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Monday, April 25, 2011


I always use some EVPGram space to thank TMA physician members who give up their time to testify for medicine before House and Senate committees. This group of 10, though, deserves special commendation for staying at the capitol until 4 am for a marathon House Public Health Committee hearing. The committee took up more than 20 bills Thursday night. Our hearty physicians testified against House Bill 708 by Rep. Kelly Hancock (R-North Richland Hills), HB 915 by Rep. Wayne Christian (R-Center), and HB 1266 by Garnet Coleman (D-Houston), each of which would allow advanced practice nurses (APNs) to practice independently. They testified against HB 2333 by Rep. Rick Hardcastle (R-Vernon), which would allow a physician to diagnose and treat a patient via the Internet without first establishing a relationship in person or doing a physical exam. It also would allow a physician or telemedicine service to use an unlimited number of physician assistants and APNs to provide care to patients via the Internet. They testified against HB 637 by Rep. Craig Eiland (D-Galveston), which would allow any patient direct access to physical therapists without a physician’s referral. And they testified against HB 75 by Rep. Dan Flynn (R-Van), which would expand access to unpasteurized, raw milk.

Our late night witnesses were TMA Council on Legislation member Gary Floyd, MD, a Fort Worth pediatrician; Lloyd Van Winkle, MD, a Castroville family physician; Tricia Elliott, MD, director of the family medicine residency program at The University of Texas Medical Branch at Galveston; Jeff Jekot, MD, and Greg Kronberg, MD, anesthesiologists from Austin; Russell Thomas, DO, an Eagle Lake family physician; Debra Patt, MD, an Austin oncologist; Kimberly Avila Edwards, MD, an Austin pediatrician; Sherif Zaafran, MD, a Houston anesthesiologist; and Eddie Seade, MD, an Austin orthopedic surgeon. Thanks again to each of you.


Thanks to intervention from TMA’s Hassle Factor Log program, a $32,000 check from UnitedHealthcare arrived earlier this year at Grand Parkway Pediatrics in Sugar Land. We helped the three-physician practice overcome a slew of claims United had incorrectly rejected as having been filed too late. In another Hassle Factor Log case, Cancer Specialists of South Texas recovered more than $28,000 in claims from Blue Cross and Blue Shield of Texas (BCBSTX) for a patient whose injections for treatment of hypogammaglobulinemia BCBSTX had denied. Since 2009, TMA’s Hassle Factor Log program has helped physicians’ practices across the state recover more than $1.1 million in unpaid claims, including more than $706,000 already in 2011. Look for details in the June Texas Medicine, and submit your own hassles at www.texmed.org/hasslefactorlog.aspx.


Gov. Rick Perry appointed three TMA-member physicians to the Texas Medical Board. New to the board will be Stanley Wang, MD, an Austin cardiologist and a vice chair of the TEXPAC Board of Directors. The governor also reappointed Irvin Zeitler, DO, a family physician from San Angelo, and Austin gastroenterologist George Willeford III, MD, to new six-year terms on TMB. Dr. Zeitler will continue to serve as TMB’s presiding officer.


TMA President Sue Bailey, MD, and President-Elect Bruce Malone, MD, spent a full day at the state’s two medical schools in Houston. Representatives of The University of Texas Health Science Center at Houston (UTHealth) and Baylor College of Medicine were both very concerned about state cuts in undergraduate and graduate medical education funding. UTHealth Interim President Giuseppe Colasurdo, MD, said that institution may have to cut 60 residency positions. New Baylor President Paul Klotman, MD, asked for TMA’s help in setting up an accountable care organization. Our presidents also took questions from students of both schools at a noontime luncheon.


Join your friends and colleagues at 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, an exhibit hall with some 100 exhibits, and a chance to learn how to enhance patient care, stay abreast of clinical updates, discuss key issues with experts in the field, and help set TMA policy on issues that are important to you and your patients. Attendance is free for TMA members. House of Delegates members: Reference committee hearings are Friday, May 13; full house debate is Saturday. The first batch of reports and resolutions is posted on the TMA website. Do you use Twitter? Use the conference hashtag #TexMed11 in your tweets.


“When it comes to improving the health of all Texans, the Senate bill is far from perfect, but it’s a far sight better than what the House came up with,” Dr. Bailey said in a letter to Senate Finance Committee Chair Steve Ogden (R-Bryan). The committee approved its 2012-13 budget plan, which should be on the Senate floor for debate this week. The Senate bill restores $100 million in state and federal funds for community-based mental health and hospital services, and reverses the 10-percent cut the House would impose on physicians’ Medicaid payments.

Monday, April 18, 2011


Thanks to nearly 400 TMA member physicians who called and wrote their state senators, a bill that would have dangerously expanded nonphysician practitioners’ scope of practice was rewritten dramatically. Senate Bill 1001 by Sen. John Carona (R-Dallas) would have given the Texas Board of Chiropractic Examiners carte blanche authority to do whatever it wants — by rulemaking — without having to worry about legal action from another state health licensure agency. It would have prevented the Texas Medical Board (TMB) from taking legal action to stop an individual chiropractor from violating the Medical Practice Act if the chiropractic board says the chiropractor is practicing within his or her scope. And it would have would enabled more than 30 nonphysician health care groups to get paid for more services and also would have increased utilization. The rewritten bill our lobby team worked out with Senator Carona would require fair payment and nondiscrimination in payment by health plans for services that chiropractors provide. It also would allow chiropractors and physicians to establish business relationships as long as the physician affirmatively reports and updates those relationships to TMB. The bill passed the Senate.


Sidney Ontai, MD, family physician from Plainview, stars in the first episode of a new satellite radio series by ReachMD. “Voices From American Medicine” involves interviews with “physicians on the frontlines of medicine discussing their personal stories of triumph, tragedy, humanitarianism, and innovation.” Dr. Ontai works in a rural environment, uses telemedicine to extend his medical care into remote areas, and still makes house calls. He is a former member and chair of both the TMA Council on Practice Management Services and the TMA Committee on Rural Health and still serves in the House of Delegates. You can hear Dr. Ontai’s interview on XM Satellite Radio Channel 160 or online. If you’re not a ReachMD member, register for free online and use promo code TexMed.


Are you getting ready for the day when government and commercial health plans pay you based on performance, not on productivity? Since we know many Texas physicians would answer that question “no,” TMA is getting ready to help you help yourself. We continue to work with our consultant, CTG HealthCare, to develop ways we can support physicians in environments such as accountable care organizations. Our goal is to provide you the infrastructure and resources you will need to evaluate your practice’s future possibilities and then help you negotiate terms of or rebuff outright practice buyout entreaties from hospitals and other systems.


Whether promoting TMA’s legislative agenda — Caring for Patients in a Time of Change — or explaining our concerns with less-than-perfect bills, TMA members make a big difference when they volunteer to testify before House and Senate committees. This week, we want to thank:

  • TMA President-Elect Bruce Malone, MD, testified against House Bill 3753 by Rep. Phil King (R-Weatherford). The bill would allow one relatively large hospital in Decatur to employ physicians.
  • Keller pediatrician Jason Terk, MD, testified in support of HB 574 by Rep. Donna Howard (D-Austin). This bill would make the state’s immunization registry — ImmTrac ― an “opt-out” registry vs. an “opt-in” one.
  • Cardiologist Paul Tucker, MD, and hospitalist Amy Arrant, MD, both from Austin, testified against HB 3520 by Rep. Bryan Hughes (R-Mineola). The bill would force physicians and hospitals to provide futile care indefinitely.
  • Council on Legislation member Dawn Buckingham, MD, testified in support of a committee substitute for HB 1534 by Rep. Craig Eiland (D-Galveston) before the House Insurance Committee. The measure is a first step toward ensuring transparent and appropriate actions by rental networks and so-called “silent PPOs.”
  • Council on Legislation member Sara Austin, MD, testified on HB 1809 by Rep. Senfronia Thompson (D-Houston). She highlighted TMA’s concerns about a bill that would establish a registration and accrediting process for nonhospital imaging centers and facilities, at an unknown expense.
  • Houston pathologist Susan N. Rossmann, MD, PhD, testified in support of HB 2063 by Rep. Hubert Vo (D-Houston). This bill would allow state employees to have up to five days of leave without a salary reduction to donate adult stem cells.


A Washington, D.C., holiday gave you three extra days, but today is the deadline for filing your federal income tax return — or asking for an extension.

Monday, April 11, 2011


A dangerously bad bill is moving. It must be stopped before it gets on the Senate floor. Senate Bill 1001 by Sen. John Carona (R-Dallas) would let the Texas Board of Chiropractic Examiners write any rule, make any expansion — and go virtually unchallenged by any other state licensing agency. Chiropractors could do whatever they want. And bill for it. No restrictions. Ask your senator for a firm commitment to stop this bill. The Texas Board of Chiropractic Examiners has a terrible track record, repeatedly voting to allow chiropractors to conduct dangerous tests and procedures they cannot safely perform given their education, skills, and training. Please call your state senator today or use the TMA Grassroots Action Center to send an easy e-mail. Ask your senator to block SB 1001 from coming up for consideration on the Senate floor.


TMA’s bills to reform the Texas Medical Board (TMB) are moving. We understand many physicians’ frustration with the board, and we are behind a package of bills that would improve how TMB handles complaints against physicians without undermining the board’s responsibility to protect the public from bad actors. Here’s a status update on our package of reform legislation:

  • The Senate has passed Senate Bills 190 and 191 by Sen. Jane Nelson (R-Flower Mound). SB 190 would allow physicians to tape the proceedings of a TMB informal settlement conference, which eliminates the truly anonymous complaints. It would provide a physician with notice if an insurance company files a complaint. It would prohibit the granting of a license to an applicant who has had a medical license suspended or revoked by another state or country. SB 191 would bind TMB to the ruling of an administrative law judge in a proceeding supervised by the State Office of Administrative Hearings.
  • SB 177 by Sen. Joan Huffman (R-Houston) is waiting to be voted out of the Senate Health and Human Services Committee. It requires the board to do all of the above.
  • SB 227 by Senator Nelson was passed by the Senate Health and Human Services Committee and is now waiting for debate in the full Senate. SB 277 would provide discretion for TMB to waive a fine in lieu of a remedial action plan for a minor administrative violation.
I’ve seen lots of e-mails crowing about a small step taken by House Bill 2013, a self-serving piece of legislation designed to remove legitimate oversight from those who practice outside the scientific basis of modern medicine. HB 2013 weakens TMB to the point that it would place our 2003 health care tort reforms at risk. If doctors are unable to police themselves through a strong and fair medical board, then today’s complaint is tomorrow’s lawsuit.


More than 350 physicians, alliance members, and medical students from across the state participated in First Tuesdays at the Capitol. They met with their lawmakers to discuss the impact of the deep state budget cuts on local health care services for Texas’ seniors, children, and persons with disabilities and mental illnesses. They also urged legislators to support a statewide smoking ban, prevent efforts by nonphysician practitioners to expand their scope of practice, and support funding for graduate medical education and the physician loan repayment program. This was just the most visible component of TMA’s grassroots lobbying at the capitol last week. Consider also:

  • During the First Tuesdays event, TMA President Susan Rudd Bailey, MD, and TMA Trustee Tom Garcia, MD, joined Lt. Gov. David Dewhurst, Senator Nelson, and cycling champion Lance Armstrong at a news conference calling on legislators to support cancer research and prevention in Texas.
  • Sara Austin, MD, a member of TMA’s Council on Legislation, testified in support of SB 1661 by Sen. Robert Duncan (R-Lubbock). This bill establishes protections for physicians’ clinical autonomy and gives to the physician board of directors of nonprofit health care corporations (501[a]s) the responsibility for all policies related to clinical care. It also strengthens the role of TMB in supervising the activities of 501(a)s.
  • John Holcomb, MD, a member of TMA’s Ad Hoc Committee on Medicaid and the Uninsured, testified before the House Public Health Committee when it took up more than a dozen bills to cut the cost of Medicaid services. The committee heard bills that ranged from charging Medicaid patients a copay and making Medicaid the payer of last resort, to forcing federally qualified health care clinics and other community clinics to stay open until 10 pm to treat patients.
  • Janet Realini, MD, MPH, a San Antonio family physician, testified before committees in both chambers on five bills that would extend the Medicaid Women’s Health Program.


Monday, April 4, 2011


A bill detailing strict protections for physicians who work for rural hospitals won approval from the Texas Senate State Affairs Committee. TMA Trustee Doug Curran, MD, testified on behalf of Senate Bill 894 by Sen. Robert Duncan (R-Lubbock). The measure guarantees physicians’ independent medical judgment and places the responsibility for all clinical matters — bylaws, credentialing, utilization review, and peer review — under the hospitals’ medical staff. The Texas Medical Board would investigate any reports of interference. TMA’s policy position is crystal clear: Maintain and protect the ban on the corporate practice of medicine. However, our stance on corporate practice should not be confused with our support and representation of all doctors, regardless of practice type, specialty, or employment status.


The Texas House of Representatives worked the first long weekend of the 2011 legislative session, finalizing a proposed 2012-13 state budget that spends $23 billion less than current budget, with deep cuts in education, health, and human services programs. “The House of Representatives must take steps to ensure Texas can maintain its ability to care for our most vulnerable patients ― children, seniors, and people with disabilities and mental illnesses,” TMA President Sue Bailey, MD, said in a press statement before the budget debate began. “If lawmakers choose to shut the door on these patients’ ability to obtain cost-effective care, local taxpayers will be stuck picking up the cost but at a much higher price.” The Senate Finance Committee, meanwhile, is working to pass a more humane and responsible spending plan. Senators voted to eliminate the 10-percent cut to physicians’ Medicaid and Children’s Health Insurance Program payments, to maintain the current level of community-based mental health services, and to fund tobacco cessation programs.


Hundreds of physicians, medical students, and TMA Alliance members will impress medicine’s 2011 legislative agenda, Caring for Patients in a Time of Change, on state lawmakers tomorrow at April’s First Tuesdays at the Capitol. It’s not too late for you to attend. I’d like to thank those TMA physicians who came to Austin last week, joining Drs. Curran and Susan Strate on the House and Senate committee witness stands:

  • Asa Lockhart, MD, chair of TMA’s Ad Hoc Committee on Accountable Care Organizations (ACOs) and an anesthesiologist from Tyler, testified for a vastly reworked version of SB 8, the plan by Lt. Gov. David Dewhurst and Sen. Jane Nelson to introduce new health care delivery systems to Texas.
  • TMA member obstetrician-gynecologists Ralph Anderson, MD, and Eugene Toy, MD, testified before the House Public Health Committee on bills looking for ways to reduce the need to use expensive neonatal intensive care units.
  • Theodore Spinks, MD, a pediatric neurosurgeon in Austin, testified on a bill that addresses the prevention, treatment, and management of concussions affecting young athletes.
  • Carol Baker, MD, an infectious disease specialist from Houston who chairs the U.S. Advisory Committee for Immunization Practices, testified (PDF) for legislation that would require proof that students have received a meningitis vaccination at least five years prior to college entry.
  • Austin pediatrician Stephen Pont, MD, testified in support of SB 226, which would enhance data gathered through the Fitnessgram. It’s a program that measures schoolchildren’s aerobic capacity, muscular strength and endurance, flexibility, and body composition.


Health and Human Services Secretary Kathleen Sibelius finally issued proposed rules to regulate the Medicare accountable care organizations created by the new health reform law. We are reviewing the 429-page document and have many concerns. TMA will complete our analysis shortly and will release that along with reports from other medical organizations to provide guidance to physicians who are contemplating joining or creating an ACO. The devil, as they say, is in the details, and these new rules are 429 pages of potentially diabolical details.


Congratulations to the physicians of the Lubbock-Crosby-Garza County Medical Society, who are celebrating the organization’s centennial. U.S. Rep. Michael Burgess, MD (R-Lewisville), the only TMA member in Congress, and Dr. Bailey were on hand for the gala. “We had only a handful of physicians here in Lubbock in 1911 — heck there were fewer than 2,000 people living in Lubbock—but those physicians felt the need to unite to advocate for physicians and patient rights,” Dr. Bailey said. “Times have changed over those 100 years … but they really haven’t. The primary challenge organized medicine faces today is how to unite to improve our patients’ access to quality health care.” The Lubbock stop was the first in a long series of travels for Dr. Bailey. She visits The University of Texas Health Science Center in San Antonio today, followed by First Tuesdays, and then flies to Hartford, Conn., where she will deliver the keynote address at the Connecticut State Medical Association’s Doctor’s Day celebration.