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Monday, June 28, 2010


The 21-percent cut is, temporarily again, on hold. Unfortunately, so are Medicare and TRICARE payments to physicians as the Centers for Medicare & Medicaid Services hustles to implement the 2.2-percent increase that Congress included in its latest Band-Aid. Payments reflecting the new fee schedule, which will be in place through Nov. 30, should begin flowing by Thursday. It was last Thursday when the U.S. House of Representatives finally approved the patch. The increase automatically will be applied retroactively for claims for services on or after June 1. It’s one of several sad commentaries on Medicare financing that the 2.2-percent increase is the largest for physicians since 2001. Here are two more: If Congress does nothing between now and Nov. 30, Medicare payments will drop by 23.5 percent. And on Jan. 1, 2011, the cut will be an additional 6.1 percent. "I don’t want to be watching Congress wrestle with this turkey of an issue on Thanksgiving," TMA President Sue Bailey, MD, said in a news release after the House vote. If history is any guide, it will likely be a Thanksgiving turkey and a Christmas goose. Prospects for a long-term replacement for the Sustainable Growth Rate (SGR) formula remain awfully dim. I do want to send a shout out to the four House members from Texas who stood up during the debate to call for a permanent fix. They were Reps. Michael Burgess, MD (R-Lewisville), Charlie Gonzalez (D-San Antonio), Gene Green (D-Houston), and Sheila Jackson Lee (D-Houston). Dr. Bailey wants to take them up on it. “I am ready, right now, to roll up my sleeves and get to work,” she wrote in a letter to the Texas delegation in Congress. “But physicians can’t do it without Congress. And our patients, your constituents, need us to work together now and get this done.”


A 1-percent cut in physicians’ Medicaid payments could actually cost the beleaguered state budget more than it saves, TMA witnesses will explain at a Texas Health and Human Services Commission (HHSC) hearing tomorrow. As outlined in a letter (PDF) Dr. Bailey wrote to state leaders, the proposed cut in Medicaid and Children’s Health Insurance Program (CHIP) payments could backfire by further reducing physician participation in those programs. “Texas must make investments in primary and preventive health care that will reap much-needed savings down the road,” she wrote. “To that end, one of the soundest investments Texas can make to limit Medicaid and CHIP cost growth is to broaden physician participation in these programs.” Dr. Bailey also called on primary care physicians to share their concerns with their state senators and representatives and with HHSC Commissioner Tom Suehs. Use the TMA Grassroots Action Center to send your comments no later than 5 pm Tuesday.


The Cancer Prevention and Resource Institute of Texas approved a half-million-dollar grant to TMA’s Physician Oncology Education Program (POEP) for the next fiscal year. The grant, a big increase over POEP’s previous funding, will pay for seven physician education modules. TMA formed POEP in 1987. Its role is to educate primary care physicians about the state of the art and science in cancer prevention, screening, early detection, and control. Lewis Foxhall, MD, of Houston, the current chair of the POEP Steering Committee, did yeoman’s work along with our staff to secure the grant.


With the latest Medicare crisis behind us for a few months, EVPGram begins our annual summer hiatus. We’ll be back to our regular schedule in August and, of course, bring you updates on fast-breaking issues as they occur. Happy Independence Day.

Monday, June 21, 2010


Medicare payment checks to physicians are flowing again — but they’re 21.3 percent smaller than they were this time last week as Medicare officials could no longer wait for Congress to figure out how to apply the latest Band-Aid. A TMA flash survey that accompanied our news reports of the latest Medicare Meltdown finds that Texas physicians will take or are considering some very drastic action in response. The chart below shows the preliminary responses to the question, “Regardless of the outcome of the current Medicare payment cut, the ongoing cash flow problems and constant uncertainty over Medicare payments has led my practice to take, or consider, the following steps:”
  • Reduce my total Medicare caseload: 252 (68%)
  • Refuse all new Medicare patients: 210 (57%)
  • Lay off staff: 197 (53%)
  • Refer Medicare patients to the emergency room: 120 (33%)
  • Drop out of Medicare altogether: 117 (32%)
  • Stop seeing existing Medicare patients: 91 (25%)
  • It doesn't matter, I don't take Medicare anyway: 2 (1%)

We will keep the survey open for a few more days, so please share your opinion if you haven’t yet. The U.S. Senate on Friday approved a deal stopping the cuts and raising fees 2.2 percent until Nov. 30. But the House of Representatives had already gone home for the weekend and was not scheduled to resume voting until tomorrow. That led the Centers for Medicare & Medicaid Services, which had held Medicare payments since the first of the month, to direct Medicare contractors to begin processing claims dated June 1 and later under the new rates on a first-in, first-out basis. “Washington obviously doesn’t realize the damage they’re doing to our practices and our patients,” said TMA President Sue Bailey, MD.


Our concerns over a potential anti-incumbent backlash at the American Medical Association House of Delegates didn’t materialize, as Austin anesthesiologist Joe Annis, MD, handily won reelection to the AMA Board of Trustees. Dr. Annis was one of eight candidates — and the only incumbent — seeking four seats on the board. “I’m so proud to be a member of a group of this caliber,” Dr. Annis told the Texas Delegation to the AMA. Other Texas candidates also did well in Chicago:
  • Elliot Richards, a first-year student at Baylor College of Medicine, was elected chair of the AMA Medical Student Section, Region 3. Andrew Harrell, another first-year student at Baylor, was elected secretary/treasurer.
  • Nakita Moore, MD, a third-year resident in child and adolescent psychiatry at Scott & White Memorial Hospital, was elected vice chair of the AMA Resident and Fellow Section, Region 3.

See photos and all of our coverage of the AMA meeting on Blogged Arteries.


A smoking cessation pilot project under development for Texas Health and Human Services Commission (HHSC) state employees throughout Texas won the support of the Public Health Coalition. TMA is a charter member of the coalition. “For the 2009 session of the Texas Legislature, the coalition’s list of ‘legislative asks’ included funding for a comprehensive, statewide tobacco prevention and cessation program,” coalition Chair Herminia Palacio, MD, wrote to Commissioner Tom Suehs. “Thus we strongly support pilot initiatives such as the one HHSC is creating.”


Attention all physicians and alliance members in Texas Senate District 22 (in and around Waco). Former Sen. David Sibley (R-Waco) needs your help. The special election runoff to replace Sen. Kip Averitt (R-Waco) is tomorrow. Please cast your vote for him and spread the word. TEXPAC Board of Directors Chair Susan Strate, MD, said, “Without question, David Sibley is the most qualified candidate in the race when it comes to issues affecting patients and physicians.”

Tuesday, June 15, 2010

Congress Leads Physicians and Patients to Medicare Meltdown

The 21-percent cut in physicians’ Medicare and TRICARE payments kicks in this week with no relief in sight. After the Senate let the June 1 deadline come and go, the Centers for Medicare & Medicaid Services (CMS) ordered carriers to hold Medicare claims for 10 business days. Today is the 10th day. This morning, CMS ordered an additional three-day hold. Carriers will begin processing claims under the new lower rates on Friday unless Congress sends legislation to the president before then. Neither the House and Senate nor Republicans and Democrats can agree on how to pay for the Medicare payments or other programs that have expired. That’s what’s causing the delay. We will keep you informed if the situation changes. TMA, the American Medical Association, and all of organized medicine continue to push for both a quick end to this brinksmanship and a long-term replacement for Medicare’s physician payment formula. “Patients and physicians should not become collateral damage in a congressional stalemate on budgetary matters,” we said in a joint statement to Congress. “We expect our elected officials to resolve the budget issues without punishing physicians, seniors, and military families.” Yesterday, the AMA House of Delegates conducted a Write Coat Rally in one more attempt to get through to Congress.

Congratulations to Incoming AMA Alliance President Susan Todd

If organized medicine in Texas were a corporation, our most valuable assets would be our human resources. We are blessed with fantastic physician and alliance leaders who make us great. In the past decade, few have shined more brightly than former TMA Alliance President Susan Todd of Fort Worth. She also has led our TMA Foundation and is the driving force behind TMA’s First Tuesdays at the Capitol. Tomorrow, she takes her starring role to the national stage when she takes office as president of the AMA Alliance. To do something better, you must work an extra bit harder. For Susan Todd, that’s a constant state of mind, a disposition. Congratulations, Susan!

Deadline Tuesday for TMA Leadership College

Ready to take your leadership skills to the next level? Applications for the TMA Leadership College are due tomorrow, June 15. I invite all interested TMA members in their first eight years of practice or under the age of 40 to apply to this new leadership development program, designed to identify, train, and build young TMA member physicians into leaders at the state and local levels.


Elliot Richards, a first-year student at Baylor College of Medicine, was elected chair of AMA Medical Student Section Region 3. Andrew Harrell, another first-year student at Baylor, was elected secretary/treasurer. Congratulations, gentlemen. And Meredith Williams, another Baylor student who formerly served on the TMA Board of Trustees, takes her seat this week as the student member of the AMA Board of Trustees. She won that position in November.

State Senate Special Election Voting Begins Today

Attention all physicians and alliance members in Texas Senate District 22 (in and around Waco). Former Sen. David Sibley (R-Waco) needs your help. Early voting in the special election runoff to replace Sen. Kip Averitt (R-Waco) runs from today through Friday. Election day is Tuesday, June 22. TEXPAC Board of Directors Chair Susan Strate, MD, said Mr. Sibley earned medicine’s endorsement "because he has committed to supporting TMA's legislative agenda of protecting tort reform, patient rights, physician autonomy, insurance reform, and public health."


Thanks to the TMA Department of Public Health for collecting these interesting stats:

  • Rates of smoking are two to four times higher among people with psychiatric disorders and substance use disorders.
  • Nearly 41 percent of people who reported having a mental illness within the last month smoked.
  • 60 percent of current smokers report a past or current history of a mental health diagnosis sometime in their lifetime.
  • Quit rates among smokers with any history of mental health diagnoses are significantly lower than smokers with no history of mental illness.

Monday, June 7, 2010


With America’s physicians sharply divided over the American Medical Association’s strategy to support health system reform, the upcoming meeting of the AMA House of Delegates should be a lively one. Two important questions that should be asked:
  • Is AMA standing up for U.S. physicians so the physicians can stand up for their patients? Is it engaging grassroots physicians in the political and legislative process?
  • Is it providing physicians the tools they need to — as TMA President Sue Bailey, MD, says — “survive and thrive in the new health care landscape”?

These are some of the issues I hope delegates address, both on the floor and in the back room discussions, when the AMA house convenes Saturday in Chicago. The debates over AMA policy and the officer elections (PDF) — three candidates are running for AMA president, and eight physicians are seeking four spots on the Board of Trustees — will provide the forum for these discussions. Austin anesthesiologist Joe Annis, MD, an incumbent trustee, is running for reelection on the TMA platform: “Keep what’s good; fix what’s wrong.” Stay tuned. We’ll live blog all the key debates and report the outcomes here and in Texas Medicine. Add your opinions on TMA’s Twitter feed and Facebook page.


As you’re reading this, members of Congress are returning from their Memorial Day recess, and TMA’s petition to “Stop the Medicare Meltdown” is collecting its 101,000th signature. The connection? Congress is back in Washington with a seven-day window to stop the 21-percent cut in physicians’ Medicare payments from taking effect. The cut kicked in June 1, but the Centers for Medicare & Medicaid Services (CMS) ordered carriers to hold Medicare claims for 10 business days. Our online petition campaign, plus nearly 20,000 paper signatures, calls on Congress to stop the Medicare madness. Physicians and patients are suffering from the constant uncertainty. If you haven’t yet, please sign the petition today and check out and share our latest mashup video.


The Texas Medical Board’s (TMB’s) loss is TMA’s gain. Alan Moore, MD, the TMB’s first medical director, is leaving the agency July 1 to return to the private sector. I also am talking to the Austin pathologist about taking an active role in the TMA policymaking process. Dr. Moore has been a voice of reason at TMB, sharing our desire for a strong and fair board.


Following up on actions last month by the TMA House of Delegates, the Texas delegation is bringing a pair of resolutions to Saturday’s AMA house meeting. Resolution 115 calls on AMA to support legislation in Congress to allow Medicare beneficiaries to make tax-free contributions to health savings accounts. Resolution 116 would change AMA policy to prevent paperwork delays at CMS from penalizing physicians who provide care for Medicare patients. Check out Blogged Arteries and next week’s EVPGram for progress on these two items.

Tuesday, June 1, 2010

With Senate Inaction, Medicare and TRICARE Cuts Kick In — Again — Today

U.S. senators left Washington to ride in Memorial Day parades but left some work unfinished. For the third time this year, Congress went on vacation and allowed a 21-percent cut in physicians’ Medicare and TRICARE payments to take effect. For the third time this year, the Centers for Medicare & Medicaid Services ordered carriers to hold Medicare claims for 10 business days, this time until June 14, to allow time for Congress to return from vacation and vote to stop the cut. “As we prepare to honor those who have given their lives to our country this Memorial Day weekend, Congress turns its back on their families when they need health care,” TMA President Sue Bailey, MD, said. “It's time to stop playing politics with our patients’ lives and health.” What the Senate failed to vote on was a House-passed proposal that would provide a 2.2-percent Medicare physician payment increase for the rest of this year and a 1-percent update for 2011, and revert back to current law in 2012 — when an estimated cut of 30 to 32 percent would be called for under the Sustainable Growth Rate (SGR) formula.

Tell Congress What You Think About the Medicare Meltdown

Tired of constantly being the yo-yo on the congressional Medicare string? Here are two ways to tell Washington what you think of the latest on-again, off-again 21-percent cut in Medicare payments. TMA and our 50 state medical society partners continue to push for signatures on our petition asking Congress for a permanent revision to the Medicare payment formula. If you haven’t yet, please sign the petition today. It takes about 10 seconds of your time. After you sign it, ask your friends, family, and neighbors to sign it until you get 10 signatures or more. Also, the American Medical Association is encouraging physicians to contact Congress to explain how its mismanagement of the Medicare program is wreaking havoc on your practices. Use AMA’s grassroots hotline, (800) 833-6354, or send an e-mail.


It took the Texas Department of Insurance (TDI) nearly a year to write rules implementing a key piece of TMA’s health insurance reform package that the Texas Legislature approved in 2009. And TDI came through with flying colors by making sure that health insurance companies play as fairly as possible in their various schemes to rank physicians on cost and quality. As mandated by House Bill 1888 by Rep. John Davis (R-Houston) and Sen. Robert Duncan (R-Lubbock), the new rules require health plans to conform to nationally recognized standards and guidelines when ranking or tiering physicians. Additionally, it gives physicians extensive due process protections. One of the most important changes requires the health plans to inform physicians ahead of time when they are gathering data for performance rankings. TDI agreed with virtually all of the recommendations TMA made when it adopted the rules.


Gov. Rick Perry appointed TEXPAC-endorsed Judge Debra Lehrmann to a seat on the Supreme Court of Texas through the November general election. Judge Lehrmann is filling the seat vacated by Justice Harriet O’Neill, who stepped down. With TEXPAC’s help, Judge Lehrmann earlier this year secured the Republican nomination for a full term on the high court.


The phones rang all over the state, and you answered. Using the tele-town hall technology, more than 4,200 TMA-member physicians and medical students listened in to our Health Reform School session. “Just like our patients, our member physicians are uncertain about what’s in the new law and what it means to their practices,” said Dr. Bailey, who hosted the call. “It’s our responsibility to bring them the facts as we know them and the implications as we see them.” If you missed it, check TMA’s Health System Reform Action Center, where we’ll post the audio recording later this week. The online education center already includes two new TMA health system reform white papers: “Four Things Physicians Need to Know About Medicare Fees” and “Eight Things Physicians in Independent or Small-Group Practice Need to Know About Health System Reform.


The Federal Trade Commission (FTC) has delayed until Dec. 31 enforcement of the "red flags rule" (PDF) that was scheduled to take effect June 1. TMA has joined with AMA and other medical societies in fighting the rule, which says physicians who regularly bill their patients for services (including billing for copayments and coinsurance) are creditors and must develop and implement written identity theft prevention programs for their practices. The programs must identify and respond to patterns, practices, or specific activities known as "red flags" that could indicate identity theft. Visit TMA's Identity Theft Compliance resource page for more information, including how to sign up for the Red Flag Rules Recorded Webinar.