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Monday, March 28, 2011

BARE-BONES HOUSE BUDGET MOVES FORWARD AS SENATORS LOOK TO MINIMIZE DAMAGE

Keeping their pledge to balance the 2012-13 state budget with no new taxes, the House Appropriations Committee passed a $164.5 billion spending bill that cuts $23 billion from the current (2010-11) budget. It would cut Medicaid payment rates to physicians and providers by 10 percent. Other education, public health, and human services programs face similar devastating cuts. The budget bill is expected to be up for debate on the House floor Friday. Moving more slowly, the Senate Finance Committee is searching for new revenue sources that might allow it to mitigate the damage. A subcommittee led by Sen. Jane Nelson (R-Lewisville) added $4.5 billion back into the health and human services budget. That panel reduced physicians’ Medicaid cuts to 1 percent and trimmed the payment reductions to hospitals and other providers to 3 percent. It also restored funding for community mental health programs and the Women’s Health Program. Keep up with all the legislative news — daily or once a week — with TMA’s Legislative News Hotline.

TMA-AMA STUDY: TEXAS PHYSICIANS A ROBUST PART OF TEXAS ECONOMY

Texas office-based physicians generate $63.6 billion in economic output each year, 5.6 percent of the state’s total gross domestic product, according to a new study we’re releasing today. The 42,000-plus physicians support almost 250,000 jobs in the state, produce nearly $40 billion in wages and benefits, and are responsible for $2.1 billion in state and local taxes. We are working with county medical societies to publicize physicians’ local economic impact. TMA collaborated with the American Medical Association to complete the study, which found that office-based physicians nationwide contribute $1.4 trillion in economic activity.

TMA EXPLORING STATEWIDE PHYSICIAN NETWORK

TMA is looking for ways to give physicians more leverage as hospitals and health plans continue to put pressure on physicians to sign up or be left out. We’ve had a number of conversations with major players about the feasibility of establishing a statewide network of physicians. Our goal is to provide a framework with the county medical societies that would guarantee physician autonomy.

PHYSICIANS TAKE THE STAND AT THE CAPITOL

I want to thank, once again, the TMA-member physicians who are taking time away from their offices to testify for medicine before state House and Senate committees. Most recently:

  • San Antonio family physician Janet Realini, MD, MPH, testified on behalf of TMA before the House Human Services Committee in support of House Bill 419 by Rep. Mike Villarreal (D- San Antonio). That bill would extend the life of the Women’s Health Program.
  • Houston neonatologist/perinatologist Charleta Guillory, MD, testified (PDF) at the Senate Health and Human Services Committee in support of Senate Bill 229 by Senator Nelson. The measure would help guarantee all newborns in Texas get a hearing screening.
  • Philip Huang, MD, MPH, the medical director for the Austin/Travis County Health and Human Services Department, testified in support of HB 2602 (PDF) by Rep. Carol Alvarado (D-Houston). Dr. Huang told the House Ways and Means Committee that increasing the tax on tobacco products is a proven way to reduce both the number of people who smoke and how much they smoke.
You can make your own impact on how the legislature treats your profession and your patients by joining us April 5 for the next First Tuesdays at the Capitol. This month’s event should be bolstered by hundreds of medical students and residents, who are also invited to watch the NCAA men’s basketball Final Four championship game with us Monday night at the TMA building.

PREVIEW THE FUTURE OF MEDICINE — NOW AND AT TEXMED 2011

We’re very excited about the big ideas our keynote speaker will bring to TexMed 2011, May 13-14 at the George R. Brown Convention Center in Houston. Jeff Goldsmith, PhD, president of Health Futures, is one of the nation’s foremost health industry analysts, specializing in corporate strategy, trend analysis, health policy, and emerging technologies. If you can’t wait to hear Dr. Goldsmith’s talk, The Future of Medicine Under the New Health System, you can read his latest Health Affairs article, “Accountable Care Organizations: The Case For Flexible Partnerships Between Health Plans And Providers,” free from a link on the TMA website. Register today, and we’ll see you in Houston.

WAY TO GO, PAT!

Looks like we’ve got another Texan taking a big leadership position in Chicago. Congratulations to Pat Hyer of Fort Worth, who was selected by the AMA Alliance nominating committee to serve as president-elect of the national organization. She will be installed president at the AMAA Annual Meeting in June 2012. Pat will be the third Texan — and the third member of the Tarrant County Medical Society Alliance — to serve as AMAA president since 2005. Mary Ann Homer served in 2005-06, and current President Susan Todd will complete her term in June.

Monday, March 21, 2011

TMA LEADERS TESTIFY ON TMB REFORMS, PHYSICIAN EMPLOYMENT

Three of TMA’s top physician volunteers took the witness stand at some contentious hearings before Texas House committees.

  • President-Elect Bruce Malone, MD, and Trustee David Teuscher, MD, told the House Public Health Committee why Texas and Texas patients need a strong medical board. Drs. Malone and Teuscher testified against House Bill 1013 by Rep. Fred Brown (R-College Station). They warned that HB 103 would threaten our hugely successful 2003 liability reforms by weakening TMB’s ability to establish and enforce standards of care, and to sanction physicians for nontherapeutic treatment or prescribing. Check out the video of the hearing. Dr. Teuscher’s testimony begins at 2:33:00; Dr. Malone’s testimony follows immediately.
  • Former TEXPAC Board Chair Susan Strate, MD, spent a grueling four hours before the House County Affairs Committee as it took up several bills to employ physicians. She testified in support of urban hospital district bills for Bexar and El Paso counties, and neutrally on several rural hospital county district bills. TMA remains committed to protecting members’ clinical autonomy as they enter into employment arrangements. And we believe the local process to reach consensus on each of these unique arrangements is as important as the product itself. Check out the video of the hearing. Dr. Strate’s testimony begins at 13:18.

WATCH AND SHARE "PHYSICIAN MOMENTS" VIDEOS; SEND IN YOUR OWN

What does it mean to be a physician? Why did you go to medical school in the first place? Do you remember that patient encounter that brought it all home to you? The patient you think of when times are tough? We’ve begun to collect and publish these “physician moments” in a series of videos on our website and on YouTube. The power in these stories will help lawmakers and the public understand the problems in medicine today and how we hope to solve them. Watch Fort Worth pediatrician Gary Floyd, MD, tell a story only a physician can tell: what it means to be someone's doctor, the trusting relationship between physician and patient. Watch Kimberly Avillas Edwards, MD, talk about diagnosing a child with cancer. Watch Adrian Billings, MD, discuss what it means to be a family physician in small-town Texas. Share these videos with your friends and colleagues through e-mail, Facebook, and Twitter. Better yet, tell your story to a video camera. We don’t care if it’s your cell phone, or a flip camera, or a full-featured video recorder. Just “get it down on film” and send it our way.

LET YOUR COLLEAGUES KNOW THEY ARE NOT ALONE

Are you or your physician peers under pressure to sell your practices or to sign up with local accountable care organizations (ACOs) or health information exchanges (HIEs)? Are you getting the message from hospitals or even insurance companies that you have to sign up now or be left out? We urge you to take your time and to look to TMA for help. Our ACO Task Force, under the leadership of Tyler anesthesiologist Asa Lockhart, MD, is developing strong policy for our Council on Legislation to use as it evaluates state and federal proposals for new health care delivery systems. At the same time, we are developing workshops, publications, and consulting programs to help physicians understand these new creatures and give them the guidance to make smart decisions. What’s going on in your medical community? Send me an e-mail with the details.

TMA'S NEW PRACTICE POLICIES AND PROCEDURES GUIDE PUBLISHED

TMA’s 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. This practical and easy-to-use guide 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 compliance, human resources, front desk and business office operations, safety, and more. Order yours today.

TMA OFFERS FREE MEDICARE 2011 UPDATE

Are you up to date on all of the changes in Medicare this year thanks to the president’s health reform bill? TMA can help with a free webinar you can listen to anytime. Donna Kinney, TMA's director of research and data analysis, and reimbursement specialist Erin Gregorcyk Smith tell you everything you need to know about changes in Medicare rules and regulations for 2011. Topics include: Medicare’s waiver of the patient cost-share for some preventive care, the Annual Wellness Visit, and the Primary Care Incentive Payment and HPSA Surgical Incentive Payment (HSIP).

Monday, March 14, 2011

BURGESS TALKS BUDGETS, MEDICARE SGR, LIABILITY, ACOs, AND MORE

U.S. Rep. Michael Burgess, MD (R-Texas), the only TMA member in Congress, briefed TMA leaders on the hot health care issues in Washington. We talked about the ongoing budget showdown in D.C. as well as prospects for a permanent Medicare payment formula fix, Dr. Burgess’ liability reform bill, the Obama administration’s plans for accountable care organizations, and the future Medicare review contracts for the TMF Health Quality Institute. This conference call came the morning of the Center for Medicare & Medicaid Services announcement that physicians’ Medicare payments will drop by 29.5 percent next year if Congress takes no action. TMA joined with the American Medical Association and a broad list of national specialty societies and state medical associations in a letter (PDF) asking Republicans and Democrats in both the House and Senate to begin work immediately on a permanent replacement for the Sustainable Growth Rate formula. “It is our hope that Congress can again work together this year to end the cycle of temporary patches once and for all and develop a long-term and meaningful solution to this issue,” the letter read.

BLUES EXPLAIN BRIDGES TO EXCELLENCE PROGRAM

My senior staff and I met with Drs. Eduardo Sanchez and Dee Whittlesey of Blue Cross and Blue Shield of Texas to review their Bridges to Excellence program for physicians who care for patients with diabetes and heart disease. The program recognizes and pays for quality management of these patients. As of Feb. 28, about 340 physicians participate in the cardiac care program (PDF) and more than 110 are part of the diabetes project (PDF). Blue Cross is recruiting more physicians.

SMOKING BAN MOVES FORWARD; TMA TESTIFIES ON EMPLOYMENT, IMG PRIVACY BILLS

Our state lawmakers remain mired in the budget fiasco and are preparing to wade into the redistricting battle. TMA leaders and our lobby and legal teams are spending long days at the capitol fighting for you and your patients. Here are some highlights:

  • The House Public Health Committee and Senate Health and Human Services Committee both approved the statewide ban on smoking in all public and workplaces. TMA supports Senate Bill 355 by Sen. Rodney Ellis (D-Houston) and House Bill 670 by Rep. Myra Crownover (R-Denton).
  • Doug Curran, MD, a family medicine physician from Athens and member of TMA’s Board of Trustees, and Sara Austin, MD, an Austin neurologist and member of TMA’s Council on Legislation, testified on bills that would allow some institutions to hire physicians. They stressed the importance of protecting physicians’ independence in making clinical decisions for patients.
  • Rodney Young, MD, a family physician in Amarillo and member of TMA’s Council on Medical Education, testified for a bill that would allow international medical graduates to apply for a medical license after two years of graduate medical education instead of three.
  • Austin ophthalmologist Dawn Buckingham, MD, a member of TMA’s Council on Legislation, testified for a bill that would protect a patient’s health information and personal information.
This week looks to be even tougher. We can use your help, as a TMA leader, in testifying before House and Senate committees. If you can devote just one day here in the next month or two — preferably a Tuesday, Wednesday, or Thursday — please let us know.

HAVE YOU TRIED THE NEW TMA MOBILE APP FOR ANDROID OR BLACKBERRY YET?

Imagine 45,000 possible referral contacts in the palm of your hand. They’re all there — along with news and alerts — in the TMA Mobile App. Warmly received last fall when we released it for the iPhone and iPad, the app is now available for Blackberry phones and devices using Android. We need your help to promote the app. Have you downloaded it and found it useful? Would you be willing to star in a short video clip to promote it to members? If so, please contact Ellen Terry

TMA BRAINSTORMS STRATEGIES TO HELP PHYSICIANS SURVIVE AND THRIVE

The health care landscape is changing rapidly. Physicians face an onslaught of challenges and are pressed to make decisions for which they are unprepared. Accountable care organizations, meaningful use, health information exchanges, and value-based purchasing are just a few of the unknowns threatening to improve — or upend — your practice. Staff from across the association spent a full day discussing these issues and brainstorming how TMA can best help our member physicians care for patients in this rapidly changing landscape. We have engaged CTG HealthCare to help us devise a suite of new services that will keep physicians in charge of efforts to deliver proven value for the health care dollar. It reminds me of the ad, “You can do it. We can help.”

GOVERNOR PERRY'S TORT REFORM PACKAGE FILED

Among the slew of bills filed on Friday’s deadline was a pair that would implement Gov. Rick Perry’s new liability reform plan. HB 274 by Rep. Brandon Creighton (R-Conroe) and SB 13 by Sen. Joan Huffman (R-Houston) would establish a “loser pays” system for liability suits, a system for early dismissal of nonmeritorious cases, and a policy that no law can be construed to create a cause of action unless the law says it in “clear and unambiguous language.”

Monday, March 7, 2011

WHITE COATS FLOOD CAPITOL FOR FIRST TUESDAY IN MARCH

Hundreds of physicians, medical students, and alliance members hit the state capitol for the second First Tuesdays at the Capitol for 2011. They met one on one with state legislators to discuss these four issues: protect funding for graduate medical education, mental health services, and physicians’ Medicaid payments; protect the ban on the corporate practice of medicine; stop unsafe scope expansions; and take steps to stop the obesity epidemic. This month’s group included more than 140 students from The University of Texas Medical Branch’s medical, nursing, and allied health schools. The Galveston Daily News witnessed the impact of the three busloads of students: “Lawmakers and guests grew quiet as they saw the medical branch students, dressed in white coats and UT scrubs. The silence quickly gave way to applause from visitors and representatives alike.” The next First Tuesdays are April 5 and May 3. I hope to see you there.

TMA PUSHES INDOOR SMOKING BAN TO SAVE MONEY, SAVE LIVES

For the third legislative session in a row, TMA is joining Texas public health advocates in calling for a statewide ban on smoking in public places and workplaces. This time around, Texas’ huge budget shortfall could work in our favor. Recent studies show that going smoke-free could save the state Medicaid program $31 million over the next two years by reducing the number of heart attacks, strokes, adult respiratory diseases, and cases of childhood asthma. “We strongly encourage our senators and representatives to make healthy choices today that can both help them balance the budget and help Texans live longer, healthier, more productive lives,” TMA President Sue Bailey, MD, said at a Texas Public Health Coalition news conference. Over the next two days, Dr. Bailey joined TMA Board of Trustees member Lewis Foxhall, MD, of Houston; John Carlo, MD, of Dallas, a member of TMA’s Council on Science and Public Health; and Joel Dunnington, MD, of Houston, a member of TMA’s Council on Socioeconomics, in testifying for indoor smoking ban bills. They expressed TMA’s strong support for Senate Bill 355 by Sen. Rodney Ellis (D-Houston) and House Bill 670 by Rep. Myra Crownover (R-Denton).

BURGESS FILES TEXAS-STYLE TORT REFORM IN CONGRESS

U.S. Rep. Michael Burgess, MD (R-Lewisville), the only TMA member in Congress, knows good things come from Texas. He reintroduced his plan for nationwide tort reform, based on our successful 2003 medical liability reforms. “We need national, across-the-board change in the tort reform system, and my bill would do just that,” Dr. Burgess said. TMA agrees. “All Americans deserve to enjoy the benefits Texas has seen thanks to the eradication of our epidemic of health care lawsuit abuse,” said Dr. Bailey in endorsing the Medical Justice Act, HR 896. “Since our new law took effect, Texas has licensed 21,000 new physicians, including a record 3,621 in fiscal year 2008. This has been good medicine for the people of Texas, and Dr. Burgess’ plan would apply this life-saving treatment to the rest of the country.”

COMING NEXT MONTH: TMA COLLECTIONS AND BILLING COMPLIANCE WORKSHOP

Does your cash flow get bogged down in stalled collections? Does your staff have a hard time asking patients for what they owe? Do you understand your rights under Texas prompt pay laws? These are important questions to address any time, but they’re critical in today’s economy. Get the answers from the experts at TMA’s Collections and Billing Compliance seminar series, which kicks off April 12 in San Antonio. You get $50 off the cost of our newly revised Policies and Procedures  guide. Speakers include Laura Palmer, one of our excellent consultants at TMA Practice Consulting.

TMA FIGHTS SCOPE OF PRACTICE BATTLES FOR PATIENT SAFETY

We strongly oppose any efforts to expand nonphysician practitioners’ scope of practice beyond what’s safely permitted by their education, training, and skills. That means we’re fighting three bills that would allow independent practice by advanced practice nurses. Those bills — HB 708 by Rep. Kelley Hancock (R-North Richland Hills), HB 915 by Wayne Christian (R-Center), and HB 1266 by Rep. Garnet Coleman (D-Houston) — include diagnosing, prescribing, ordering tests, and making referrals without physician supervision within nurse practitioners’ scope of practice. We also oppose HB 637 by Rep. Craig Eiland (D-Galveston), which authorizes physical therapists to treat patients without a physician referral. And Sen. John Carona (R-Dallas) has filed SB 1056 that broadens the scope of practice for optometrists. We oppose that bill as it currently stands. We expect to see more bills that would expand the scope of practice of chiropractors and possibly other allied health professionals.

IT'S NOT TOO EARLY TO REGISTER FOR TEXMED 2011 IN HOUSTON

Take advantage of your TMA membership by attending TexMed 2011 May 13-14 at the George R. Brown Convention Center and Hyatt Regency Houston. “Caring for Patients in a Time of Change” is the theme of the conference, which offers more than 100 hours of clinical and business continuing medical education and an exhibit hall with some 100 exhibits. The House of Delegates meets Friday and Saturday mornings. Keynote speaker Jeff Goldsmith, PhD, gives you a glimpse of The Future of Medicine Under the New Health System. Attendance at TexMed is free for TMA members.