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Tuesday, December 18, 2012

Dual-Eligibles Cut Partially Reversed


After months of TMA-organized rallies, lobbying, and meetings, the Legislative Budget Board has directed the Texas Health and Human Services Commission (HHSC) to reverse part of the cut in payments for patients covered by both Medicare and Medicaid.
The tipping point was a meeting State Sen. Juan “Chuy” Hinojosa (D-McAllen) organized at the Capitol last week with Lt. Gov. David Dewhurst and House Speaker Joe Straus. The group included TMA Board of Trustees Vice Chair Carlos Cardenas, MD, of Edinburg, and La Joya family physician Javier Saenz, MD. Although Gov. Rick Perry did not attend the meeting, his support helped move the change over the finish line.
“It’s a great first step,” said TMA President Michael E. Speer, MD. “Physicians across the state and their patients have been reeling from the impact of these cuts for almost a year. We definitely needed a reprieve. Since January, it’s been a true medical emergency. Physicians who care for Texas’ most sick and most vulnerable patients have had to borrow money to keep their doors open, lay off staff — some dropped out of the Medicaid program, and some did close their practices.”
The 2011 Texas Legislature ordered the cut in dual-eligible payments as a budget-saving move. The way HHSC implemented it covered two pieces of the complex interaction between Medicare and Medicaid payments to physicians. The change effectively:
  1. Stopped Medicaid from covering all of the dual-eligible patients’ $140 annual Medicare deductible; and
  2. Prevented Medicaid from paying more than the Medicaid-allowable charge; this stopped Medicaid coverage of the Medicare copay.
The agreement reached would reinstate coverage of the Medicare deductible in 2013. Exact details of how HHSC would implement that change were still being worked out as this issue of EVPGram was prepared. TMA will keep you informed as we learn more.
South Texas physicians praised Senator Hinojosa, state Rep. Richard Raymond (D-Laredo), state leaders, TMA, and HHSC officials for reaching agreement on the deductibles issue.
“This was indeed a team effort from the rallies we have had here in the border and in countless meetings in Austin,” Hidalgo-Starr County Medical Society President Victor Gonzalez, MD, told the Rio Grande Guardian. “Chairman Raymond and Senator Hinojosa and all our elected officials were so helpful and supportive.”
Reversing the cut is one of the top priorities identified by TMA’s Physicians Medicaid Congress. Dr. Speer said TMA will continue to pressure lawmakers when the legislature convenes in January to reverse the remainder of the cut.
“We now urge lawmakers to eliminate the rest of this cut as soon as possible,” he said. “While this cut has disproportionately impacted dual-eligible patients with disabilities and seniors, when physicians are forced to close their doors or reduce services, it affects all of our patients.”

Monday, December 10, 2012

AETNA DEAL CREATES PHYSICIAN PAYMENT FUNDS

Aetna has agreed to pay physicians and patients nationwide up to $120 million because it used databases that deflated rates for out-of-network services. The agreement stems from settlement of a 2009 lawsuit against Aetna by TMA, the American Medical Association, and nine other state medical societies. The suit alleged Aetna used databases created by Ingenix, Inc., a subsidiary of United Healthcare, to set usual, customary, and reasonable (UCR) rates for out-of-network services. It said Ingenix databases were inherently flawed and unable to establish proper UCR rates. Physicians will be notified once the judge in the case approves the settlement and will have 90 days to file a claim.

PHYSICIANS MEDICAID CONGRESS RECOMMENDS SWEEPING CHANGES

Increasing physicians’ payments, eliminating the dual-eligible payment cut, sharply reducing red tape and administrative hassles, and curtailing fraud-and-abuse witch hunts are what Texas Medicaid needs to recruit physicians back to the program. That’s the conclusion of our Physicians Medicaid Congress, which finalized its recommendations over the weekend. The TMA Board of Trustees and Council on Legislation will consider and prioritize the list, which includes advocacy for reforms at the Texas Legislature, U.S. Congress, and Health and Human Services Commission (HHSC). Check out TMA’s newest video on why Texas physicians feel Medicaid is broken.

MEDICINE'S LEADERS SET LEGISLATIVE PRIORITIES

Nearly 100 physician, alliance, and medical student leaders from TMA and state specialty societies gathered in Austin to discuss the lay of the land and establish priorities for the 2013 Texas Legislature. Improving payment from Medicaid tops everyone’s list, followed by restoring cuts to graduate medical education and physician loan repayment programs, stopping scope-of-practice expansions, and enacting health insurance reforms. House Calendars Committee Chair Todd Hunter (R-Corpus Christi), key legislative staffers, and state agency heads — including Insurance Commissioner Eleanor Kitzman and Texas Medical Board Executive Director Mari Robinson — previewed the tough issues that lie ahead. TMA Board Chair Tom Garcia, MD, and San Antonio neonatologist Alex Kenton, MD, were our guinea pigs, bravely delivering testimony at a mock legislative hearing before State Reps. Craig Eiland (D-Galveston) and John Kuempel (R-Seguin).

BORDER PHYSICIANS ASK DEWHURST, STRAUS FOR QUICK ACTION ON DUAL-ELIGIBLE CUT

TMA’s Border Health Caucus called on Lt. Gov. David Dewhurst and House Speaker Joe Straus to stop the cuts in dual-eligible payments before another disastrous January rolls around. “We have met with leaders from HHSC on many occasions and they want to help us,” Drs. Luis Calo of Harlingen and Carlos Cardenas of McAllen wrote in a letter hand-delivered to the two leaders. “They agree there is a problem, but they tell us their hands are tied until the state leadership provides direction. We are asking for that direction now. We have been told specifically that even as late as the end of this month, the deductible can be paid if there is an agreement from our state leadership. … Offices have been closed. Doctors have left our area, and bank notes and credit cards have hit their respective limits as we struggle to deal with these cuts.”

HOSPITALS FORCE DALLAS COUNTY MEDICAL SOCIETY TO CLOSE PROJECT ACCESS

A sad follow-up to last week’s story about Dallas County Medical Society (DCMS) pulling out of the regional Medicaid 1115 waiver project: Because hospitals in the area have cut local physicians out of the plan to care for low-income residents, DCMS made the tough decision to eliminate Project Access Dallas, a nationally recognized service project that provided more than $34 million in charity care and served more than 10,000 uninsured patients during its 10-year span.

TMA: DON'T SACRIFICE MEDICAID HIKE TO OFFSET MEDICARE CUT

It should be either-or, not neither-nor. That’s what TMA told Texas congressional leaders in a letter backing upcoming Medicaid payment increases for primary care services. Among the “fiscal cliff” proposals on Capitol Hill is one to stop the Medicaid increase to help avoid the 27-percent Medicare payment cut set for Jan. 1. “We cannot turn Medicaid into a more effective delivery system until we shore up Medicaid patients’ eroding access to primary care physicians and key specialists,” TMA President Michael Speer wrote in a letter also signed by the presidents of the Texas Academy of Family Physicians, Texas Chapter of the American College of Physicians, and Texas Pediatric Society. “Reversing this solution for short-term savings — even if those savings might be used to fix Medicare’s glaring payment problems — will ultimately cost lives and more money.”

CONGRESSMAN SMITH TO CHAIR HOUSE SCIENCE COMMITTEE

Congratulations to U.S. Rep. Lamar Smith (R-San Antonio), my congressman, the new chair of the House Committee on Science, Space, and Technology. “The purpose of the Science Committee is to grow research and development that leads to new innovation,” Representative Smith said in announcing his new post. He previously chaired the House Judiciary Committee. Other Texans with leadership spots in the new Congress include Reps. Jeb Hensarling (R-Dallas), Financial Services Committee; Michael McCaul (R-Austin), Homeland Security Committee; Pete Sessions (R-Dallas), Rules Committee; and Rubén Hinojosa (D- Edinburg), Congressional Hispanic Caucus.

EVPGRAM TO TAKE HOLIDAY BREAK


This will be your last regular EVPGram for 2012. We will return early next year and, of course, send you special editions for any important, breaking news. Happy Holidays.

Monday, December 3, 2012

BILLIONS AND BUPKIS: DALLAS COUNTY PHYSICIANS WITHDRAW FROM MEDICAID WAIVER PROJECT

Citing the more than $4 billion in federal and local money that Dallas hospitals are set to receive over the next four years to care for the county’s uninsured and Medicaid populations and the “next to nothing” they will share with physicians who provide the actual care, the Dallas County Medical Society (DCMS) has pulled out of the 1115 Medicaid waiver program. “If independent physician practices cannot maintain economic viability as a consequence of their participation in this program, they will be forced to withdraw from the Medicaid insurance program (as many have already done) or go bankrupt,” DCMS President Rick Snyder, MD, wrote. Texas’ 1115 waiver sets up regional cooperatives that are to share in a redistributed mix of the hospitals’ complex Medicaid finances and new managed care programs to coordinate coverage for Medicaid patients. TMA took part in meeting with Texas Health and Human Services Commissioner Kyle Janek, MD, and DCMS leaders to discuss the Dallas doctors’ concerns with the hospitals plans.

TMA ATTACKS PROPOSED NETWORK ADEQUACY RULES

The Texas Department of Insurance’s (TDI’s) proposed rules governing the adequacy of physician networks in insurance plans are bizarre, misguided, “extremely poor public policy,” unacceptable, inappropriate, feeble, confounding, insurer-friendly, and unsupportable, TMA President Michael Speer, MD, writes in a formal letter to be delivered to TDI today. “If the Department’s current path is not abandoned, it will ultimately result in irreparable harm to Texas’ consumers as, inter alia, the value of the products they have purchased will be reduced; their out-of-pocket expenses will be increased; and ― unjust and ― deceptive policies will (by the Department’s own admission) be allowed in the market for purchase by unsuspecting consumers,” Dr. Speer wrote. TMA, TDI, and the health plans have been involved in lengthy negotiations over the rules since we pushed passage of network adequacy laws in the 2007 and 2009 sessions of the Texas Legislature. Shortly before they were to take effect, TDI Commissioner Eleanor Kitzman late last year suspended a solid package of rules TMA helped to put together.

CALL CONGRESS TUESDAY: STOP MEDICARE ZOMBIE FINANCING

We need your help to convince Congress to stop the “zombie Medicare financing” it uses to pay physicians. Please call Washington at 7 am tomorrow, and at 7 am every Tuesday thereafter, until Congress stops this year’s 27.5-percent payment cut and agrees to fix the defective Sustainable Growth Rate (SGR) formula. Get commitments from Sens. John Cornyn and Kay Bailey Hutchison and your representative to fix the 12-year-old problem. For talking points and congressional phone numbers, go the Medicare Meltdown Action Center on the TMA website.

MINNESOTA LEADER BRINGS QUESTIONS

Minnesota Medical Association CEO Bob Meiches, MD, is the latest in the long line of state association leaders to visit the TMA building. Dr. Meiches came to share his organization’s plan for a strategic revitalization and to seek our answers to the tough questions: How do we provide value in today’s changing medical marketplace? What advocacy and services do physicians employed by large systems need and expect? While Minnesota’s health care delivery systems are very different from ours, I found the conversation engaging and thought-provoking. What answers do you have?

THOUSANDS JOIN PHYSICIANS MEDICAID CONGRESS CALLS

Dr. Speer and John Holcomb, MD, chair of TMA’s Committee on Medicaid, CHIP, and the Uninsured, hosted a pair of tele-town hall meetings to seek physicians’ ideas on how to improve health care for low-income Texans. The telephone listening sessions — along with an in-person meeting in McAllen hosted by TMA Board Vice Chair Carlos Cardenas, MD — are a key component of TMA’s Physicians Medicaid Congress. Thousands of Texas physicians listened in and shared their complaints with the current system and suggestions for fixing it. The Physicians Medicaid Congress meets in Austin this week to draft its legislative and state-agency advocacy agenda.

TMA WEBINARS PROVIDE REQUIRED PRIVACY TRAINING


Texas’ new Medical Privacy Law requires that all physicians and their staff receive training tailored to their scope of employment within 60 days of hire and every two years thereafter. Log on to the TMA Education Center next week for one of three, live, lunch-time webinars that deliver the necessary training on HIPAA and the new state law. Buy the three-pack bundle for the best price:
  • Dec. 11: Complying With HIPAA and Texas Privacy Laws — a must for compliance officers, physicians, and a good overview for the entire staff;
  • Dec. 12: HIPAA for Nonclinical Staff — tailored for reception and medical records personnel; and
  • Dec. 13: HIPAA for Clinical Staff — focusing on physicians, nurses, billing and coding staff, and others involved in clinical care.

Monday, November 19, 2012

RIP, LADON W. HOMER, MD (1935-2012)

With sadness, we say goodbye to a great leader, an excellent physician, a fine man, and a dear friend. Funeral services are at 2 pm today at Keene Seventh-day Adventist Church for former TMA President Ladon Homer, MD. He was a man of utmost integrity and an inspiration to many of us. “I will always refer to Ladon as Dr. Chairman,” said TMA Immediate Past President Bruce Malone, MD. “He was a mentor for everyone and a true Southern gentleman. The dynamic duo of Ladon and Mary Ann will always hold a special place in our leadership.” On behalf of all of Texas medicine, I send my deepest sympathies to Mary Ann, Kevin, Greg, Jana, and their families. Mary Ann Homer’s mailing address is 6601 Sahalee Dr., Fort Worth, TX 76132-4508.

AMA HOUSE: SAVE MEDICARE, HELP EMPLOYED PHYSICIANS, STOP ICD-10

The American Medical Association House of Delegates took significant action at its 2012 interim meeting to address some of medicine’s most pressing problems. Delegates completed a multi-year plan by adopting a framework to transition Medicare to a defined contribution program that would allow beneficiaries to either buy coverage of their choice from a wide variety of plans or stay in the traditional Medicare system. The new AMA Principles for Physician Employment should be helpful for young doctors coming out of residency and fellowship with no training on the business side of medicine. After winning a one-year delay in the mandatory implementation of the ICD-10 coding system, AMA delegates voted to “vigorously advocate” with the Centers for Medicare & Medicaid Services to make the change permanent. And Texan Pat Hyer, president of the AMA Alliance, won a standing ovation when she told the house, “With the uncertainty about the future of medicine, there is no greater time than now to join the AMA Alliance.”

PRACTICE YOUR TESTIMONY SKILLS AT TMA ADVOCACY RETREAT

The start of the 2013 Texas Legislature will be just a month away when the TMA Specialty Society Advocacy Retreat convenes in Austin, Dec 7-8. Added to this year's retreat is a mock legislative hearing at the State Capitol, where you can practice testifying in a way that will sway lawmakers. We’re also featuring a dinner with legislative leaders, expert insights into the political and policy landscape, and the state specialty societies’ rundown of critical issues. Register today.

CONGRATULATIONS TO HOWARD MARCUS, MD

Gov. Rick Perry appointed Austin internist Howard Marcus, MD, to the Texas Council on Cardiovascular Disease and Stroke. The council educates, informs, and coordinates activities to reduce the human and financial toll of cardiovascular disease and stroke. Dr. Marcus is the longtime chair of the Texas Alliance for Patient Access, which defends our 2003 tort reforms.

TMA CALLS ON STATE TO KEEP STUDENTS' FITNESS DATA

Nearly 120 years ago, the great physicist Lord Kelvin taught us you cannot improve what you cannot measure. That maxim applies to politics, business, and education as well as science. Austin pediatrician Stephen Pont, MD, brought that lesson to the Texas Sunset Commission when he spoke against a recommendation to eliminate the state’s Physical Fitness Assessment Report. Known as the FitnessGram, the report is a physical education assessment and reporting program required under current law for children in grades 3 through 12 who participate in physical education classes. “Obesity and its related disorders cost the Texas economy a projected $9 billion in 2009,” Dr. Pont said, testifying on behalf of TMA, the Texas Pediatric Society, and the Texas Academy of Family Physicians. “If unchecked, this cost is anticipated to grow to more than $32 billion by 2030. That is $32 billion we could use elsewhere in the state budget, such as in our education system. It is $32 billion we cannot afford to squander.”

IN SHORT: SENATOR CORNYN, SMOKE-FREE TEXAS, NETWORK ADEQUACY, TEXTING DANGERS


Here’s a quick recap of TMA highlights from the past week:
  • TMA congratulated Sen. John Cornyn (R-Texas) on his election as Senate minority whip.
  • The Texas Public Health Coalition’s “University of Health” session focused on the health and economic benefits of a ban on smoking in public places.
  • TMA told the Texas Department of Insurance to rethink its rules, again, on physician network adequacy for PPOs and EPOs.
  • Rep. Tom Craddick (R-Midland) refiled his bill, with TMA support, to ban texting while driving.

Monday, November 12, 2012

AMA HOUSE DIGS INTO TESTY ISSUES

Just days after the election, leading Texas physicians and medical students gathered in Honolulu to help chart the future of medicine in President Obama’s second term. Among the hottest items up for debate at the 2012 Interim Meeting of the AMA House of Delegates: whether to save Medicare by turning it into a defined contribution system, what to do with the now-optional Medicaid expansion, how to navigate thorny logistical issues and bring the interim house meeting to the nation’s capital every year, and how to put a permanent stake into the ICD-10 coding system. We’ll have a recap in next week’s EVPGram and full coverage in Texas Medicine magazine.

TEXPAC SCORES BIG ELECTION WINS

The Nov. 6 election was another successful one for TEXPAC as voters elected a record seven TMA and TMA Alliance members to the Texas Legislature. Sen. Bob Deuell, MD (R-Greenville), won reelection to the Texas Senate, while Rep. Charles Schwertner, MD (R-Georgetown), and Donna Campbell, MD (R-New Braunfels), were elected to their first Senate terms. In House elections, Reps. John Zerwas, MD (R-Simonton), and Susan King (R-Abilene), a TMA Alliance member, won new terms. Newcomers Greg Bonnen, MD (R-Friendswood), and J.D. Sheffield, DO (R-Gatesville), will join them. In a tough State Senate race in Fort Worth, Mark Shelton, MD, lost to incumbent Democratic Sen. Wendy Davis. The vote was close — only 1,600 votes separated them. Voters reelected U.S. Rep. Michael Burgess, MD (R-Flower Mound), to another term as the only TMA member in Congress. In contested races for the Texas Supreme Court, incumbent Republican justices Don Willett and Nathan Hecht were reelected.

QUITE DISTINGUISHED INDEED

I am so proud of former TMA President Mark Kubala, MD. The Beaumont neurosurgeon received the 2012 AMA Distinguished Service Award “for meritorious service in the science and art of medicine.” He has been active in organized medicine since his days as a medical student in 1968 and a member of the AMA House of Delegates since 1994. TMA and the American Association of Neurological Surgeons celebrated the occasion with a Texas-style luau.

NATIONAL GRASSROOTS ADVOCACY COALITION TAKING SHAPE

I’m pleased to report that eight other state medical societies have joined with TMA to establish a new coalition to improve medicine’s voice in Washington, D.C. Our goal is to focus the efforts of physicians from blue and red states on medicine’s issues without partisan politics getting in the way. The coalition will work as a complement to AMA; it will have the same agenda but a different strategy and tactics. Our first step will be to meet with Representative Burgess and other physician-congressmen next month to discuss how best to achieve medicine’s goals.

PHYSICIANS MEDICAID CONGRESS REGIONAL HEARINGS START THIS WEEK

Our search for a constructive plan to reinvent the Medicaid system heads to South Texas this week with a pair of regional hearings of the Physicians Medicaid Congress. The hearings are seeking physician suggestions for ways to improve Medicaid payments, reduce hassles, and reeducate the state’s newly enhanced fraud-and-abuse cops. Congress Co-Chair John Holcomb, MD, and Bexar County Medical Society President Roberto Trevino Jr., MD, will lead Monday’s hearing in San Antonio. Cameron-Willacy County Medical Society Exec Javier Vasquez will serve as master of ceremonies Tuesday in the Rio Grande Valley.

TMA CALLS OUT CHIROPRACTIC BOARD ON NEW RULE

The Texas Board of Chiropractic Examiners (TBCE) is at it again. The board has lost numerous court battles with physicians over its attempts to expand chiropractors’ scope of practice by passing a rule. This time, TBCE proposed a new definition of biomechanics, one of the keys to that profession’s statutorily prescribed scope. The new rule defines “biomechanics” to cover tendons, ligaments, and joint capsules as well as “the nervous system that allows a body or part of a body to move from one place or position to another or to maintain position.” TMA and the Texas Neurological Society (TNS) fired off a strongly worded letter protesting that the rule goes way beyond any medical or standard English definition of biomechanics. “It is inappropriate for the TBCE to manufacture its own definition of biomechanics in such a way that it circumvents the statutory limitations placed on the scope of chiropractic,” TMA President Michael Speer, MD, and TNS President Sara Austin, MD, wrote. “This proposed rule incorporates terms to ultimately encompass procedures and areas of practice that are prohibited by statute.”

Monday, November 5, 2012

VOTE TOMORROW

Tomorrow is Election Day. I hope you take the time to go to the polls and encourage your family, friends, colleagues, staff, and patients to do the same. TEXPAC has endorsed an impressive list of candidates that includes physicians and TMA Alliance members. Check out the list of TEXPAC-endorsed congressional, legislative, and judicial candidates. While the outcome of the presidential contest surely will have a huge impact on medicine, it’s critical that we elect patient- and physician-friendly candidates to counter or help the next president's agenda.

NOVITAS TO BEGIN PROCESSING MEDICARE CLAIMS


Novitas Solutions takes over administration of physicians’ Medicare claims in Texas and several surrounding states from TrailBlazer Health Enterprises on Nov. 19.

TMA established the Novitas Resource Center on the TMA website. It tells you what you need to do right now and links to the Novitas transition website.
Here are six things you need to do now to make sure your patient care and cash flow aren’t interrupted:
  1. Double check that you’ve sent your electronic funds transfer paperwork to Novitas;
  2. Review Novitas’ Local Coverage Determination policies;
  3. Familiarize yourself with the Novitas website;
  4. Take a close look at Novitas’ evaluation and management coding guidelines;
  5. Consider enrolling in TMA’s statewide fall Medicare seminar series; and
  6. If you have any questions, please call the TMA Knowledge Center at (800) 880-7955.

DO YOU USE AN EHR?

Two surveys are examining how physicians use electronic health records (EHRs). Thanks to a Physicians Foundation grant, the Louisiana State Medical Society is conducting a nationwide survey of why physicians do or do not adopt EHRs. The grant allows our neighbors to expand a statewide survey they did last year. The survey will address factors that discriminate between nonadopters and adopters, the presence of specific inhibitors of EHR adoption, and the patterns of adopters that lead to meaningful use. Physicians who take the survey are eligible to win an e-reader.

Meanwhile, the American Medical Association and AmericanEHR Partners are teaming up to survey physicians who use or plan to use an EHR. The survey results will help populate a growing database of EHR system rankings.

THOUGHTS ON THE ELECTION

“As physicians, citizens, potential patients and, if we are fortunate, seniors, we should cast our vote only after very careful consideration. The future of health care delivery for the elderly depends on it!” Those are the words of former TMA President Robert M. Tenery, MD, in his Oct. 29 blog entry “Obamacare Has Thrown Our Seniors Under the Bus.”

Monday, October 29, 2012

ONE WEEK LEFT TO VOTE EARLY

Today through Friday are the final five days to vote early before the Nov. 6 elections. Check with your local elections offices to find early voting locations near you, and encourage your family, friends, colleagues, staff, and patients to go to the polls. If you’re still undecided on the races, check out the list of TEXPAC-endorsed congressional, legislative, and judicial candidates. While the outcome of the presidential contest surely will have a huge impact on medicine, it’s critical that we elect patient- and physician-friendly candidates to counter or help the next president’s agenda.

TMA MEMBERSHIP ROLLS PAST THE 46,000

Thank you so much! TMA membership passed the 46,000 milestone, and the year isn’t over yet. We are projecting ending 2012 near 46,500 members on our way to TMA President Michael Speer, MD’s, goal of 50,000. That means TMA remains the largest (and the best) state medical association in the country. The more members we represent, the stronger our collective voice, and the more we can accomplish for every Texas physician and the patients you serve. The next legislative and congressional sessions are right around the corner. Please renew your membership today if you haven’t yet — and recruit a new member — to make sure medicine’s voice is indeed strong in the fight to restore a sense of control, stop the tide of decisions made by others, make sure you are paid what you’re worth, and allow you more time for patient care.

THOUSANDS LISTEN IN TO NOVITAS TELE-TOWN HALL MEETING


TMA reached out and touched more than 20,000 members with news on how to prepare for the Nov. 19 transition to a new Medicare carrier for Texas. More than 2,000 stayed on the line for our Tele-Town Hall meeting with TMA staff experts and senior staff from Novitas Solutions, the new carrier. If you missed it, or want to listen again, the full recording is on the TMA website. Here are six things you need to do now to make sure your patient care and cash flow aren’t interrupted:
  1. Double check that you’ve sent your electronic funds transfer paperwork to Novitas;
  2. Review Novitas’ Local Coverage Determination policies;
  3. Familiarize yourself with the Novitas website;
  4. Take a close look at Novitas’ evaluation and management coding guidelines;
  5. Consider enrolling in TMA’s statewide fall Medicare seminar series; and
  6. If you have any questions, please call the TMA Knowledge Center at (800) 880-7955.  

"BECAUSE HE IS AN EXCELLENT DOCTOR"

Americans are very happy with their primary care physicians, according to a new national survey conducted by The Physicians Foundation. Among those who had visited a family physician or primary care doctor (at least once) in the past year, 79 percent said that they were “very satisfied” or “extremely satisfied” with the visit(s). When asked why, one typical respondent said, “Because he is an excellent doctor. He knows me and understands my medical needs.” Americans point away from physicians when asked who is to blame for the rising cost of health care. Three-quarters said insurance companies and pharmaceutical manufacturers were “very” or “completely responsible,” 62 percent cited the cost of liability insurance, and 59 percent laid the blame on the government. One last snapshot from this survey: When asked about the Patient Protection and Affordable Care Act, 39 percent believe it will have a negative impact on health care, 26 percent feel the impact will be positive, and 35 percent express no opinion. Harris Interactive conducted the survey of 2,236 adults for The Physicians Foundation in late July.

ALMA MATER PRAISES DR. VARMA

Congratulations to Lubbock pediatrician and longtime TMA leader Surendra Varma, MD. King George Medical University in Lucknow, India, bestowed a Doctor of Science Honoris Causa award on Dr. Varma for being an outstanding academician, clinician, and teacher “who has made India proud with his professional achievements and scientific contributions, keeping the Indian flag flying high at the foreign soil.” Dr. Varma, a leading pediatric endocrinologist, is best known for developing a newborn screening tool for congenital hypothyroidism.

SENDING OUR PRAYERS NORTHWARD


Right now, it looks as if Hurricane Sandy will strike a tremendous blow to the northeastern United States and inland to the Great Lakes. On behalf of TMA, I send our hopes and prayers that your family, friends, and colleagues in Sandy’s path will brave the storm safely. We know from our experience with Gulf Coast hurricanes how difficult it can be for communities to regroup and physicians to reopen flooded and damaged practices.

Monday, October 22, 2012

WOMEN'S HEALTH PROGROM GAG RULE DEFEATED

Responding to strong opposition from TMA and state specialty societies, Health and Human Services Commissioner Kyle Janek, MD, pulled the gag clause from rules governing the state’s redesigned Women’s Health Program. As proposed by Commissioner Janek’s predecessor, the rule would have prohibited a participating physician from discussing abortion with a patient. The new rule still prohibits Women’s Health Program funds from going to a physician or provider who promotes or performs abortion, but the definition of “promote” was revised to exclude “neutral, factual information and nondirective counseling.” TMA President Michael Speer, MD, praised the change. “It is very important that patients are able to trust that their doctor is giving the best medical advice for them — based on their medical needs and nothing else,” he said. TMA remains concerned for the program’s long-term viability — and for the women it serves — as the state next month tries to run the program on its own without $35 million a year in federal funding.

EARLY VOTING BEGINS TODAY; VOTE THE PARTY OF MEDICINE

The end of the seemingly interminable 2012 election cycle is almost here. Early voting for the Nov. 6 general election begins today and runs through Nov. 2. TEXPAC has created a Voter’s Guide of our endorsed candidates that you can download, print, and take with you to the polls. “As physicians we must do our part both large and small to ensure the Texas Legislature adopts the best policy solutions available,” said Jerry Hunsaker, MD, chair of TEXPAC’s Candidate Evaluation Committee. “That starts in the voting booth. Medicine’s candidates need your support.” From U.S. Senate candidate Ted Cruz on down, medicine has endorsed a strong slate of patient- and physician-friendly candidates. Look for your customized list in your email in-box today.

ANSWER THE PHONE THURSDAY FOR NOVITAS ANSWERS

TMA will hold a tele-town hall meeting Thursday at 8 pm CDT to help you prepare for the Nov. 19 switch from TrailBlazer Health Enterprises to Novitas Solutions for processing Medicare claims. Novitas officials will join TMA physician and staff experts to give you a quick overview of what the transition means to you and to field your questions. No reservations are necessary. Just pick up your home phone when it rings at 8. (Let the TMA Knowledge Center know if you would prefer that we call you at another number or if you would like to include your office administrator or another staff member.) The tele-town hall is one of our many efforts to help you make sure the transition doesn’t affect your cash flow or office operations. Our statewide Medicare seminar series runs from Oct. 30 through Nov. 15. Topics include the switch to Novitas plus Medicare coding tips and advice on how to avoid a fraud-and-abuse investigation. See our Novitas Resource Center for more.

OUR HEALTHY VISION NEW EVEN CLEARER

Thanks to your feedback, and the Supreme Court’s ruling in June, we’ve reformulated TMA’s Healthy Vision 2020 in preparation for the coming legislative session. This is TMA’s roadmap for advocacy success in Austin and in Washington for the rest of the decade. Whether you’re concerned about payment, workforce, scope of practice, tort reform, obesity, measuring real quality of care, or maintaining your clinical autonomy, Healthy Vision addresses all of this and more. Read it online or order a limited number of hard copies from the Knowledge Center.

CANDIDATES WITH A CURE FIELD E-QUESTIONS AT FALL CONFERENCE

A highlight of 2012 TMA Fall Conference was our open forum with six physician and alliance candidates for the Texas Legislature and U.S. Congress. From veterans like U.S. Rep. Michael Burgess, MD (R-Flower Mound), and State Sen. Bob Deuell, MD (R-Greenville), to State House hopeful J.D. Sheffield, DO (R-Gatesville), panelists shared their predictions on coming legislative battles. But the candidates were the only ones with microphones. Our on-site audience asked their questions via text message and Twitter. Moderator Ross Ramsey, executive editor of The Texas Tribune, received them on his iPad then posed them to the panel. Topics ranged from Medicaid and medical education funding to the future of the federal health care reform law. Read more about what makes doctors run for office, in this preview from November’s Texas Medicine.

COUNCILS TACKLE TMA OF THE FUTURE PROJECTS


The fall conference was the first chance for our councils and committees to begin work on the many hands-on, practice-support ideas that came out of this summer’s TMA of the Future meeting. I’d specifically like to thank Carl Trusler, MD, and the Council on Practice Management Services; Frank Villamaria, MD, and the Council on Health Care Quality; and a new task force headed by Trustee Dan McCoy, MD, for diving headlong into:
  • An easy-to-use patient satisfaction tool kit,
  • A multistakeholder coalition to agree on a uniform set of meaningful clinical quality metrics and data processes across all payers in Texas, and
  • A management services organization to support physicians regardless of the practice setting or business strategy they are considering.
Our goal is to complete some of these projects, and more, and have a comprehensive action plan to present to the House of Delegates in May.

Monday, October 15, 2012

LOOKING FORWARD AT 2012 TMA FALL CONFERENCE

This weekend’s Fall Conference has a decidedly forward-looking feel to it. Keynote speaker Tom Miller tells us what’s next for the patient-physician relationship and the overall health care marketplace in the wake of the Supreme Court ruling on the Patient Protection and Affordable Care Act. A host of incoming and hopeful physician and alliance lawmakers handicap the coming sessions of the Texas Legislature and U.S. Congress. The third class in the TMA Leadership College begins its studies. We get a sneak preview of coming new Medicaid fraud rules. And our Physicians Medicaid Congress convenes for the first time. Plus Twitter and Facebook schools. See you there.

TEXPAC BACKS CONGRESSIONAL HOPEFULS

The outcome of the Nov. 6 presidential race obviously will be the major determinant of the flavor and direction of health care reform in the 113th U.S. Congress. But whether President Obama or Mitt Romney is in the White House, we need to elect congresswomen and men who turn to their local physicians for guidance on the tough decisions. Redistricting added three new positions to the Texas delegation. In contested races, TEXPAC has endorsed newcomers Randy Weber (R-Pearland), Beto O’Rourke (D-El Paso), Joaquin Castro (D-San Antonio), Roger Williams (R-Weatherford), Marc Veasey (D-Fort Worth), and Filemon Vela (D-Brownsville). These incumbents in contested races got the TEXPAC nod: Reps. Louie Gohmert (R-Tyler), Ted Poe (R-Humble), Ralph Hall (R-Rockwall), Jeb Hensarling (R-Dallas), Joe Barton (R-Ennis), John Culberson (R-Houston), Kevin Brady (R-The Woodlands), Al Green (D-Houston), Michael McCaul (R-Austin), Mike Conaway (R-Midland), Kay Granger (R-Fort Worth), Ruben Hinojosa (D-Mercedes), Sheila Jackson Lee (D-Houston), Lamar Smith (R-San Antonio), Pete Olson (R-Sugar Land), Francisco “Quico” Canseco (R-San Antonio), Kenny Marchant (R-Coppell), Michael Burgess, MD (R-Flower Mound), Blake Farenthold (R-Corpus Christi), Henry Cuellar (D-Laredo), Eddie Bernice Johnson (D-Dallas ), John Carter (R-Round Rock), Pete Sessions (R-Dallas), and Lloyd Doggett (D-Austin). Here’s the full list of this fall’s TEXPAC endorsements. And here’s an order form for our famous slate cards.

DR. DICKEY STEPS DOWN AT TEXAS A&M

After 11 years in the corner office, Nancy Dickey, MD, resigned as president of the Texas A&M Health Science Center. “This is an opportunity for me to return to my passion regarding health policy, health care delivery solutions, medical ethics, and professionalism — and the importance of these topics in the education of health professionals,” Dr. Dickey said in a statement. She has been a staunch ally of TMA and Texas physicians throughout her career, including her term as the first female president of the American Medical Association. She was a tremendous strategic leader and visionary — the kind of person medicine really needs. We wish her the best. E.J. “Jere” Pederson, former executive vice president and chief operating officer of The University of Texas Medical Branch at Galveston, will serve as acting head of the Texas A&M Health Science Center.

PHYSICIANS TAKE LEGISLATIVE AGENDA TO DAVID DEWHURST

Medicaid funding and end-of-life issues topped the agenda when TMA President Michael Speer, MD, led a delegation of physicians meeting with Lt. Gov. David Dewhurst. We reviewed much of our Healthy Vision 2020 plan with Lieutenant Governor Dewhurst, who has reappointed Sen. Jane Nelson (R-Flower Mound) to chair the Senate Committee on Health and Human Services. In addition to Dr. Speer and TMA staff, our team included Drs. Bruce Malone, Dawn Buckingham, Sara Austin, Travis Bias, and David Fleeger, all of Austin. Later that day, Dr. Speer headlined a health care reform panel discussion convened by the McLennan County Medical Society. Others speaking at the Waco event included former TMA (and AMA) President Jim Rohack, MD; county society president Charles Stern, MD; and American Academy of Family Physicians Board Chair Roland Goertz, MD.

MEDICAID WOES PROMPT FIRST JOINT MEDICAL SOCIETY MEETING IN RIO GRANDE VALLEY

The still-unresolved payment crisis for dual-eligible patients was the impetus for the first-ever joint meeting of the Hidalgo-Starr and Cameron-Willacy county medical societies. TMA Board Vice Chair Carlos Cardenas, MD, and a contingent of TMA legislative, legal, and policy staffers took part. About 40 physicians attended, expressing their frustration over the problem. Resolution of the dual-eligible payment disaster will be a key goal of our new Medicaid agenda.

HEARTY CONGRATULATIONS TO ...


  • Ray Callas, MD, whom Gov. Rick Perry appointed to the Jefferson and Orange County Board of Pilot Commissioners. A Beaumont anesthesiologist, Dr. Callas is a member of the TMA Council on Legislation and the Texas Delegation to the AMA House of Delegates.
  • Michael Darrouzet, named to the Dallas Business Journal’sWho’s Who in Health Care” for Dallas-Fort Worth. Michael is the long-time CEO of the Dallas County Medical Society.

Monday, October 8, 2012

PICKING WISCONSIN'S BRAIN OVER CLAIMS DATABASE

Several senior TMA staff and I met with leaders of the Wisconsin Medical Society to discuss that state’s all-payer claims database. We expect that could become an issue in the 2013 Texas Legislature. Knowing the limitations of harvesting useable data from claims forms, we want to make sure such a database would give Texas physicians helpful ways you can compare your practice with your peers. It’s very important that the data be used for process improvement, and not for physician ranking schemes.

TEXPAC UNVEILS JUDICIAL ENDORSEMENTS


“Now more than ever, we need qualified individuals on the bench,” TEXPAC Chair Joe Todd, MD, said as he released the list of Supreme Court and appeals court judges that won our endorsement:
  • Texas Supreme Court: Justices Don Willett and Nathan Hecht;
  • 1st Court of Appeals (Houston): Justices Jane Bland, Harvey Brown, Rebecca Huddle, Terry Jennings, and Michael Massengale;
  • 3rd Court of Appeals (Austin): Justices Diane Henson, Robert Pemberton, David Puryear, and Jeff Rose;
  • 4th Court of Appeals (San Antonio): Justices Karen Angelini, Marialyn Barnard, Steve Hilbig, Rebecca Simmons, and Phylis J. Speedlin;
  • 5th Court of Appeals (Dallas): Justices Robert Fillmore, Douglas Lang, and James Moseley;
  • 6th Court of Appeals (Texarkana): Justice Bailey Moseley;
  • 8th Court of Appeals (El Paso): Justice Christopher Antcliff;
  • 13th Court of Appeals (Corpus Christi and Edinburg): Tom Greenwell and Justices Gina Benavides and Nelda Vidaurri Rodriguez; and
  • 14th Court of Appeals (Houston): John Donovan and Justices Jeffrey Brown, Brett Busby, and Martha Hill Jamison.

ARE YOU READY FOR SOME BIG MEDICARE CHANGES?


Are you ready for Novitas? On Nov. 19, Florida-based Novitas Solutions replaces TrailBlazer Health Enterprises as the Medicare carrier in Texas. That means a new way to get payments into your bank account, new local coverage determination policies, and new names and phone numbers for questions and problems. TMA has a quartet of helpful servings to make sure you’re prepared:
  1. Your first stop should always be our transition resource center at www.texmed.org/novitas.
  2. Don’t miss our free transition webinar this Wednesday at noon (CT), especially for office managers and administrators.
  3. Pick up your home phone at 8 pm (CT) Oct. 25 for a TMA tele-town hall meeting, hosted by TMA President Michael Speer, MD, with our staff experts and the Novitas transition leader.
  4. Beginning Oct. 30, our can’t-miss Medicare seminar series begins touring the state. We have last-minute tips for the Novitas transition plus our usual array of news and suggestions to keep your practice out of trouble and keep your Medicare payments arriving on time.  

PROJECT TO BUST PHYSICIANS' RED TAPE

 TMA is one of seven state medical societies to begin working with the American Medical Association on an in-depth study of physician satisfaction. The purpose of the research is to identify those factors that affect practicing physicians’ satisfaction with the profession, and to identify and reduce red tape. The study will include up to 60 practices of various sizes and types. AMA has asked us to recommend practices of various sizes to participate in the research. If you’re interested, let me know. All data collected will remain confidential.

TMA MIGHT BUILD SOME ORANGE-BLOODED LEADERS

I’ve begun talking with the team at Texas Executive Education at The University of Texas McCombs School of Business about developing leadership and management education programs for TMA-member physicians. This would be part of our ongoing initiative on physician leadership training, such as TMA Leadership College. I will discuss this with our Board of Trustees next week.

PHYSICIAN-LEGISLATORS IN THE SPOTLIGHT AT FALL CONFERENCE


A record number of TMA and TMA Alliance members are poised to enter the Texas Legislature and U.S. Congress after the November elections. Almost all of them will join us for a lively panel discussion Oct. 20 at 2012 TMA Fall Conference. Ross Ramsey, executive editor of The Texas Tribune, will moderate the event. Don’t forget, tomorrow is the last day to register to vote in the Nov. 6 general election. Early voting begins Oct. 22.

Monday, October 1, 2012

PHYSICIANS FOUNDATION SURVEY PAINTS GLUM FUTURE

Physicians are working fewer hours, seeing fewer patients, and limiting access to their practices in light of significant changes to the medical practice environment. That’s according to a huge and comprehensive new survey of practicing physicians by The Physicians Foundation. As president of the foundation, I spend a good bit of time sharing the findings — and their implications — with national and regional news media. As dire as the national data look, Texas physicians are even more pessimistic about the future. Fifty-three percent of the Texans mostly agree that the medical profession is declining, compared with 41.6 percent nationally. Whether it’s advocacy or practice management education, organized medicine in the U.S. needs to step it up to help our members.

FOCUS GROUPS FIND STRONG SUPPORT FOR PATIENT-PHYSICIAN RELATIONSHIP

The preliminary results of our focus groups with pro-life voters on women’s health issues start with some very good news. Conservative Texans have a lot of trust in the patient-physician relationship and don’t want the government anywhere near the exam room. Even when the talks might veer into abortion or other political hot buttons, these voters don’t want the government thwarting these intensely personal discussions between patients and their physicians. Although our position on the state’s proposed gag order has drawn heavy flak from some anti-abortion groups, this research tells us that those organizations are not in synch with their so-called constituents.

GET FLU SHOTS, LEARN TO TWEET AT 2012 TMA FALL CONFERENCE

Online registration is still open for 2012 TMA Fall Conference, Oct. 19-20 in Austin. In addition to the usual great speakers — this time on the federal health reform law and physicians on the ballot — you can pick up some useful skills and a little health care for yourself. Learn how to be an effective witness at a legislative committee hearing by signing up for one of two advocacy training classes on Friday, Oct. 19. Afraid to admit you don’t know a tweet from a like? We’re teaching beginner Twitter and Facebook classes Friday afternoon and Saturday morning. Or drop by the on-site flu clinic, where you can get your flu shot ($25) or nasal spray flu vaccine ($40) before the General Session on Saturday morning. Your family and office staff are welcome, too.

"TMA'S JUNKYARD DOG" TAKES A BITE OUT OF INSURANCE SNAFU

Despite all the warnings and training and preparation on all sides, we knew we’d see some patient care problems during the transition from Blue Cross and Blue Shield of Texas (BCBSTX) to UnitedHealthcare for the huge state Employee Retirement System. And we knew TMA had to be ready to help. One Austin surgeon is grateful for the intervention of our Payment Advocacy Department, which he calls “TMA’s Junkyard Dog.” One phone call from our team reversed a decision that would have required major surgery on an outpatient basis and rehab in a skilled nursing facility. Woof!

COMMISSIONER JANEK RECEIVES OUR STATE HEALTH PRIORITIES

Chief TMA Lobbyist Darren Whitehurst and I had our first official meeting with Kyle Janek, MD, Gov. Rick Perry’s newly appointed head of the Texas Health and Human Services Commission. We are, of course, quite familiar with Dr. Janek from his days as a TMA member, state representative and state senator, and health care lobbyist. We spoke with Commissioner Janek about TMA’s state priorities. Among the most pressing right now: finding a way to reverse the steep state cuts in payment for services to dual-eligible patients covered by both Medicaid and Medicare.

WOULD-BE MEDICAL PARLIAMENTARIANS GET SOME GAVEL TRAINING

New TMA House of Delegates Vice Speaker Susan Strate, MD, and five of her colleagues spent the weekend learning the ins and outs of debatable motions, second-order amendments, and calls for the question. Barry Glazer, MD, a certified professional parliamentarian and teacher from Indianapolis, focused on how to preside at meetings using the Sturgis conduct code as the parliamentary authority. In addition to Dr. Strate, his pupils included Drs. Dawn Buckingham and Michelle Berger of Austin, Lisa Erlich and Bill Gilmer of Houston, and Ray Callas of Beaumont.

UNIVERSITY OF HEALTH SESSION FOCUSES ON OBESITY

“We need to spend more time preventing disease so we can spend less money treating disease,” Texas Agriculture Commissioner Todd Staples said at the Texas Public Health Coalition’s third University of Health class. Speaking to policy analysts and legislative aides from the Texas Senate and House, Commissioner Staples and BCBSTX Chief Medical Officer Eduardo Sanchez, MD, discussed obesity, “the health issue eating Texas’ economy.” Commissioner Staples said the focus needs to be on lifestyle changes through education and improved nutrition standards. The Department of Agriculture developed the 3E’s of Healthy Living in Texas to tackle obesity: Education, Exercise, and Eating Right.

Monday, September 24, 2012

COUNTY EXECS' MEETING BOLSTERS GRASSROOTS STRENGTH

I spend a lot of my time in meetings, but none are as satisfying or important as the gatherings I have with our county medical society execs. We share information in all directions — from the grassroots up, from Austin down, and best practices all around. The latest execs meeting didn’t disappoint. We engaged in strategic planning sessions on our legislative agenda and the multiple forces that are rearranging the health care marketplace in every Texas community. We discussed membership opportunities and plans for meeting TMA President Michael Speer’s 50,000-member challenge. And we talked about what new services our members need from organized medicine in Texas. I never forget — our strength flows from our great relationship with the counties.

ABILENE PHYSICIANS, BLUE CROSS EXPLORE VIRTUAL MEDICAL COMMUNITY SAVINGS POSSIBILITIES

TMA Trustee Austin King, MD, and I met with other Abilene physicians and Blue Cross and Blue Shield of Texas officials to flesh out ideas for a pilot “virtual medical community” in that West Texas town. Plans call for participating physicians — in solo practice or small groups — to implement and use an electronic health record to better coordinate care for patients with chronic conditions like diabetes, heart disease, and depression. Savings and costs would be shared. If it’s successful, TMA will work to bring this collaboration model to physicians in other parts of Texas.

PHYSICIANS MEDICAID CONGRESS ORGANIZING

Invitations are going out this week to the group of Texas physicians who will devise TMA’s plan to repair or replace Texas’ broken Medicaid system. TMA’s Physicians Medicaid Congress will be charged with mapping the path to a system for providing health care to low-income Texans with realistic payment, less stifling state bureaucracy, and no fraud-and-abuse witch hunts. Dr. Speer will chair the Congress, which will convene its first session at the TMA 2012 Fall Conference next month. We’ll follow that up with regional hearings around the state. The Congress will reconvene in Austin at the TMA 2012 Advocacy Summit in December to incorporate the feedback received and finalize our proposal for the 2013 Texas Legislature and U.S. Congress.

FEDS TO TMA: YOU WERE RIGHT ABOUT THE FLU FINDER, AND WE'LL FIX IT

It’s always a pleasant surprise to get a positive response from a government office; it’s nearly amazing to have that happen within just two days of sending a complaint. Earlier this month, TMA and the Texas Pediatric Society; Texas Academy of Family Physicians; and American College of Physicians, Texas Chapter, wrote the U.S. Department of Health and Human Services (HHSC) to complain about an obvious problem with its new online Flu Vaccine Finder. The web app does not acknowledge the medical home as the first place to seek flu shots and appears to be populated primarily with freestanding and grocery-store pharmacies that provide the influenza vaccine. “Your point is well taken, and we are already exploring options to resolve the oversight,” an HHSC official answered just two days later. “The finder will become even more important later this year or early in 2013 when the finder will be expended beyond flu vaccine(s) to provide information about the availability of nearly a dozen adult vaccines.” We’ll follow up to make sure that happens.

AMA TO CMS: STOP RAC AUDITS OF MEDICARE E&M CODES

The American Medical Association has come out swinging against the federal government’s announcement that Recovery Auditor Contractor (RAC) Connolly, Inc. may begin auditing Medicare coding for CPT 99215 (evaluation and management [E&M] of an established patient) in physician offices in Texas and several other states. “Physicians who provide E&M care apply complex decisionmaking based on myriad clinical approaches, including research and review of patient medical history, analyses regarding appropriate medication, discussion of home situation and prescription distribution plan, preventive care planning, and many other variables,” AMA Executive Vice President James Madera, MD, wrote in a letter asking the Centers for Medicare & Medicaid Services to stop the audits before they begin. “In particular, based on our historical experience with the RACs, and in light of the fact that the RACs are not required to have same-specialty physicians review RAC determinations, we have no confidence that the RACs will be up to the task of understanding these variables or their clinical relevance.”

TMA PHYSICIANS SPEAK OUT FOR PATIENTS AND THE PROFESSION

Three member physicians assumed high-profile positions in the capital city last week, speaking and testifying for TMA. Board of Trustees Vice Chair Carlos Cardenas, MD, told the House Committee on Human Services that physicians along the Texas-Mexico border cannot keep caring for patients without immediate action by lawmakers to lessen the dual-eligible payment cuts that went into effect in January. Pflugerville family physician Travis Bias, DO, urged the Legislative Budget Board to support the Texas Department of State Health Services’ proposed 2014-15 budget, including requests for additional funding to address costly and threatening public health concerns such as obesity and mental illness. And Austin obstetrician-gynecologist Kimberly Carter, MD, participating in a Texas Tribune Festival panel discussion on family planning, said Texas “should champion ways to make individuals responsible for their contraception and personal health.”

Monday, September 17, 2012

AMA SEEKS TEXAS PHYSICIANS' INPUT ON SGR, PRIVATE CONTRACTING

TMA leaders are answering the American Medical Association’s calls for help. Last week (and again this week), AMA’s senior management and advocacy team reached out to the leadership of TMA and other key state societies to discuss strategy on a handful of looming federal issues. Top on the list is devising a plan to win enactment of a permanent and fair new Medicare payment formula while avoiding the 27-percent cut scheduled for Jan. 1 because of the Sustainable Growth Rate disaster. The federal budget nonagreement earlier this year also has physicians facing an additional 2-percent cut in Medicare payments in 2013. TMA joined with AMA and more than 100 state and specialty medical societies urging Congress to nullify both cuts. Another priority is the Medicare Patient Empowerment Act, which would allow Medicare patients and their physicians to freely enter into private contracts for care. Any action on these contentious issues likely will wait until after the November elections. Stay tuned for alerts asking you to send your calls and letters to Capitol Hill.

REGISTER TO VOTE, JOIN TEXPAC TO MAKE MEDICINE'S VOICE HEARD

Here are two easy things you can do to help elect a record number of TMA and TMA Alliance members to the Texas Legislature in the Nov. 6 general election. First, make sure you’re registered to vote. The deadline is Oct. 9. Second — if you’re a TMA or alliance member — please consider joining TEXPAC. Every dollar will be spent to better position TMA for the 2013 legislative session and beyond. TEXPAC wants you to be on our team and be a part of our success.
Political observers already have tagged the Fort Worth Senate race of Rep. Mark Shelton, MD, as the contest to watch this fall. Don’t just watch it — do something.

NO SOLUTION YET TO DUAL ELIGIBLES CRISIS

Despite ongoing pressure from TMA and South Texas lawmakers, the Health and Human Services Commission still has not found a viable way to reverse the huge cut in state payments to physicians caring for patients who are eligible for both Medicaid and Medicare coverage. We are continuing to work with new Health and Human Services Commissioner Kyle Janek, MD, to eliminate the cap on Medicaid-allowable payments that affects more than 320,000 dual-eligible patients. The issue will top the agenda at the TMA Board of Trustees meeting next month.

WORRIED ABOUT E&M RAC AUDITS? TMA CAN HELP

TMA’s payment advocacy team is ramping up to investigate the details of the federal government’s announcement that Recovery Auditor Contractor (RAC) Connolly, Inc. may begin auditing Medicare coding for CPT 99215 (evaluation and management [E&M] of an established patient) in physician offices in Texas and several other states. As soon as we get it, TMA will share the specifics of where and when the audits of the highly subjective coding determinations will begin. TMA offers several online courses and publications to help you avoid trouble. TMA Practice Consulting has certified professional medical auditors and coders on staff to review physicians’ documentation. Finally, if you find yourself on the wrong side of a RAC overpayment decision, we’ve put together this checklist of your discussion, rebuttal, and redetermination options.

TMA JOINS WITH SPECIALTY SOCIETIES TO PREPARE FOR LEGISLATIVE SESSION

The voice of medicine at the Capitol can be loud but, unfortunately, sometimes discordant. Our lawmakers appreciate it when we all sing from the same page, and we’re much more effective that way. That’s why TMA leaders are meeting with our state specialty society counterparts now — four months ahead of the start of the legislative session. TMA President Michael Speer, MD; Immediate Past President Bruce Malone, MD; Board Chair Tom Garcia, MD; and Council on Legislation Chair Les Secrest, MD, got together with the leadership of the Texas Radiological Society. The conversation focused on issues of joint interest like scope of practice, protecting our tort reforms, and securing appropriate payment for services. More specialty society meetings are upcoming.

TWO TEXANS NAMED TO AMPAC BOARD OF DIRECTORS

Congratulations to Lyle Thorstenson, MD, and Amy Ho on their selection to serve on the AMPAC (AMA’s political action committee) Board of Directors. Dr. Thorstenson, of Nacogdoches, is chair of the Texas Delegation to the AMA. Ms. Ho is a third-year medical student at The University of Texas Southwestern Medical School.

Monday, September 10, 2012

TMA: Medicaid Inspectors’ Proposals Go Way Too Far

In a strongly worded 35-page letter to the Health and Human Services Commission, TMA is opposing proposed new “program integrity” rules that cast every Medicaid billing error as a possible target for fraud-and-abuse prosecution. “TMA strongly opposes the proposed rules because they expand [the Office of Inspector General’s] authority, minimize the rights of physicians and other providers, and have a tenor that implies a presumption of wrongdoing,” John Holcomb, MD, chair of TMA’s Select Committee on Medicaid, CHIP and the Uninsured, wrote. Without due process protections and other important changes in the draft rules, Dr. Holcomb wrote, “the pervasive fear among physicians that they will be incorrectly accused of fraud, waste, or abuse, or denied meaningful recourse in a fraud investigation will continue to contribute to the decline in physician participation in Medicaid.”

Thirty-Five Win TEXPAC Support in Contested State House Races

Friendswood neurosurgeon Greg Bonnen, MD, and Gatesville family physician J.D. Sheffield, DO, head the list of 35 candidates who have earned TEXPAC’s endorsement in contested races for the Texas House of Representatives. The 23 Republicans and 12 Democrats — 28 incumbents and seven newcomers — with medicine’s backing in the Nov. 6 general election also include: Rep. Byron Cook (R-Corsicana); Kyle Kacal (R-Bryan); Reps. John Raney (R-Bryan), Tim Kleinschmidt (R-Lexington), Craig Eiland (D-Galveston), and Ron Reynolds (D-Missouri City); Ed Thompson (R-Pearland); and Reps. Geanie Morrison (R-Victoria), Ryan Guillen (D-Rio Grande City), Connie Scott (R-Corpus Christi), Mando Martinez (D-Weslaco), J.M. Lozano (R-Kingsville), Jason Isaac (R-Dripping Springs), Paul Workman (R-Austin), and Jimmie Don Aycock (R-Killeen). Also on the list are Reps. Larry Phillips (R-Sherman) and Myra Crownover (R-Denton); Ron Simmons (R-Carrollton); Reps. Dee Margo (R-El Paso), Four Price (R-Amarillo), Charlie Geren (R-Fort Worth), and Linda Harper-Brown (R-Irving); Bennett Ratliff (R-Coppell); Reps. Joe Farias (D-San Antonio), Roland Gutierrez (D-San Antonio), Dan Huberty (R-Houston), and Sarah Davis (R-West University Place); Gene Wu (D-Houston); and Reps. Sylvester Turner (D-Houston), Senfronia Thompson (D-Houston), Ana Hernandez Luna (D-Houston), Garnet Coleman (D-Houston), and Hubert Vo (D-Houston). All have solid relationships with the physicians in their districts.

Academic Physicians: Get the Credit You’re Due

Be among the first to qualify for TMA’s new Award for Excellence in Academic Medicine. This multilevel award program recognizes teaching physicians who are clinicians and have a record of TMA leadership, scholarly activity, mentoring, professional development, advocacy, and community service. We are accepting self-nominations through Dec. 31. Apply today.

“Medicaid Is Broken,” Texas Doctors Say


More than two-thirds of Texas physicians surveyed in TMA’s latest survey agree, or strongly agree, with the statement, “Texas Medicaid is broken.” But the nearly 1,200 doctors responding to the survey have a prescription to fix it. Almost 90 percent say, “We need a system for providing health care to low-income Texans with realistic payment, less stifling state bureaucracy, and no fraud-and-abuse witch hunts.” Here’s a snapshot of some physician attitudes toward Texas Medicaid.
Click for Larger Image
 

JUDGE RULES MEDICAL BOARD IS RIGHT IN TELADOC CASE

The Texas Medical Board (TMB) is correct to require a face-to-face meeting before a physician can diagnose or treat a patient, Travis County District Judge Amy Clark Meachum ruled in a case Teladoc, Inc. brought against TMB. The judge has not yet released a copy of her decision or order.

STATE AGAIN LICENSES RECORD NUMBER OF NEW PHYSICIANS POST-TORT REFORM

A record 3,630 physicians received new Texas medical licenses in the fiscal year that ended Aug. 31. TMB broke the old record of 3,621, set in 2008.

Tuesday, September 4, 2012

LEADERS PLAN BREAKTHROUGH STRATEGIES TO HELP PRACTICES SURVIVE

Practice performance metrics, an easy-to-use patient satisfaction survey, business education for physicians, and other crucial TMA services and products are what Texas physicians need most in today’s rapidly changing health care economy. Those are the bottom-line recommendations the TMA Board of Trustees and more than 70 other leading Texas physicians reached after an intensive and unique weekend strategy session. The goal of the DesignShop® was to accomplish in a couple of days what could usually take three to six months using traditional approaches. I am confident we achieved that goal. We will have a full report and action plan to present at 2012 TMA  Fall Conference in October. Watch this video to get a better idea of what we did and why.

TEXPAC ENDORSES 12 FOR STATE SENATE

TEXPAC is moving quickly to keep the momentum going after an extremely successful primary season. The PAC endorsed a dozen Texas Senate candidates who have great support from — and relationships with — their local physicians. The Senate candidates with opposition in the Nov. 6 election who have the TEXPAC endorsement are incumbent Sens. Kevin Eltife (R-Tyler), Mario Gallegos (D-Houston), Dan Patrick (R-Houston), John Whitmire (D-Houston), Carlos Uresti (D-San Antonio), Juan “Chuy” Hinojosa (D-McAllen), Judith Zaffirini (D-Laredo), Royce West (D-Dallas), and José Rodríguez (D-El Paso). Looking to move up to the Senate with TEXPAC backing are current State Reps. Ken Paxton (R-McKinney), Mark Shelton, MD (R-Fort Worth), and Larry Taylor (R-Friendswood). Look for news of additional TEXPAC endorsements in coming weeks.

REGISTER TODAY FOR 2012 TMA FALL CONFERENCE

Health care economist Thomas Miller will discuss the impact of the U.S. Supreme Court’s ruling on the Patient Protection and Affordable Care Act (PPACA) on physicians and patients at TMA’s 2012 Fall Conference Oct. 19-20 at the AT&T Conference Center in Austin. Mr. Miller is a former senior health economist for the Joint Economic Committee of Congress and has been at the forefront of health care policy on the national level. Also on tap: a panel discussion including current and hope-to-be physician and TMA Alliance members of Congress and the Texas Legislature; Twitter 101 and Facebook 101 classes in the TMA Social Media Lab; legislative testimony training, and flu shots.

AVOID EMPLOYMENT LAW MINEFIELDS WITH NEW TMA SEMINAR SERIES

Is your practice at risk for allegations of harassment and discrimination? Are you paying your hourly employees correctly? Do you know how to properly counsel or terminate employees? Are you prepared to meet staff training regulations under the new Texas privacy law? If you don't know the answers to these questions, your practice may be in big trouble down the road. Learn to safeguard your practice by developing sound practice policies. TMA’s new half-day seminar series, “Policies and Procedures: Avoiding Minefields in Employment Law,” will show you how. The seminars run from Sept. 18 through Oct. 31 across the state.

TMA FOUNDATION BRINGS MEDICINE, BUSINESS, COMMUNITY TOGETHER

Read, hear, and see how TMA and TMA Alliance members are collaborating with business and community groups to help Texans achieve great health in TMAF’s 2011 Annual Report (try out the QR codes featured in the report, too). Medicine + Business + Community = A Prescription for Great Health celebrates how medicine’s visible and trusted leadership is improving the health of all Texans. You also can support your colleagues’ efforts by making a tax-deductible gift to TMAF.

NEW AND UNDERREPORTED NEWS ITEMS


Here are a few interesting and important stories that crossed our radar during the summer:

Monday, July 9, 2012

GOVERNOR SAYS "NO" TO EXCHANGES, MEDICAID EXPANSION

Texas will neither expand Medicaid nor establish a health insurance exchange, Gov. Rick Perry said in a letter to U.S. Health and Human Services Secretary Kathleen Sibelius. The Patient Protection and Affordable Care Act (PPACA) authorizes the two projects. “I stand proudly with the growing chorus of governors who reject the Obamacare power grab,” the governor said in a statement, the Texas Tribune reports. “I will not be party to socializing health care and bankrupting my state in direct contradiction to our constitution and our founding principles of limited government.” The U.S. Supreme Court ruled that PPACA cannot force a state to give up its current federal Medicaid funding if it does not want to expand Medicaid. The health insurance exchanges are not optional. If Texas does not implement its own exchange, the federal government will set up a Washington-devised one for us.

MEDICARE, MEDICAID ACCEPTANCE DROP DRAMATICALLY, TMA SURVEY SHOWS

The share of Texas physicians who will take new Medicare or Medicaid patients has dropped to an all-time low, according to the results of a TMA physician survey being released today. Hardest hit are low-income Texans who rely on Medicaid for their care. Texas physicians available to treat new Medicaid patients have plummeted from 42 percent in 2010 to 31 percent; that’s less than half the 67 percent who reported they would take all new Medicaid patients in 2000. The number of Texas physicians accepting all new Medicare patients dropped from 66 percent in 2010 to 58 percent in 2012. That’s part of a trend that’s seen the number decline steadily from 78 percent in 2000. “All the bureaucratic red tape and administrative burdens only serve to increase the cost of running a practice while diverting a physician’s attention away from patient care,” said TMA President Michael E. Speer, MD. “Every business has a breaking point; physicians’ practices are no different.”

TMA LEADERSHIP COLLEGE APPLICATIONS DUE THIS WEEK

Who will lead Texas medicine into the future? Will it be you? Someone you know or mentor? Applications for the third class in the TMA Leadership College are due Friday, July 13. The college can put physicians age 40 or under or in the first eight years of practice on the path to becoming leaders for the house of medicine. The program uses organizational education, skills training, mentoring, and guided experiences to develop tomorrow’s physician leaders. The 2012 Leadership College class graduated at TexMed 2012; many of the graduates moved immediately into spots on TMA boards, councils, and committees.

SUIT CHALLENGING PHYSICIAN OWNERSHIP RESTRICTIONS STILL ON

The lawyer for physician-owned hospitals seeking to overturn the PPACA restrictions against doctors owning hospitals says the lawsuit will continue despite the Supreme Court’s ruling last month that other parts of the PPACA are constitutional. The high court’s decisions on the individual mandate and Medicaid provisions of PPACA do not stop suits, such as this, challenging other portions of the law. TMA has consistently backed physicians’ right to own and operate hospitals and has filed several amicus briefs in this case. A physician-owned hospital in Tyler —Texas Spine & Joint Hospital — is the named plaintiff in the case, which is currently pending before the 5th U.S. Circuit Court of Appeals

GOVERNOR NAMES NEW THERAPEUTICS COMMITTEE MEMBER

Governor Perry appointed TMA member Scott Schams, MD, a College Station pediatrician, to the state Pharmaceuticals and Therapeutics Committee. He is an assistant clinical professor of pediatrics at the Texas A&M Health Science Center College of Medicine. The committee makes recommendations about preferred drug lists for programs such as Medicaid and the Children’s Health Insurance Program.

EVPGRAM TO TAKE SUMMER BREAK

It’s time for EVPGram to take its annual summer holiday. Don’t forget to vote in the party primary elections on July 31. We will, of course, send special editions to keep TMA leaders apprised of important breaking news. And you can keep up with TMA news via the Action newsletter and the TMA website. We’ll be back in your inbox around Labor Day.

Monday, July 2, 2012

PPACA IS CONSTITUTIONAL; NOW WHAT?

Now that the U.S. Supreme Court has ruled the Patient Protection and Affordable Care Act (PPACA) constitutional, we’ll focus our Washington lobby attention on finding what’s missing (like a replacement for Medicare’s Sustainable Growth Rate physician payment formula) and fixing what’s wrong (like eliminating the Independent Payment Advisory Board.) We also will continue to work to protect the good parts of the law, like the insurance consumer protections. Here at home, Gov. Rick Perry and legislative leaders have two important decisions to make: how, if at all, will they implement the health insurance exchange; and will they opt to expand Medicaid to low-income single adults? The Supreme Court ruled that PPACA cannot force a state to give up its current federal Medicaid funding if it does not want to expand its Medicaid program. We know physicians and patients have many unanswered questions about the law and how it will affect them. I’ve directed the TMA staff to begin work immediately on updating our Health Reform School educational materials for physicians and to develop some easy-to-understand brochures you can share with your patients. I welcome your suggestions on what would be most helpful. Email me at lou.goodman@texmed.org.

IT'S NOT TOO LATE. REGISTER TO VOTE BY TODAY FOR JULY 31 PRIMARY RUNOFFS

Today is the last day to register to vote in time to be eligible for the upcoming runoff elections. The Texas Secretary of State provides easy online systems to find out if you are registered, and to fill out and print a voter registration application. It must be postmarked by today. Once you’ve registered, of course, you need to vote. The 2012 party primary runoffs will occur on Tuesday, July 31; early voting will last from Monday, July 23, to Friday, July 27. TEXPAC is working hard to help our endorsed candidates win and to educate our physician and alliance members about the importance of engaging the political system.

IS OUR HEALTY VISION CLEAR ENOUGH FOR YOU

Have you told us yet what you think of TMA’s Healthy Vision 2020, our strategic roadmap for state and federal advocacy initiatives for the remainder of the decade? We’ve set up a special blog for TMA leaders like you to use to give us feedback on the draft document and help us get everything exactly right. Make sure we hear from you at www.texmed.org/vision.

EVALUATE HEALTH PLAN CONTRACTS

Patient Protection and Affordable Care Act or not, physician practices still have to decide for themselves how to deal with health plan contracts. Summer is a good time to study the question and make decisions before employers’ annual open-enrollment deadlines, many of which are in the fall. Physicians or practice managers should examine contract profitability and payer mix to make informed contracting decisions. Need some quick instruction on a simple way to do that? Join a short TMA lunchtime webinar on July 9. Log on to the TMA Education Center to register. And if you’re looking for an easy way to get continuing medical education, visit the CME page on our website.