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Tuesday, November 30, 2010


With plenty of calls and e-mails from Texas physicians and patients, Congress took a tentative first step toward stopping the 23-percent Medicare physician payment cut set to take effect Dec. 1. The U.S. House of Representatives will have two days to stop the cut when Congress returns next week from its Thanksgiving recess. Before leaving Washington, the Senate approved a 31-day reprieve. TMA and the Texas AARP joined physician and patient groups from around the country in publicly calling for Congress to stop what TMA President Sue Bailey, MD, calls “this game of chicken.” In just three days, Texas physicians, students, alliance members, and patients sent more than 2,100 calls and e-mails to Capitol Hill. Watch the video from our Fort Worth news conference. Prospects for longer-term relief from the next Medicare Meltdown — a 25-percent cut scheduled for Jan. 1 — are still up in the air. We continue to push Congress to set stable rates for at least a full year.


More than 100 TMA Alliance members, medical students, and physicians of all specialties gathered to plan joint strategies for the 2011 Texas Legislature. The expected $20-billion-plus state budget deficit and how medicine should deal with it dominated many discussions. When representatives of state specialty societies laid out their legislative priorities, a few trends emerged:

  • Many specialties expect nonphysician practitioners to push for unsafe expansions of their scope of practice, and they called on all of medicine to work together to fight those battles.
  • There was strong support for TMA’s call to defend the ban on corporate practice of medicine.
  • Many physicians said patients benefit when offices can own their own labs, imaging equipment, and outpatient facilities.
We'll take all of that input, and more, into consideration as we draft TMA’s 2011 agenda over the next few weeks. By the way, have you registered for First Tuesdays at the Capitol yet?


The Rookie Report is always one of the most interesting segments of the specialty advocacy summit. This year, five incoming House members shared war stories from the campaign trail. I was quite impressed with this year’s crop of featured freshman, all of whom bring some important health care connections to the 2011 legislature. They were:

  • Rep.-Elect Jose Aliseda (R-Beeville), whose father Jose is a retired anesthesiologist in McAllen.
  • Rep.–Elect Sarah Davis (R-Houston), a cancer survivor whose Houston Medical Center district has more physicians and TMA Alliance members than any other in the state.
  • Rep.-Elect J.M. Lozano (D-Kingsville), whose father, sister, and brother-in-law are all Texas physicians.
  • Rep.-Elect Dan Huberty (R-Kingwood), who defeated two TEXPAC-member physicians in the spring primaries and now has a great working relationship with TMA.
  • Rep.-Elect Charles Schwertner, MD (R-Georgetown), a surgeon who will become the fourth TMA member in the legislature next year.


A pair of Texas psychiatrists — Cliff Moy, MD, of Austin, and Les Secrest, MD, of Dallas — will serve on the Physician Consortium for Performance Improvement® (Consortium) Adult Major Depressive Disorder Work Group. The intent of each Consortium workgroup is to develop measures that are useful to physicians at the point of care and in practice-wide analysis.


Congratulations to physician Howard Marcus, MD, who was recognized by the Texas Chapter of the American College of Physicians (ACP) as Advocate of the Year. Dr. Marcus, an Austin internist with Austin Regional Clinic, is a statewide leader in medical liability reform from his post as chair of the Texas Alliance for Patient Access. “Dr. Marcus has demonstrated outstanding leadership in the areas of legislative advocacy and grassroots activism,” ACP said. “He has worked tirelessly with our elected representatives on behalf of Texas physicians and their patients; he has effectively communicated health care issues on behalf of the Texas Chapter of the ACP to elected officials.” The Texas chapter added that Dr. Marcus “represents the best in advocacy and serves as a role model for all of us to be involved in legislative activities in the service of our patients. He is a true leader of Texas medicine in general and the Texas Chapter of the American College of Physicians.”


Despite all the negative news of late, I hope all of you take the time this week to count and be thankful for all of our blessings. I hope you have a chance to spend some Thanksgiving time with family and friends. EVPGram will take a Turkey Day break and return to your inbox on Dec. 6.

Monday, November 15, 2010


Congress returns to Washington today for a lame duck session, and lawmakers need to hear from you and your patients. If they leave town without taking action, physicians’ Medicare payments will drop by 23 percent on Dec. 1 and more than 25 percent on Jan. 1. We need to light up the phones on Capitol Hill and ask for stable rates through the end of next year. On Wednesday, TMA President Sue Bailey, MD, will join representatives of AARP at a news conference in Fort Worth to encourage Medicare patients to call their U.S senators and representative to stop the cuts. Look for a TMA Action Alert Wednesday morning with details on where you should call. This seemingly never-ending crisis affects more than 3 million Texas seniors, people with disabilities, and military families. Get your patients engaged in the Medicare Meltdown Countdown. Post this poster in your waiting and exam rooms. Or, play TMA’s new video explaining the Medicare Meltdown to your patients. In case you’re wondering if they care, 94 percent of Americans say they are concerned about a looming Medicare cut to doctors, according to a new American Medical Association poll.


Texans in the AMA House of Delegates pushed the house to force AMA leadership to articulate the major flaws in the Affordable Care Act and devise a plan to correct those flaws. We argued successfully that AMA needs a very specific action plan to take to the new Congress. In what appeared to be a major sea change at the house’s interim meeting in San Diego, delegates voted to overturn AMA policy that supports an individual mandate to buy health insurance. Minutes later, however, the house decided to send that item — and several others relating to the new health reform law — to the AMA Board of Trustees for further study. Several other items brought by the Texas delegation found favor with the house:

  • The house sent the AMA board a resolution asking AMA to take a closer look at turning itself into an organization of organizations instead of an individual-membership association. AMA is losing membership at an unsustainable rate at a time of unprecedented change and upheaval in the American health care system. It’s a time when physicians and patients need the strength that comes from the ability of AMA to say it represents the majority of America’s physicians.
  • The delegates unanimously approved a Texas resolution to support pending federal legislation that would exclude from consumer credit reports, within 30 days, medical debt that has been fully paid or settled. This would motivate patients to pay off their medical debt quickly.
  • Finally, the house accepted a resolution brought by Edward Rensimer, MD, of Houston, stating that hospital medical staffs should be able to choose their own officers without interference from hospital leaders. AMA will take this strong new policy to The Joint Commission.


Congratulations to the people of San Angelo. They voted in the Nov. 2 election to become smoke-free. That makes 34 cities in Texas that now prohibit indoor smoking.


Are you registered for the TMA/Specialty Society 2010 State Advocacy Retreat, Nov. 19-20 in Austin? It’s your chance to start building the health care system that awaits you tomorrow. All state specialty societies are welcome. For details and to register, please e-mail Lisa Jackson or call her at (800) 880-1300, ext. 1520, or (512) 370-1520.


As we move closer to the start of the 2011 Texas Legislature, I want to remind you of TMA’s positions on key issues. I’ll start today with corporate employment of physicians. TMA’s long-standing policy in opposition to the corporate practice of medicine remains unchanged. At the heart of the issue is protecting the patient-physician relationship. The direct employment of physicians by hospitals and other corporations — outside the jurisdiction of the Texas Medical Board (TMB) — threatens patient care and physicians’ clinical decision making.

In 2011, we will continue to oppose efforts to allow hospitals and corporate entities to directly employ physicians. We will support efforts to strengthen TMB oversight of existing employment exceptions. At the same time, we recognize that many rural hospitals see direct employment as a solution to recruiting physicians to their communities. TMA believes the state should identify and correct barriers to physicians locating in medically underserved areas, such as payment formulas and incentives.

Physicians should work for the patient not the insurance company, hospital, or anyone else not directly responsible for the care of the patient. Tools currently exist for corporate entities and counties to recruit new physicians to their communities without eliminating the private practice of medicine.

TMB has the ultimate authority to regulate the practice of medicine in Texas on behalf of all our patients. The state should look to TMB not only to maintain high standards of ethical practice but also to establish mechanisms and processes that protect physicians’ responsibility to make clinical decisions in the best interest of their patients.

Monday, November 8, 2010


Regardless of your partisan leanings, you had to be surprised by the strength of the state and federal Republican landslide in last week’s elections. (In case you somehow missed it, the GOP swept all the Texas statewide contests, won control of the U.S. House of Representatives, narrowed its minority margin in the U.S. Senate, took a nearly 2-1 advantage in the Texas House, and kept its 19-12 superiority in the Texas Senate. Gov. Rick Perry’s reelection effort led the Republican tide in Texas. The GOP won 21 new seats in the Texas House and three Democratic seats in the Texas delegation to Congress.) The victors’ campaign messages consistently featured tough anti-Washington rhetoric and fiscal conservatism. What do the election results portend for medicine when the Congress and Texas Legislature convene for new sessions in January?

In Washington, the new Republican House majority probably can’t overcome the Democratic leadership in the Senate and President Obama’s veto pen to actually repeal and replace the health system reform law. Expect them to hold a largely ceremonial vote on such a plan but then use the power of the purse to starve implementation of many of the new law’s programs.

We’re still pushing for the lame duck congressional session to vote for a 13-month reprieve of the pending 30-percent Medicare payment cuts for physicians. With the Democratic leadership reeling, there’s no telling what will happen in the lame duck. And if they slap on another patch — or worse, do nothing — will the 2011 House leadership support Medicare payment reform?

The Texas Legislature will convene next year facing a record $20-billion-plus shortfall. With that big a hole, look for health, human services, and education programs to be on the chopping block. Some GOP leaders are even floating the idea of Texas opting out of Medicaid.


Although the American Medical Association supported the president’s health reform bill, AMA didn’t get all that it wanted and frequently calls the law a “work in progress.” Just to make sure AMA knows what to keep and what to fix, Texas physicians attending the 2010 Interim Meeting of the AMA House of Delegates are pushing to set priority items for reforming the law. Among the issues our delegation is pushing to top the agenda:

  • Medical liability reform;
  • Repeal the Independent Payment Advisory Board;
  • Repeal the fiscal noose placed on physician-owned hospitals; and
  • Make physicians responsible for defining quality care.
These recommendation and many others will come before the house Monday and Tuesday. Check out Blogged Arteries and our Twitter feed daily to stay abreast of all the action


Mike Maves, MD, the AMA’s executive vice president since 2001, will leave that post when his contract expires next June. “As we enter into a new era that is redefining the way health care is delivered, both Dr. Maves and the Board of Trustees share the belief that new top leadership is required to address these challenges and to ensure the rights of physicians and patients continue to be passionately and effectively protected,” said AMA Board Chair Ardis Hoven, MD.


Congratulations to four Texas medical students and two fellows for winning AMA leadership roles:

  • Justin Bachman, MD, a cardiology fellow from The University of Texas (UT) Southwestern Medical School, Dallas, is chair-elect of the AMA Resident and Fellow Section Governing Council.
  • Erin Dunnigan, MD, a fellow in endocrinology at Parkland Hospital in Dallas, was reelected alternate delegate to the AMA House of Delegates from the Resident and Fellow Section.
  • Neil Prikh and Archit Gulati, both students at Baylor College of Medicine in Houston, were elected Region 3 delegates to the AMA Medical Student Section House. Jasmeet Kaur from The University of Texas Medical Branch at Galveston and David Savage, who is a student at the UT- Houston School of Medicine, were elected alternate delegates.


It’s official. The Centers for Medicare & Medicaid Services posted the final 2011 Physician Fee Schedule Rule. It’s a cut of almost 30 percent, counting the 23-percent cut in physicians’ Medicare payment set to take effect Dec. 1 and the additional 6.5-percent cut coming Jan. 1. Look for a TMA Action Alert next week as we push the lame duck congressional session to stop this madness.


You must decide your 2011 level of participation in Medicare by Dec. 31, even if Congress fails to stop the pending cuts. TMA cannot tell you what to do, but we are offering some help in making a decision through a recorded seminar, “Evaluating Your Medicare Options,” on the TMA website. The one-hour webinar, featuring TMA's in-house Medicare specialists, provides detailed information about participation options and the consequences of those choices.

Monday, November 1, 2010


Tomorrow is Election Day. If you haven’t yet, please go to the polls and cast your ballot. TEXPAC has endorsed (PDF) Gov. Rick Perry, Lt. Gov. David Dewhurst, and a host of executive, judicial, legislative, and congressional candidates. Please vote for the Party of Medicine.


The Texas Delegation to the American Medical Association House of Delegates has submitted four resolutions — including one that would reorganize AMA membership — for the house to consider at its interim meeting, which starts this weekend in San Diego. Before I outline our four resolutions, though, I have a question for you. What message should we carry to AMA for you? Regardless of whether you’re a member, what suggestions do you have to help make AMA a true national voice for physicians and patients? Send me an e-mail with your ideas. Now, for our resolutions:
  • First, we ask AMA to take another hard look into turning itself into an organization of organizations (PDF) instead of an individual-membership association. AMA is losing membership at an unsustainable rate at a time of unprecedented change and upheaval in the American health care system. It’s a time when physicians and patients need the support and strength that comes from the ability of AMA to say it represents the majority of America’s physicians.
  • Second, we ask AMA to sponsor an annual, state-by-state study of retention rates (PDF) for medical students and residents trained in each state. Such a study will help states, and state medical societies, plan how to invest in undergraduate and graduate medical education.
  • Third, we ask the house to support pending federal legislation (PDF) that would exclude from consumer credit reports, within 30 days, medical debt that has been fully paid or settled. This would motivate patients to pay off their medical debt as quickly as possible.
  • Finally, we ask AMA to restate its recent position on antitrust protections (PDF) for accountable care organizations (ACOs) to emphasize that those protections should apply only to physician-led ACOs. We need to give physicians — not hospitals or insurance companies — those protections.


TMA is working with Texas’ four health information technology regional extension centers (RECs) to bring you a good deal. For just $300 a year, you get a consultant to help you decide if your practice is ready for an electronic medical record (EMR). If so, your REC can teach you how to select an EMR appropriate to your practice, how to navigate the EMR installation process with minimal disruption to your practice, and how to make meaningful use of an EMR so it helps your patients and qualifies you for a Medicare or Medicaid bonus. If you already have an EMR, the REC consultants can help you determine how to qualify for federal bonuses using your existing system. For physicians who qualify, reaching meaningful use can mean up to $63,750 in incentives from Medicaid or $44,000 from Medicare. Medicare incentives are highest for early adopters who commit to EMRs in 2011-12. For more information, visit the TMA REC Resource Center.


TMA President Sue Bailey, MD, the self-described “headmistress of TMA’s Health Reform School,” called class to order in Beaumont and Dallas last week. More are scheduled. We’re collecting the most frequently asked questions, and their answers, to publish in an upcoming issue of Texas Medicine. One that comes up, frustratingly, at almost every event is this: Why did TMA support the health system reform law? Answer: We didn’t. No way. Backed by a set of principles adopted by the TMA House of Delegates, we opposed the bill that became law. We continue to work to keep what’s good in the law and fix what’s broken. That’s a lengthy agenda.


A team of TMA experts, under the direction of Asa Lockhart, MD, will participate in an ACO stakeholder meeting with the Texas Department of Insurance and the Texas Health and Human Services Commission. The state agencies are starting to develop policy on how the state might want to regulate these new health care delivery systems. Here are the two priority points we will make:
  1. ACOs must be physician-led organizations to ensure that physicians’ clinical judgment is paramount in making patient care decisions.
  2. The driving force for how ACOs increase quality and hold down costs must be patients, not profits.