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Tuesday, December 13, 2011

TEXAS PHYSICIANS BUILD GRASSROOTS STRENGTH THROUGH COUNTY CONFERENCE

I joined the chief executives of more than a dozen Texas county medical societies in a day-long conference to discuss our shared challenges and opportunities in this tumultuous heath care environment. While health system reform and demands for physicians to join the information technology revolution are creating upheavals, they also give us new chances to provide value to Texas physicians. Issues on the table ranged from politics, Medicaid, and physician employment to TMA’s new online CME delivery system, concerns over grievances filed against physicians, and physician health and rehabilitation programs. I know this sounds like a broken record, but the strength of Texas medicine stems from the grassroots involvement of physicians at the county level and the tremendous relationship between TMA and the county societies.

SURPRISE! SGR PATCH CAUGHT UP IN CAPITOL HILL POLITICS

Here’s the relatively good news. The Republican leadership in the U.S. House of Representatives is pushing for a vote, perhaps as soon as tomorrow, on a year-end financial package that would stop the 27.4-percent cut in physicians’ Medicare payments scheduled for Jan. 1. In fact, the bill would increase the payment rates by 1 percent in both 2012 and 2013, provide some relief for physician-owned hospitals, and negate expected geographic adjustments of physicians’ Medicare payments that would have hit some Texas practices particularly hard. Here’s the sad news. The legislation doesn’t do away with the Sustainable Growth Rate (SGR) formula that drives the annual cuts, but it does require Congress and the Obama administration to study some possible alternatives before 2014, when physicians’ payments would be chopped by about 37 percent. Here’s the bad news. The bill has little chance of passing the Senate as it now stands. It’s not because of the SGR patch. Tacked onto the measure, which also would continue the payroll tax cut and extend unemployment insurance, is a provision to fast-track a permit decision on the Keystone XL oil sands pipeline. President Obama and Senate Democratic leaders oppose the pipeline for environmental reasons and are saying “no” to the whole package because of that. Meanwhile, uncertainty strengthens its grip on your practice, and the Big, Bad SGR continues to threaten Grandma.

TEXPAC ADDS TO 2012 ENDORSEMENT LIST

Judges, Texas lawmakers, and a pair of newcomers earned medicine’s support for the 2012 primary elections at the TEXPAC Board of Directors meeting. The list includes four judicial candidates, eight incumbent state senators, and 18 sitting state House members. Of interest:

  • We are backing John Raney (R-College Station) in tomorrow’s House District 14 runoff election. The winner will serve the remaining term of Rep. Fred Brown (R-College Station), who resigned.
  • The TEXPAC board voted unanimously to endorse Chris Paddie (R-Marshall) in House District 9 against an unfriendly incumbent who has developed a particularly egregious antiphysician, antipatient record during his tenure.
  • House Speaker Joe Strauss (R-San Antonio) picked up TEXPAC’s endorsement.
This adds to the list of TEXPAC endorsements for primary races, which already includes Gov. Rick Perry’s run for president, Lt. Gov. David Dewhurst’s bid for the U.S. Senate, and a record number of TMA and TMA Alliance members’ campaigns for Congress and the legislature. More endorsements will come in January, after the U.S. Supreme Court clears up the ongoing uncertainty over the maps for legislative and congressional districts in the 2012 elections.

JUDGE SAYS NO TO CHIROPRACTIC BOARD, AGAIN

An Austin state district judge ruled in TMA’s favor and granted our motion to stop chiropractors from performing vestibular testing. Judge Rhonda Hurley’s ruling invalidates the Texas State Board of Chiropractic Examiners’ (TBCE’s) vestibular testing rule, declaring it to be beyond chiropractors’ lawful scope of chiropractic. This is the fourth part of TBCE’s scope of practice rule that a court has overturned because it exceeded the scope of chiropractic as defined by law. The first three parts of the rule unlawfully authorized chiropractors to perform manipulation under anesthesia and needle electromyography, and to diagnose diseases.

TWO DEC. 31 OPPORTUNITIES AWAIT ON TMA'S CALENDAR OF DOOM

Dec. 31 marks the end-of-year reporting deadline for you to claim a 1-percent Medicare bonus for electronic prescribing. But if you haven’t adopted e-Rx, you face a 1-percent penalty next year. Dec. 31 is also the end of the reporting year for the Medicare electronic health record incentive program. Register by Feb. 29, 2012, to claim your incentive payment. Details on these and many more regulatory deadlines — and help for your office to comply — are on TMA’s Calendar of Doom.

FINAL EVPGRAM OF THE YEAR

It’s holiday time for the EVPGram. We’ll be back in your inbox on Jan. 9, 2012. Happy New Year!

Monday, December 5, 2011

SPECIALTY SOCIETIES LAY OUT PRIORITIES AT TMA ADVOCACY RETREAT

Preserving tort reform, defeating scope of practice expansions, preventing Medicare and Medicaid cuts, restoring graduate medical education funding, growing the physician workforce, protecting physician ownership, and stopping the corporate practice of medicine. Those issues came up again and again at the TMA Advocacy Retreat as 15 state specialty societies from allergy to urology laid out their legislative priorities for the coming year. “Please remember that while each of you is here representing your specialty society, each of you is really representing your patients,” TMA Board of Trustees Chair Tom Garcia, MD, said at the start of the two-day conference. “Throughout today’s discussions, I urge you all to focus on what unites us. Please don’t dwell on what separates us from each other. We all need each other … and our patients need all of us.”

BURGESS: NO MEDICARE FIX THIS YEAR, BUT "NO CUTS WILL HAPPEN"

U.S. Rep. Michael Burgess, MD (R-Lewisville), told Texas medicine’s leaders he sees no permanent fix this year for Medicare’s Sustainable Growth Rate (SGR) formula. But, appearing at the advocacy retreat via a Skype video call from his Capitol office, the only TMA member in Congress predicted “with 95-percent certitude” that “no cuts will happen” in physicians’ Medicare payments on Jan. 1. Under current law, the SGR mandates a 27.4-percent cut when the new year begins. Dr. Burgess said he expects Congress will intervene at the last hour, again, stopping the cuts for two years with perhaps a small increase, while work for a permanent SGR replacement continues.

TMA HONORS "FRIENDS OF MEDICINE"

Fifteen Texas legislators picked up TMA’s Friends of Medicine award at the retreat for their relentless energy, dedication, and steady leadership on behalf of Texas’ patients and physicians during the 2011 session. Since 1995, TMA has honored lawmakers who have gone above and beyond to champion important legislation on behalf of Texas patients. TEXPAC Board Chair Joe Todd, MD, and Candidate Evaluation Committee Chair Jerry Hunsaker, MD, hosted the awards dinner, which began with some political prognostications from Texas Monthly Senior Editor Paul Burka. From the House, the winners were State Reps. Rep. Dan Branch (R-Dallas), John Davis (R-Houston), Sarah Davis (R-West University Place), Todd Hunter (R-Corpus Christi), Susan King (R-Abilene), Elliot Naishtat (D-Austin), Charles Schwertner, MD (R-Georgetown), Mark Shelton, MD (R-Fort Worth), Vicki Truitt (R-Keller), and John Zerwas, MD (R-Richmond). On the Senate side, the friends are State Sens. Bob Deuell, MD (R-Greenville), Robert Duncan (R-Lubbock), Juan Hinojosa (D-McAllen), Joan Huffman (R-Southside Place), and Jane Nelson (R-Flower Mound).

"GRANDMA & THE BIG, BAD SGR" VIDEO GOING VIRAL

Medical societies from around the country are sharing the link to TMA’s new animated video that explains the Medicare financing conundrum in terms even a child can understand. Launched late last week to help garner public support for replacing the SGR formula, “Grandma & the Big, Bad SGR” already has nearly 1,400 views on YouTube. Please share the link with your colleagues, staff, patients, family, and friends via email or social media. “Doctors have no choice but to consider limiting the number of Medicare patients they see,” Dr. Malone said. “No doctor wants that to happen. Our Medicare patients and military families deserve better.” Brent Annear, TMA’s media relations manager, conceived and produced the video. The tremendous, sweet voice belongs to the daughter of TMA Assistant General Counsel Andrea Schwab.

Monday, November 21, 2011

AMA ENDORSES TEXAS' CALL TO STOP ICD-10

The American Medical Association House of Delegates unanimously approved the Texas Delegation’s proposal that AMA “immediately petition the Centers for Medicare & Medicaid Services (CMS) to stop implementation and development of all new coding and billing standards including ICD-10.” ICD-10 has about 69,000 codes and will replace the 14,000 ICD-9 diagnosis codes currently in use. “The implementation of ICD-10 will create significant burdens on the practice of medicine with no direct benefit to individual patient care," AMA President Peter Carmel, MD, said after the house vote. Just days later, CMS announced it is delaying for 90 days enforcement of the HIPAA 5010 electronic claims standards, which are a necessary prelude to ICD-10 adoption. TMA advises that physicians continue planning to begin HIPAA 5010 on Jan. 1 if you want to get your claims paid. For guidance on both HIPAA 5010 and ICD-10, log on to TMA’s Calendar of Doom.

TAPA TO TAP RAND TO END TORT REFORM'S DUELING DATA

We know that Texas’ 2003 liability reforms have been good for patients and physicians. But the trial lawyers continue to finance bogus “studies” that try to poke holes in the tremendous increase in access to medical care that the reforms have brought. At its annual membership meeting, the Texas Alliance for Patient Access (TAPA) decided to commission the prestigious RAND Corporation to put an end to the we-said, they-said arguments. Rand will start with a great set of facts: Since 2003, professional liability insurance rates have plummeted nearly 50 percent, attracting record numbers of good, new physicians to Texas.

SPECIALTY LEADERS JOIN TMA PLANNING SESSION

Dozens of leaders of Texas specialty societies will spend an afternoon with the TMA Board of Trustees in part two of our year-long drive to build the TMA of the Future. As part of the TMA 2011 Advocacy Retreat, the group will hear an update on our member research project from Robin Rather of Collective Strength. Then we will take part in some in-depth discussions of how TMA should prepare for and respond to issues such as the trend for physician employment and growing scope-of-practice battles. Our leadership planning team, which includes representatives from the board, TMA councils, and county society leaders, meets tomorrow night to finalize the agenda.

THE NEW YORK TIMES FEATURES TMA'S CALENDAR OF DOOM

“No matter what the Supreme Court decides about the constitutionality of the federal law adopted last year, health care in America has changed in ways that will not be easily undone,” The New York Times concluded in an article about the court’s decision to review the Affordable Care Act. The corporatization of health care and ever-growing government intrusion into physicians’ practices are trends that likely will not reverse. “In states like Texas, the law is deeply unpopular, and the medical association has a ‘Calendar of Doom’ listing the timeline for important provisions of the law and other government rules,” Times reporters wrote. They then added this quote from me: “There’s a feeling among doctors here that government is crushing them.”

HAPPY THANKSGIVING; EVPGRAM TAKES TURKEY BREAK

I want to wish a very happy Thanksgiving to each of you, your families, colleagues, patients, and staff. We all have so much for which we are thankful. Despite the growing anxiety in the medical profession caused by the uncertain future, I know how thankful you are to be able to make such a tremendous difference in your patients’ lives. And we are thankful to be working for 45,000 of the greatest physicians and medical students in the world. The EVPGram will take a brief holiday next Monday, but we’ll be back in your in-box with details of the TMA 2011 Advocacy Retreat on Dec. 5.




Monday, November 14, 2011

TEXANS TELL AMA TO JUST SAY "NO" TO ICD-10

The American Medical Association should move now to stop the federal government from requiring physicians and health care providers to switch to the onerous ICD-10 documentation system, Texas physicians argued at the Interim Meeting of the AMA House of Delegates, which convened this weekend in New Orleans. “ICD-10 is going to be an absolute disaster in implementation for the physicians of this country,” TMA Trustee David Teuscher, MD, of Beaumont told the AMA Reference Committee on Legislation. “It will be disastrous for those who are our members, and they will ask, 'Why didn't the AMA do something?' Those that are not our members will say, 'See, the AMA didn't do something.' It is time for the AMA to stand up and say 'no' to the implementation of ICD-10.” He said that ICD-10 implementation costs for a three-physician practice are estimated to be $83,000 per doctor, and $28,500 per physician for a 10-doctor practice. Watch a video of Dr. Teuscher’s testimony to the reference committee. He spoke in support of a Texas resolution that asks AMA to “immediately petition the Centers for Medicare & Medicaid Services to stop implementation and development of all new coding and billing standards including ICD-10.” Just in case this fails, TMA’s Calendar of Doom can help you prepare for ICD-10.

TODD LAUNCHES BID FOR TEXAS HOUSE

TMA Alliance superstar Susan Todd of Fort Worth, the founder and organizer of TMA’s First Tuesdays at the Capitol, has decided she wants to spend more than one day a month at the Texas capitol. Susan announced she is a candidate for the Republican nomination in House District 97, the seat vacated by Rep. Mark Shelton, MD (R-Fort Worth), who is running for the Senate. The former nurse — and past president of the Tarrant County, Texas, and AMA alliances — is married to TEXPAC Chair Joe Todd, MD. She kicked off her campaign with a packed-house fundraiser and reception at the AMA Interim Meeting.

CIVIL JUSTICE LEAGUE CORRECTS "DELIBERATE MISREPRESENTATION" OF LIABILITY REFORMS

In a meticulously documented special report, the Texas Civil Justice League (TCJL) “sets the record straight” on the lawsuit abuse epidemic we faced in 2003 and the stunning success of the state’s medical liability reforms. “Since Texas enacted comprehensive medical liability reform in 2003, including a constitutional amendment ratifying limitations on noneconomic damages in medical liability lawsuits against health care providers, Texas has seen signi´Čücant improvements in access to critical health care services across the state,” the report states. “Opponents of these reforms, most recently Public Citizen, claim that liability reforms have not produced the promised results. This claim is simply false and rests on a deliberate misrepresentation of the purpose of the 2003 legislation.” TCJL also announced it promoted longtime staffer Carole Sims to executive director and brought Lisa Kaufman back from Speaker Joe Strauss’ office to be general counsel.

TWO TEXAS STUDENTS NAB AMA POSTS

Congratulations to a pair of Texas medical students who won election as new Region 3 representatives to the AMA Medical Student Section. David Savage from The University of Texas Medical School at Houston is a new Region 3 delegate, and Elliott Richards from Baylor College of Medicine is an alternate delegate.

MALONE: LET MEDICARE PATIENTS CHOSE HOW TO USE THEIR BENEFITS

Don’t miss this short but compelling video of TMA President Bruce Malone’s testimony at an AMA House reference committee. Speaking in support of AMA’s efforts to make direct Medicare contracting a priority, Dr. Malone tells the story of a patient who understands that Medicare is his benefit and not his doctors’. “When all the patients finally figure out what's going to happen in a few years, this is going to be a reasonable solution” to the Medicare Meltdown, he said.

SUE TAKES THE GAVEL; OTHER TEXANS TAKE THE LEAD

TMA Immediate Past President Sue Bailey, MD, walked to the podium this weekend for her first session as vice speaker of the AMA House of Delegates. Elected in June, the Fort Worth allergist runs the meeting alongside House Speaker Andy Gurman, MD, of Pennsylvania. A quartet of other Texas physicians played leadership roles in the meeting as we continue our work to make AMA more like TMA. Nacogdoches ophthalmologist Lyle Thorstenson, MD, chaired the Reference Committee on AMA Finance and Governance. Drs. Ed Buckingham of Austin and Gary Floyd of Fort Worth served on the Reference Committee on Legislation. Melissa Garretson, MD, of Fort Worth served on the Reference Committee on Medical Service, Medical Practice, and Insurance.

Tuesday, November 8, 2011

TEXANS ASK FEDS TO HALT ICD-10, HIPAA 5010 REQUIREMENTS

A sharply worded resolution the Texas Delegation is taking to the American Medical Association House of Delegates asks the Centers for Medicare & Medicaid Services (CMS) to immediately “stop implementation and development of all new coding and billing standards, including ICD-10 and HIPAA 5010.” The resolution, cosponsored by the North Carolina and Nebraska delegations, says CMS has not accounted for the massive disruption these standards will wreck on physicians’ practices on top of the big changes that will accompany the large-scale transitions to electronic health records and other health information technology tools. It calls on AMA to “work with other national and state medical and informatics associations to develop and evaluate the appropriate replacement” for the current ICD-9 coding system. Practices that do not implement the 5010 transaction standards by Jan. 1, 2012, will not be paid for their work. The deadline for adopting the ICD-10 coding system is Oct. 1, 2013. Read more about complying with these new regulatory burdens at the TMA Calendar of Doom. The AMA house convenes Saturday in New Orleans.

PHYSICIANS FOUNDATION TO REACH OUT TO ALL U.S. PHYSICIANS

The Physicians Foundation board has decided to conduct an unprecedented survey of all 630,000 practicing physicians in the United States. The results will tell the story of what is currently happening to the profession and be used as a resource for the industry and policymakers. The foundation also will conduct a broad survey of American patients and a study of the next generation of U.S. physicians. I serve as president of the foundation, which is taking these steps and many others to continue our drive to prepare physicians for changing practice conditions. With the growing employment of physicians, for example, I am excited about our decision to explore developing a handbook on the rights of hospital medical staff.

2012 MEDICARE PAYMENT CUT NOW "ONLY" 27.4 PERCENT; CONTACT CONGRESS TODAY

CMS published its final rule on Medicare payments for next year, and physicians will see a cut of just 27.4 percent — down from the original estimate of 29.5 percent — beginning Jan. 1. Obviously, this remains a completely unacceptable situation. Congress has once again let uncertainty over the nation’s largest health payment system fester until the 23rd hour. Please use the TMA Grassroots Action Center to send a critical message to Capitol Hill. “For the past decade, Congress has recognized the value that hospitals, nursing homes, home health services, durable medical equipment, and other health care professionals provide Medicare patients,” TMA President Bruce Malone said. “They all have received annual payment updates. Physicians should, too. Before any future updates are given, Washington needs to fix the broken physician payment system.”

TMA'S DOOMSDAY CALENDAR SHARED WITH NATIONAL ORGANIZATION

I had the opportunity to discuss the oppressive weight of compliance with growing regulatory burdens in a presentation to 150 members of the American Board of Quality Assurance and Utilization Review Physicians. I explained not only how our Calendar of Doom can help physicians prepare for and comply with new regulations but also how our initiatives like the smoking cessation calculator and the Bridges to Excellence program are rewarding physicians for quality care.

PHYSICIANS MUST BE PART OF PLANNING HUGE NEW MEDICAID WAIVER PROGRAM

Texas’ plan to ask CMS to allow a significant restructuring of Medicaid payments through hospital districts and counties will fail without extensive physician participation, Dr. Malone wrote in a letter to the Texas Health and Human Services Commission (HHSC). “Any sense among physicians that they have been systematically excluded from the process may further fuel the exodus of community-based physicians from Medicaid at a time the state will need more physicians practicing in the program, not less,” Dr. Malone and John Holcomb, MD, chair of TMA’s Select Committee on Medicaid, CHIP, and the Uninsured, wrote. HHSC is asking CMS for a “Medicaid 1115 waiver” to restructure Texas’ Upper Payment Limit Program. The letter suggests dozens of improvements to the waiver, including integration with the Project Access initiatives managed by several county medical societies across the state.

TMA: CUTS IN DUAL ELIGIBLES' PAYMENTS WILL HURT SOME OF TEXAS' MOST VULNERABLE CITIZENS

The state’s plan to save millions by eliminating payments for Medicare Part B coinsurance and deductibles to those eligible for both Medicaid and Medicare “will come at the expense of the health and well-being of some of the state’s most vulnerable citizens,” Dr. Malone told HHSC. Testifying in person against the proposal, the TMA president said the plan “would result in a 20-percent payment cut for physicians who care for these patients” and fuel physicians’ exodus from both Medicare and Medicaid. “The proposed rules penalize the physicians who care for the sickest and frailest Medicare patients. They hit particularly hard practices in rural, inner-city, and border Texas since those practices serve a disproportionate number of dually eligible Medicare patients.”

Tuesday, November 1, 2011

MAKE PLANS FOR TMA ADVOCACY RETREAT: DEC. 2-3 IN AUSTIN

By the first weekend in December, the March primary elections will be three months away, and the next Texas legislative session will be more than a year off. That makes the timing of TMA’s 2011 Advocacy Retreat just about perfect. Medicine must make our mark to be sure we can elect patient-friendly candidates who understand your profession. Several highly qualified physicians and alliance members already are running for office, some ready to move up. This year’s retreat, to be held in Austin at the Westin Hotel at the Domain, includes a session for state specialty society leaders and a campaign training school for TMA Leadership College scholars (open to all). The Friends of Medicine dinner on Friday night will honor legislators instrumental in our successes this legislative session. For a 90-second jolt on the retreat and the 2012 elections, watch this.

COURT UPHOLDS HIGHER LIABILITY STANDARDS FOR EMERGENCY CARE

The Ninth Court of Appeals in Beaumont overturned a lower court ruling that threatened Texas’ special liability protections for physicians providing emergency care. This marks the third appeals court to uphold the higher liability threshold for emergency services that was part of our 2003 tort reforms. Physicians providing emergency care need greater protection from lawsuit abuse because, in many cases, they provide life-saving care immediately and with limited patient information.

NOW SHOWING: THE VIDEO OF DOOM

Last week’s EVPGram promised the videotape of the 2011 TMA Fall Conference panel presentation on our new Calendar of Doom. Well, here it is. You can catch TMA President Bruce Malone, MD, and his colleagues discussing the new TMA service designed to help you keep up — and comply — with the onslaught of new state and federal regulations and insurance company rules governing medical practices. Don’t have time for the hour-long show now? Catch our 30-second preview. And check out the Calendar of Doom for details on meeting tomorrow’s deadline to claim a hardship exemption from the e-prescribing rule and avoid a 1-percent Medicare penalty in 2012.

TMA WARNS TMB: STEM CELL RULE MIGHT GO TOO FAR

A proposed Texas Medical Board (TMB) rule regulating the use of investigational agents including stem cells in patient treatment might unintentionally restrict some currently accepted clinical practices, Dr. Malone wrote in a letter to the board. “We need to make sure current, well-established stem cell therapies, such as ordinary bone marrow transplants, do not require physicians to undertake a review and approval process by an institutional review board,” Dr. Malone wrote in a formal TMA comment to TMB. “Bone marrow, peripheral blood stem cells, and cord blood are all used in transplants for hematopoietic reconstitution (usually referred to generically as bone marrow transplants).” Special thanks to Houston pathologists Susan Rossman, MD, PhD, a member of TMA’s Council on Science and Public Health, and Arthur Bracey, MD, chair of the Committee on Blood and Tissue Usage, for their guidance on this complex issue.

AMA SECURES A TWO-YEAR DELAY OF MEDICARE REVALIDATION REQUIREMENT

The Centers for Medicare & Medicaid Services (CMS) had planned to require every Medicare physician, provider, and supplier to revalidate their enrollment by March 23, 2013, as part of a provision of the Affordable Care Act (ACA). CMS has informed the American Medical Association that it will push back the revalidation effort through 2015, and physicians will be among the last to revalidate. The American Medical Association sent a letter to CMS in September disagreeing with the agency’s analysis of the ACA screening provisions. CMS also announced numerous significant improvements to the online Medicare Provider Enrollment, Chain, and Ownership System (PECOS) that should make revalidation less onerous. Physicians can expect to see the changes in place by the end of 2012.

Monday, October 24, 2011

CALENDAR OF DOOM CAN KEEP YOU OUT OF REGULATORY HEAT

We unveiled a brand-new TMA service designed to help you keep up — and comply — with the onslaught of new state and federal regulations and insurance company rules governing medical practices. Our Calendar of Doom lists all of the key deadlines you need to know about and connects you with the resources you need to understand them and lead your practice away from the precipice. “As bad as it sounds, I am quite hopeful that the Calendar of Doom will be a good thing … a very good thing … for you and all Texas physicians,” TMA President Bruce Malone, MD, said as he unveiled the calendar at 2011 TMA Fall Conference. “I think it will be good because the demands to comply with growing state and federal regulations are so onerous, and because so few of us are really prepared for it all. The Calendar of Doom will provide a great opportunity for TMA to demonstrate tremendous value to our members.” Joining Dr. Malone in reviewing some of the key doomsday scenarios were Drs. Dan McCoy of the TMA Board of Trustees, Gary Floyd of the Council on Legislation, Matt Murray of the Council on Health Care Quality, Charles Stiernberg of the Council on Health Care Quality, Joe Todd of the TEXPAC Board, and some outstanding TMA staff members. We videotaped the presentations and will share a link in next week’s EVPGram.

TEXPAC ENDORSES PERRY, DEWHURST, PHYSICIANS, ALLIANCE MEMBERS, JUDGES

The TEXPAC Board of Directors unanimously endorsed Gov. Rick Perry’s run for president of the United States. The move to back the champion of Texas tort reform for president and Lt. Gov. David Dewhurst for U.S. senator was one of several early endorsements in 2012 races. Members of the family of medicine to earn TEXPAC’s backing included incumbents U.S. Rep. Michael Burgess, MD (R-Lewisville), State Sen. Bob Deuell, MD (R-Greenville), and State Reps. John Zerwas, MD (R-Simonton), and Susan King (R-Abilene). We hope to bring another TMA Alliance member to the Texas House with TEXPAC’s endorsement of Sonal Bhuchar (R-Sugarland) and another physician to the Senate with our backing of Rep. Mark Shelton, MD (R-Fort Worth).

REVISED ACO RULE WINS OPTIMISM/SKEPTICISM FROM PHYSICIANS

When the Centers for Medicare & Medicaid Services (CMS) released its draft rule for the Medicare shared-savings accountable care organizations (ACOs) earlier this year, the document was roundly panned by physician groups as unworkable, impractical, and unaffordable. Some observers think CMS was listening. “After a preliminary review, the AMA believes this final rule includes a number of positive changes,” said American Medical Association President Peter Carmel, MD. The American College of Cardiology and American Medical Group Management Association also had good first impressions of the rule. Other reviewers say the new rule is still way too proscriptive, gives hospitals too much power, and doesn’t address other fundamental flaws in the concept. Stay tuned for our take on the final rule and guidance on moving forward.

FALL CONFERENCE FOCUSES ON QUEST FOR ACCOUNTABLE CARE

From the first meeting of our new Council on Health Care Quality to the Calendar of Doom, 2011 TMA Fall Conference focused on how TMA can help physicians survive and thrive in the new health care landscape. Among the highlights:

  • Alice G. Gosfield, JD, one of the top 25 health lawyers in the country, kept the audience spellbound as she described numerous ways physicians can keep their independence and actually take advantage of all the health care financing schemes under development.
  • The TMA Board of Trustees heard about the latest round of our research into the needs of physicians employed by large groups and hospital organizations. The board also received presentations on four new sets of tools that will help solo practitioners and physicians in small practices measure their performance and take advantage of change.
  • Former TMA President Bohn Allen, MD, received the TMA Distinguished Service Award.
  • The second class of scholars in the TMA Leadership College spent four days soaking up advice on topics ranging from psychological profiles to active listening skills to thought leadership through social media.

TMA'S MEDICARE 2012 SEMINARS HIT THE ROAD

With Medicare a hot-button issue in Washington, the pressure is on to reduce costs and improve efficiency. Physicians and staff need to understand the ever-more-complicated Medicare system to ensure they can get paid accurately, benefit from incentives, and avoid allegations of fraud and abuse. TMA is bringing this important information to your city. Our “Medicare 2012” seminar covers Recovery Audit Contractor audits, claim denials, HIPAA 5010 billing standards, and incentives and penalties lying ahead.

REPORT PQRS DATA AT A DISCOUNT

Most practices already have all the data they need to qualify for the Medicare Physician Quality Reporting System (PQRS) incentive (for 2011, eligible physicians will be paid an additional 1 percent of their total allowed charges for Medicare services). Reporting the data is easy with the right tools. That’s why TMA has endorsed Covisint DocSite, a user-friendly portal for PQRS reporting. TMA members can register at a discount. New users pay $300 (a $50 discount; use code TMAPQRS11). Returning users pay $185 (call TMA at [800] 880-7955 to arrange this).

Monday, October 17, 2011

SEE YOU THIS WEEKEND IN AUSTIN FOR 2011 TMA FALL CONFERENCE

I’m really excited about this year’s TMA Fall Conference and hope to see you there. Throughout the conference, we’ll be talking about — and showing you— how physicians can regain control of their practices in today’s chaotic health care landscape. Our conference agenda includes a keynote address from one of the nation’s top health care lawyers. (And, yes, she is on our side.) We’re unveiling the TMA Calendar of Doom, a new tool that will help you keep up with the onslaught of state and federal regulations and keep your practice out of hot water. If you can’t make the conference, we will be sharing the Calendar of Doom presentation live on the Internet from 11 am to noon on Saturday. Our boards, councils, and committees are taking on some tough issues throughout the weekend. I hope you can join us Thursday at 6 pm at the Hyatt Regency Austin for a reception honoring the TMA Leadership College Class of 2012 scholars. And, of course, past president Bohn Allen, MD, will receive the TMA Distinguished Service Award. Online registration is closed, but you still can register at the TMA building on Friday or at the Hyatt on Friday or Saturday.

REPRESENTATIVE BURGESS SHARES INSIGHTS INTO CONGRESS

U.S. Rep. Michael Burgess, MD (R-Lewisville), the only TMA member in Congress, briefed association leaders on the key health care matters Washington will/could/might/should tackle in the closing months of 2011. Tops on everyone’s mind, of course, was Medicare’s Sustainable Growth Rate (SGR) formula and the pending 29.5-percent cut in physicians’ Medicare payments. Dr. Burgess told us he expects Congress will stop the cuts with a one- to three-year freeze, but he isn’t optimistic that we’ll see a replacement for the SGR this year. (If you haven’t yet, be sure to use TMA’s Grassroots Action Center to let the Texans on Capitol Hill know what we think of this annual disaster.) Dr. Burgess also discussed some ideas for controlling health care costs that don’t involve complete federal control of physicians’ offices. He is working on a plan that would recruit physicians to manage the care of the “dual eligibles” — the chronically ill seniors on both Medicare and Medicaid who eat up a disproportionate share of the health care budget. He is looking for Texas physicians who care for Medicare patients in a concierge-style practice. If you or someone you know has this type of practice, please let me know, and I’ll pass your name and contact information on to Dr. Burgess.

FORT WORTH PHYSICIANS LINE UP BEHIND SHELTON'S SENATE BID

Pediatrician and State Rep. Mark Shelton, MD (R-Fort Worth), announced his bid for a seat in the Texas Senate with an impressive array of Fort Worth physician and community leaders already on his list of supporters. His competition for the Republican nomination in Senate District 10 includes State Rep. Kelly Hancock (R-North Richland Hills), with whom TMA has tangled numerous times on important health care issues. The incumbent in a district that has been substantially redrawn is Sen. Wendy Davis (D-Fort Worth). The TEXPAC Board of Directors will look at the race this week.

TEXAS MEDICAL HOME INITIATIVE MOVING FORWARD

TMA, primary care specialty societies, and two of the state’s largest health insurance companies are supporting a program to improve health care quality, care coordination, and practice efficiency. The Texas Medical Home Initiative continues to grow in North Texas, project coordinators Sue Bornstein, MD, and Robert Jackson, MD told us. Blue Cross and Blue Shield of Texas and UnitedHealthcare are both participating in the program.

TMA WINS COURT BATTLE OVER HOSPITAL FINANCIAL RECORDS

A nonprofit Texas hospital cannot withhold its financial records from members of its medical staff, a state district judge ruled. TMA is supporting the physicians in the case of Knapp Medical Center vs. Grass. The battle for the Weslaco hospital’s financial information centers on alleged financial improprieties and poor application of the resources of the hospital resulting in a deteriorating hospital capacity and performance. TMA submitted an amicus curie brief in the case.

MEMORIAL INFORMATION FOR THE MOTHERS OF DRS. MALONE AND BAILEY

In a previous EVPGram, we promised more details on services for Florence Elizabeth Buck Malone, mother of TMA President Bruce Malone, who passed away Sept. 9. Family members held a graveside service this past weekend. Gifts of remembrance may be made to the Michael Scott Malone Scholarship Fund at Austin Community Foundation or the charity of your choice. I am saddened also to report that Sarah Evelyn Dickson Rudd, mother of TMA Immediate Past President Sue Bailey, MD, passed away last week. Memorial services were this morning in Fort Worth. Memorials in Mrs. Rudd’s name may be made to the Fort Worth University Christian Church Children’s Closet or the Cystic Fibrosis Foundation.

Monday, October 10, 2011

TELL CONGRESS: FIX SGR BEFORE BOOSTING ANY MEDICARE PROVIDERS' PAYMENTS

TMA President Bruce Malone, MD, has a message he wants you to deliver to U.S. Sens. John Cornyn and Kay Bailey Hutchison and your U.S. representative. With a nearly 30-percent cut in physicians’ Medicare payments set to kick in Jan. 1 absent congressional intervention, it’s time to stop treating physicians like the low profession on the Medicare totem pole. “For the past decade, Congress has recognized the value that hospitals, nursing homes, home health services, durable medical equipment, and other health care professionals provide Medicare patients,” Dr. Malone writes in an action alert going out to all TMA member physicians today. “They all have received annual payment updates. Physicians should, too. Before any future updates are given, Washington needs to fix the broken physician payment system.” Please use the TMA Grassroots Action Center to deliver Dr. Malone’s message to Congress today. We’re also activating our Me and My Doctor networking, asking your patients to make the same request to replace the broken Sustainable Growth Rate (SGR) formula before pouring more money into other Medicare providers’ payments.

TMA SURVEY: HALF OF TEXAS PHYSICIANS WILL DROP MEDICARE IF CUTS GO THROUGH

The planned 29.5-percent SGR cut in physicians’ Medicare payments in January would devastate access to care for senior citizens, Texans with disabilities, and military families, a new TMA survey found. “Our survey indicates that half of all Texas physicians are considering opting out of the Medicare program altogether if the planned cuts go through,” Dr. Malone said at a news conference unveiling the results. “We knew some physicians would consider leaving the program, but we didn’t think the number would be that high.” Even considering a possible “compromise cut” of 10 percent, physicians’ responses were the same — they would be forced to leave Medicare. The gaping problem has eroded access for both Medicare and Medicaid patients. One-third of all Texas physicians put limits on new Medicaid patients. Medicaid access would suffer even more if Congress lets the Medicare cuts go through: More than one-quarter of Texas physicians say they will impose more Medicaid limits if the cuts occur; another 27 percent are considering such limits

CPRIT GRANTS TMA CANCER PROGRAM $350,000

TMA’s 24-year-old Physician Oncology Education Program (POEP) has won a nearly $350,000 grant from the Cancer Prevention and Resource Institute of Texas (CPRIT). The grant, which provides the bulk of POEP’s operating funds, will finance live conferences and the POEP Speakers’ Bureau, the development of two new iPhone/iPad applications, more cancer-prevention-and-detection education modules for Texas physicians, and promotion and dissemination of the revised Texas Cancer Plan to be released in January 2012.

HUMANA OFFICIALS EXPLAIN NEW MEDICARE PPO FOR RETIRED STATE EMPLOYEES

A big, new Medicare Advantage plan is about to hit Texas. Beginning in January, all retired state employees in the Texas Employees Group Benefits Program will be enrolled in a new Medicare preferred provider organization from Humana. George Smith, MD, president of Humana Senior Products, Texas, met with Dr. Malone and TMA staff to explain the new Humana Medicare Advantage Plan. Retired employees who want to keep their HealthSelect coverage, provided by Blue Cross and Blue Shield of Texas, will have to opt out of the new program by Dec. 9.

HONORING DR. ALLEN, PREVENTING DOOM ON TMA FALL CONFERENCE AGENDA

We typically honor the winner of TMA’s Distinguished Service Award at our annual TexMed conference, but this year’s winner had a conflict he couldn’t avoid. The wait will make the presentation to former TMA President Bohn Allen, MD, at TMA’s 2011 Fall Conference even more special. Dr. Allen’s colleague — former TMA Trustee Paul Handel, MD — will present the award. After we honor Dr. Allen for a lifetime of achievements, we look ahead to all of the new rules and regulations being heaped onto physicians’ practices. We will unveil TMA’s Calendar of Doom, a web-based regulatory compliance tool designed to give physicians a strategic view of upcoming state and federal compliance timelines. Registration is still open for the conference, Oct. 21-22 at the Hyatt Regency Austin.

WHAT'S ON YOUR MIND

In these turbulent times, physicians across the country are worried about their practices, their patients, and their profession. I spend the next two days with the board of the Physicians’ Foundation, established to advance the work of practicing physicians and to improve the quality of health care for all Americans. What’s bothering you today? What can TMA do to help? What strong advocacy do you need? What expert services would help your practice survive? Send me an email with your ideas, questions, and suggestions.

Monday, October 3, 2011

TEXPAC ENDORSES DRS. SCHWERTNER AND BONNEN

The TEXPAC Board of Directors endorsed two outstanding physicians for open seats in the Texas Legislature in the 2012 elections. State Rep. Charles Schwertner, MD (R-Georgetown), earned TEXPAC’s endorsement for State Senate District 5, which is being vacated by the retiring Sen. Steve Ogden (R-Bryan). Greg Bonnen, MD, a neurosurgeon from Friendswood (we incorrectly listed Dr. Bonnen’s hometown in last week’s EVPGram), won our endorsement for House District 24. The incumbent, Rep. Larry Taylor (R-Friendswood) is running for an open Senate seat. We know both candidates would work diligently on behalf of their patient and physician constituents.

HOW VALUABLE IS YOUR TMA MEMBERSHIP?

TMA and county medical societies have begun mailing dues invoices for 2012. I encourage you to rejoin immediately and recruit any of your nonmember colleagues to become a part of America’s best medical society. You might be wondering — though you, as a TMA leader, shouldn’t be — just what you get in return for your dues dollars. Austin otolaryngologist Daniel Leeman, MD, found out. He gained a 1,520-percent return on his TMA and county society annual dues investment. What about you? Find out by visiting the interactive TMA Return on Investment Calculator. TMA developed the tool to help you learn more about the value of your membership and the benefits that come to you from TMA and your county society.

GET YOUR TMA POLICIES AND PROCEDURES GUIDE FOR MEDICAL PRACTICES

Our new Policies & Procedures guide contains more than 200 up-to-date policies and procedures, tools, sample letters, and forms you can customize for your office. It is specific to Texas medical practices and Texas law. Based on best practices, it is vital to running an efficient practice — from solo physicians to large groups. Written by practice management and health law experts, this guide includes new policies on human resources, front desk, business office, management responsibilities, medical records, safety, compliance, HIPAA, and more. Each guide contains a customizable CD. Call (800) 880-7955 to order your copy today or order online.

HEALTH COMMISSIONER HEARS TMA BUDGET CONCERNS

Department of State Health Services (DSHS) Commissioner David Lakey, MD, met with TMA senior staff and me to review the department’s critical budget reductions and several key policy issues. We discussed Dr. Lakey’s vision for the future of DSHS for the next couple of years, pending rules on hospital licensure and health care worker vaccinations, and the still contentious problems with the state’s electronic death registry. We talked about cutbacks at local health departments and explored the potential consequences of the new state budget to physicians and patients. Dr. Lakey will give a budget presentation to the TMA Board of Trustees later this month along with Jason Terk, MD, chair of the Council on Science and Public Health.

NEW TMA QUALITY COUNCIL GETS SOME EXPERT DIRECTION

Frank Villamaria, MD, chair of the new TMA Council on Health Care Quality, is passionate about quality and determined to get his new council off on the right foot. Dr. Villamaria and I met with TMA President Bruce Malone, MD, and Ken Shine, MD, executive vice chancellor for health affairs at The University of Texas System and former president of the Institute of Medicine. Among the issues we agreed the council should address are patient safety, clinical effectiveness, and what the focus on measuring quality will mean to practicing physicians.

HOT NEWS FROM WICHITA FALLS FOR DRS. MALONE AND STRATE

A few weeks ago, EVPGram reported on Dr. Malone’s visit to physicians in Wichita Falls and the Wichita Falls Record-News. The reporters there listened well and today published an excellent story on what the pending Medicare payment cut would mean to physicians and patients. “We fear the future may see a wholesale drop out of physicians, forced to leave practice,” Dr. Malone said. Also in our inbox today is a news release announcing the College of American Pathologists honored Wichita Falls pathologist Susan Strate, MD, with its Lifetime Achievement Award. It lists the many leadership roles Dr. Strate has held in the college, which is really quite amazing considering how many assignments she has accepted here at TMA. Congratulations!

Monday, September 26, 2011

TMA LEADERS TAKE CONCERNS TO CMS CHIEF BERWICK

Centers for Medicare & Medicaid Services (CMS) Administrator Don Berwick, MD, came to Dallas to hear our concerns, and we gave him an earful. Led by TMA President Bruce Malone, MD, the TMA delegation spoke to Dr. Berwick about the urgent need to replace Medicare’s Sustainable Growth Rate formula, about accountable care organization (ACO) rules that allow physician leadership and control, and about physician leadership in a better-coordinated system of care. The latter issue appears to be Dr. Berwick’s top priority. In contrast to all the talk coming out of Washington, he spoke about finding ways to improve, not cut, Medicare. Our group also included Immediate Past President Sue Bailey, MD; Council on Health Care Quality Chair Frank Villamaria, MD; Lee Spangler, JD, our vice president, Medical Economics; and me. CMS Regional Director Randy Farris and leaders of the Arkansas Medical Association also participated. The North Texas Regional Extension Center (REC) made a presentation on progress in educating and bringing physicians to meaningful use of electronic health records. Learn more about the RECs on the TMA website.

PHYSICIAN CANDIDATES JOIN CAPITOL SHAKEUP

Redistricting, retirements, and chances to climb the political ladder are opening plenty of opportunities for physician candidates in the 2012 Texas elections. Senate Finance Committee Chair Steve Ogden (R-Bryan) and Education Committee Chair Florence Shapiro (R-Plano) aren’t seeking reelection, and Sen. Mike Jackson (R-La Porte) is running for one of the state’s four new congressional seats. Rep. Charles Schwertner, MD (R-Georgetown), immediately jumped into the race for Senator Ogden’s seat. In the Houston suburbs, Greg Bonnen, MD, a neurosurgeon from Webster, announced he will be a Republican candidate to succeed Rep. Larry Taylor (R-Friendswood), who is running for Senator Jackson’s slot. TMA Alliance member Sonal Bhuchar, a Fort Bend Independent School District trustee, is a GOP candidate for the seat now held by Rep. Charlie Howard (R-Sugar Land), who isn’t running for a 10th term in the House. TEXPAC leaders will consider endorsing these and many other candidates at next month’s TMA Fall Conference.

TMA HOSTS MEDICARE REGION'S CHIEF MEDICAL OFFICER

David Nilasena, MD, the chief medical officer for CMS Region VI, spent a day visiting with Dr. Malone and senior TMA staff. We discussed implementation of health system reform, e-prescribing and meaningful use, ACOs, the Physician Quality Reporting System, the new Pre-Existing Condition Insurance Plan, physician workforce problems, and public health issues such as flu shots and drug shortages.

1,500 LEARN ABOUT 5010 CONVERSION

More than 1,500 TMA-member physicians and office managers listened in to our Tele-Town Hall meeting on the HIPAA 5010 billing transaction standards. Physicians who don’t move their practices to the new system won’t get paid — by Medicare, Medicaid, or commercial carriers — after Jan. 1. Dr. Malone and TMA staff experts led a discussion on details of the conversion, how to prepare to upgrade your practice management or electronic health record system, how to develop an action plan, and the impact on your business functions. Listen to highlights of the meeting — and check out all the tips and advice we have — on TMA’s HIPAA 5010 Resource Center.

TAPA LEADERS DEFEND LIABILITY REFORMS AT TEXAS TRIBUNE DEBATE

Congratulations to Texas Alliance for Patient Access (TAPA) Chair Howard Marcus, MD, and general counsel Mike Hull on a great job at the Texas Tribune Festival. The two squared off against one of the state’s top trial lawyers and a national health reform expert in a debate over the benefits of our 2003 liability reforms. Actually, it wasn’t much of a debate, as Mike and Dr. Marcus had both skill and the facts on their side. The festival’s health and human services track included an address by U.S. Rep. Michael Burgess, MD (R-Lewisville). Former TMA President Jim Rohack, MD; state Rep. John Zerwas, MD (R-Simonton); and former TMA Council on Legislation Chair Spencer Berthelson, MD, also participated in panel discussions during the festival.

CONGRATULATIONS TO LISA JACKSON, TMA'S NEWEST ASSOCIATE VICE PRESIDENT

I am pleased to announce the promotion of long-time TMA staffer Lisa Jackson to associate vice president for conference and association management services. Lisa’s team will provide executive management services to 20 specialty and professional societies, and be responsible for running TexMed and all of our other conferences. Congratulations, Lisa.

Monday, September 19, 2011

MEDPAC CONSIDERS CUTS AND FREEZES IN MEDICARE PAYMENTS

Looks like everyone in Washington is out to cut access to care for seniors, military families, and Texans with disabilities. The congressional Medicare Payment Advisory Committee is considering what American Medical Association leaders call “a misguided scheme.” It would cut payments by 18 percent to nonprimary care physicians over the next three years followed by a freeze for seven years. Payments to primary care physicians would be frozen for 10 years. This comes as a cost-cutting alternative to the 29.5-percent across-the-board cut that will kick in Jan. 1 if Congress doesn’t intervene. TMA is working with AMA and other medical societies across the country to convince lawmakers there is a better way. The groups are calling on the Joint Select Committee on Deficit Reduction not only to eliminate Medicare’s sustainable growth rate (SGR) formula but also to bring some Texas-style medical liability reforms to the table.

FOCUS GROUP OFFER INSIGHT INTO EMPLOYED PHYSICIANS' NEEDS

In our continuing quest to define the TMA of the Future, I traveled to San Antonio with senior staff to hear 16 physicians talk about their careers and their needs for representation and practice management help. This was our third focus group with doctors employed by either large physician groups or hospital-run nonprofit health organizations. We have four more scheduled in Houston and Dallas. Part of our goal is to find the issues and services these physicians and their employers find most relevant. The Board of Trustees will receive a full report on the focus group findings next month at TMA 2011 Fall Conference as our year-long strategic planning process continues.

HIPAA 5010 COMPLIANCE HELP JUST A PHONE CALL AWAY

Answer your home phone at 8 pm (CT) Thursday evening to help make sure your payments will continue after Jan. 1, 2012. TMA President Bruce Malone, MD, will lead a group of physician and TMA staff experts in a half-hour education and Q&A session on compliance with the HIPAA 5010 electronic claims standards. If you don’t make the switch by the first of the year, Medicare, Medicaid, and the commercial insurance carriers will not pay your claims. Please join the conversation Thursday evening and see TMA’s 5010 Resource Center for important information. Contact the TMA Knowledge Center today if you want to add your practice manager to the call list.

PAYMENT ADVOCACY PROGRAMS EARN $1 MILLION FOR YOU

Thanks to the persistence of our Payment Advocacy staff, TMA has helped members recover more than $1 million from health plans this year. This includes money TMA has helped practices recover from incorrectly processed claims, lost or delayed Medicare enrollment applications, educating staff on how to resolve ongoing billing issues with health plans, and various other advocacy efforts. For instance, TMA staff efforts helped one practice recover $84,000 in improved drug benefits. Thank you and congratulations to Lee Spangler, our vice president of Medical Economics; Genevieve Davis, director of Payment Advocacy; and their hard-working staff.

COUNTY SOCIETIES GATHER AT TMA FOR MOBILE SUMMIT

Physicians, and most other Americans, like their phones smart. In fact, 80 percent or more of America’s doctors use mobile phones or tablet computers that can download and run apps that connect them with friends, family, colleagues, and patients while on the go. Forty-five execs and key staff from Texas county medical societies and TMA gathered in a packed conference room for an all-day summit on how we can help physicians best take advantage of the mobile revolution. The TMA Mobile App gives physicians 24/7 access to names and contact information for more than 45,000 TMA members across the state. DocBookMD founders Tim Gueramy, MD, and Tracey Haas, DO, explained how their app lets physicians share HIPAA-compliant messaging anytime from anywhere. Both apps are available only for TMA members, and they include only TMA members.

LOBBY AND POLITICS TEAM TAKE CLOSE LOOK AT 2012 ELECTIONS, 2013 LEGISLATURE

TMA’s lobby and TEXPAC staff spent a day with Council on Legislation Chair Gary Floyd, MD, reviewing the wins and losses from the 2011 legislative session, and taking a broad-brush look at 2012 elections and the many and significant opportunities for physicians and TEXPAC to influence the makeup of the next legislature. The team also began projecting key issues for 2013 (including scope of practice, graduate medical education funding, and Medicaid) and initiated the always-difficult exercise of setting priorities. Have ideas or suggestions? Send them my way. And if advocacy and politics are really your bag, don’t forget to register for the TMA 2011 Advocacy Retreat, Dec. 2-3, in Austin.

DR. MALONE REACHES OUT TO PHYSICIANS, SCHOOLS, PAPERS, POLITICIANS

Dr. Malone has had a busy week and a half on the road for TMA. He started out discussing the future of medical practice in San Antonio as the keynote speaker at the Baptist Health System PHO Physician Conference. He traveled to West Texas where he spoke to the Wichita-Archer-Baylor-Clay-Knox and Wilbargar county medical societies and met with the editorial board of the Wichita Falls Times-Record-News. After a late-night drive to Lubbock, he spoke to the editorial board of the Lubbock Avalanche-Journal; met with Texas Tech University Health Sciences Center President Tedd Mitchell, MD, and his staff; spent some planning time with Cynthia Jumper, MD, chair of the TMA Council on Medical Education; and touched base with influential State Sen. Robert Duncan (R-Lubbock).

Tuesday, September 13, 2011

TMA INVESTIGATING UNAPPROVED DRUG, DEVICE INVESTIGATIONS

As Texas Medicine reported in August, the Texas Office of the Attorney General and the Texas Medical Board are investigating the use of medical devices and/or pharmaceutical products labeled for use in another country. Several Texas physicians have discovered they purchased and/or used what they believed was an approved device or drug from a vendor not licensed in Texas only to find that the drug or device had been mislabeled. TMA is reviewing this issue and is in contact with both state agencies. We are looking for more information to help evaluate the problem. If you have encountered this problem, please share your experience confidentially with TMA. The Texas Department of State Health Services has established a website where you can determine if a vendor has a Texas license.

TMA ASKS APPEALS COURT TO OVERTURN PHYSICIAN-OWNED HOSPITALS DECISION

TMA and The Physicians Foundation have filed an amicus curiae brief with the U.S. Court of Appeals for the Fifth Circuit challenging President Obama’s Affordable Care Act. Section 6001 of the act prohibits expansion or construction of physician owned hospitals (POHs), which we argue have better health care outcomes, shorter hospital stays, and much higher patient satisfaction ratings than non-POHs. We assert that the arguments lodged against POHs, which Congress relied upon to enact the law, are flawed and unreasonable. We argue that Section 6001 worsens conflicts of interest, removes competition, and limits physicians’ ability to make important health care decisions: “These aggressive non-POHs have eliminated the competition, and the result will be greater financial conflicts of interest, higher health care costs, fewer choices for patients, and less innovation.” We also applaud the significant community benefit POHs provide, contrasting it with the very profitable “not-for-profit” hospitals that do not pay federal or state income, property, or sales tax resulting in billions of dollars in tax breaks per year: “Whether through paying [billions in] taxes and employing thousands, providing hospital access in poor areas, or providing charity care, physician owned hospitals provide a contribution to society which is unmatched.”

REGISTER TODAY FOR 2011 TMA FALL CONFERENCE

Quest for Accountable Care — Maximize the Moment! is the theme for this year’s Fall Conference, Oct. 21-22 at the Hat Regency Austin. Health reform has moved quality, value, accountable care, and integration to the forefront of U.S. health care policies and strategies. Under development are new measures for virtually every kind of care financed by public programs. Employers, who still foot the bill for most health care in the United States, also will demand a better value proposition, because current volume-driven approaches are not sustainable. So, in what direction should the vast majority of physicians, hospitals, and other providers be headed? Keynote speaker Alice Gosfield, JD, will discuss how physicians can shape their future, regardless of practice setting.

PAYMENT ADVOCACY PROGRAMS EARN $1 MILLION FOR YOU

Thanks to the persistence of our Payment Advocacy staff, TMA has helped members recover more than $1 million from health plans this year. This includes money TMA has helped practices recover from incorrectly processed claims, lost or delayed Medicare enrollment applications, educating staff on how to resolve ongoing billing issues with health plans, and various other advocacy efforts. For instance, TMA staff efforts helped one practice recover $84,000 in improved drug benefits. Thank you and congratulations to Lee Spangler, our vice president of Medical Economics; Genevieve Davis, director of Payment Advocacy; and their hard-working staff.

TMA CONNECTION EARNS TMLT TOP GRADES FROM ANALYSTS

A.M. Best has assigned the financial strength rating of “A” (excellent) and the issuer credit rating of “a” for Texas Medical Liability Trust (TMLT) and its wholly owned subsidiary, Texas Medical Insurance Company. “The ratings of TMLT reflect its excellent risk-adjusted capital position, favorable operating performance, experienced management team and its leading market position in Texas,” A.M. Best wrote in a news release. TMLT also benefits from its strong relationship with the Texas Medical Association, which has exclusively endorsed TMLT since 1992.”

IN MEMORY OF ELIZABETH MALONE

Elizabeth Malone, mother of TMA President Bruce Malone, MD, passed away Friday at St David's Hospital in Austin. She celebrated her 91st birthday on Aug. 17. We will provide more details as they become available.

Tuesday, September 6, 2011

TMA'S 5010 CAMPAIGN WILL HELP YOU GET PAID NEXT YEAR

If you’re like most Texas physicians, your electronic billing systems aren’t compliant with the HIPAA 5010 electronic claims standards. If you don’t fix that by Jan. 1, you won’t get paid for the patient care you provide; not by Medicare, not by Medicaid, and not by commercial carriers. We’re pulling together physician and staff experts from across the association to give you the tools and information you need to make that transition in time. Look for the 5010 Resource Center on the TMA website by week’s end. Answer your home phone when we call at 8 pm (CT) on Thursday, Sept. 22, for a TMA-wide tele-townhall meeting on the new standards. Sign up for one of our ICD-10 Boot Camps or take some of our 15-minute ICD-10 webinars.

FOCUS GROUPS HELP US UNDERSTAND WHAT PHYSICIANS IN GROUPS NEED

In many ways, physicians who practice in large, physician-owned groups and those who work for hospital-run 501(a) corporations are no different from the small, private-practice physicians who’ve been the mainstay of our membership for 150 years. But how are those physicians different? What are their most pressing lobby concerns? Where are they getting their practice management education? How can TMA provide them the most value for their dues dollars? Those are some of the questions we’re asking in a series of focus groups across the state. The research is part of the strategic planning process our Board of Trustees began this summer to help design and build the TMA of the Future.

FRAUD AND EMBEZZLEMENT: ARE YOU GETTING RIPPED OFF FROM THE INSIDE?

No matter the size, location, or staff expertise of a practice, fraud and embezzlement can occur. Physicians can learn to recognize areas of financial risk, identify actions and policies to support internal controls, and establish hiring practices that are thorough and responsible. This fall, TMA offers evening, physicians-only programs across the state to give you effective ways to guard against embezzlement and common areas of fraud. For more information and to register for the seminar, visit the TMA website or call the TMA Knowledge Center at (800) 880-7955.

CONGRESSIONAL "SUPER COMMITTEE" AN OPPORTUNITY FOR SGR REFORM

TMA chief lobbyist Darren Whitehurst travels to Washington this week for the American Medical Association’s SGR Legislative Task Force. The group’s goal is repeal of Medicare’s Sustainable Growth Rate formula, replacing it with a stable and fair new system for paying physicians for Medicare services. Looming large in the background is a 29.5-percent cut in fees set to take effect Jan. 1 if Congress doesn’t intervene first. But before then, the Joint Select Committee on Deficit Reduction must make its recommendations on how to trim billions from the federal deficit over the next 10 years. Medicare spending obviously will be on the table. Our plan is to convince the so-called “Super Committee” that a slash-and-burn approach will backfire. As TMA President Bruce Malone, MD, wrote to U.S. Rep. Jeb Hensarling (R-Dallas), the committee’s co-chair, “When it comes to Medicare, the responsible thing to do is to eliminate the SGR, eliminate the massive SGR debt, and replace it with a permanent payment formula. Failure to act now will dramatically increase the cost of necessary action in the future.”

TMLT RATE CUT, DIVIDEND BRING TOTAL POST-REFORM SAVINGS TO $745 MILLION

The Board of Governors of Texas Medical Liability Trust (TMLT) approved an average 6.9-percent rate reduction for TMLT policyholders and an 18.5-percent dividend for renewing policyholders, effective Jan. 1. Actual rate cuts will vary by physician specialty and practice location. The combined rate reduction and dividend will save TMLT policyholders nearly $35.8 million in 2012 premiums. TMLT has reduced rates for Texas physicians for nine consecutive years since the passage of medical liability reform in 2003. TMLT-insured physicians will have saved $745.5 million in decreased premiums once this latest round of rate cuts and dividends is implemented.

PERRY NAMES TEUSCHER TO HIGHER EDUCATION COORDINATING BOARD

TMA Trustee David Teuscher, MD, an orthopedic surgeon from Beaumont, now has a seat on the agency that sets policy for Texas colleges, universities, and medical schools. Gov. Rick Perry appointed Dr. Teuscher to a six-year term on the Texas Higher Education Coordinating Board.

Thursday, July 28, 2011

Rural Health Care at Risk in Texas - from the Texas Tribune



Rural Health Care at Risk in Texas, Study Says


by Bill Zeeble


 

According to a new study, already strained health care providers in rural regions will suffer without technological improvements. Bill Zeeble of KERA reports on the growing problem that could affect up to two million Texans.


  

 
This article originally appeared in The Texas Tribune at http://www.texastribune.org/texas-health-resources/health-reform-and-texas/rural-health-care-at-risk-in-texas-study-says/.

Monday, July 18, 2011

LEADERS GATHER TO BEGIN DESIGNING THE TMA FUTURE

The TMA Board of Trustees and dozens of physician leaders from across the state assembled for a two-day strategic planning session to begin designing and building the TMA of the Future. The meeting was the start of a year-long process that will examine the massive changes affecting the health care system, what those changes mean for Texas physicians, and how TMA can best help physicians prepare for and handle those changes. In addition to the board, the group included various TMA council and committee chairs, coalition leaders, TEXPAC, the Board of Councilors, presidents and staff leaders of county medical societies, TMA Alliance leaders, our consultants, and senior TMA staff. Participants reviewed the outcome of the 2011 Texas Legislature and began preparing for the 2012 elections and the 2013 legislative session. Led by Board Chair Tom Garcia, MD, and TMA President Bruce Malone, MD, they examined how current health care trends will affect TMA membership and the demand for TMA services. They pointed the way toward where we need more research, some ideas that are worth fleshing out for further exploration, and some potential changes that need serious, in-depth vetting. What about you? Please let me know where you think we need to focus our energies. Below is a “word cloud” that summarizes the discussion. The larger a word or phrase appears in the cloud, the more prominent it was in the meeting.

PHYSICIAN LOAN REPAYMENT PROGRAM SOLVENT FOR NEXT TWO YEARS OF PAYMENTS

Despite huge budget cuts, physicians currently in the state’s underserved area Physician Education Loan Repayment Program will see their loans covered for at least three of their four years, the Texas Higher Education Coordinating Board (THECB) has informed us. The legislature cut funding for the program by 78 percent for the next two years, a loss of $17.4 million. THECB says it has enough funds to provide loan repayment to physicians currently in the program for at least three of their four-year service commitments. These projections are based on assumptions of maximum annual loan payouts and no dropouts. Availability of funds to cover the final year will depend on what the legislature does in 2013. While this does not allow for the growth we had hoped for in the next biennium, this news at least calms concerns that repayments might halt immediately.

TMA'S HEALTH REFORM SCHOOL AND HARD HATS FOR LITTLE HEADS WIN AWARDS

Our peers around the country have found merit in two of TMA’s excellent programs. Our Health Reform School project, which helped to educate thousands of Texas physicians on the impact of the Affordable Care Act, won a Profiles of Excellence Award from the American Association of Medical Society Executives. The award recognizes how “medical societies are making waves among their membership, in their community, and the country with their unique and creative efforts.” Congratulations to TMA Media and Public Relations Director Pam Udall, who coordinated the project. The American Society of Association Executives (ASAE) is giving a Power of A Gold Award to our Hard Hats for Little Heads program in the Power to Enrich Lives category. The Power of A Gold Award is “ASAE’s second highest level of recognition for association programs that exemplify how the association industry and professionals are essential to a stronger America and world.” Congratulations to TMA’s Tammy Wishard, our Hard Hats program manager.

EVPGRAM TO TAKE SUMMER BREAK

It’s time for EVPGram to take its summer vacation. We will be back in your inbox right after Labor Day and, of course, to deliver any breaking news before then. In the meantime, please stay in touch with Texas Medicine, Action, and the award-winning TMA website. (Speaking of Texas Medicine, check out our new digital edition. Let editor Larry BeSaw know what you think.)




Tuesday, July 5, 2011

A REPORT CARD YOU'D BE PROUD TO SHOW TO MOM AND DAD

Our top priority as the 2011 legislative session convened was to protect the patient-physician relationship in every aspect of the health care system. With an enormous budget deficit and special interest groups from hospitals to midlevel practitioners lining up to take on medicine, it felt like everyone wanted a piece of the profession. Many of our adversaries wanted control of physicians, your practices, and your patients. Others wanted to weaken the Texas Medical Board, jeopardizing Texas’ hard-fought liability reforms and Texans’ access to care. Some believed physicians were the cost drivers and needed restraint. However, when the session finally ended, physicians crossed the finish line with the reins still in hand. Even better, lawmakers took major steps to protect and strengthen the patient-physician relationship from outside interference. Working with the legislature, we were able to minimize Medicaid cuts to office-based physicians so that you can continue to see the neediest Texas patients and continue your important work of improving the health of all Texans. Read our full report card — and spread it around. We’re quite proud of it — and you should be, too.

LAWMAKERS PASS HEALTH AND BUDGET BILLS; FINALLY GO HOME:

After 170 days, the 2011 legislative session finally came to an end. Gov. Rick Perry called the special session on May 31 for lawmakers to balance the 2012-13 budget and cut health care spending. Senate Bill 7 is the omnibus health care bill that would:


  • Establish a statewide plan to improve quality and increase efficiency by forming and regulating health care collaboratives;
  • Ensure physicians would have an equal say and vote in a collaborative’s governing board, and due process protections and the ability to participate in more than one collaborative arrangement in their community;
  • Create a new Medicaid and Children’s Health Insurance Program Quality-Based Payment Advisory Committee and program that would tie a portion of Medicaid HMO premiums to improved health outcomes and quality, and implement copayments in Medicaid to reduce unnecessary emergency department use;
  • Create more than $460 million for Medicaid by placing a premium tax on Medicaid managed care companies that are expanding to the Rio Grande Valley;
  • Protect patients from vaccine-preventable diseases in health care facilities, such as hospitals, by requiring them to implement vaccination policies to immunize their employees;
  • Establish the Texas Emergency and Trauma Care Education Partnership Program to ensure support of the trauma infrastructure in Texas;
  • Allow Texas to participate in a multistate compact to help fund and administer Medicaid and Medicare; and
  • Deny state funding to public hospital districts that perform abortions except in the case of a medical emergency.

TMA PRACTICE MANAGEMENT WEBINARS; ONE HOUR, ONE FEE, LOTS OF VALUE

Have an hour, and need to earn some continuing medical education (CME)? Have an hour, and need to train staff about a specific topic? TMA offers a range of one-hour, on-demand webinars to fulfill your licensure requirement and to improve your professional skills and those of your staff. These Texas-specific programs delve into hot topics related to medical records, patient relations, legal considerations, and more. You pay only one fee per webinar, and your entire staff can watch it. You may start and stop the program at your convenience, continue where you left off, and review supporting materials as often as you like. Find the full course list on the TMA website.

TWO ON TMA STAFF PROMOTED TO ASSOCIATE VICE PRESIDENTS

 I’d like to congratulate two of the hardest-working members of the TMA staff on their promotions. Alan Atwood is now associate vice president for technology information systems, printing, and graphics. Peggy Pringle is now associate vice president for TMA practice management services.

MEDICINE WINS; CMS DROPS LAB SIGNING RULE

Admitting it did not fully understand the impact of what it was requiring, the Centers for Medicare & Medicaid Services (CMS) now says it will drop a proposed rule that the ordering physician or nonphysician practitioner (NPP) must sign requisitions for all clinical diagnostic laboratory tests paid under the clinical laboratory fee schedule. Earlier this year, TMA along with numerous specialty societies; hospitals; and several members of Congress, including U.S. Rep. Michael Burgess, MD (R-Lewisville), asked CMS to delay the rule until next year. “Creating more bureaucracy in a system that can sometimes already be hard to navigate only creates more problems,” Congressman Burgess said. “Patients, physicians, hospitals, nursing homes, and laboratories could not afford to have this change implemented, and all supported this effort.”

Monday, June 27, 2011

TMA PHYSICIANS WIN THREE AMA POSITIONS; TWO LAST-MINUTE CANDIDATES COME UP SHORT

Led by former TMA President Sue Bailey, MD, three Texas physicians won key leadership spots in elections at the American Medical Association House of Delegates. As the newly elected vice speaker of the AMA house, Dr. Bailey becomes a member of the AMA Board of Trustees and is now on what historically has been a track toward becoming AMA president. Dallas internist Lynne Kirk, MD, won a contested race for the AMA Council on Medical Education, and Houston’s Russ Kridel, MD, won his race for reelection to the AMA Council on Science and Public Health. Responding to two last-minute openings on AMA councils, Drs. Dawn Buckingham and Ken Mattox willingly threw their hats into the ring. Although neither Dr. Mattox, a trauma surgeon from Houston, nor Dr. Buckingham, an Austin ophthalmologist, won their races, they ran well and displayed TMA's “bench strength” in Chicago. Check out the video of their short campaigns.

HEALTH BILL SPENDS WEEK IN LIMBO AS SPECIAL SESSION NEARS END

Disagreements over how many more restrictions legislators would put on abortions stymied consideration of Senate Bill 7, the omnibus health care bill that rolls up many measures from the regular session of the Texas Legislature. In addition to making huge changes in Texas’ health care delivery systems, the bill would deny state funding to public hospital districts that perform abortions, except in the case of a medical emergency. The week-long delay came over the definition of “medical emergency.” Compromise language in the new conference committee report on SB 7 says the medical emergency exception would apply only when the fetus could not survive outside the womb. The latest word is that the bill, by Sen. Jane Nelson (R-Flower Mound) and Rep. John Zerwas, MD (R-Simonton), likely will be up for House and Senate consideration today. The special legislative session ends Wednesday, with many other key issues still unresolved. SB 28 by Sen. Rodney Ellis (D-Houston) passed the Senate Health and Human Services Committee a week ago but has made no progress since. It would ban smoking in some public places and could save the state more than $30 million in Medicaid costs.

NATIONAL RADIO NETWORK HOSTS DR. MALONE ON AMA DECISION ON INSURANCE COVERAGE

Immediately after the AMA House of Delegates voted to keep AMA’s support for a mandate that nearly all Americans be required to have or buy health insurance, TMA arranged an interview with national CBS Radio for TMA President Bruce Malone, MD. The discussion ranged from the issue itself, to the tenor of the often-heated debate, to the impact the vote will have on AMA membership. “The AMA house has struggled with the question of how do you provide insurance for more of our citizens without violating individual rights.” Dr. Malone said. “The mandate to buy health insurance is offensive to some, but insurance pools do not work economically without broad participation. So Texas physicians wanted to leave these rules to the states instead of having it determined by the federal government.” The state option failed in the House by a 3:2 margin.

TMA ASKS CMS TO DELAY E-PRESCRIPTION DEADLINE

TMA urged the Centers for Medicare & Medicaid Services (CMS) to push back its June 30 deadline for physicians to report they have prescribed medications electronically or be penalized. The unreasonable deadline is causing serious problems for Texas physicians and their patients. CMS requires physicians who see Medicare patients to report having transmitted 10 e-prescriptions by June 30 or face a 1-percent penalty on all allowable charges they bill to Medicare beginning in 2012. To comply with the deadline, some physicians are rushing into e-prescribing to avoid the penalty, using free or temporary systems. TMA asked CMS to defer the compliance date to Oct.1. We also asked the agency to grant physicians automatic exemptions if they attest that they intend to e-prescribe by Oct. 1, 2012, under a Medicare incentive program that rewards physicians for “meaningful use” of an electronic health record, including the use of e-prescribing technology.

REST IN PEACE, RUTH BAIN, MD

Funeral services are today in Centerville, Texas, for Ruth Bain, MD, TMA’s second female president. During 39 years in private practice, the family physician from Austin delivered more than 1,000 babies. Dr. Bain was president of Travis County Medical Society and first winner of its Gold-Headed Cane Award, inducted into the Central Texas Women’s Hall of Fame, a member of the State Board of Medical Examiners, and a winner of TMA’s Distinguished Service Award. In lieu of flowers, please make donations to the Texas Women’s University Foundation; The University of Texas Medical Branch; the Texas Medical Association Foundation; Hospice of East Texas, 4111 University Blvd., Tyler, TX 75701; or the charity of your choice.

MAGAZINE HONORS DR. MALONE, RAISES FUNDS FOR HARD HATS

Nside Austin magazine held a reception at Lambert’s in downtown Austin to honor Dr. Malone. Around 70 physicians, alliance members, and Austin business people attended. Dr. Malone discussed the challenges and opportunities in today’s changing health care landscape. He also discussed why TMA started Hard Hats for Little Heads and our accomplishment of giving 100,000 Texas children new bicycle helmets since 1994. Most of the helmets have been given away in the past six years. Part of the money raised at the event will help buy more helmets for little heads.

Monday, June 20, 2011

HUGE HEALTH CARE BILL IN CONFERENCE COMMITTEE

Five state senators and five representatives are reportedly very close to finalizing the details of Senate Bill 7, the omnibus health care bill that rolls up many measures from the regular session of the Texas Legislature. We expect to have a conference committee report ― and possibly votes in both chambers ― as early as tomorrow. Sen. Jane Nelson (R-Flower Mound) is the author of SB 7; Rep. John Zerwas, MD (R-Simonton), is the House sponsor. Key provisions of the bill would:

  • Establish a statewide plan to improve quality and increase efficiency by forming and regulating health care collaboratives;
  • Ensure physicians have an equal say and vote in a collaborative’s governing board, and due process protections and the ability to participate in more than one collaborative arrangement;
  • Create a Medicaid and CHIP Quality-Based Payment Advisory Committee and program that would tie a portion of Medicaid HMO premiums to improved health outcomes and quality, and implement copayments in Medicaid to reduce unnecessary emergency department use;
  • Create more than $460 million for Medicaid by placing a premium tax on Medicaid managed care companies expanding to the Rio Grande Valley; and
  • Protect patients from vaccine-preventable diseases by requiring health care facilities to have a plan for properly immunizing health care workers.

BAILEY RUNNING HARD; KRIDEL DECLARES VICTORY

It seems like it’s been all politics all the time here in Chicago at the annual meeting of the AMA House of Delegates. Former TMA President Sue Bailey, MD, is campaigning hard in her race for vice speaker of the AMA house. Her support team includes Drs. Melissa Garretson, Dawn Buckingham, David Fleeger, and Dan McCoy, but the entire Texas Delegation to the AMA is making contacts on Dr. Bailey’s behalf. The election is tomorrow morning. Meanwhile, we’re proud to announce that Houston’s Russ Kridel, MD, has already won his race for reelection to the AMA Council on Science and Public Health. On the policy side, the big debates continue to focus on AMA’s support for the health system reform law. Delegates in one reference committee spent several hours Sunday talking about whether AMA should continue to back the mandate for all Americans to buy health insurance. Another committee tackled a long list of improvements that need to be made in the law ― along the lines of TMA's Find It, Fix It, Keep It campaign.

PERRY SIGNS OUR TMB-REFORM BILLS INTO LAW

TMA’s package of bills to reform the Texas Medical Board is now law. Gov. Rick Perry signed SB 227 by Senator Nelson and Rep. Susan King (R-Abilene), and House Bill 680 by Rep. Charles Schwertner, MD (R-Georgetown), and Sen. Joan Huffman (R-Southside Place). One of the most important things the bills do is prohibit the filing of anonymous complaints. They also:

  • Require the board to notify the physician when insurance companies, pharmaceutical companies, or third-party administrators file a complaint;
  • Increase the time for a physician to respond to a complaint notice from 30 days to 45 days;
  • Allow physicians to tape the proceedings of a TMB informal settlement conference;
  • Allow TMB to require a remedial action plan rather than impose a fine for a minor administrative violation; and
  • Institute a seven-year statute of limitation on bringing a disciplinary action.

TMA ANNOUNCES NEW MEMBER BENEFIT FOR PQRS

TMA presents PQRIwizard, a simple and cost-effective online tool that eligible physicians can use to collect and report quality measure data under Medicare’s Physician Quality Reporting System (PQRS) pay-for-reporting program. The $250 TMA discounted fee for PQRIwizard is competitively priced and easily used by smaller practices. The tool lets you participate in PQRS without modifying your billing process. On average, 2009 bonus payments for satisfactory reporters in PQRS were $1,956 per eligible professional.

THREE TEXAS MEDICAL STUDENTS WIN AMA LEADERSHIP SPOTS

Our Texas medical students racked up three leadership positions in the AMA Medical Student Section. Congratulations to:

  • The new AMA MSS Region III chair Abhinav Khanna, a second-year student at Baylor College of Medicine;
  • Mary McFarland, a second-year student at Texas A&M University Medical School, Region III Community Services Chair; and
  • Rikki Baldwin, a second-year student at the Texas College of Osteopathic Medicine, Region III Membership Chair.

Monday, June 13, 2011

HOUSE, SENATE PASS MASSIVE HEALTH BILL IN SPECIAL SESSION

Both chambers of the legislature have approved Senate Bill 7 by Sen. Jane Nelson (R-Flower Mound) and Rep. John Zerwas, MD (R-Simonton). We’re waiting to hear whether the Senate will accept the House version or take the bill to conference committee. In a (large) nutshell, SB 7 would:

  • Establish a statewide plan to improve quality and increase efficiency by forming and regulating health care collaboratives:
  • Ensure physicians have an equal say and vote in a collaborative’s governing board, and due process protections and the ability to participate in more than one collaborative arrangement;
  • Create a Medicaid and CHIP Quality-Based Payment Advisory Committee and program that would tie a portion of Medicaid HMO premiums to improved health outcomes and quality, and implement copayments in Medicaid to reduce unnecessary emergency room use;
  • Create more than $460 million for Medicaid by placing a premium tax on Medicaid managed care companies expanding to the Rio Grande Valley;
  • Protect patients from vaccine-preventable diseases by requiring health care facilities to have a plan for properly immunizing health care workers; and
  • Establish the Texas Emergency and Trauma Care Education Partnership Program to ensure support of the trauma infrastructure in Texas.

SMOKING BAN, SILENT PPO REGULATION NEED YOUR HELP

We’re asking TMA members to call the capitol on two key issues today.
  • Legislation to ban smoking in certain public places is still burning. If passed, the bill would save Medicaid more than $30 million because fewer people will get sick. The Senate may take up its version of the bill — SB 28 by Sen. Rodney Ellis (D-Houston) — early this week. Please call your senator — if you’re from Houston, call Sen. Mike Jackson (R-Houston) — in support of SB 28.
  • Also, please take a moment today to call Gov. Rick Perry’s office at (512) 463-2000. Ask the governor to support the silent PPO amendment (No. 20) on Senator Nelson’s SB 7. The amendment promotes transparency of who is using physician and hospital contracted discounts. Governor Perry’s support is critical to keeping regulation of silent PPOs alive.

TEXAS TAKES TWO CANDIDATES, ONE RESOLUTION TO AMA HOUSE OF DELEGATES

Barely a month removed from her hectic year as TMA president, Sue Bailey, MD, is aiming for the American Medical Association’s leadership rungs. Currently a member of the AMA Council on Medical Education, Dr. Bailey is running for vice speaker of the AMA House of Delegates at the AMA house meeting that begins Saturday. She faces off against David Hannan, MD, of New York. Vice speaker is traditionally a path to the AMA presidency. Russ Kridel, MD, an otolaryngologist from Houston, is running for reelection to the AMA Council on Science and Public Health. He is one of three announced candidates for three seats on the council. And, we’re taking Resolution 718 (PDF) — passed last month by the TMA House of Delegates — to AMA. This resolution asks AMA to push the Centers for Medicare Medicaid Services (CMS) to develop fair and accurate ranking measures to use on its Physician Compare Website. It also asks AMA to advocate that CMS develop an appeals process for physicians to use before any information is posted to the site. Follow all the action on Blogged Arteries.

1,400-PLUS LISTEN IN TO TMA LEGISLATIVE UPDATE CALL

If you missed TMA’s 2011 Tele-Legislative Update, you can still get all the details on the 2011 regular session by watching the video recording online. An audio recording also is available. TMA President Bruce Malone, MD, along with Gary Floyd, MD, chair of TMA’s Council on Legislation, and Dan McCoy, MD, immediate past chair of the council, walked more than 1,400 physicians through what happened during the regular session that affects physicians and their patients, and what is still in play during the special session. TMA’s lobby team was available to answer questions.

TWO FORMER TMA PRESIDENTS HONORED AS DISTINGUISHED UTMB ALUMNI

Congratulations to former TMA Presidents Tom Hancher, MD, and Bill Bailey, MD, who were honored with The University of Texas Medical Branch (UTMB) Ashbel Smith Distinguished Alumnus Award. The highest honor given by the university’s School of Medicine Alumni Association, the award recognizes outstanding service to the medical profession and to humanity. It honors the memory of Ashbel Smith, MD, a prominent figure in Texas medicine, politics, and education.

IN LOVING MEMORY OF LILLIAN E. GOODMAN

TMA staff asks that you join us in offering condolences Lou Goodman, PhD, and his family on the passing of his mother, Lillian. Like her son, Lillian Goodman was an avid joiner. She was an active member of Temple Beth El, holding such positions as treasurer, golden book chair, gift shop chair, and ways and means and corresponding secretary. She was a life member of Hadassah and also was awarded Woman of Valor for Sisterhood. Graveside services were held Sunday in New Jersey.

Monday, June 6, 2011

DON'T CALL US, WE'LL CALL YOU WEDNESDAY FOR UPDATE ON TMA'S GREAT LEGISLATIVE SESSION

 It was a tough legislative session from the outset. With an enormous budget deficit and special interest groups from hospitals to midlevel practitioners to those who wanted to emasculate the Texas Medical Board lining up to take on organized medicine, it seemed TMA’s agenda for the 2011 Texas Legislature faced tough sledding. But when the session ended on May 30, TMA scored some dramatic victories for physicians and your patients. Learn more at 8 pm (CT), Wednesday, June 8, when TMA President Bruce Malone, MD, will call you at your home telephone number and invite you to stay on the line for TMA’s Tele-2011 Legislative Update. Members of the TMA Council on Legislation and TMA’s lobby team will be on the line for the hour-long program that gives you the chance to earn 1 AMA PRA Category 1 CreditTM. If you prefer that we call you on your cell or office telephone, please contact the TMA Knowledge Center by telephone at (800) 880-7955 or by email by the end of the day today.

SPECIAL SESSION ROARS THROUGH HEALTH ITEMS

When lawmakers started picking up the pieces in the special session Gov. Rick Perry called, TMA was there picking up our pace from the regular session. Asa Lockhart, MD, chair of TMA’s Ad Hoc Committee on Accountable Care Organizations, testified before the Senate Finance Committee in support of Senate Bill 7, the omnibus health care bill that rolls up many measures from the regular session. SB 7 would create new health care collaboratives in Texas and reduce costs in Medicaid and the Children’s Health Insurance Program. Sen. Jane Nelson (R-Flower Mound) is sponsoring SB 7; Rep. John Zerwas, MD (R-Simonton), is the sponsor of House Bill 7, its counterpart across the rotunda. We’re also watching SB 5 by Sen. Joan Huffman (R-Southside Place) that would establish the Interstate Health Care Compact to petition the federal government to block-grant all federal funding to the states for health care services. A similar bill in the House, HB 13 by Rep. Lois Kolkhorst (R-Brenham), calls for the development of a Section 1115 federal waiver (block grant) to give Texas greater flexibility in the design and operation of the Medicaid program. TMA submitted written comments to the House Appropriations Committee on HB 13. We emphasized our concerns about whether Texas could secure enough funding to cover not only annual medical inflation but also caseload growth.

TMA SEMINAR SERIES EXPLAINS ACO PITFALLS

If you are thinking about joining an accountable care organization (ACO) or if you don’t know what an ACO is, TMA has the answers you need in a series of seminars across Texas this summer. “What Health Reform & Accountable Care Mean to Physicians” will address whether ACOs are an opportunity or challenge, understanding and negotiating employment contracts, new payment models, and health information technology. TMA does not endorse participation in an ACO or any other post-reform program. We encourage physicians to be wary, be informed, and learn what these systems can mean to your practice and patients.

AMA PICKS MADARA AS NEW EVP/CEO

James L. Madara, MD, will become the American Medical Association’s new executive vice president and CEO on July 1. Dr. Madara, 60, is an accomplished academic medical center physician, research pathologist, and administrator who served as Timmie Professor and chair of the Department of Pathology and Laboratory Medicine at the Emory University School of Medicine before assuming the Thompson Distinguished Service Professorship and deanship at the University of Chicago Pritzker School of Medicine. He later added the title of CEO of the University of Chicago Medical Center. Dr. Madara replaces Mike Maves, MD, who has led the AMA since 2001.