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Monday, February 28, 2011

CORPORATE PRACTICE OF MEDICINE REMAINS A BIG "NO"

The fight over hospitals’ desire to hire and control physicians is heating up again in the Texas Legislature. TMA remains strongly opposed to the corporate practice of medicine, period. We oppose all bills that remove the ban on corporate practice or allow direct employment, but we are negotiating on some bills to ensure that physicians retain their ability to determine the care for the patient. We also want to protect physicians’ right to choose their own liability insurance carrier (PDF) and keep the decision to fight or settle if they are involved in a liability suit.

WILL YOU COME TO FIRST TUESDAYS TOMORROW

It’s hard to believe that tomorrow is already the first Tuesday in March, which means it’s time for TMA’s second First Tuesdays at the Capitol for 2011. It’s not too late for you to make plans to be a lobbyist for a day. We need every voice to explain to state legislators why they need to avoid Medicaid and public health cuts, stop unsafe scope of practice expansions, keep a strong but fair Texas Medical Board, and protect our 2003 liability reforms and the state’s ban on the corporate practice of medicine. I’ve been meeting with key lawmakers on these and other issues, and they’re very receptive to our legislative agenda when we take the time to talk with them. Please join your colleagues and TMA Alliance members from around the state — and three busloads of students from The University of Texas Medical Branch (UTMB) at Galveston — in our white coat invasion.

TMA'S PUBLIC HEALTH AGENDA SAVING MONEY, SAVING LIVES

The state’s public health budget got a lot of legislative scrutiny last week, and TMA was on hand to help shore it up. Philip Huang, MD, a family physician and the health authority and medical director for the Austin/Travis County Health and Human Services Department, testified on behalf of TMA before the House Public Health Committee. He explained that when public health is successful, it’s invisible because it prevents bad things from happening. He stressed the great job Texas did responding to the public health needs of hurricanes Katrina and Rita victims in 2005, and to the H1N1 crisis last year. Texas has made great advances in public health and needs to continue building a solid public health care system. Also last week, Corpus Christi anesthesiologist Mary Dale Peterson, MD, testified for TMA before the Senate Finance Subcommittee on Medicaid. She addressed how the proposed 10-percent cut to Medicaid and Children’s Health Insurance Program (CHIP) payments would devastate the state’s ability to maintain an adequate Medicaid and CHIP physician network.

LEGISLATIVE BLACK CAUCUS MEETS IN TMA HISTORY OF MEDICINE GALLERY

Our exhibit, “Courage and Determination — A Portrait of Pioneering African-American Physicians in Texas,” serves as the backdrop tonight for a reception for the Texas Legislative Black Caucus’ 11th African American Legislative Summit. This groundbreaking exhibit in the TMA History of Medicine Gallery tells the stories of more than 60 African-American physicians from across Texas. It highlights the medical societies they founded, the hospitals they formed, and the public health issues they fought. TMA Board of Trustees Chair Carolyn Evans, MD, is our host for the event.

TMA MOBILE APP EXPANDS TO ANDROID AND BLACKBERRY PHONES

The TMA Mobile App now is available on two more phone platforms. The smart phone application, which launched last fall for the iPhone and iPad, offers 24/7 data on 45,000 of your Texas colleagues. Plus, the app gives you TMA news, events, and alerts to keep you informed. You can locate specialists across the state, follow TMA in the media, plan out your Toxemia schedule, and respond to legislative action alerts. To get this free, members-only mobile application, go to www.texmed.org/tmamobile from your iPhone, iPad, Blackberry, or Android phone and download it. You will need your TMA website user name and password to log in and use the app features. 

GOVERNOR PERRY REAPPOINTS TWO TO HEALTH POSTS

A new TMA ally and a long-time TMA member won new terms in their positions from Gov. Rick Perry. The governor reappointed Deeia D. Beck to the Office of Public Insurance Counsel, which represents insurance consumers in regulatory matters. TMA worked closely with Ms. Beck in convincing Texas Commissioner of Insurance Mike Geeslin to ban discretionary clauses in insurance policies. The governor also reappointed Ben Raimer, MD, as a member and chair of the Health Disparities Task Force, which works to close the gap in access to health care among special or underserved populations across Texas. Dr. Raimer is vice president and professor at UTMB.

Monday, February 21, 2011

VISIT WITH LAWMAKERS TO BUILD RELATIONSHIPS, INFLUENCE

Over the past few weeks, I have visited with Senate Health and Human Services Committee Chair Jane Nelson (R-Lewisville), House Calendars Committee Chair Todd Hunter (R-Corpus Christi), House Public Health Committee Chair Lois Kolkhorst (R-Brenham), and other state legislators crucial to our cause in this very difficult session. I’ve found these visits to be cordial and very constructive. They allow me to build on longstanding relationships and make sure these leaders understand our positions. Please take the time now to meet with your state senator and representative, at home or here in Austin at First Tuesdays at the Capitol. It will pay off later in the year when you call and ask them to cast a critical vote for patients and physicians

TEXAS HEALTH REFORM PACKAGE MUST NOT VIOLATE PATIENT-PHYSICIAN RELATIONSHIP

TMA joined Lt. Gov. David Dewhurst and Senator Nelson at a news conference promoting a pair of bills that would reduce costs in Texas Medicaid and establish statewide health care quality and efficiency standards. As with all comprehensive reform bills of this magnitude, TMA’s position is we will keep what works and fix what’s broken. TMA Board of Trustees Vice Chair Tom Garcia, MD, of Houston said TMA is committed to working with them on efforts to improve care and reduce costs in our health care system, and we support making the system more efficient and care more effective. But, Dr. Garcia added, “For physicians, the patient-physician relationship is the cornerstone of this system. We must ensure that our work here ensures that health care decisions remain between patients and their physicians.”

NO PROGRESS YET ON MEDICARE SGR FIX

TMA President Sue Bailey, MD, and chief lobbyist Darren Whitehurst traveled to Washington to work on fixing the broken Medicare payment system. They joined leaders from the American Medical Association, state associations, and national specialty societies in the ongoing work group. Unfortunately, there is little sign that Congress is working on a new formula, and Medicare payment rates will drop around 30 percent on Dec. 31. One proposal rolling around the House would tie a new payment formula to complete repeal of the new health system reform law.

IN MEMORY OF MAX BUTLER, MD

Max Butler, MD, the family physician from Houston with a mile-long résumé in organized medicine, passed away on Friday. We offer our sincere condolences to Barbara Butler and the family. Dr. Butler was TMA’s 124th president and received the Distinguished Service Award in 2008. Calling hours are 4-8 pm Tuesday in the Library of Geo. H. Lewis & Sons, 1010 Bering Dr., Houston. The funeral is 10 am on Wednesday in the Sanctuary of Second Baptist Church, 6400 Woodway Dr., Houston.

NURSES ASKING FOR AUTHORITY WAY BEYOND THEIR TRAINING

Several bills TMA is tracking this session would expand the scope of practice of advanced practice nurses way beyond what their education, skills, and training safely allow. House billls 708 by Rep. Kelley Hancock (R-North Richland Hills), 915 by Wayne Christian (R-Center), and 1266 by Rep. Garnet Coleman (D-Houston) would include diagnosing, prescribing, ordering tests, and making referrals without physician supervision within nurse practitioners’ scope of practice. TMA is fighting these bills as unsafe for patients. For details on our position, see our scope of practice issue brief

BILL WOULD PROTECT PHYSICIANS FROM NEW LIABILITY FROM REFORM LAW

A bipartisan group of congressmen, including U.S. Reps. Henry Cuellar (D-Laredo) and Lamar Smith (R-San Antonio) introduced legislation to protect physicians and providers from new causes of legal action possibly arising from last year’s health system reform law. The Provider Shield Act of 2011 states that practice guidelines or standards arising from the reform law may not be used as evidence of the standard of care in a medical liability claim. TMA and the Texas Medical Liability Trust worked with the bill sponsors on the language.

Monday, February 14, 2011

TMA-CONNECTED LEGISLATURES WELL PLACED FOR COMING BATTLES

I don’t think doctors and patients could have asked for much more when it came to placing members of the Family of Medicine on key Texas House and Senate Committees. Three TMA member-legislators and one TMA Alliance member were appointed to the Texas House Appropriations and Public Health committees by House Speaker Joe Straus (R-San Antonio). These two powerful committees make critical budget and public health decisions. They are: Reps. Susan King (R-Abilene); Charles Schwertner, MD (R-Georgetown); Mark Shelton, MD (R-Fort Worth); and John Zerwas, MD (R-Simonton). Representative Zerwas, the only one of the four not serving on the Public Health Committee, will also chair the House Appropriations Subcommittee, writing health and human services portions of the budget. Across the rotunda, Sen. Bob Deuell, MD (R-Greenville), the only physician and the only TMA member in the Senate, already has spent weeks examining the budget on the Senate Finance Committee. Dr. Deuell is also vice chair of the Senate Health and Human Services Committee.

TEXANS TROMP CAPITOL HILL FOR HEALTH CARE IMPROVEMENTS

Although it was difficult at times to get our senators and representatives to focus on anything other than the earthshaking events in Egypt, a delegation of TMA and TMA Alliance members enjoyed a productive three-day lobby trip to Congress. They met one-on-one with U.S. representatives and senators to discuss the Sustainable Growth Rate (SGR) and issues relating to the new health law. The SGR remains a critical issue, and we are working particularly closely with Rep. Michael Burgess, MD (R-Lewisville) to move a bill through Congress. By the end of the year, physicians are looking at a cut of 30 percent or more to their Medicare payments. "Congress needs to be working now on a plan to ensure stability in the program to protect patients and their physicians," said TMA President Sue Bailey, MD. Read about the other issues discussed at Capitol Hill: "Affordable Care Act: Find What's Missing, Keep What Works, Fix What's Broken." Dr. Bailey led a group of Texans that included Drs. Joe Annis of Austin, Les Secrest of Dallas, Russ Kridel of Houston, Lyle Thorstenson of Nacogdoches, and Alex Valadka of Austin. The alliance members working the hill were AMA Alliance President Susan Todd of Fort Worth, TMA Alliance President Doris Johnson of Fort Worth, Lisa Breech of Victoria, and Pat Hyer of Fort Worth.

ENGAGED IN A BIG-PICTURE DISCUSSION ON THE FUTURE OF HEALTH CARE

It was quite stimulating to take part in a health economics forum and health market simulator that Humana and the Santa Fe Institute convened with representatives from insurance, medicine, hospitals, employers, consumer groups, and government. The goal of the conference was to initiate a conversation about national health care challenges and opportunities. We heard presentations on complex systems, behavioral economics, and building sustainable organizations. A big emphasis was placed on individual and organizational well-being. Among the keynote speakers was former U.S. Surgeon General Richard Carmona, MD.

GOVERNOR PERRY TOUTS THE POWER OF 2003 MEDICAL LIABILITY REFORMS

During his State of the State Address, Gov. Rick Perry recognized a special guest who symbolized the progress Texas has made since passage of our 2003 liability reforms. "Joining us today is Dr. Javier Cardenas, an OB-Gyn who returned to his hometown of McAllen to practice medicine thanks to tort reform,” the governor said. “He represents all those doctors who are able to practice medicine in our state without the ever-present threat of a frivolous lawsuit. Those doctors represent better access to care, a higher quality of life, and, more importantly, lives saved." Dr. Cardenas enjoyed the attention. "Very cool day for my wife, kids (and me)!" he wrote on his Facebook page. "Hope I helped put a friendly face on tort reform."

ABORTION-SONOGRAM BILL MOVES TO TEXAS SENATE

The Texas Senate State Affairs Committee passed Senate Bill 16 by Dan Patrick (R-Houston). As originally filed, the measure would require a physician to perform a sonogram before an abortion, explain the procedure as it is performed, and require the patient to view the image and hear the heartbeat. Committee amendments now would give the patient the option to refuse seeing and hearing the sonogram altogether. It also changed the amount of time between sonogram and abortion from 2 hours to 24 hours. TMA outlined our concerns with the proposal in a letter to the committee. Specifically, we believe the legislature’s role should not be to dictate how physicians and patients communicate with one another or what procedures and diagnostic tests must be performed on a given patient. The full Senate is expected to debate the bill this week.

TMA SUES TEXAS BOARD OF CHIROPRACTIC EXAMINERS AGAIN

TMA filed suit in an Austin district court asking the judge to throw out a Texas Board of Chiropractic Examiners’ rule that allows certain licensed chiropractors to perform “Technological Instrumented Vestibular-Ocular-Nystagmus” testing. We contend this rule exceeds the lawful scope of the practice of chiropractic and unlawfully authorizes chiropractors to practice medicine.

Tuesday, February 8, 2011

NEITHER RAIN, NOR SNOW, NOR DARK OF NIGHT KEEP US AWAY FROM FIRST TUESDAYS

Although snow and ice kept many physicians from North and West Texas at home, more than 200 physicians, medical students, and TMA Alliance members participated in the first “white coat invasion” of the season. Check out the photos on TMA’s Facebook page. The budget crisis — especially for Medicaid and mental health — was the biggest topic of conversation. Scope of practice came up quite frequently in our talks with lawmakers, especially because the advanced practice nurses were swarming the capitol the day before we got there. Legislators of both parties told physicians how important it is to make their voices heard on all these issues. Register now for the March 1 First Tuesdays at the Capitol. And keep your calendar clear for April 5 and May 3.

SENATE FINANCE COMMITTEE STARTS BUDGET DEBATE WITH HEALTH CARE

The Senate Finance Committee took public testimony most of last week on Article II — the section of the budget that deals with state health care services. Health and Human Services Commissioner Tom Suehs told the committee that you can’t cut Medicaid without affecting the patients it serves or the physicians who provide the service. He called on lawmakers not to cut payment by 10 percent for primary care and specialty physicians who treat children in Medicaid and the Children’s Health Insurance Program. Instead he offered up a cut of only 2 percent. Other physician services still would be subject to the proposed 10-percent reduction.

Commissioner Suehs also asked lawmakers to restore funding for the Medicaid physician loan repayment program and the children’s Medicaid medical home pilot. These TMA physicians testified:

  • Janet Realini, MD, a San Antonio family physician, discussed how the Women’s Health Program has a proven track record of reducing unplanned pregnancies and lowering costs.
  • Austin pediatrician John Hellerstedt, MD, urged the committee not to force physicians out of Medicaid. Instead of cutting physician payments, he said, a better way to slow Medicaid spending is for the state to support development of payment and delivery system reforms, such as the patient-centered medical home and physician-led accountable care organizations.

USE NEW TMA FLYER TO HELP FIGHT MEDICAID CUTS

Are Medicaid’s problems perception or reality? As state lawmakers look to balance the budget with steep cuts to the program, TMA debunks seven persistent myths about Texas Medicaid. Use this flyer to educate your friends, colleagues, and patients, and legislators.

GOVERNOR PERRY REAPPOINTS AS A PAIR OF STATE HEALTH CARE LEADERS

Gov. Rick Perry has signed Commissioner Suehs and Workers’ Compensation Commissioner Rod Bordelon to another two-year term in office. TMA has excellent working relationships with both men. Commissioners Suehs has served as executive commissioner of the Health and Human Services Commission since September 2009, where he has overseen the state’s five health and human services agencies, including more than 55,000 employees and combined annual budgets of more than $30 billion. Commissioner Bordelon heads the Texas Department of Insurance Division of Workers’ Compensation, which regulates the workers’ compensation system in Texas, ensuring that injured workers receive the necessary benefits to return to work quickly, and that workers’ compensation costs are kept at a reasonable level for Texas employers.

TMA LEADERS HEAD TO CAPITOL HILL

TMA President Sue Bailey, MD, leads a delegation of TMA physicians, alliance members, and staff to the American Medical Association’s National Advocacy Conference. We’ll be talking to Texas senators and representatives about fixing the Medicare payment formula and problems with the new health care law. We also have a meeting scheduled with our new Washington lobbyist, who is focused on all the new regulations the Obama administration is issuing as part of the health law. Look for a full report in next week’s EVPGram.

EDITORIAL WRITERS LISTEN TO OUR AGENDA

Dr. Bailey and TMA Council on Legislation member Gary Floyd, MD, had a very productive session with the Austin American-Statesman editorial board. In our continuing campaign to promote TMA’s legislative agenda, the conversation focused mainly on the budget and scope-of-practice issues. It’s critical that these opinion shapers understand the physicians’ point of view.

DRS. THORSTENSON, MALONE HEAD AMA DELEGATION

Nacogdoches ophthalmologist Lyle Thorstenson, MD, has been elected chair of the Texas Delegation to the American Medical Association. TMA President-Elect and Austin orthopedic surgeon Bruce Malone, MD, was reelected vice chair.