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Monday, February 22, 2010

TEXAS HEALTH AND HUMAN SERVICES COMMISSION PROPOSES MEDICAID PAYMENT CUTS

Under orders to cut its budget by 5 percent starting Sept. 1, the Texas Health and Human Services Commission (HHSC) has proposed reductions in the state’s Medicaid, Children’s Health Insurance Program (CHIP), mental health care, and public health systems. HHSC Commissioner Tom Suehs has tried wisely to avoid budget moves that would remove families from these programs’ rolls. But his plan to cut children’s Medicaid and CHIP payments to physicians and providers by 1 percent — and adult Medicaid payments by 2 percent — surely will limit families’ access to care. TMA is preparing a letter to Gov. Rick Perry, Lt. Gov. David Dewhurst, and House Speaker Joe Straus that recommends state leaders work with physicians to devise innovative models of health care delivery that emphasize prevention, early detection and intervention, and better health outcomes.

MEDICARE MELTDOWN JUST ONE WEEK AWAY WITH NO RELIEF IN SIGHT

TMA has begun a broad news media campaign to raise the public’s awareness of how the March 1 cut in physicians’ Medicare payments will hurt patients throughout the entire health care system. Unless Congress acts — and right now, there’s no bill in sight — the Sustainable Growth Rate (SGR) formula will mandate a 21.2-percent cut in physicians’ payments beginning next Tuesday. “In Texas, more than 2.5 million senior citizens and people with disabilities, and 850,000 military family members depend on Medicare for health care,” TMA President Bill Fleming, MD, said in the first of our Countdown to Medicare Meltdown news releases. “If Congress does not stop the cut in the next eight days, these patients will have Medicare coverage but may not have a physician of their choice to care for them. This is devastating.” Every day for the next week, TMA will highlight the impact of the looming cuts. You can do your part by using TMA’s Grassroots Action Center to tell Sens. John Cornyn and Kay Bailey Hutchison and your U.S. representative that we want a permanent fix to the broken SGR.

TMA: PHYSICIAN ASSISTANTS CANNOT EMPLOY THEIR SUPERVISING PHYSICIANS

The Texas Physician Assistant Board should not adopt a proposed rule that would allow a physician assistant (PA) to “employ” his or her supervising physician, even as an “independent contractor,” Dr. Fleming wrote in a letter to the board. “A physician cannot meaningfully supervise the person paying his salary or fees as an independent contractor,” Dr. Fleming wrote. The rule also would violate Texas’ prohibition on the corporate practice of medicine, he said. Those issues and more came up in a meeting Dr. Fleming, TMA senior staff, and I had with Mari Robinson, who is executive director of both the Texas Medical Board (TMB) and the Physician Assistant Board. We also discussed how the 5-percent reduction in the TMB budget — required of all state agencies by our top elected officials — would affect its ability to process license applications.

HUMANA WILL CONTINUE TO HONOR KEY TERMS OF RICO LAWSUIT SETTLEMENT

Organized medicine’s settlement agreement with Humana in our class action antiracketeering lawsuit expired late last year, but the company has voluntarily agreed to maintain many of the most important terms of the agreement. Humana will continue to honor important new coding rules, the clinical definition of medical necessity, and the 18-month limit on seeking recovery for overpayments. TMA entered the lawsuits against the country’s largest for-profit health plans in 2001. Blue Cross and Blue Shield, CIGNA, Health Net Inc., Prudential Insurance Company of America, Anthem Inc./WellPoint, and Humana all agreed to settlements with the medical societies.

EARLY VOTING ENDS FRIDAY — VOTE FOR TEXPAC'S CANDIDATES IN PARTY PRIMARIES

Early voting in the March 2 party primaries ends at 7 pm, Friday, Feb. 26. Please get out this week to vote for TEXPAC’s endorsed candidates. From Gov. Rick Perry down, TEXPAC has endorsed 56 executive, congressional, legislative, and judicial candidates in both parties (PDF). Please share the list with your colleagues, friends, family, and patients. You can order TEXPAC 2010 primary election judicial slate cards by e-mailing the TMA Knowledge Center or calling (800) 880-7955.

TMA: CHIROPRACTORS LACK TRAINING TO PERFORM, INTERPRET VESTIBULAR DIAGNOSTIC TESTS

It is not safe for patients for chiropractors to perform and interpret vestibular diagnostic tests, Dr. Fleming wrote in a letter to the Texas Board of Chiropractic Examiners opposing a proposed rule that would permit such testing by chiropractors. It is not within the scope of the chiropractic license and not safe for chiropractors’ patients. “It takes years of training and education in the intricacies of the audiovestibular system in order to perform, read, and interpret [these tests] and counsel patients effectively,” Dr. Fleming wrote. “Incorrect performance and/or interpretation … can result in wrong side diagnosis, wrong site diagnosis, poor and/or incorrect patient counseling, and ineffective and potentially dangerous intervention.”

Monday, February 15, 2010

EARLY VOTING FOR MARCH 2 PRIMARY ELECTIONS STARTS TOMORROW

Tuesday, Feb. 16, is the first day you can vote early for TEXPAC’s endorsed candidates in the March 2 party primaries. From Gov. Rick Perry on down, TEXPAC has endorsed 56 executive, congressional, legislative, and judicial candidates in both parties (PDF). Please share the list with your colleagues, friends, family, and patients. Remember, you can order TEXPAC 2010 primary election judicial slate cards by e-mailing the TMA Knowledge Center or calling (800) 880-7955. Early voting runs through Feb. 26.

MEDICARE PAYMENT FROZEN IN, THEN OUT, OF CONGRESSIONAL JOBS BILL

For a short while last week, it appeared that a measure to extend physicians’ current Medicare payment rates until October — and avoid the 21.2-percent cut scheduled for March 1 — would be a part of the U.S. Senate’s bipartisan jobs bill. That proposal disappeared in the Washington snow storm almost as soon as it was first floated. That reminds organized medicine we have plenty of work to do to stop the cut and win a permanent fix to the Medicare payment formula. Please use the TMA Grassroots Action Center for talking points and a very easy way to tell Sens. John Cornyn and Kay Bailey Hutchison and your U.S. representative we need to stop the cut and install 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.

GOT QUESTIONS? ASK THE TMA KNOWLEDGE CENTER

Have a question about Medicare billing or how to keep patients’ records? Need to register for TMA's Recovery Audit Contractor (RAC) seminar? Want to know if you’ve paid your 2010 TMA dues yet? Since 2003, the TMA Knowledge Center has been answering these and hundreds of other questions for members and their office staff. You can call (800) 880-7955, e-mail, browse the Web, or visit in person. Here are the five most frequently asked questions for 2010 and links to the answers. (You have to log in to see the answers because this is such a valuable member benefit.)
  1. What is a “designated doctor,” and what do these physicians do differently from physicians who treat workers’ comp patients? Answer.
  2. Does TMA have information about "Stark" self-referral laws and regulations? Answer.
  3. How long must I keep patient medical records? Answer.
  4. What can I charge for medical records needed by patients, lawyers, or others? Answer.
  5. How should I handle “no-show” patients? Answer

Monday, February 8, 2010

TEXPAC LISTS BEST CANDIDATES FOR PATIENTS AND PHYSICIANS IN MARCH 2 PRIMARIES

Success in the Texas Legislature and Congress – and fair rulings from appellate courts – starts by electing the best candidates for the job. Check out the list of TEXPAC’s endorsements (PDF) in the March 2 party primary elections. “We are proud to announce our selection of candidates in their respective party primaries who are committed to stand firm with Texas patients and for their physicians,” said TEXPAC Board Chair Susan Strate, MD. “We believe these candidates will listen to their patients' and physicians' concerns and will work on their behalf to improve the accessibility, cost-effectiveness, and efficiency of Texas' health care system.” Early voting begins Feb. 16. Watch your mailbox for an envelope full of TEXPAC 2010 primary election judicial slate cards. You can order more for your office by calling the TMA Knowledge Center at (800) 880-7955.

TELL CONGRESS: FIX, DON'T FREEZE, MEDICARE RATES

The latest scuttlebutt from Washington is that Congress will likely put another short-term patch on the leaky Sustainable Growth Rate (SGR) formula rather than devise a long-term fix for physicians’ Medicare payments. That means we may avoid the 21-percent cut in fees for a few more months. It’s currently scheduled to kick in on March 1. We need to stop the cuts and install 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. In an e-mail and prerecorded video sent to all physician members, TMA President Bill Fleming, MD, urges Texas physicians to ask Sens. Kay Bailey Hutchison and John Cornyn and their U.S. representative “for a commitment, a solid promise, to support a fair, permanent fix to the Medicare payment fiasco now – no ifs, ands, or buts.” Use the TMA Grassroots Action Center for talking points and a very easy way to share your thoughts and concerns with our leaders in Washington.

MAKE PLANS NOW FOR TEXMED 2010 IN FORT WORTH, APRIL 30-MAY 1

All the leaders of Texas medicine will be there. Will you? The TMA House of Delegates and our boards, councils, and committees will meet at the Fort Worth Convention Center and Omni Hotel, April 30-May 1 for TexMed 2010. More than 100 free hours of continuing medical education, a great exhibit hall, and the TMA Foundation’s annual gala are among the hottest attractions. Check out the advance program (PDF) and register online starting at 1 pm today. County society leaders and delegates, please remember that March 12 is the deadline for submitting resolutions to be included in the Handbook for Delegates. I want to give special thanks to the TexMed 2010 Planning Team, chaired by Gregory Fuller, MD, for putting together a fine program for our long-awaited return to Fort Worth.

DON'T GET RACKED BY THE RACs

Medicare's new Recovery Audit Contractor (RAC) program is designed to ferret out incorrect payments to physicians, hospitals, and other health care professionals. TMA is offering a statewide series of seminars to help you and your staff make sure the RAC has nothing to ferret out in your practice. This course will explain the RAC program, highlight common billing and coding errors, and show you how to conduct a self-audit as part of your overall billing and coding compliance plan. Plus, everyone who attends will receive a free chart auditing tool that will help you identify problems in your office. The program is accredited to offer up to 3.75 AMA PRA Category 1 Credits™ and 3.75 credits in medical ethics and/or professional responsibility. Physicians who are insured with Texas Medical Liability Trust may earn a professional liability insurance discount. The seminar series begins March 23. Register online today.

Monday, February 1, 2010

PERRY RAILS AGAINST WASHINGTON INTERFERENCE IN HEALTH CARE

Speaking to a packed house at TMA’s 2010 Winter Conference, Gov. Rick Perry denounced congressional health system reform efforts. “Has there ever been a time in your 150-year history that you all have faced a greater threat than you face today?” the governor said. “If they would take the time to talk to Texas doctors about how to reform the system our country would be better off. … I hope they will listen to the membership of the Texas Medical Association. You understand what it’s like to have the life of a patient in your hands.” Watch a video of the governor’s speech.

In other highlights from the Winter Conference general session:
  • American Medical Association President Jim Rohack, MD, and National Medical Association President Willarda Edwards, MD, engaged the audience in a lively discussion of health care disparities. They presented strong evidence of how minorities in the U.S. receive poorer quality of care regardless of whether they’re insured. Watch a video of their presentations.
  • Stanford University Professor Chip Heath, PhD, coauthor of the about-to-be released book Switch, offered some practical and humorous advice on how physicians can respond to – and direct – change. If you want to know what it means for the Rider to trick the Elephant into following the right Path, look for our upcoming announcement on how you can buy Switch at a discount and receive continuing medical education credits for reading it.
  • Governor Perry invited all Texas physicians who are interested in volunteering to provide care to Haiti’s earthquake victims to e-mail him at haiti@governor.state.tx.us.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.

FLEMING ASKS TMA MEMBERS TO GET CONGRESS TO COMMIT TO FIXING MEDICARE SGR

With just 29 (now 27) days remaining until a 21-percent cut in physicians’ Medicare payments automatically kicks in, TMA President Bill Fleming, MD, on Saturday asked Texas physicians to get on the phone today. “Please contact Senators John Cornyn and Kay Bailey Hutchison and your U.S. representative first thing Monday morning,” he said. “Ask each of them for a commitment, a solid promise, to support a permanent fix to the SGR now – no ifs, ands, or buts.” Watch a short video clip of Dr. Fleming’s request. The Sustainable Growth Rate (SGR) formula does not work because it is not based on physicians’ cost of providing care to Medicare patients. TMA will accept nothing less than a fair payment system. The U.S. Senate last week passed a resolution that would allow Congress to freeze current payment rates for five years without raising taxes. Dr. Rohack called that an $80 billion down payment toward a permanent SGR fix that will cost another $130 billion now. He said AMA will not accept a freeze.

TODAY IS THE DEADLINE TO REGISTER TO VOTE IN MARCH 2 PRIMARY ELECTIONS

Are you sure you’re registered to vote in next month’s party primaries? You can check your registration status online. If your registration is not current or correct, complete, print, sign, and mail a Voter Registration Application form to your county registrar at the address provided on the form. The application must be postmarked by today to ensure your eligibility.

COUNTY MEDICAL SOCIETY LEADERS PONDER MEMBERSHIP AND KEY ISSUES

Thirty-two physician officers from 19 Texas county medical societies participated in a five-hour sharing and training session at our annual County Medical Society Leadership Forum. Joined by their own staff and TMA senior management, the physician leaders discussed such vexing problems as how to bridge the generational divide with younger members who look to their employers to provide services and opportunities that once were the exclusive purview of organized medicine. They also discussed issues ranging from exclusive hospital contracts with physicians to health insurance and liability reform.

TMA MEMBERS GIVE DR. FLEMING LONG-OVERDUE CONGRATULATIONS

Readers will remember that Dr. Fleming took the oath of office and delivered his installation address long-distance from a Houston hospital bed last May. Because we didn’t have the chance to congratulate him and wish him good luck then, TMA threw a special reception in his honor at Winter Conference. “Despite that under-the weather start, Bill has done a remarkable job just when Texas medicine needed a leader of his caliber,” said Immediate Past President Josie Williams, MD. “Bill has kept a firm hand on the wheel through all of those storms, steering us carefully but purposefully down a narrow, winding path laden with political landmines.”

CHECK OUT THE NEW WWW.TEXPAC.ORG

TEXPAC has launched a totally redesigned Web site at www.texpac.org. Sign in using your TMA Web site user name and password for loads of political insight. While you’re at it, please join TEXPAC if you’re not a member, or increase your contribution level if you already belong.