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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.

PHYSICIAN WORK GROUPS DEVISE TMA'S HEALTH SYSTEM REFORM PLANS

Three of the four work groups from TMA’s Health System Reform Task Force met via conference call to hammer out the details of what Texas medicine wants from congressional reform efforts. The fourth work group meets tomorrow in anticipation of the full task force convening on Saturday. The panel’s goal is to use the 17 guiding principles (PDF) our House of Delegates approved to answer 10 key questions and develop TMA’s proposal for system reform. What do you want to see in our plan? What’s critical for your practice and your patients? Please e-mail me your suggestions.

CHAIR AND I PICK UP TRAINING TO ENHANCE TMA BOARD OF TRESTEES

Michael Speer, MD, the new chair of the TMA Board of Trustees, and I attended a two-day workshop on building an exceptional board. Sponsored by the American Society of Association Executives, the seminar covered strategies for creating a cohesive board that provides effective leadership for the association.

Monday, May 18, 2009

MEDICINE'S BILLS STILL MOVING AS LEGISLATIVE SESSION BEGINS LAST TWO WEEKS

Deadlines and the constantly ticking clock are killing off thousands of bills as the 2009 Texas Legislature moves into its nerve-wracking, final two weeks. All eyes are watching House-Senate negotiations over the 2010-11 state budget bill. Our big concerns there include Medicaid and Children's Health Insurance Program (CHIP) payments for physicians and funding for graduate medical education. Other pieces of our legislative agenda continue to move forward:
  • On the health insurance reform front, HB 1342 by Rep. Jose Menendez (D-San Antonio) and Sen. Chris Harris (R-Arlington) won Senate approval. The bill, which requires health plans to provide pertinent patient coverage information at the time of service, goes back to the House. A Senate committee passed HB 1888 by Rep. John Davis (R-Houston) and Sen. Robert Duncan (D-Lubbock), which gives physicians important protections in health plan ranking schemes.
  • The House passed HB 2962 by Rep. Garnet Coleman (D-Houston), which would expand eligibility for CHIP coverage and provide a continuous 12 months' eligibility for Medicaid.
  • A bill to enhance Texas' physician loan repayment program, HB 2154 by Rep. Al Edwards (D-Houston), also passed in the House.
  • The House approved SB 61 by Sen. Judith Zaffirini (D-Laredo) and Rep. Allen Vaught (D-Dallas), which adopts American Academy of Pediatrics standards for booster seats for children.

SEND ME YOUR IDEAS ON HEALTH SYSTEM REFORM

Meanwhile, at the other capitol building, our federal legislators are promising to send a health system reform bill to President Obama's desk by summer's end. TMA's Health System Reform Task Force meets next week. The panel's goal is to use the 17 guiding principles our House of Delegates approved to answer 10 key questions and develop TMA's proposal for system reform. What do you want to see in our reform plan? What's critical for your practice and your patients? Please e-mail me your suggestions. We also are watching closely the actions of the Senate Finance Committee and submitted an extensive brief in response to some of the committee's initial reform plans. We called for abolition of the Medicare physician payment formula and for antitrust reform.

REPRESENTATIVE/DOCTOR ZERWAS SAVES COLLEAGUE'S LIFE

What's the value of having a doctor - or two - in the House? Ask the family of State Rep. Ed Kuempel (R-Seguin). The veteran lawmaker suffered a heart attack in a capitol elevator during a late night session. Anesthesiologist Rep. John Zerwas, MD (R-Richmond), supervised the work to resuscitate Representative Kuempel before ambulances arrived to rush him to the hospital. 'Dr. Zerwas saved Edmund's life,' House Administration Committee Chair Charlie Geren (R-Fort Worth) said the next day as the House gave a standing ovation to Representative Zerwas and Rep. Mark Shelton, MD (R-Fort Worth). Representative Kuempel remains in critical but stable condition.

NORTH CAROLINA TO TEAM WITH TMA ON HEALTH SYSTEM REFORM

I presented our 17 guiding principles and 10 key questions on health system reform to the leaders of the North Carolina Medical Society (NCMS). I also shared some key public opinion data gleaned from focus groups and surveys conducted by the Physicians Foundations. Those data show the public trusts physicians and is ready to follow your lead in the reform debate. NCMS and TMA will work together as we take our proposals to Congress.

Monday, May 11, 2009

PATIENTS' RIGHT TO KNOW BILLS MOVING THROUGH THE LEGISLATURE

Four key pieces of our Patients’ Right to Know health insurance reform package won approval from the Texas Senate. Our Health Insurance Code of Conduct Act of 2009 (PDF) — Senate Bill 1257 by Sen. Kip Averitt (R-Waco) — provides important patient protections and is drawing the wrath of the health plan lobby. Rep. Craig Eiland (D-Galveston) is likely to try to get the bill out of the House Insurance Committee this week. Other bills winning Senate approval include:
  • Our health insurance facts label legislation — SB 815 by Sen. Kirk Watson (D-Austin);
    SB 485 by Sen. Robert Deuell, MD (R-Greenville), which sets a standard definition for “medical loss ratios”; and
  • SB 206 by Sen. Eliot Shapleigh (D-El Paso), which requires health plans to report to the Department of Insurance details on the cancellation and rescission rates of their products.

TMA HOUSE ADOPTS HEALTH SYSTEM REFORM GUIDELINES

Last week’s EVPGram ran out of room before I could summarize the highly efficient actions of the TMA House of Delegates at TexMed 2009. Most importantly, the house approved the 17 guiding principles developed by the Select Committee on Health System Reform. Those principles already are guiding our new Health System Reform Task Force. Delegates also voted:
  • To urge the legislature to require nonphysicians with direct patient contact to “display or clearly identify their name, degree held, and specialty (PDF) on lab coats, ID badges, main entrances to their medical practices,” and in public promotional material so patients won’t think they’re physicians;
  • To support legislation or rulemaking to establish a temporary license (PDF) for non-Texas physicians testifying in the state as expert medical witnesses;
  • To support legislation or rulemaking that would set “a reasonable statute of limitations” (PDF) for handling Texas Medical Board (TMB) administrative violations.

FIRST TUESDAYS TOTAL FOR THE YEAR TOPS 1,000 PHYSICIANS, STUDENTS, AND ALLIANCE MEMBERS

More than 165 physicians, medical students, and alliance members attended the last First Tuesdays at the Capitol, bringing the total attendance for 2009 to more than 1,000. While their colleagues lobbied lawmakers, some TMA members spent the day testifying at House and Senate committees:
  • TMA Board Chair Michael Speer, MD, testified against SB 2336 by Sen. Dan Patrick (R-Houston). He said we need a strong and fair TMB to give physicians due process in complaints and investigations, to protect patients, and to uphold high ethical and professional standards for physicians. Dr. Speer outlined our strong stand on nontherapeutic prescribing.
  • Former board chair Lyle Thorstenson, MD, testified in support of SB 2077 by Sen. Carlos Uresti (D-San Antonio). The measure would create a special state committee to identify physician shortage areas and recommend residency training programs to meet health care needs.
  • Joseph Schneider, MD, chair of TMA's Health Information Technology Committee, testified in support of SB 7 by Sen. Jane Nelson (R-Lewisville). Dr. Schneider discussed how the bill would use information technology to improve the quality of care in the Texas Medicaid program.

TMA OUTLINES BUDGET PRIORITIES

As a joint House-Senate committee began work finalizing the 2010-11 state budget, TMA, the Texas Pediatric Society, and the Texas Academy of Family Physicians sent the committee a letter outlining our funding priorities (PDF). These include spending on programs to reduce the number of uninsured Texans, increasing physician payments for Medicaid and Children's Health Insurance Program (CHIP) services, fixing the eligibility system for Medicaid and CHIP, improving mental health services, and implementing routine newborn screening for cystic fibrosis. We’re also asking physicians across the state to urge the committee to remove a provision that would expand Medicaid HMO-like plans across Texas and further reduce out-of-network payments to physicians.

GOVERNOR SIGNS IMMUNIZATION BILL INTO LAW

TMA’s public health agenda is gaining steam at the capitol. Gov. Rick Perry signed SB 346 by Senator Nelson, which would establish a lifelong adult immunization registry in Texas. Meanwhile, House Bill1358 by Rep. Jim Keffer (R-Eastland), which strengthens the Cancer Prevention and Research Institute, passed the Texas House. Dr. Speer testified in support of HB 1672 by Senator Deuell, which relates to the confidentiality of newborn screening information. And Austin pediatrician Kimberly Edwards, MD, testified before a House committee on SB 282 by Senator Nelson, which would establish grant programs to provide nutrition education to children, and to school districts for best practices in nutrition.

STAY UP TO DATE ON SWINE FLU AT TMA WEB SITE

The Texas Department of State Health Services and the U.S. Centers for Disease Control and Prevention continue to provide new guidance for physicians on testing and treating the H1N1 flu. Check TMA’s swine flu resource center regularly for the latest news and information.

Monday, May 4, 2009

FLEMING TAKES LONG-DISTANCE OATH TO BECOME TMA'S 144TH PRESIDENT

Ill health kept Bill Fleming, MD, away from the TexMed 2009 revelry, but it couldn’t stop the Houston neurologist from taking the oath of office to become TMA’s first African-American president. Connected via a telephone link to loudspeakers at the Austin Convention Center, Dr. Fleming was installed along with new TMA Alliance President D’Anna Wick of Tyler. “I am terribly proud to lead the biggest and best state medical society in the country,” he said. “You know, here in Texas we have world-renowned, world-class physicians and hospitals and other facilities. But Houston and Texas, we have a problem. There are far too many citizens of Texas who cannot access these world-class services.” He called on TMA to address the problem of Texas’ huge number of uninsured with the same vigor we used to stop the lawsuit abuse epidemic in 2003.

BAILEY CHOSEN TMA PRESIDENT-ELECT; FOXHALL, HENKES, READ ELECTED AS TRUSTEES

The TMA House of Delegates unanimously selected Fort Worth allergist Sue Bailey, MD, as TMA’s president-elect and gave the former house speaker a standing ovation as she accepted the new mantle of responsibility. Delegates also elected three new members to the TMA Board of Trustees: Lewis Foxhall, MD, a family physician from Houston; pathologist David Henkes, MD, of San Antonio; and Dallas colon and rectal surgeon Don Read, MD. Austin ophthalmologist Michelle Berger, MD, won election to the Texas Delegation to the American Medical Association. The new medical student trustee is Spencer Pruitt from The University of Texas Health Science Center at Houston. In choosing its own officers, the Board of Trustees selected Houston’s Michael Speer, MD, as chair; Carolyn Evans, MD, of Dallas as vice chair; Dr. Read as secretary; and Carlos Cardenas, MD, of Edinburg and Tom Garcia, MD, of Houston as members of the executive committee.

DISTINGUISHED SERVICE AWARD GOES TO TENERY

Dallas ophthalmologist Rob Tenery, MD, son and grandson of physicians and the conscience of a generation of Texas physicians, received TMA’s Distinguished Service Award at TexMed 2009. “What this means to me is a validation of those of us who hold on to the conviction that the practice of medicine should always be a profession where what one does continues to be more important than what one gets,” Dr. Tenery said. Also honored at the annual meeting:

  • Fred Merian, MD, of Wimberley won the Young Physician Section’s Young at Heart award. Amelia Martinez of Sabinal received the Michael O’Malley, MD, Memorial Scholarship. The award helps rural high school seniors pursue a degree in medicine.
  • The Resident and Fellow Section named Fort Worth orthopedic surgeon Steve Brotherton, MD, the winner of the J.T. “Lamar” McNew, MD, Award for mentoring.
  • Arlo Weltge, MD, an emergency medicine specialist from Houston, received the C. Frank Webber, MD, Award from the Medical Student Section. The students also named the University of North Texas Health Science Center the Chapter of the Year and University of Texas Southwestern Medical School student Jessica Nguyen-Trong the Student of the Year.




HEALTH INSURANCE CODE OF CONDUCT POISED FOR SENATE VOTE - CONTACT YOUR SENATOR NOW

Please use TMA’s Grassroots Action Center to contact your state senator today and urge him or her to vote “AYE” on Senate Bill 1257 by Sen. Kip Averitt (R-Waco), TMA’s Health Insurance Code of Conduct Act of 2009 (PDF). The bill, which is currently eligible for Senate debate, would bring greater transparency and accountability to the way big health insurance companies conduct business. This is TMA’s No. 1 bill in the 2009 Texas Legislature. Here are highlights from last week at the capitol:
  • The Senate passed SB 2243 by Sen. Judith Zaffirini (D-Laredo), which would improve and expand Texas’ physician education loan repayment program.
  • The Senate Finance Committee passed SB 841 by Senator Averitt, which would allow families at 200 to 300 percent of the federal poverty level to buy into the Children’s Health Insurance Program (CHIP). The House Human Services Committee passed House Bill 1541 by Rep. Sylvester Turner (D-Houston) that would strengthen outreach for Medicaid and CHIP.
  • Dr. Foxhall testified before the House State Affairs Committee for HB 5 by Rep. Myra Crownover (R-Denton), which would ban smoking in all public workplaces.
  • The House Public Health Committee passed HB 3816 by Rep. Fred Brown (R-College Station), which relates to the power and duties of the Texas Medical Board. TMA has been working with medical board leaders and legislators to improve the bill.

PHYSICIANS PACK THE HOUSE FOR SWINE FLU UPDATE

Texas Health Commissioner David Lakey, MD, and Ed Sherwood, MD, chair of TMA’s Committee on Infectious Disease, educated a large crowd of TexMed 2009 physicians on how to protect patients in their communities against the H1N1 flu outbreak. So far, there are 40 confirmed cases in Texas.

FINAL FIRST TUESDAYS AT THE CAPITOL IS TOMORROW

If you have not signed up for tomorrow’s last First Tuesdays at the Capitol, it's not too late. We need your help to get bills moving or stopped in the final days of the session.

Check out the Doctor’s Orders video to get a more complete view of TMA’s 2009 legislative agenda. You can see all of TMA’s 2009 legislative issue briefs on the TMA Web site.