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Monday, November 23, 2009


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.


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 The bill would have repealed the SGR payment formula.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.


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.


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


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.


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.


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.


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


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.


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.


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.


(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


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.


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.


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.


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.


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.