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Tuesday, January 27, 2009


The Children’s Health Insurance Program (CHIP) deserves to be reauthorized and expanded. But that’s no excuse for Congress to put heavy restrictions on physician ownership of hospitals. The House already passed a bill, HR 2, that does both. The Senate is expected to vote today on a measure that would reauthorize CHIP without the ownership restrictions. Check out TMA’s Grassroots Action Center for an easy way for you to share your sentiments with your representative and Sens. John Cornyn and Kay Bailey Hutchison.


Interested in earning an extra 1.5 percent on your Medicare payments this year by participating in the Physicians Quality Reporting Initiative (PQRI)? The board of the Physicians’ Foundations met to discuss how to spread the word on DocSite, a free, patient registry that can help you qualify for the PQRI bonus. The board also continued to examine the results of our survey on national workforce needs and how to address them.


State Sen. Kirk Watson (D-Austin) and Reps. Garnet Coleman (D-Houston) and John Zerwas, MD (R-Katy) will share their insights into this year’s Texas Legislature at TMA’s 2009 Winter Conference this weekend. We also have a great dawn duster program on e-prescribing, a medical humorist for lunch, and our annual county medical society leadership forum late in the day. TMA boards, councils, and committees have business meetings throughout the weekend. You can still register at the door Friday or Saturday.


Texas’ three largest county medical societies put new presidents in place last week. TMA President Josie Williams, MD, was on hand as Dallas County Medical Society installed Phillip Huber, MD. Dr. Williams also was in San Antonio, where Roberto San Martin, MD, became the new Bexar County Medical Society president and Rebecca Waller assumed the helm of the Bexar County Alliance. Robert Jones, MD, received the Golden Asclepius Award and Bill Hinchey, MD, the first ever Distinguished Service Award from Bexar County Medical Society. In Houston, Lewis Foxhall, MD, is the new president of the Harris County Medical Society; Betty Jo Edwards, MD, is now president of the Houston Academy of Medicine.


Next Tuesday, Feb. 3, is the first First Tuesdays at the Capitol for 2009. Veteran and rookie white-coated lobbyists are invited to spend the day with colleagues, spreading the word with your representative and senator about TMA’s 2009 legislative agenda. Check out the video on the First Tuesdays registration page, then sign up. We provide some lobbying tips and a briefing on Doctor’s Orders, our legislative priorities. Then we all walk to the Capitol to bend some ears on behalf of medicine and patients. The TMA Alliance and TEXPAC cohost this award-winning event.


By statute and longstanding case law, Texas prohibits the corporate practice of medicine. The principle is simple. Only physicians, as opposed to corporate entities, are licensed by Texas to provide medical services. The fundamental purpose of this prohibition is to ensure physicians’ independent medical judgment. Texas’ case law has upheld this principle and continues to prohibit corporations or other lay entities from directly employing physicians.

Maintaining the physician’s independent medical judgment is critical. It ensures that a patient’s medical needs come before the hospital or governmental entity’s business needs. If the physician were to become an employee of a hospital, insurance company, or any other entity not licensed to practice medicine, the patient’s health and well-being could be compromised. Business considerations, not medical needs, could lead to poor patient care decisions.

Over time, the corporate practice of medicine doctrine has evolved. Medical schools may employ physicians, as can other physicians. Nonprofit health care corporations (commonly referred to as 501[a] corporations) sponsored by hospitals and hospital districts also may employ physicians. Under each of these avenues, however, a licensed physician or physicians are ultimately responsible for patient care. In the case of the 501(a) nonprofit corporation, even if the organizing entity is a hospital, that corporation must have a physician board of directors. Rules governing their operation are designed to ensure that physicians remain in charge of medical decisions.

Medicine’s 2009 Agenda
  • Oppose efforts to broaden the corporate practice of medicine beyond the current exceptions for medical schools, 501(a) corporations, and federally qualified health centers (FQHCs).
  • Require the Texas Medical Board to maintain current information on the sponsorship, governance, and membership of 501(a) corporations.
Medicine’s Message
  • Physicians should work for the patient not the insurance company, hospital, or anyone else who is not directly responsible for the care of the patient.
  • Physicians licensed to practice medicine in Texas have met stringent qualifications. They have earned the right to be trusted to apply their expertise to provide the appropriate medical care for their patients. Physicians should not be under the control of a lay administrator whose focus is the budget and economic health of a corporate entity.

Check out the Doctor’s Orders video to get a more complete view of TMA’s 2009 legislative agenda.

See all of TMA’s legislative issue briefs in the Governmental Affairs section of the TMA Web site.

Tuesday, January 20, 2009


The 81st Texas Legislature convened. Comptroller of Public Accounts Susan Combs said lawmakers will have 10.5 percent less in general revenue to spend for the 2010-11 biennium. The House elected Rep. Joe Straus (R-San Antonio) as its new speaker. The Senate wrangled over its operating rules. Then they all left town. The House won't reconvene until Thursday, while the Texas Senate is out until Monday, Jan. 26. But we’re starting to see action on our 2009 legislative agenda: Doctor’s Orders: TMA’s Prescription for a Healthy Texas. Specifically:


Editorial board visits, chamber of commerce speeches, and radio and television interviews were all on the agenda as TMA President Josie Williams, MD, took our Doctor’s Orders plan on a road trip. Her travels included stops in Abilene, El Paso, Longview, Tyler, and Amarillo. She also met with the founding dean and other leaders of the new Texas Tech University Health Sciences Center Paul L. Foster School of Medicine in El Paso.


The U.S. House of Representatives quickly approved one of President-Elect Obama’s health care priorities. The Children’s Health Insurance Program (CHIP) Reauthorization Act of 2009 (HR 2) would cover 6.7 million children currently enrolled in CHIP and 3.9 million children who are eligible for CHIP but not enrolled. The program’s authorization expires on March 31, 2009, if not passed. Unfortunately, the bill also includes provisions that would place restrictions on physician ownership of hospitals. TMA strongly opposes those restrictions. Good news came from the other side of the Capitol later in the week, when the Senate Finance Committee passed a CHIP reauthorization bill without the ownership provision. We will fight to keep the Senate version.


Dr. Williams represented TMA at the installation of officers at two of Texas’ largest county medical societies. The El Paso County Medical Society installed Luis Urrea, MD, as president and Andres Enriquez, MD, as president-elect. In Amarillo, Geoffrey Wright, MD, is the new president of the Potter-Randall County Medical Society. Meanwhile, TMA President-Elect Bill Fleming, MD, attended the installation of Thomas Kimbrough, MD, who took over as the new president of the Galveston County Medical Society.


In 2003, the Texas Legislature passed sweeping liability reforms to combat health care lawsuit abuse, reverse skyrocketing professional liability insurance premiums, and ensure Texans’ access to high-quality medical care. Texas voters then approved Proposition 12, a constitutional amendment that ratified the legislature’s authority to impose these most important reforms.

By all measures, the reforms have worked exactly as promised. Patients have better access to needed and timely care. More physicians provide specialty and high-risk obstetrical care in both urban and rural areas. Physicians enjoy lower premiums and a more competitive liability insurance market.

One key provision in the law, a higher liability threshold for emergency services, ensured that severely ill and injured patients receive timely critical care. This is important because physicians providing emergency care need greater protection from lawsuit abuse. In many cases, they must provide life-saving care immediately and with limited patient information. In the past two sessions, tort reform adversaries have tried to reduce this protection. We expect this issue to return in 2009 with additional aggressive attempts to weaken Texas’ landmark reforms. We must protect the existing laws. The reforms are good for Texas and good for Texas patients.

Medicine’s 2009 Agenda

  • Protect the 2003 health care liability reforms, including caps on noneconomic damages and protecting emergency services.
  • Expand the Texas Medical Board’s (TMB’s) jurisdiction to include physicians’ testimony in liability cases regarding appropriate standards of medical care.

Medicine’s Message

  • Texas has gained more than 14,000 new physicians to take care of Texas patients. Many of these physicians practice high-risk specialties such as emergency medicine, neurosurgery, pediatric intensive care, and pediatric infectious disease medicine. Patients now can get more timely and convenient care when needed.

  • Twenty-one rural Texas counties have added at least one obstetrician since the passage of Proposition 12, including 12 counties that previously had none.

  • The emergency care provisions have saved lives by helping ensure Texas patients have access to critical and timely care. The threat of lawsuit frenzy could harm Texas’ emergency room care.

  • The 2003 liability reforms have worked. They’ve lived up to their promise. Sick and injured Texans now have more physicians who are more willing and able to give them the medical care they need.

Watch this 1-minute videoto see what your medical association is doing to protect the liability reforms and how you can help.

See all of TMA’s legislative issue briefs in the Governmental Affairs section of the TMA Web site.

Monday, January 12, 2009


The 81st Texas Legislature convenes tomorrow, with a new speaker of the house waiting in the wings, a tight two-year budget needing to be written, and the house of medicine prepared to push an aggressive agenda for physicians and patients. TMA is asking lawmakers to follow the treatment we outline in Doctor’s Orders: TMA’s Prescription for a Healthy Texas. We know it will be a difficult session, but TMA’s design asks legislators to:
  • Hold health insurance companies accountable and create a health insurance code of conduct;
  • Protect our 2003 health care liability reforms;
  • Stop the unsafe expansion of nonphysicians’ scope of practice;
    Preserve physicians’ autonomy from hospital and corporate ownership and interference; and
  • Improve Texas’ fiscal and physical health.

Each week for the next 140 days, we will outline one of TMA’s priorities in the EVPGram. We begin today with our plan for a “health insurance product label.” I encourage you, the leaders of medicine, to engage from the beginning, stay in touch with your legislators, and come to our First Tuesdays at the Capitol. You can begin watching the six-minute video we produced to accompany Doctor’s Orders.


The American Medical Association has joined with five other national organizations in a multimillion-dollar national television advertising buy. Their message: To fix the ailing economy, the country needs health care reform that addresses the related problems of health care costs and people losing health coverage. “Health care reform is a key component to jump-starting our national economy,” said AMA President Nancy Nielsen, MD. “As our new ad makes clear – quality, affordable health care is good for families, and it’s good for businesses.”


Send your front-office staff to TMA’s first practice management seminar of 2009 to learn how quality customer service translates into patient satisfaction, a smoother-running practice, and fewer collection problems. We’re conducting the daylong seminar in eight different cities across the state. Register on the TMA Web site.


As expected, The University of Texas (UT) Board of Regents named Francisco Cigarroa, MD, a pediatric and transplant surgeon who is president of the UT Health Science Center at San Antonio, the new chancellor of the UT System.


Make sure you're prepared for the 2009 Texas Legislature. Register today for the TMA Winter Conference Jan. 30-31 at the Hyatt Regency Hotel in Austin. Catch up on the most crucial health care issues and visit with key legislators.


Purchasing health insurance coverage today is increasingly complex. Health insurance companies offer a wide range of plans with different benefits, exclusions, and costs. It is nearly impossible to decipher the health insurer’s sales literature and then figure out a way to make a direct, product-to-product comparison.

Employers and patients need accurate, current, and honest information on copays, deductibles, and health plan networks to make decisions in today’s health care market.

The real need for this information is not when patients are sick or injured, but rather when Texas businesses and their employees are shopping for health insurance coverage. A California study in June 2008 examined what would make shopping for health insurance easier. It found that people wanted standardized information that makes it easier to do a side-by-side comparison of each product, much like the nutritional label on a soup can. Furthermore, study participants wanted information that is accurate, complete, and reliable.

Standardized and reliable nutritional labeling has made it much easier for consumers to make better food choices. Consumers can examine 20 different boxes of cereal and easily compare the product benefits, such as number of calories and percentage of fat, sodium, sugar, or protein. TMA believes the same standardized system could aid employers and patients when shopping for health insurance. The “health insurance product label” would enable employers and patients to compare health plans easily based on standardized measures of value. For example, the label could identify the premium and copay, medical loss ratio, average annual amount paid by the health insurance company vs. out-of-pocket expense paid by the patient, and out-of-network benefit – to name a few. Read the Coverage Facts: Individually Purchased Health Insurance, 2006 (PDF) report.

Medicine’s 2009 Agenda

  • Support the requirement of standardized reporting and value measures that health insurers/HMOs and their brokers could use to help employers and individuals make direct side-by-side product comparisons.

Medicine’s Message

  • Health insurance companies should be more accountable and more transparent about what benefits are available in each product they sell.
  • Brokers and agents should be required to use a standardized format when presenting the coverage options for each product line.
  • A 2007 statewide poll found that 72 percent of Texans feel our health care system puts insurance profits ahead of patient care.

See all of TMA’s legislative issue briefs in the Governmental Affairs section of the TMA Web site.