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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.