, MD, of Georgetown announced he is running for the open seat in Texas House District 20. He is one of several physician leaders looking to take a seat in the house, including Drs. Martin Basaldua and Susan Curling, who both are running for the open Houston-area seat in House District 127. Are you interested in running for office? Enroll in the TEXPAC Campaign School, part of the TMA/TEXPAC/specialty society legislative retreat (PDF), Oct. 23-25 at the Westin Stonebriar in Frisco.

HOUSE CALL TOMORROW IN MCALLEN

TMA’s popular House Call program, where physicians listen to patients’ hopes and fears about health care and health system reform, moves to McAllen tomorrow. You can join the event from 6:30-8:30 pm at The Forum, 100 E. Laurel Ave., or watch it online.

Wednesday, September 30, 2009

TMA FIRMLY ENGAGED IN HEALTH SYSTEM REFORM DEBATE

Joined by other state medical societies and the American Medical Association, TMA is taking an active role in health system reform debates underway in both houses of Congress. Along with the California Medical Association, we wrote a letter to Senate Finance Committee Chair Max Baucus (D-Mont.) to oppose the use of another one-year “Band-Aid” Senator Baucus’ bill would place on the Sustainable Growth Rate formula Medicare uses to determine physician payments. We also took strong positions against the faulty physician rating systems in the bill, the proposed $350 “enrollment fee” for physicians to participate in Medicare and Medicaid, and other provisions. TMA President Bill Fleming, MD, also issued a news release and sent a letter asking the entire Texas Delegation in Congress to support extensive health insurance reforms. Dr. Fleming is urging TMA and TMA Alliance members to write Congress and President Obama in support of these reforms. We were pleased that the House Energy and Commerce Committee approved an amendment by U.S. Reps. Michael Burgess, MD (R-Lewisville), and Gene Green (D-Houston) that would require hospitals and health plans to be more transparent about the costs of health care services.

ME AND MY DOCTOR CAMPAIGN TIP OF THE WEEK

Here’s another way to make sure your patients can best take advantage of our Me and My Doctor health system reform materials: Give four 28-cent stamps to every patient who promises to send our “fix what’s wrong, keep what’s good” postcards to Congress and President Obama. For $1.12, you can take a simple step to make sure our message gets through. Order more free materials through the TMA Web site or by calling the TMA Knowledge Center at (800) 880-7955. Don’t forget to sign the Twitter petition to President Obama and join the Me and My Doctor cause on Facebook. Learn more about how the campaign and its message were developed in a Podcast TMA interview with Council on Legislation Chair Dan McCoy, MD, and TMA’s political consultant Bryan Eppstein.

FLEMING TALKS REFORM WITH BENEFIT SPECIALISTS

Dr. Fleming took part in a town hall meeting in Austin sponsored by the International Society of Certified Employee Benefit Specialists. He shared TMA’s views on health system reform and challenged audience members to rethink their views on the forces that are driving up the costs of health care. Dr. Fleming also joined TMA staff in a discussion with leaders of the Texas Dietetic Association, looking for common legislative ground on wellness, diabetes, and other issues.

TMA PUSHES FOR PHYSICAL EDUCATION AND HEALTH CLASSES

We joined with numerous other public health advocacy organizations in urging the State Board of Education to keep as much leverage as possible on high school students to take health and physical education classes. Although recent legislation stripped those classes from recommended graduation course plans, TMA pushed the board to include them in the minimum and distinguished graduation plans. “The opportunity to decrease the burden of obesity and promote good health in Texas is an investment in our children and the future of Texas,” Dr. Fleming wrote.

ROHACK TO BE FETED AT AMA INTERIM MEETING

Our own Jim Rohack, MD, president of the AMA, will be the guest of honor at a Taste of Texas reception at the interim meeting of the AMA House of Delegates, Nov. 7-10 in Houston. Dr. Rohack’s family, alma maters, and specialty societies will join with TMA, county societies, and Scott & White Healthcare in hosting an event that will share Texas’ wide variety of gastronomic delicacies for physicians from across the country.

CORRECTION: EMR BONUS ONLY AVAILABLE FOR MEDICARE OR MEDICAID

An item in the Sept. 14 EVPGram promoting TMA’s upcoming “Prepare Your Practice for Electronic Medical Records” (EMRs) seminar series incorrectly implied that physicians can earn bonuses from both Medicare and Medicaid for using EMRs. The bonuses apply to one program or the other, not to both. Through Medicare, physicians can earn a bonus of up to $44,000 for “meaningful use” of EMRs through 2015. Medicaid-participating physicians can earn up to $63,750.

Monday, September 14, 2009

REPORT: VARIATIONS IN HEALTH COSTS DRIVEN BY ECONOMIC AND HEALTH FACTORS

Poverty and poor health, not pervasive overtreatment and overtesting, are the causes of much of the geographic variation in health care spending in the United States, according to a new report from the Physicians’ Foundations. The report found that wealthier communities use more services and have better health and better outcomes; low-income individuals use more services, yet have worse outcomes; and patients who are in the poorest health use the most health care services and have the poorest outcomes. In a study prepared for President Obama and Congress, Richard Cooper, MD, professor of medicine and senior fellow at the Leonard Davis Institute of Health Economics at the University of Pennsylvania, and others also found that today’s health care system doesn’t have the resources or workforce to handle the load of new patients that would come with universal access envisioned by national reform legislation. It calls for substantial increases in federal support for undergraduate and graduate medical education to offset a projected shortage of 200,000 physicians by 2025. I highly recommend you take the time to read the report (PDF) or the executive summary (PDF). It includes vital information our national leaders must consider as they make decisions that will impact you, your patients, and the entire health care delivery system for many years to come, if not forever.

ME AND MY DOCTOR CAMPAIGN TIP OF THE WEEK

TMA-member physicians report that they get the most out of our Me and My Doctor health system reform materials by making sure patients encounter them in various locations throughout their offices. Placing the campaign posters and postcards in waiting rooms, exam rooms, and at check-in and check-out stations gives physicians and office staff multiple opportunities to discuss health system reform with interested patients. You can learn more about how the campaign and its message were developed in a Podcast TMA interview with Council on Legislation Chair Dan McCoy, MD, and TMA’s political and advertising consultant Bryan Eppstein. Order more materials through the TMA Web site or by calling the TMA Knowledge Center at (800) 880-7955. And don’t forget to sign the Twitter petition to President Obama and join the Me and My Doctor cause on Facebook.

LEARN HOW TO RUN FOR OFFICE AND WIN AT TEXPAC CAMPAIGN SCHOOL NEXT MONTH IN FRISCO

With more physicians and alliance members running for local, state, and national offices, we’ve pulled together an all-star cast of consultants and current officeholders to share their secrets at the TEXPAC Campaign School. It’s part one of a weekend of political and legislative strategizing that includes the TMA Friends of Medicine Awards and Dinner. Register today for the TMA/TEXPAC/specialty society legislative retreat (PDF), Oct. 23-25 at the Westin Stonebriar in Frisco.

TMLT CELEBRATES 30 YEARS OF SERVING TEXAS PHYSICIANS

Today we celebrate the 30th anniversary of the Texas Medical Liability Trust (TMLT). TMA formed TMLT in 1978 as a self-insurance trust in the midst of a severe liability crisis. TMA-member physicians wanted to pool their money to have more control and not be directed by the insurance industry. TMLT’s first employee, Ennis Bogle, who served as an administrator as the company prepared for operations to begin in 1979, will be on hand for today’s ceremony along with current and former governing board members, and attorneys who have represented physicians over the years. TMLT is now the largest physician liability insurance company in Texas with nearly 15,000 policies in place and assets of nearly $670 million. Since the passage of Texas health care liability reforms in 2003, TMLT premiums have dropped by almost 50 percent.

HOUSE CALL TONIGHT IN GREENVILLE

TMA’s popular House Call program, where physicians listen to patients’ hopes and fears about health care and health system reform, travels to Greenville tonight. The 6 pm event at Fletcher Warren Civic Center is cosponsored by the Hunt County Alliance for Economic Opportunity; the Greenville Chamber, Convention & Visitors Bureau; and Hunt Regional Healthcare.

CAN YOU EARN YOUR ELECTRONIC MEDICAL RECORD BONUS?

Is your practice ready to demonstrate “meaningful use” of electronic medical records (EMRs) so you are in line to earn Medicare and Medicaid bonuses of up to $100,000 through 2015? Do you know what to look for in an EMR, how to compare the various vendors’ systems, and how to make an EMR work for your practice? Check out TMA’s newest seminar and vendor demonstrations beginning in Austin Oct. 8 and traveling to Dallas, Houston, and San Antonio.

Tuesday, September 8, 2009

FALL CONFERENCE TIMED PERFECTLY FOR HEALTH SYSTEM REFORM DISCUSSION

Congress returns to Washington today from one of its most tumultuous August recesses in recent memory. President Obama addresses the country in prime time tomorrow. The cause of all this ruckus, of course, is the debate over pending health system reform legislation. TMA physician leaders emphasized their keen interest in this red hot issue by turning out in record numbers on a holiday weekend for the 2009 TMA Fall Conference, where system reform was the No. 1 topic. American Medical Association President Jim Rohack, MD; U.S. Rep. Henry Cuellar (D-Laredo); and TMA Council on Legislation Chair Dan McCoy, MD, presented various views on the debate in a wide-ranging discussion before the packed audience. Physicians polled in the room said Congress should hold more hearings or a public referendum before moving forward with any legislation. Nancy Dickey, MD, chair of TMA’s Health System Reform Task Force, served as moderator for the forum. Some highlights:
  • Dr. Rohack summed up AMA’s position on health reform legislation this way: “If it’s good for our patients, it’s going to be good for physicians.” He compared health system reform to a Rubik’s cube, saying it will take many moves to arrive at the right solution.
  • Representative Cuellar received a standing ovation when he called for nationwide health care liability reform. He said his top priorities for health reform legislation are that it reduce costs, increase coverage, and preserve choice without increasing the national debt. “The ink is not dry on this bill. You have to stay involved. You have to stay engaged," said Representative Cuellar, the lone congressional Blue Dog Democrat from Texas.
  • Dr. McCoy called on physicians to use TMA’s new Me and My Doctor campaign to bring their patients into the debate. He said TMA likes the health insurance industry reforms in the current House bill – but would like to see more, is concerned that the bill lacks a permanent fix in the physicians’ Medicare payment formula, and wants strong liability reforms and protection for physician-owned hospitals and other facilities. See TMA’s Health System Reform Principles.

GOVERNOR, SENATOR MEET WITH TMA LEADERS

Gov. Rick Perry and U.S. Sen. Kay Bailey Hutchison both spent time talking with TMA leaders at Fall Conference. Governor Perry stopped by to share with the Board of Trustees his commitment to medicine, particularly rural health and tort reform. Senator Hutchison spoke to the TEXPAC Board of Directors, sharing her insight and observations on how national health system reform should wend its way through the Senate process this fall. Both also stressed their close ties to medicine, their vow to protect the state’s 2003 health care liability reforms, and their desire to work with physicians to improve Texas health care. Both Perry and Hutchison are battling for the Republican gubernatorial nomination next spring. TEXPAC has made no endorsements in the governor’s race or any other 2010 contest, but the board did approve a process to analyze and make endorsements as soon as its next meeting at the TMA legislative retreat in Frisco in late October.

ME AND MY DOCTOR CAMPAIGN BEGINS WITH SNAIL MAIL, MOVES TO SOCIAL MEDIA

Most active TMA-member physicians with office practices received their first packet of TMA’s health system reform patient education campaign materials in a big envelope delivered by the U.S. Postal Service. But Dr. McCoy urged members at Fall Conference to use much newer communication methods to spread the campaign’s “fix what’s broken, keep what’s good” message. TMA has developed a Twitter petition and a cause on Facebook in hopes that the Me and My Doctor campaign will “go viral,” Dr. McCoy said. See our special Web page for step-by-step directions. You can order more campaign materials online or by calling TMA Knowledge Center at (800) 880-7955.

HEALTH COMMISSIONER SHARES LATEST ON H1N1 FLU BUG FOR THE FALL

David Lakey, MD, commissioner of the Texas Department of State Health Services, called on physicians to get flu shots for themselves and their staff … and to get ready for a surge in H1N1 influenza strains along with seasonal flu this fall. Dr. Lakey shared the latest epidemiological surveillance reports and provided an update on development of an H1N1 vaccination. Physicians can keep up with latest news online at www.texasflu.org or by following DSHSflu on Twitter. Sept. 13 is the last day for Texas physicians to preregister their practices to receive the H1N1 flu shot.

DON'T MISS THE TMA LEGISLATIVE RETREAT

Thinking of running for political office? Ready to dig in to state and national goals, objectives, strategies, and tactics for health care legislation? Want to honor Texas medicine’s champions from the 2009 Texas Legislature? Register today for the TMA/TEXPAC/specialty society legislative retreat (PDF), Oct. 23-25 at the Westin Stonebriar in Frisco.

Monday, August 24, 2009

HOUSE CALLS BUILD PATIENT-PHYSICIAN POLITICAL RELATIONSHIP

In courthouses, clinics, hospitals, and schools across Texas, TMA and county medical societies are conducting “passionate but calm” discussions among physicians and patients about health system reform. TMA’s “House Calls” give physicians the opportunity to hear their patients’ hopes, fears, and concerns about the health care overhaul legislation that’s brewing in Washington, D.C. The main themes we’ve heard so far: Patients love their physicians and the life-saving treatments they provide, both patients and physicians oppose more intrusion into health care decisions by either the government or private insurance companies, and patients and physicians both fear the unknown consequences of the massive health care reform bills. We’ve seen scattered support for HR 3200, the only legislation actually on paper, mostly from the event here in Austin and from some primary care physicians. Join us this week for House Calls in Houston, Beaumont, and San Antonio on Tuesday; Houston and Corpus Christi on Wednesday; and Lubbock on Thursday. Next week we’ll make House Calls in Fort Worth and Wichita Falls. If you can’t attend, we’re streaming live video from most of the House Calls on ustream.tv.

ME AND MY DOCTOR CAMPAIGN TELLS CONGRESS TO GET HEALTH CARE REFORM RIGHT

Materials to help you get your patients involved in the health system reform debate will be in the mail to your office this week. TMA’s Me and My Doctor campaign materials include posters, lapel stickers, and preaddressed postcards for your patients to send to President Obama and members of Congress. They call on Congress not to rush reform legislation, and to fix what’s wrong with our current system but keep what’s good. The program directs patients to the Me and My Doctor Web site, where they can find up-to-the-minute news about the health care debate, easy ways to send electronic messages to Congress, and forms for them to share their thoughts and concerns with us or write a letter to the editor. (Don’t like the grammar in the title of the campaign? Just think of the old song, “Me and My Shadow.” We think it’s an effective way to put the patient first.)

HEATH SYSTEM REFORM TOPS THE AGENDA FOR 2009 TMA Fall CONFERENCE

Because our annual fall conference falls on Labor Day weekend this year, we’re keeping it short. But that doesn’t mean we’re shortchanging the programming. U.S. Sen. Kay Bailey Hutchison and American Medical Association President Jim Rohack, MD, top the bill Sept. 5 for an after-breakfast discussion of the national health system reform debate. We’re working to bring a Democratic member of Congress, too. Plus, David Lakey, MD, commissioner of the Texas Department of State Health Services, will share the Texas Plan for preparing for a pandemic influenza. Boards, councils, and committees will meet on Friday, Sept. 4, and after the general session on Saturday. I hope to see you there.

WELCOME BACK

As you can see, your TMA leaders and staff have been hard at work since the EVPGram took its summer vacation at the end of June. Remember, you can always follow TMA on Twitter or join our Facebook page for ongoing coverage.

Thursday, July 30, 2009

SPECIAL LEGISLATIVE SESSION BEGINS WEDNESDAY

Gov. Rick Perry called a special session of the Texas Legislature to start on July 1. The governor controls the agenda for any special session, and so far he has limited it to legislation to extend the life of five state agencies whose “sunset bills” failed at the end of the regular session. One of those agencies is the Texas Department of Insurance. He is also asking lawmakers to consider several issues related to financing for Texas highway projects. Already, legislators are asking the governor to add other items, such as expansion of the Children’s Health Insurance Program coverage, which died late during the regular session. Follow TMA’s daily or weekly Legislative News Hotline for all the details of the session.

TMA MONITORING TEXAS MEDICAID MENTAL HEALTH RECOUPMENT ACTIONS

The Texas Health and Human Services Commission (HHSC) has begun sending letters to approximately 125 physicians and 75 hospitals to recover payments HHSC says were made erroneously for services provided to patients residing in Institutions of Mental Disease (IMDs). TMA’s Office of General Counsel and Division of Medical Economics have been researching the problem and are monitoring the recoupment activity. Under federal law, services provided to IMD residents between the ages of 21 and 64 are not eligible for federal matching Medicaid funding. HHSC is sending letters to physicians and hospitals seeking refunds of money paid for dates of service from 2001 to 2007. HHSC says no state law imposes a time limit on how far back the agency can reach for these recoupments. The letters say that the physician or hospital has 60 days to send a payment or proof of a prior refund. Actual recovery is scheduled to begin on Sept. 1. The amounts of the recoupment range from about $1,000 to $128,000. Physicians with financial hardships may ask the Texas Medicaid and Healthcare Partnership to consider repayment arrangements. According to HHSC, “the provider is required to submit financials to establish the need and the terms of the repayment.”

HENRICH NAMED PRESIDENT OF UTHSCSA

The University of Texas System Regents appointed William L. Henrich, MD, the new president of the University of Texas Health Science Center at San Antonio. An internist, Dr. Henrich had been interim president of the health science center since former president Francisco Cigarroa, MD, left to become chancellor of the UT System in January. In his service as dean of the medical school in San Antonio, Dr. Henrich worked hard to connect organized medicine with the school’s faculty, residents, and students.

TMA PLANNING HOUSE CALLS ON HEALTH SYSTEM REFORM

TMA’s communications and lobby staff are working with county medical society to conduct town hall meetings this summer to discuss health system reform with local patients and business leaders. Tied to TMA’s “Me and My Doctor, We Know Best” campaign, the town hall meetings give physicians a chance for frank dialogue on health system reform with their patients and community leaders. The first “house call” takes place at the Denton County Courthouse on July 29. If you are interested in hosting a town hall meeting in your community, please contact Pam Udall, TMA’s director of media and public relations.

SEE YOU IN AUGUST

The EVPGram will take its traditional summer hiatus for the next six weeks or so. We’ll be back in mid-August in time to fill you in on all the details of the TMA Fall Conference, which is Sept. 4-5 in Austin. Of course, we’ll send you special editions on any news that breaks over the summer. Follow TMA on Twitter or join our Facebook page for ongoing coverage. Your TMA leaders and staff will still be here working on health system reform, devising new practice management programs for you, and monitoring public health issues. Many of us will travel to Baltimore in late July when our own Connie Minogue, TMA vice president for marketing, will be installed as president of the American Association of Medical Society Executives.

Monday, June 22, 2009

GOVERNOR PERRY VETOES BAD LIABILITY BILL

Gov. Rick Perry stopped a sneak attack from the Texas Trial Lawyers Association by vetoing a bill that would have weakened Texas’ landmark 2003 health care liability reforms. “The bill’s provision regarding physician liability was neither debated nor discussed, but rather amended onto this bill late in the session,” the governor said in his veto message of House Bill 3485. “It risks unraveling the progress we made in curtailing excessive liability and ensuring that patients who need physicians will be able to find them.” TMA President Bill Fleming, MD, issued a news release, applauding Governor Perry “for recognizing that we cannot risk even the slightest dent in a new liability system that has worked exactly as promised. … We are proud that Governor Perry always has been and remains a true champion for our patients by standing tall and leading the way toward enacting and protecting the 2003 liability reforms.” TMA worked closely with Rep. Garnet Coleman (D-Houston), the bill’s author, to forge strong protections for physicians’ clinical autonomy before the legislation was sabotaged by the trial lawyers’ 11th-hour amendment.

TMA TO TACKLE NEW WAYS TO BRING PHYSICIANS TO UNDERSERVED RURAL AREAS

The bill Governor Perry vetoed was intended to attract new physicians to underserved rural areas of Texas by allowing government-owned hospitals in counties with fewer than 50,000 residents to hire physicians directly. TMA is committed to helping solve rural Texas’ health care problems without jeopardizing our liability reforms. In coming months, we will work with rural physicians and hospitals to forge some solid solutions. “We will continue to work with state leaders to craft a consensus plan for the 2011 legislative session that more effectively addresses the problem of underserved areas and protects patient care and access,” Dr. Fleming said. The governor made an excellent start by signing House Bill 2154, which helps underserved counties attract new physicians by significantly strengthening the Texas Physician Loan Repayment Program. The new budget the legislature approved increases graduate medical education (GME) funding for the next biennium from $5,634 to $6,653 per year per residency slot. It also gave a 21.5-percent hike to the Higher Education Coordinating Board’s Family Practice Residency Program.

GOVERNOR PERRY SIGNS TMA PRIORITY LEGISLATION INTO LAW

The period for the governor to veto bills from the 2009 Texas Legislature ended yesterday, so we can wrap up some of medicine’s highlights for the session (PDF). (Contact TMA Public Affairs if you want copies of that legislative report card.) Among the bills Governor Perry signed into law:
  • House Bill 1888 by Rep. John Davis (R-Houston) sets standards for health plans’ schemes for ranking physicians.
  • HB 2256 by Rep. Kelly Hancock (R-Fort Worth) provides important patient protections as well as a mediation venue to resolve disputes for out-of-network, facility-based physician claims by health benefit plans.
  • Senate Bill 78 by Sen. Jane Nelson (R-Lewisville) creates the new Healthy Texas program to help small businesses obtain affordable health insurance for their employees.
  • Senate Bill 346 by Senator Nelson establishes a lifelong adult immunization registry in Texas, and Senate Bill 347 by Senator Nelson allows states to share immunization registry records during a disaster.
  • Senate Bill 870 by Sen. Eddie Lucio Jr. (D-Brownsville) directs Medicaid and the Children’s Health Insurance Program to implement pilots to help reduce childhood obesity among enrollees, and Senate Bill 282 by Senator Nelson establishes grant programs to provide nutrition education to children and to school districts for best practices in nutrition.
  • House Bill 1357 by Rep. Carl Isett (R-Lubbock) requires that freestanding emergency room facilities be licensed and sets minimum standards for their construction, design, and operation.

LISTEN TO DR. ROHACK'S INSTALLATION ADDRESS AS AMA PRESIDENT

Jim Rohack, MD, became the 164th president of the American Medical Association one day after President Barack Obama made a historic visit to the AMA, and on the eve of a long, hot summer of negotiations over health system reform. The former TMA president took his audience through a history lesson – the evolution of medicine, of organized medicine, and of Jim Rohack himself. “I can promise that our AMA is committed to offering guidance, our expertise, the benefits of our relationship with patients, and the powerful voice of our profession, to help the powers that be make the right decisions,” Dr. Rohack said to an audience of his national peers and Texas friends. “This is an effort that will define our organization, define our nation, and define each and every one of us.” Listen to Dr. Rohack’s address in a special installment of Podcast TMA.

BORDER DELEGATION SEEKS HELP FROM CONGRESS

Physician leaders from along the U.S.-Mexico border and San Antonio head to Washington, D.C., to discuss the dire health care situation along the border. Physicians representing TMA and the Border Health Caucus are meeting one-on-one with U.S. representatives and senators to support legislation that improves health care access. They also have included numerous congressional leaders in their 4th Annual Border Health Conference. El Paso surgeon Manny Acosta, MD, chair of the Border Health Caucus, is leading the delegation, which also includes Dr. Rohack. We’ll have more details in next week’s EVPGram.

Monday, June 15, 2009

PRESIDENT OBAMA BRINGS HIS HEALTH SYSTEM REFORM PROPOSALS TO U.S. PHYSICIANS

We’re in for an exciting couple of days here in Chicago, and all of it is wrapped up in the future of American health care and your great profession. President Barack Obama spoke to the American Medical Association House of Delegates this morning on his plans for health system reform. “I need your help doctors,” he said. “To most Americans, you are the health care system. We just do what you tell us to do. That's what we do. We listen to you. We trust you. That's why I will listen to you and work with you to pursue reform that works for you." The president addressed all of the controversial elements of his plan:
  • Mr. Obama said it is an "illegitimate concern" that "a public option is somehow a Trojan horse for a single-payer system. …I believe that it's important for our reform efforts to build on our traditions here in the United States. When you hear the naysayers claim that I'm trying to bring about government-run health care, know this: They're not telling the truth."
  • In place of Medicare’s sustainable growth rate, he said, “We will ensure that you will be reimbursed in a thoughtful way that's based on patient outcome.”
  • Several times, the president said he wants to keep what works in the current system and fix what’s broken. “We will make this promise to the American people: If you like your doctor, you will be able to keep your doctor, period,” he said. “If you like your health care plan, you will be able to keep your health care plan, period. No one will take it away.”
  • Referring to a widely circulated New Yorker magazine article concerning Medicare spending in McAllen, Mr. Obama said, “We spend vast amounts of money on things that aren't necessarily making our people healthier.” He said he wants the government to invest in comparative effectiveness research. “Identifying what works is not about dictating what kind of care should be provided. It's about providing patients and doctors with the information they need to make the best decision. I have the assumption that if you have the information, you're going to make the best decision. I have confidence in that.” TMA disagrees with many of the conclusions in The New Yorker article because it ignores many of the stark realities of practicing medicine in the poorest metropolitan community in the country. We are working with local physician leaders to invite the president to visit the Rio Grande Valley to see the situation firsthand.

The president was warmly received by the AMA audience. Many who disagreed with his policy positions said they were impressed that he came to Chicago to speak directly to the organization. You can read the highlights of the president’s address on TMA’s Blogged Arteries.

The AMA house meeting thus far has been dominated by discussions of what health system reform physicians want for their patients and their practices. Is the so-called “public health insurance option” just a stepping stone to a single-payer system? How can we expand affordable coverage for all Americans, do away with the sustainable growth rate formula for physician Medicare payments, and bring about both antitrust reform and liability reform? Will physicians have the right to choose what plans they will join? Should the AMA demand that physicians have the right to contract privately with patients outside of Medicare? How will physicians – and it must be physicians, not government – deal with variations in the cost and quality of health care across the country? How can all the major players in health care work together for the sake of the patients? As AMA President Nancy Nielsen, MD, PhD, said, “We can’t keep on hating everyone all the time.”

Here are some additional resources you might find useful:

Stay tuned to Blogged Arteries through Wednesday for complete coverage of the AMA meeting.

DR. ROHACK TO BECOME FIFTH TEXAN TO LEAD AMERICAN MEDICAL ASSOCIATION

Tomorrow night, Dr. Rohack takes the oath of office as AMA president. Those of us who have worked closely with him over the past few decades are excited to have a leader of Dr. Rohack’s stature and capacity at this critical juncture in American medicine. We’re excited that a physician with such a long history of service to TMA will be at the helm. TMA staff presented Dr. Rohack with a Texas tuxedo cufflink and stud set during a private dinner with him here in Chicago. The Temple cardiologist will be installed at 6 pm tomorrow. We will live blog his address on Blogged Arteries and hope to post the full speech later that night as a special edition of Podcast TMA.

TEXANS WIN AMA LEADERSHIP POSTS WITH TWO ELECTIONS STILL TO COME

We won’t know until after tomorrow morning’s balloting whether Fort Worth plastic surgeon Larry Reaves, MD, wins his quest to serve on the AMA Council on Constitution and Bylaws or whether Dallas internist Lynne Kirk, MD, is elected to the Council on Medical Education. But we already have several election victories to celebrate:

  • San Antonio internist Jayesh Shah, MD, is the new chair of the AMA International Medical Graduate Section.
  • Jason Sharp, MD, a resident physician from Dallas, was unanimously reelected to a second term on the Council on Constitution and Bylaws.
  • Ankit Shah, a second-year student from Baylor College of Medicine, was elected AMA Medical Student Section Region 3 vice chair; and Elizabeth Carroll, a third-year student at The University of Texas Southwestern Medical School, was elected Region 3 secretary-treasurer.

Monday, June 8, 2009

LAWMAKERS FOLLOWED DOCTOR'S ORDERS: SESSION A SUCCESS FOR PHYSICIANS AND PATIENTS

The strange 81st session of the Texas Legislature ended with some very good news for physicians and patients. “Thanks to patients’ champions in the House and Senate, the 2009 Texas Legislature passed bills to reform health insurance, increase access to health care, preserve the patient-physician relationship, and improve the health of all Texans,” Dr. Fleming said. Lawmakers:
  • Preserved Texas’ landmark 2003 medical liability reforms (pending Governor Perry’s veto of HB 3485);
  • Increased funding for graduate medical education in Texas;
  • Required insurers to use accurate data and valid, recognized standards when ranking or tiering physicians in their networks;
  • Expanded efforts to improve the use and reliability of health information technology in Medicaid and the health care system;
  • Funded expansions of community-based obesity prevention programs;
  • Directed the state to evaluate the adequacy of insurers’ physician networks in local markets to reduce the chances of out-of-network services and unexpected out-of-pocket costs for patients;
  • Expanded the Texas physician loan repayment program;
  • Protected funding to enhance cancer prevention and research programs in Texas;
  • Enhanced funding for local mental health crisis intervention; and
  • Created a lifelong immunization registry in Texas.

“THE GIANT” OF ORGANIZED MEDICINE, CHARLES MAX COLE, MD, DIES

With sadness, I write to inform you that Charles Max Cole, MD, passed away on June 1, at the age of 95. He was the oldest living former TMA president. For many years, he was clinical professor of surgery at The University of Texas Southwestern Medical School. He led both the Dallas County Medical Society (1964) and TMA (1970) as president. TMA presented him with the Distinguished Service Award in 1984. And Dallas County Medical Society has attached Dr. Cole’s name to its own annual distinguished service award. Physicians from across the country have responded with a very consistent message. Here are a few examples.

  • “He was a giant — no, ‘the giant’ — in organized medicine from our community; a true leader, yet so very humble.”
  • “He was a wonderful man, a true gentleman, and the finest representative of medicine's best.”
Dr. Cole’s family has arranged a memorial service for Friday, June 12, at 11 am at Preston Hollow Presbyterian Church, 9800 Preston Rd., in Dallas. A private family funeral was held June 3.

FOLLOW THE AMA HOUSE OF DELEGATES ACTION IN BLOGGED ARTERIES

As per our recent custom, TMA staff will bring you up-to-the-minute news, photos, and audio from the annual meeting of the American Medical Association House of Delegates via Blogged Arteries. The meeting convenes in Chicago on Saturday. Our own Jim Rohack, MD, will be installed as the new AMA president next week, and we will live blog his installation address. The Texas Delegation is also backing two Texas candidates for office and five resolutions from our House of Delegates.

Monday, June 1, 2009

STRANGE DAYS: TEXAS LEGISLATURE ADJOURNS

We warned you that partisan politics would play a major role in the 2009 session of the Texas Legislature. The five-day House battle between Democrats and Republicans over a bill requiring voters to show a picture ID brought chaos to the legislature’s closing weeks. The 140-day session ends today with the fate of many bills still uncertain. The capitol is filled with rumors that Gov. Rick Perry will call a special session. Here’s a rundown on bills important to medicine that passed:
  • The $182.3 billion state budget increases funds for graduate medical education and mental health services. It will not increase Medicaid payments to physicians. We stopped a plan to expand HMO-like Medicaid programs and cut physicians’ out-of-network Medicaid payments.
  • House Bill 1888 by Rep. John Davis (R-Houston) and Sen. Robert Duncan (R-Lubbock) requires health plans to use accurate physician data in any physician ranking system, allows due process for physicians prior to the publication of their ranking, and specifies that the measurements used be reliable, evidence-based, and consistent across all health plans in the market.
  • HB 2256 would provide important patient protections as well as a mediation venue to resolve disputes for out-of-network, facility-based physician claims. Senator Duncan and Rep. Kelly Hancock (R-North Richland Hills) carried the bill.
  • Small physician practices could get a double benefit from HB 2154 by Rep. Al Edwards (D-Houston) and Sen. Juan Hinojosa (D-McAllen). It enhances the state’s loan repayment program to provide up to $160,000 over four years for physicians who work in a medically underserved area. The bill raises money through a new way to tax smokeless tobacco and also helps cover the cost of increasing to $1 million the exemption for businesses subject to the margins tax.
  • A session-long battle over allowing hospitals to employ physicians directly ended with two bills passing: SB 1705 by Sen. Royce West (D-Dallas) for the Dallas County Hospital District and a Senator Duncan amendment to HB 3485 by Rep. Garnet Coleman bill (D-Houston) that applies to government-owned hospitals in counties of 50,000 or less. TMA won very strong protections for physicians' clinical autonomy including a Texas Medical Board-supervised certification program. The bill potentially expands liability exposure to government hospitals that use this option to employ physicians. That has drawn the governor’s attention for a possible veto.
  • SB 532 by Sen. Robert Deuell, MD (R-Greenville), and Representative Coleman ensures proper oversight of physicians' delegation of prescriptive authority and other responsibilities to allied health practitioners at retail health clinics.
  • No bills passed that would dilute our 2003 health care liability reforms.
  • Two immunization bills by Sen. Jane Nelson (R-Lewisville) passed: SB 1328 gives state and local experts an opportunity to assess the vaccine needs of first responders before they respond to emergencies and disasters. SB 346 creates a lifelong adult immunization registry in Texas.

TMA TASK FORCE WORKS TO DEFINE "WHAT WE'RE FOR" IN HEALTH SYSTEM REFORM

Our Task Force on Health System Reform met Saturday to spell out exactly what Texas physicians want to see in any reform package that Congress might pass this year. We will release the final plan for comment in a week or so, but it’s certain to include language that would:
  • Eliminate Medicare’s flawed physician payment formula;
  • Focus on prevention and wellness, both for individual patients and the population as a whole;
  • Ensure that physicians define science-based standards of care;
  • Eliminate unnecessary complexities and paperwork that add to physicians’ costs; and
  • Align financing and incentives to ensure that physicians, hospitals, patients, health plans, and government agencies all are working together for the good of the patient.

TEXAS PHYSICIANS BRINGING FIVE RESOLUTIONS, TWO CANDIDATES TO AMA HOUSE OF DELEGATES

The Texas Delegation to the American Medical Association House of Delegates will be a very busy bunch when the AMA meeting convenes in Chicago on June 13. In addition to celebrating the installation of Jim Rohack, MD, as the new AMA president, we are asking the house to back two Texas candidates for office and five resolutions from our own House of Delegates. They include:
  • Electing Fort Worth plastic surgeon Larry Reaves, MD, to the AMA Council on Constitution and Bylaws; and Dallas internist Lynne Kirk, MD, to the Council on Medical Education;
  • A resolution calling for legislation mandating clear and transparent health insurance company language so patients know their financial responsibility when receiving care out of network;
  • A resolution calling for legislation requiring insurers to adopt standardized verbiage spelling out coverage for preventive care, including adequate payment for recommended vaccines;
  • A resolution calling for the use of standard commercial physician payment rates in all government health care benefit programs;
  • A resolution requiring all Medicare patients to register the advance directive of their choice; and
  • A resolution asking AMA to help physicians and medical staffs establish transparent policies to implement and conduct Ongoing Professional Practice Evaluations.

FLEMING EXHORTS NEW PHYSICIANS TO 'GO FORTH AND MAKE US PROUD'

In his first public appearance since becoming TMA president, Bill Fleming, MD, addressed the graduating class at The University of Texas Medical School at Houston. Dr. Fleming acknowledged the students’ hard work to date – and the work, fears, and excitement to come. He urged them to always put their patients first and to get involved in organized medicine. “You are embarking upon the greatest profession in the world,” he said. “Cherish it. Go forth and make us proud.”

Tuesday, May 26, 2009

CALL YOUR REPRESENTATIVE NOW ON AMENDMENTS TO INSURANCE DEPARTMENT SUNSET BILL

Medicine’s hopes to bring some transparency and accountability to health insurance in Texas rest on our amending the bill that will reauthorize the Texas Department of Insurance (TDI). The health insurance industry and trial lawyers see their own opportunities in the TDI sunset bill. In an emergency weekend session with the TMA Board of Trustees and leaders of TEXPAC, TMA’s Council on Legislation called for a telephone blitz to the House of Representatives to add five crucial amendments and kill four awful ones when Senate Bill 1007 comes up for debate. Check your e-mail in box or go to TMA’s Grassroots Action Center for key talking points.
  • We’re pushing to protect patients whose insurance is about to be cancelled, require health insurance companies to report exactly how much they spend on health care vs. elsewhere, regulate silent preferred provider organizations that take physicians’ discounts without approval, set uniform language for physician-health plan contracts, and study how health plans are using data mining to affect patient care.
  • The amendments we’re fighting would allow health plans to fix prices for out-of-network services, destroy the affiliation between insurance trusts and the associations that created them, prohibit assignment of claims for services provided out of network, and create an unregulated new type of insurance product that would be bad for patients.

MEDICINE'S AGENDA HANGS IN THE BALANCE WITH SEVEN DAYS REMAINING IN SESSION

The partisan battle over a bill to require voters to show photo identification brought the Texas House of Representatives to a painfully slow crawl for three days and jeopardized passage of hundreds of other important pieces of legislation. Any bill that hasn’t passed the House by midnight tonight is dead. TMA’s health insurance reform agenda is tied to the must-pass TDI sunset bill as described above. Watch our latest Political Action at Work video. Here is a quick rundown on other pieces of Doctor’s Orders:
  • House-Senate negotiators have just about completed their work on the 2010-11 state budget. Their signatures aren’t on the paper yet, but right now it looks as if we’ve stopped a plan to extend Medicaid HMOs statewide. But there’s no increase in physicians’ Medicaid payments, and we’re still analyzing how graduate medical education funding has fared.
  • With the exception of possible amendments to the TDI sunset bill, we have been successful in killing all attempts to weaken our 2003 liability reforms.
  • Bills that would allow unsafe expansion of nonphysician practitioners’ scope of practice are dead. Our bill to provide flexibility to retail health clinics’ staffing is awaiting Senate approval.
  • Legislation that would allow hospitals all over Texas to hire physicians directly is stuck in the House logjam. We were able to amend the bill to narrow substantially the hospitals to which it applies. We also added language that protects patients and their physicians from outside interference from anyone not directly responsible for the care of the patient.
  • The bill banning smoking in all public places and workplaces statewide is dead.
  • A bill significantly expanding Texas’ physician loan repayment program won Senate Finance Committee approval yesterday. It also picked up a tactical boost as a popular bill reducing small businesses’ franchise tax liability was tied to the fate of the loan repayment measure.