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Tuesday, January 26, 2010

Senate Shakeup Puts Focus on SGR, Health Insurance Reform

The Democrats’ surprise loss of the late Sen. Teddy Kennedy’s U.S. Senate seat in Massachusetts left Washington in what-do-we-do-now mode on health system reform. Absent a filibuster-proof majority in the Senate, the Obama administration is now reportedly considering a strategy that involves smaller, less-controversial pieces of legislation. We will continue to press representatives and senators to “keep what’s good and fix what’s broken” in our health care systems. TMA-supported health insurance industry reforms — including stronger consumer protections and the prohibition of policies that contain a preexisting condition exclusion — are among those concepts under consideration as stand-alone bills.

The American Medical Association and AARP, meanwhile, launched a television ad campaign urging Congress to rewrite Medicare’s broken Sustainable Growth Rate (SGR) formula before 21-percent cuts in physicians’ Medicare payments begin on March 1. “The Congressional Record is replete with statements by Senators from both sides of the aisle calling for permanent Medicare physician payment reform,” AMA and AARP wrote to House and Senate leaders. “What is missing, however, is action. As the nation’s largest organizations representing physicians and older Americans, we urge you to support passage of legislation to permanently repeal the SGR.” Physicians have until March 17 to make their Medicare participation decisions for 2010. To help you decide, TMA has developed a new Webinar that outlines your choices — and their consequences — and an interactive tool to help you estimate the financial impact of Medicare’s payment changes on your practice.

NEW LEADERS TAKE OVER IN TEXAS COUNTY MEDICAL SOCIETIES

“Tough times demand great leaders … and great followers,” TMA President Bill Fleming, MD, told newly elected county medical society presidents and their constituents at installation ceremonies across Texas in the past few weeks. The new leaders at Texas county societies include:
  • Family physician Andres Enriquez, MD, at the El Paso County Medical Society;
  • Mary Jo Godinich, MD, a nephrologist, at the Galveston County Medical Society;
  • Neurologist William Gilmer, MD, at the Harris County Medical Society, and family physician JoAnne Rogers, MD, at the Houston Academy of Medicine; and
  • Stephen Ozanne, MD, an orthopedic surgeon, at the Dallas County Medical Society. The Dallas physicians also presented the Max Cole Leadership Award to Don Read, MD, and the Robert L. and Millard J. Heath Award to Gov. Rick Perry.

HAVE YOU PAID YOUR DUES YET?

TMA and county medical society dues were technically delinquent if not paid by Jan. 1, but we don’t drop anyone from the membership rolls until the end of March. Given the tremendous challenges facing medicine this year — not to mention what is already shaping up to be a very tough session of the Texas Legislature in 2011 — we need to make sure that America’s largest medical society stays as strong as ever. You can renew online. In this election year, I also make a special plea for physicians and their spouses to contribute to TEXPAC as well.

I'LL SEE YOU FRIDAY AT TMA 2010 WINTER CONFERENCE

Leadership for Changing Times is the theme of this year’s TMA Winter Conference, Friday and Saturday, here in Austin. As medicine faces what could be the biggest changes in a generation, Texas physicians are counting on you — their leaders — to be up to the challenge. Speakers include Governor Perry; American Medical Association President Jim Rohack, MD; National Medical Association President Willarda V. Edwards, MD, MBA; and Chip Heath, PhD, coauthor of the about-to-be-released book, Switch: How to Change Things When Change Is Hard. Your TMA Board of Trustees will adopt the association’s 2010 budget and has scheduled a meeting with a group of Texas hospital administrators to discuss potential opportunities and constraints on hospital-physician relations both in Austin and at the community level. Online registration is closed, but you can still register for the conference on-site. If you can’t make it, we will stream Governor Perry’s speech live over the Internet from 10:40 to 11 am on Saturday.

Tuesday, January 19, 2010

THREE TEXAS CONGRESSMEN ASK PELOSI TO PROTECT TEXAS TORT REFORMS IN HEALTH BILL

The final federal health system reform bill shouldn’t in any way override Texas’ successful 2003 liability reforms, and it shouldn’t create new causes of legal action against physicians, U.S. Rep. Henry Cuellar (D-Laredo) and two of his colleagues wrote in a letter to House Speaker Nancy Pelosi. Reps. Gene Green (D-Houston) and Charlie Gonzalez (D-San Antonio) joined Representative Cuellar’s request. The letter comes on the heels of a very successful trip I took to Capitol Hill with TMA President-Elect Sue Bailey, MD; Council on Legislation Chair Dan McCoy, MD; and chief lobbyist Darren Whitehurst. Along with delegations from California and other state societies, we met with Rep. Pete Stark (D-Calif.), chair of the Health Subcommittee of the House Ways and Means Committee; Rep. Michael Burgess, MD (R-Lewisville); and staff of Speaker Pelosi and Reps. Cuellar, Green, and Henry Waxman (D-Calif.), chair of the House Energy and Commerce Committee. In all of our meetings, we discussed how Congress must replace the Sustainable Growth Rate (SGR) formula with a stable funding platform for physicians’ Medicare payments and other health system reform issues.

YOU STILL HAVE TIME TO REGISTER FOR TMA 2010 WINTER CONFERENCE

You won’t want to miss this year’s TMA Winter Conference, Jan. 29 and 30, here in Austin. On Saturday, Jan. 30, keynote speaker Gov. Rick Perry will discuss the future of health care delivery in Texas. American Medical Association President Jim Rohack, MD, and National Medical Association President Willarda V. Edwards, MD, MBA, will discuss health disparities and health system reform. I’m also excited to hear Chip Heath, PhD, professor of organizational behavior at the Stanford University School of Business and coauthor of the book Made to Stick: Why Some Ideas Survive and Others Die. TMA boards, councils, and committees will meet both days at the TMA building and the AT&T Conference Center. You can register online through Friday, Jan. 22.

EIGHT CHALLENGED JUDICIAL CANDIDATES EARN TEXPAC ENDORSEMENT

Two candidates for the Texas Supreme Court and six appeals court hopefuls – all of whom face opposition in the March 2 Republican primary – won TEXPAC’s endorsement over the weekend. For the Supreme Court, we are backing Rebecca Simmons of San Antonio in Place 3 and incumbent Justice Eva Guzman of Houston in Place 9. In the First Texas Court of Appeals (Houston), TEXPAC voted to support incumbent Justices Evelyn Keyes and Michael Massengale. In the Sixth Court of Appeals (Texarkana), we endorsed incumbent Chief Justice Josh Morriss. Al Scoggins of Waxahachie won TEXPAC’s backing in the Tenth Court of Appeals (Waco). And in the Fourteenth Court of Appeals (Houston), we are supporting incumbent Justices Leslie Yates and Kent Sullivan. Early voting runs from Feb. 16 to Feb. 26.

TMA LEADERS LEARN ADVANCED ADVOCACY COMMUNICATION SKILLS

Whether you’re talking to your children, a roomful of physicians, or the U.S. Congress, you need to have a specific “ask,” a powerful supporting message, and a solid understanding of what makes your audience tick. That’s just one of the lessons that Dr. Bailey; TMA Board Chair Michael Speer, MD; former Chair Bruce Malone, MD; TMA’s senior communicator Steve Levine; and I learned this weekend at a high-level advocacy communication workshop that the Annette Strauss Institute for Civic Participation hosted. Karen Hughes, the former ambassador and spokesperson for President George W. Bush, was one of the speakers. The 15-person class learned about new media and old media, fund-raising, and grassroots politics, and picked up some first-person experience of what it’s like to appear on a national cable TV news show.

TMA'S HEALTH REFORM MESSAGE STAYS THE SAME: KEEP WHAT'S GOOD, FIX WHAT'S BROKEN

Our trip to D.C. and the advocacy communication class reinforced to me the importance of having a simple, consistent message on something as vital and complicated as health system reform. We’re still telling our representatives and senators to “keep what’s good and fix what’s broken” in today’s health care system. All of our positions are based on principles endorsed by the TMA House of Delegates. As the congressional debate moves into its final stages, here are our primary concerns and requests:
  • Both sides of the aisle continue to play political games with medicine over how and when they will fix the SGR formula. If both Democrats and Republicans recognize that the formula is flawed and needs to be fixed, why can’t we get the job done? We’re asking every member of our congressional delegation for a commitment to support a fix to the SGR – no ifs, ands, or buts. Medicine is not responsible for the huge budget hole that Congress created on the issue; we just want the problem fixed so physicians can continue providing care to patients.
  • We don’t know exactly where the debate on health system reform will end; we do know that the current bills have provisions we support and others to which we are adamantly opposed because they will result in harm to patients. We are asking Texas senators and representatives to tell us they will support our upcoming efforts with the Centers for Medicare & Medicaid Services and other agencies that implement the bill to ensure that patients continue to receive appropriate care and that the patient-physician relationship is protected from outside influence.

Monday, January 11, 2010

TMA DELEGATION HEADED TO CAPITOL HILL TO LOBBY ON HEALTH SYSTEM REFORM

TMA President-Elect Sue Bailey, MD, is leading a group that includes Council on Legislation Chair Dan McCoy, MD, chief lobbyist Darren Whitehurst, and me that is traveling to Washington, D.C., this week. We will work with delegations from California and other state societies to lobby House and Senate members on the health system reform bill that’s on a fast track for final votes. We will work to build support for replacing the Sustainable Growth Rate formula (SGR) with a stable funding platform for physicians’ Medicare payments. We are also after protections for Texas’ medical liability reforms and a rewrite of some of the more odious physician-evaluation provisions in the bill. The Council on Legislation met last week via conference call to reaffirm TMA’s priorities. We have posted a comprehensive comparison of the House and Senate bills on the TMA Web site (PDF) fair, stable funding formula.

LEADERS SHARE INSIGHTS ON STATE HEALTH CARE ISSUES AT AMA STRATEGY CONFERENCE

TEXPAC Chair Susan Strate, MD, joined Dr. Bailey, Darren Whitehurst, and me at the American Medical Association’s 2010 State Legislative Strategy Conference (PDF). Hot topics included how federal health system reform will affect the states, the uncertain funding future for state Medicaid programs, liability reform, scope of practice, health information technology, and health insurance reform. Lee Spangler, TMA’s vice president for medical economics, was part of a panel discussion on ways to corral health plans’ efforts to stop balance billing for out-of-network services. The TMA Council on Legislation already has begun work on our agenda for the 2011 Texas Legislature, and will start examining the details later this month at TMA 2010 Winter Conference.

FLEMING HELPS TO WELCOME DR. BENJAMIN AS U.S. SURGEON GENERAL

TMA President Bill Fleming, MD, is in Washington, D.C., today for the swearing in of Regina Benjamin, MD, as the nation’s 18th surgeon general. The 53-year-old family physician is nationally known as the founder of a nonprofit clinic serving the Alabama Gulf Coast. Dr. Benjamin is an invited speaker for the 2010 TMA Winter Conference. We’ve asked her to join AMA President Jim Rohack, MD, and National Medical Association President Willarda Edwards, MD, in a panel discussion of health care disparities and health system reform. Later this week, Dr. Fleming will travel to El Paso and Galveston to install new officers at county societies there.

RIP KELLY FERO: 1952-2010

The TMA family joins the Texas Capitol community in mourning for Kelly Fero, who was found dead at his home last week. The 57-year-old Fero has served as a Democratic consultant to TEXPAC and the TMA Council on Legislation. The low-key strategist was known for his sharp wit, pithy one-liners, and willingness to engage in bare-knuckles political tactics. We extend our deepest sympathies to Kelly’s wife Mary, his two daughters, and four grandchildren.

INSURANCE COMMISSIONER TAKES FIRST STEP IN BLOCKING DISCRETIONARY CLAUSES

Texas Insurance Commissioner Mike Geeslin has asked all life, accident, and health insurance companies in Texas to stop filing insurance policy forms containing discretionary clauses while he considers a rule prohibiting their use. TMA has joined with the Office of Public Insurance Counsel in asking Commissioner Geeslin to ban discretionary clauses in insurance policies. Such clauses, already outlawed in 22 states, give the insurers free rein to interpret policy terms and evaluate a patient’s claim for benefits any way they choose. As Dr. Fleming wrote in a letter to Commissioner Geeslin, discretionary clauses create a “fox guarding the henhouse situation that serves to provide the insurer with the authority to consistently deny benefits that a reasonable insured person would believe falls within the terms of the policy.