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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.