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Monday, March 29, 2010


The following article by TMA President Bill Fleming, MD, was published in several Texas papers over the weekend. I am reprinting it here because I want all TMA leaders to know exactly where the association stands in this post-health-care-reform era. (I also want to share with you an article from Saturday’s Boston Herald that I coauthored as president of the Physicians’ Foundation.)

The health system reform bill is now law. While the legal and political wrangling will go on for years, the physicians of Texas remain committed to our patients. We want to keep what’s good and fix what’s broken in our health care system.

Frankly, we cannot allow our political views or the new law to get in the way of what medical care is all about: physicians caring for our patients. Patients and their doctors must work together to take advantage of this change. We cannot waste this opportunity to improve the access and care we provide to our patients. We also must keep a constant eye out for opportunities to improve the new law.

We have begun a massive new education campaign to help Texas physicians and their practices survive and thrive in this new environment. Our patients depend on that. And lucky for them, no organization is better prepared to help doctors in the post-health-reform jungle than the TMA.

Because of its immense size and scope, the new law contains many provisions that neither we nor our patients fully understand yet. We’ve asked some of the best health care minds in the state to give us a complete analysis. Right now, here are three good things about the new law soon to happen — and three things the physicians of TMA already know must change.

Three Good Things

  1. Prevention is covered. Health plans must cover services like vaccinations and screening tests without charging a copay or deductible. Flu shots, childhood immunizations, and cancer screenings will keep us all in better health. And, in the end, they keep down the cost of medical care.
  2. Uninsured Texans with current illnesses are covered. A new insurance pool will allow the uninsured to buy coverage if they have a preexisting condition. It will allow uninsured Texans— even cancer survivors or those with chronic illnesses like diabetes or high blood pressure — to get the coverage they need. They will be able to receive care and ensure their health doesn’t get even worse.
  3. Coverage should be easier to understand. Volumes of legal jargon from the health plans are replaced with summaries and simple labels. No more wondering if certain services or treatments are covered or if you can afford the copay or deductible.

Three Things That Must Change

  1. We remain terribly concerned about the Medicare system. Medicare is the largest government health plan we have right now. It is the foundation for many of the changes the new law will bring. The current system is forcing some doctors to make a horrible choice to stop seeing Medicare patients if they want to keep their practices open in order to see any patients at all.
  2. We must work together to stop the Medicare meltdown.
    We need to protect the patient-doctor relationship from outside interference. No government agency and no insurance company should come between patients and their doctors. As the bureaucrats work to implement this new law, we promise to fight to ensure doctors and patients can make health care decisions that are best for our patients.
  3. We need to protect Texas’ health care liability reforms. In 2003, Texas voters adopted important medical liability reforms for our state. These changes have made it easier for sick and injured Texans to get the care they need. Dozens of rural and medically underserved parts of the state now enjoy the services of high-risk specialists, such as emergency physicians and obstetricians. Physicians who once turned away high-risk patients for fear of a lawsuit are now expanding their practices and offering new, life-saving treatments. We need to make sure nothing in the new law takes away the tremendous progress we’ve made in Texas.

Since 1853, the physicians of TMA have worked to improve the health of all Texans. Medicine has changed tremendously over those 157 years. The health reform law is just the most recent change, and we now must move forward to ensure that it benefits our patients.


For the second month in a row, the U.S. Senate left town unable even to put another Band-Aid on Medicare’s Sustainable Growth Rate (SGR) formula. That means the 21.2-percent cut in physicians’ Medicare payments takes effect April 1. Congress reconvenes from its Easter recess on April 12. The Centers for Medicare & Medicaid Services will hold all claims for the month until April 14. That gives lawmakers two days for another flash freeze. Congress’ constant toying with physicians on this issue — and legislators’ inability to approve a permanent replacement for the SGR — is totally unacceptable. Next week, TMA and county medical societies will hold news conferences across the state to emphasize what this means to access to care for the elderly, Texans with disabilities, and military families. Please sign TMA’s petition to “Stop the Medicare Meltdown.”


Harold R. High, MD, of Cuero, Texas, passed away at the age of 85. Dr. High was a TMA member for 56 years, during which he served in various leadership positions including president of the 50-Year Club; membership on the Board of Trustees, the Texas Delegation to the American Medical Association, and the Committee on Manpower; delegate to the TMA House; and an active involvement in TEXPAC. We are all deeply saddened to hear the news. Dr. High was a great friend and very good man. He loved organized medicine and devoted a large part of his life to making things better for us all. Condolences can be sent to Mrs. Paula High at 1012 N. Hunt St., Cuero, TX 77954-2633.

Monday, March 22, 2010


It’s all over but the signing. Amid a flurry of last-minute arm twisting and deal making, the U.S. House of Representatives last night approved far-reaching health system reform legislation, 219-212. TMA sent a letter to all 32 Texans in Congress, asking them to vote against the bill. At the bell, the Texans voted almost purely along party lines. All of the state’s Republican representatives plus Rep. Chet Edwards (D-Waco) voted against it; all the rest of the Democrats voted for it. “We are disappointed and saddened that Congress and President Obama would pass a half-baked Senate proposal and call it ‘Health System Reform,’” TMA President Bill Fleming, MD, said in a statement issued after the historic vote. “The bill is simply bad medicine for patients and the state of Texas.” Assuming President Obama signs the legislation and the U.S. Senate approves an accompanying set of amendments, TMA faces a four-fold set of challenges for physicians:
  • We will continue to fight for a permanent replacement of Medicare’s Sustainable Growth Rate (SGR) formula for physician payments. (See below for more details.)
  • We will continuously advocate in Congress on behalf of physicians and your patients for necessary changes in the new law.
  • We will actively participate in the process that is sure to add thousands of new pages of federal health care rules.
  • Our practice management team will educate members on the details of the new law, provide guidance on how to stay out of federal hot water, and use all of our resources to help physicians develop and grow viable practices in this new health care landscape.


A big reason for our disappointment in the House-passed health bill is that it does nothing to replace the SGR with a rational physician payment system that automatically keeps up with the cost of running a practice and is backed by a fair, stable funding formula. The current freeze of payment rates expires April 1. The House and the Senate have passed separate bills to extend the freeze until April 30 and Sept. 30, respectively. “Senators and representatives from both parties recognized this glaring problem — this gaping wound in our health care system — but have been willing to address it only with ‘Band-Aids,’” Dr. Fleming said after Sunday’s vote. “We need more than Band-Aids. We need more than sutures. We need a complete transplant. Congress created this disease, and only Congress can cure it.” Please participate in our drive to gather 1 million petition signatures to “Stop the Medicare Meltdown.” Put your name on our online petition and provide print copies (PDF) for your patients, colleagues, and staff to sign as well.


Applause, boos, threats of legal action, and promises of more legislation were prominent among the reactions to Sunday’s House vote on HR 3590. A sampling:
  • The American Medical Association called it “the most important health care legislation since the creation of the Medicare program.” But AMA also called it “an imperfect bill” and said it will “vigorously work to pass additional legislation to correct deficiencies.”
  • U.S. Rep. Michael Burgess, MD (R-Lewisville), the only TMA member in Congress, blasted his Democratic colleagues for ignoring the voices of physicians and the will of the American people in passing a bill that will bring the country “more IRS agents but less doctors.”
  • Gov. Rick Perry vowed “to do everything in our power to fight this federal excess and find ways to protect our families, taxpayers, and medical providers from this gross federal overreach.”
  • Texas Attorney General Greg Abbott said he would join with other states in challenging the constitutionality of the new law.


Congratulations to the Fort Worth dynamo Pat Hyer. The former TMA Alliance president was nominated to serve as the 2010-11 treasurer of the American Medical Association Alliance. As treasurer, she will be a member of the Executive Committee and the Board of Directors of the national organization. And hats off to Keely Hunsaker, DDS, of Corpus Christi. That former TMA Alliance president also won a nomination to the AMA Alliance Board of Directors.


Proposed federal rules that provide physicians Medicare or Medicaid bonuses for “meaningful use” of electronic medical records (EMRs) need substantial revisions, Dr. Fleming and Joseph Schneider, MD, chair of the TMA Ad Hoc Committee on Health Information Technology, wrote in formal comments to the Centers for Medicare & Medicaid Services (PDF). Specifically, they wrote, the rules need to be rewritten to avoid the unintended patient safety consequences of hurried EMR implementation and delete the “all-or-nothing” requirement for physicians to win the bonuses.

Monday, March 15, 2010


A confluence of events in Washington is pushing TMA to increase the volume of our work to enact a permanent fix to the Medicare payment formula. Despite their professed support for a new Medicare payment system for physicians, senators and representatives from both parties have done nothing to fix the formula that threatens to bankrupt physicians and leave Medicare patients without a doctor. For 10 years, they’ve done nothing to fix the single largest government health program. How can they build a new system on a broken foundation?

To educate patients on Medicare’s problems and engage all Texans in the drive to fix them, we are embarking on a campaign to gather 1 million signatures to stop the Medicare Meltdown. We begin with an open letter to Congress (PDF), which we will deliver to members of the Texas congressional delegation the last week of March at news conferences across the state. (Please see — and sign — the open letter to Congress, below.) The petition drive will include online petitions (PDF) posted on the TMA (PDF) and MeAndMyDoctor Web sites, social media petitions for Facebook and Twitter, and other tactics. We will use all of our communication vehicles and our county medical society partners to send campaign materials and the petitions to physicians and patients. We will work with community partners such as senior citizen groups, disability rights organizations, and others.


Please add your signature to this letter and forward it to TMA or your county medical society. You can fax it to the TMA Public Affairs Division at (512) 370-1633.

To the Texas Delegation in Congress:

I’m writing today as one of nearly 45,000 physicians and medical student members of the Texas Medical Association to ask for swift action to stop the implosion of our Medicare system. The government simply cannot run its largest health care program without physicians to care for the millions of senior citizens, people with disabilities, and military families who depend on Medicare.

TMA’s message to Congress for the past year on health system reform is “Keep what’s good in our health care system and fix only what’s wrong.” Physicians and patients across Texas agree that the system is broken and needs to be fixed.

One of the critical broken pieces is the Sustainable Growth Rate (SGR) formula for Medicare. Since its inception, the SGR has not worked. Annually, it has forced physicians to limit access for our patients, pushing patients into higher cost areas like emergency rooms. Every year for a decade, we have faced steep cuts that jeopardize our ability to care for patients. You and your colleagues have recognized this glaring problem — this gaping wound in our health care system — but have been willing to address it only with Band-Aids. We need more than Band-Aids. We need more than sutures. We need a complete transplant. You created this disease, and only you can cure it.

Now, Congress wants to rush into health system reform and ignore the crumbling Medicare foundation you created. As physicians, we learn the first thing we must do in a medical crisis is stabilize the patient. You must do the same. You must act now and develop 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. There is no more time. There is no other solution. You must stabilize Medicare today and ensure a firm foundation for future generations of patients.

On behalf of our patients and ourselves, we implore that you fix Medicare before moving forward with even bigger health system reform. We believe you cannot have true health system reform without fixing the Medicare crisis first. You cannot build on a crumbling foundation.

TMA supports health system reform — reforms that truly put our patients first. However, we believe bad health system reform will create more dire consequences than no health care reform at all.

Please, on behalf of Texas’ patients and their physicians, do the right thing. Stop the Medicare Meltdown by working with your colleagues in both parties to replace the faulty funding formula used to pay physicians immediately. No more Band-Aids. It’s time for a permanent Medicare fix.



The U.S. Senate passed another Band-Aid for Medicare’s SGR formula — this time freezing current Medicare payment rates until Oct. 1. We don’t know if the House will follow suit before the 21.2-percent cut comes back again on April 1. The other piece of the puzzle is House Speaker Nancy Pelosi’s announcement that, sometime this week, the House will consider the same “reform” bill the Senate approved on Christmas Eve. TMA opposed the Senate bill in December because it was bad for patients and bad for the profession. It is still bad for patients. It is still bad for the profession. We still oppose it.


Last week’s primary election update missed an important local race won by a TMA member. Bert Cobb, MD, a San Marcos physician and member of the TMA House of Delegates, won a tough primary for the Republican nomination for Hays County judge. Congratulations, Dr. Cobb.

Monday, March 8, 2010


It’s ironic – or just plain sad – that the next deadline in Washington’s game of “Medicare Chicken” with physicians falls on April Fool’s Day. Congress voted to freeze physicians’ Medicare payment rates once again, forestalling a 21.2-percent cut that otherwise would have affected all claims for services provided in March. “This 28-day freeze is worthless if Congress doesn’t spend the next 28 days devising and passing a permanent new Medicare payment formula,” TMA President Bill Fleming, MD, said in a news release. “We need Washington to understand that they’re playing politics with our patients’ lives.” We continue to urge member physicians to use TMA’s Grassroots Action Center to contact Sens. Kay Bailey Hutchison and John Cornyn and their U.S. representatives. Share your stories of what the Medicare Meltdown means to your patients and your practice. If you need some inspiration, see some of the videos we’ve posted on TMA’s YouTube channel. Take advantage of the resources we’ve developed to engage your patients, too. Remember also that March 17 is the deadline for physicians to make their Medicare participation decisions for 2010. The TMA Web site includes details on how, and why, to exercise your options.


From perennial victors to newcomers, TEXPAC-backed candidates either won or will go on to compete in the April 13 runoff in 90 percent of the challenged primary races where we endorsed a medicine-friendly candidate. Among the highlights:

  • Gov. Rick Perry easily won the Republican nomination for his reelection;
  • Georgetown surgeon Charles Schwertner, MD, clinched the open seat in State House District 20 by winning the GOP nomination for a race in which there is no Democratic opponent in the fall;
  • Judge Al Scoggins of Ennis defeated incumbent Justice Felipe Reyna of Waco in his bid to gain a seat on the 10th Court of Appeals bench;
  • Susan Curling, MD, an anesthesiologist from Humble, is in the runoff for State House District 127;
  • TMA members U.S. Rep. Michael Burgess, MD (R-Lewisville), won renomination to Congress; Sen. Robert Deuell, MD (R-Greenville), won his party primary for the Texas Senate; and
  • State Reps. Mark Shelton, MD (R-Fort Worth), and John Zerwas, MD (R-Richmond), won their party’s nod to return to the Texas House of Representatives; and


We will launch the new TMA Leadership College at the 2010 TMA Fall Conference, Oct. 14-17. This intensive program is designed to identify, train, and build young TMA-member physicians into leaders at the state and local levels. This program is for active members in their first eight years of practice or under the age of 40. Learn more about the TMA Leadership College and apply online.


Watch your e-mail in box for details on TMA’s plan to bring patients and physicians together in a mass action to spur Congress to stop the Medicare Meltdown.

Tuesday, March 2, 2010


Medicare payments to physicians drop by a whopping 21.2 percent starting today. A lone U.S. senator blocked a last-minute congressional attempt to delay the cuts one more time. It’s what we call the Medicare Meltdown. “Both Congress and the president talk about the importance of physicians being able to care for their patients; yet actions speak louder than words,” said TMA President Bill Fleming, MD, in a special message to TMA members. “Every Texan should be angry and disgusted with Congress for toying with patients. This is truly a sad day for Texas patients and physicians, and for patients across America.” Democratic leaders on Capitol Hill are confident they can put yet another Band-Aid on Medicare’s flawed Sustainable Growth Rate (SGR) formula before the new, smaller checks start flowing in 10 days. That is absolutely necessary, but it is far from sufficient. Another patch won’t do. We need a permanent, 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.


TMA President-Elect Sue Bailey, MD, is leading a delegation of physician and alliance leaders and senior staff to Washington this week for the American Medical Association’s annual National Advocacy Conference. We will meet with Texas senators and representatives, making the case in person to reverse the 21.2-percent cut in physicians’ Medicare payments and permanently repeal the SGR. Do your part, as well. Use TMA’s Grassroots Action Center to contact Sens. John Cornyn and Kay Bailey Hutchison and your U.S. representative. Tell your story. Tell them what Medicare’s flawed payment scheme is doing to your patients and your practice. Tell them you won’t accept another patch. No more Band-Aids. Ask for their commitment to support a fair and permanent new payment system. But physician action alone won’t be enough; patient power is the key to our success. TMA is making it easy for patients to understand the Medicare Meltdown and take action. We’re activating and updating our MeAndMyDoctor.com Web site. Patients can log in and send a strong message directly to Congress. Please, talk to your patients. Explain what's happening and how it affects them. Ask them to get involved. Point them to MeAndMyDoctor.com. TMA is writing easy-to-understand talking points for you to use. We have flyers to post in your office and letters to hand out and send. Contact your county medical society for materials or download them later today from the TMA Web site. I also encourage you to write letters to the editor of your local newspaper and help us share with the media your personal stories that illustrate how the Medicare Meltdown is affecting your patients.


Medicine’s successes in the Texas Legislature and Congress begin with success at the ballot box. TEXPAC has endorsed a strong list of patient-friendly candidates (PDF) in tomorrow’s party primary elections. Polls are open from 7 am to 7 pm. “Your TEXPAC Board of Directors is confident in our slate of candidates for the Republican and Democratic primaries,” said TEXPAC Board Chair Susan Strate, MD. “No matter which primary you, your family, or your colleagues choose to vote in, please support these promedicine candidates. Most important, please vote!”


As I explained in last week’s EVPGram, the Texas Health and Human Services Commission is recommending cuts in the state’s Medicaid, Children’s Health Insurance Program (CHIP), mental health care, and public health systems to help balance the state budget starting Sept. 1. Dr. Fleming and the presidents of 20 state specialty societies signed a letter asking Gov. Rick Perry, Lt. Gov. David Dewhurst, and House Speaker Joe Strauss to make healthier choices. "Instead of adopting indiscriminate, broad-based cuts, we encourage you to have a careful and open review of health care spending in order to develop a comprehensive plan that in the end will save the state money,” the presidents wrote. “We respectively ask that many of these cuts are deferred until the larger implications can be carefully evaluated and new ideas considered.” The letter outlined six examples of innovative, cost-effective health care delivery models that recently have been launched in Texas. The presidents pledged that TMA and the specialty societies will work with the state “as partners to find targeted solutions that achieve our mutual goal of better care and at a more affordable price.”