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Monday, February 27, 2012

TMA BRINGS NETWORK ADEQUACY CONCERNS TO INSURANCE COMMISSIONER

TMA President Bruce Malone, MD, along with several senior staff members and me, met with new Texas Insurance Commissioner Eleanor Kitzman to share our concerns over how several of her recent decisions could hurt patients’ access to care. Commissioner Kitzman has suspended new rules, years in the making, that ensure adequate networks in provider benefit plans. The networks were to be tailored to local market needs. We told her that the proposed changes to those rules would no longer protect patients. They also would no longer hold health insurers accountable for developing adequate networks before putting their plans up for sale in a local market. The suspended rules also protect physicians who provide services out of network. We also expressed our trepidation over her decision to pull down proposed rules on utilization review.

UNIVERSITY OF HEALTH FORUM EDUCATES LEGISLATIVE STAFF ON PUBLIC HEALTH AND ECONOMY

Dozens of legislative staff and capitol reporters took in the Texas Public Health Coalition’s first University of Health forum, which focused on the economic value local public health infrastructure provides to legislative districts. Eduardo Sanchez, MD, chief medical officer at Blue Cross and Blue Shield of Texas (BCBSTX) gave a presentation, “A Healthy Texas Is a Wealthy Texas.” The forums are targeted at legislative staff on key public health priorities. Subsequent University of Health forums will focus on immunizations, obesity, and cancer and tobacco. TMA founded the Texas Public Health Coalition, a group of more than 20 organizations dedicated to advancing core public health principles at the state and community levels.

UNITED WINS STATE EMPLOYEE CONTRACT

The Texas Employees Retirement System has awarded the primary health plan contract for nearly half a million state workers, retirees, and their families, to UnitedHealthCare. United will begin serving as the third-party administrator for the self-funded HealthSelect of Texas starting Sept. 1. TMA will stay on top of what members need to know about the switch to United from BCBSTX.

TEXAS PHYSICIANS TO GET AT LEAST $10.7 MILLION IN UNITED SETTLEMENT

 Physicians who filed claims against UnitedHealthCare in the lawsuit over its usual, customary, and reasonable (UCR) claims payment system will soon receive payments. A federal judge has approved the release of payments from the 2009 settlement of the case. Texas physicians will receive at least $10.7 million. The suit alleged United used the UCR system to underpay physicians’ claims for out-of-network services for 15 years. TMA participated in the case via our support of The Litigation Center of the American Medical Association and State Medical Societies.

HEALTHY VISION 20/20 IN THE WORKS

As part of our plan to build the TMA of the Future, our legislative, policy, legal, and communication teams are writing a new advocacy blueprint for the association. When we publish Health Vision 20/20 this spring, we expect it to guide our actions in the Texas Legislature, courts, and state agencies through the end of the decade. Built on the core principles of empowerment, effectiveness, and efficiency, the document covers such important themes as protecting the viability of physician practices, creating a 21st century health care workforce, and ensuring accountable state oversight of health care delivery in Texas. A recurring theme throughout Healthy Vision 20/20 will be the tremendous economic impact of physicians’ practices in Texas.

NEW AND UNDERREPORTED NEWS ITEMS

Here are a few stories that crossed our radar over the past few days:

Monday, February 20, 2012

NO SURPRISE — CONGRESS MISSES OPPORTUNITY TO REPLACE SGR, PATCHES IT AGAIN

Rather than seize the opportunity to use leftover war money to scrap the Sustainable Growth Rate (SGR) formula that cuts physician payments and threatens to drive you out of the Medicare program, Congress did what it has done every year for 10 years — opt for a short-term solution. It stopped the 27.4-percent cut scheduled for March 1 and froze fees at current levels for the rest of the year. That means it will have to consider the issue again by December, and a permanent fix — if it ever happens — will be even more expensive. “It’s irresponsible,” said TMA President Bruce Malone, MD. “Congress keeps calling it a ‘Doc fix,’ but they haven’t done anything to fix it. Congress missed a great opportunity to solve the broken SGR formula once and for all.”

SURPRISE — SEBELIUS DELAYS ICD-10 INDEFINITELY

TMA advocacy paid off again as U.S. Health and Human Services (HHS) Secretary Kathleen Sebelius announced physicians will not have to begin using the new ICD-10 coding system next year. ICD-10 codes were to take effect Oct. 1, 2013, but Secretary Sebelius delayed that until an unspecified date. She called the ICD-10 codes “important to many positive improvements in our health care system,” but said HHS had heard from many physicians “who have concerns about the administrative burdens they face in the years ahead. We are committing to work with the provider community to reexamine the pace at which HHS and the nation implement these important improvements to our health care system.” The official decision came two days after Acting Centers for Medicare & Medicaid Services (CMS) Director Marilyn Tavenner told the American Medical Association’s National Advocacy Conference that CMS would “reexamine the [ICD-10] timeframe.” TMA delegates convinced the AMA House of Delegates in November to go on record opposing implementation of ICD-10. At our insistence, the house adopted a resolution asking AMA to “immediately petition CMS to stop implementation and development of all new coding and billing standards including ICD-10.” TMA is prepared, whenever CMS ultimately goes ahead with ICD-10. TMA is committed to educational efforts to help physicians and their staff begin using ICD-10 successfully.

ONCOLOGISTS, PSYCHIATRISTS WIN RELIEF FROM DUAL-ELIGIBLE CUT

Our January meeting with the Texas Health and Human Services Commission (HHSC) on the impact of the dual-eligible payment cut has yielded some relief. TMA arranged for specialty society leaders to meet with Billy Millwee, deputy executive commissioner for health services, to discuss the agency’s new policy of not paying coinsurance and deductible payments for Medicare Part B services for patients eligible for both Medicare and Medicaid. Now HHSC officials have advised us they will provide relief for oncologists by increasing payment for chemotherapy-related drugs to Medicare parity no later than June 1. HHSC also will exempt psychiatrists and psychologists from the cut entirely, effective no later than July 1. The agency will monitor the impact of the remainder of the cuts on dual-eligible patients’ access to care. HHSC officials say any additional relief will require legislative action. TMA will continue to push for a long-term solution to the high cost of caring for the dual eligibles. There is no financial incentive for states to improve continuity of care for these patients since the majority of any savings would accrue to the federal government, which pays for their acute-care services. A couple of states have shown significant savings through a federal waiver that promotes stronger case management for these patients.

SENATOR DUNCAN RECEIVES FRIENDS OF MEDICINE AWARD

For a politician, it doesn’t get much better than winning heaps of praise in front of an audience of constituents and voters. State Sen. Robert Duncan (R-Lubbock), whose heavy legislative load included our first-in-the-nation laws protecting the rights of employed physicians, was on the receiving end of the praise at a meeting of the Lubbock-Crosby-Garza County Medical Society. Dr. Malone and I — along with TMA chief lobbyist Darren Whitehurst — travelled to Lubbock to give the senator his Friends of Medicine Award from the 2011 legislative session. Senator Duncan was one of 15 lawmakers honored for going above and beyond to champion important legislation on behalf of Texas patients and physicians.

PAI OFFERS HELP FOR RAC AUDITS, PHYSICIAN RANKING SCHEMES

The Physicians Advocacy Institute, Inc. (PAI) has two new sets of tools to help physicians with some of the toughest problems they face right now.
 PAI was founded in part to enforce the settlements of our antiracketeering lawsuits against the nation’s for-profit health plans. I have served on the PAI Board since its inception.

REGISTER NOW FOR TEXMED 2012 IN DALLAS

Registration is open for TexMed 2012, May 18-19 at the Sheraton Dallas. Don’t miss it.

Monday, February 13, 2012

SHARE YOUR MEDICARE STORIES WITH CONGRESS

It’s SGR crunch time again. In a little over two weeks, the Sustainable Growth Rate (SGR) formula will drive a 27.4-percent cut in physicians’ Medicare payments unless Congress steps in first. Hopes that Washington would finally repeal the SGR seem to wax and wane daily, as the issue is tied up with the partisan debate over extending Social Security tax cuts and extending unemployment benefits. One thing we know for sure is that members of Congress react to real stories from their constituents far more than to form letters or emails. You have an excellent story to tell. You know what the constant threat of the Medicare Meltdown has meant to your patients and your practice. Please pick up the phone today and share your story with Sens. John Cornyn (202-224-2934) and Kay Bailey Hutchison (202-224-5922), and your representative (see the TMA Grassroots Action Center for the number). TMA President C. Bruce Malone, MD, and American Medical Association President Peter Carmel, MD, published a joint column in the Austin American-Statesman urging Congress to act now. We’re also working with Texas AARP to submit joint articles to newspapers all over the state.

TEXANS TACKLE CAPITOL HILL

I’m pleased to join chief TMA lobbyist Darren Whitehurst and an outstanding group of Texas physicians in Washington this week to lobby our congressional delegation on the SGR and other key issues. We’re here as part of the AMA’s National Advocacy Conference. I also will spend some time meeting with key national health care journalists in my role as president of the Physicians Foundation. Our team includes Sue Bailey, MD, vice speaker of the AMA House of Delegates; AMA Board of Trustees member Joe Annis, MD; Lyle Thorstenson, MD, chair of the Texas Delegation to the AMA; AMA Alliance President-Elect Pat Hyer, of Fort Worth; and TMA lobbyist Dan Finch.

TMA HELPS YOU PREPARE FOR ICD-10

The ICD-10 code sets will soon be medicine’s new coding language. Is your practice ready to take on the challenge? Preparing for ICD-10 is more than learning a new code set and upgrading office technology. Start your smooth and successful transition by attending TMA’s half-day seminar “ICD-10 Essentials.” Our coding experts will help you:

  • Understand the foundation and background of ICD-10,
  • Learn the ICD-10 documentation requirements for increased code specificity,
  • Realize how ICD-10 will impact all aspects of your practice, and
  • Create “role-based” training sessions for you and your staff.
As a bonus, each registrant receives a one-time discount on the Simple Solutions GEMs Translator. This downloadable tool helps you easily identify which ICD-10 codes replace the ICD-9 codes you use now. Those who attend the seminar can buy the translator for $99, a $30 savings.

MALONE VISITS WITH UTHSCSA LEADERS, STUDENTS, FACULTY

Dr. Malone led a very productive TMA and Bexar County Medical Society (BCMS) visit with the leadership of The University of Texas Health Science Center at San Antonio. The team met with President William Henrich, MD, and Dean Francisco Gonzalez-Scarano, MD. The primary concern was medical education funding at all levels in Texas and the severity of recent cuts for both undergraduate and graduate medical education. The group included former TMA President Bill Hinchey, MD; TMA Board of Trustees member David Henkes, MD; BCMS President Robert Trevino Jr., MD; and BCMS CEO John Wisnewski. Dr. Malone also enjoyed a lively question-and-answer lunch with students and faculty. Topics included scope of practice, liability reform, public health, and the Texas Medical Board.

WHAT NEEDS TO BE IN TMA'S HEALTHY VISION 20/20?

Under the guidance of the TMA Council on Legislation, our lobby, policy, legal, and communications staff are writing our next strategic roadmap for advocacy. Our Healthy Vision 20/20 will guide our work for you in Austin and Washington over the next several sessions. What problems – and what solutions – do you think need to be part of 20/20? Send your thoughts to TMA Communications VP Steve Levine. The new publication will be a complete rewrite and update of Healthy Vision 2010.

CHIROPRACTIC BOARD WITHDRAWS SCOPE RULES

Ongoing opposition from TMA and others to the Texas Board of Chiropractic Examiners' attempts to expand chiropractors' scope of practice caused the board to shelve those plans. The board's executive director said the board intends to stay within its statutory authority in the future. The proposed rules, which would have permitted chiropractors to perform some procedures that state law only allows physicians to perform, were withdrawn.

Monday, February 6, 2012

SGR FIX GAINS MOMENTUM IN CONGRESSIONAL CONFERENCE COMMITTEE

Negotiators from both parties and both chambers of Congress are now publicly proclaiming the time has come to replace Medicare’s faulty Sustainable Growth Rate (SGR) formula and halt the 27.4-percent cut in physicians’ Medicare pay that’s scheduled for March 1. The question, as usual, is how to pay for it. “We know fewer and fewer doctors can afford to see our Medicare patients,” U.S. Rep. Kevin Brady (R-The Woodlands) said after meeting with Harris County Medical Society and TMA leaders. “In fact, fewer and fewer doctors can afford to run a practice with these uncertain payments. So what I’m looking for today is the ammunition to take back to Washington.” TMA Board Chair Tom Garcia, MD, and chief lobbyist Darren Whitehurst were among those who spoke with Congressman Brady in Houston. Funds that had been projected to be spent on the wars in Iraq and Afghanistan appear to be the best source of financing the nearly $300 billion cost of eliminating the SGR. The negotiators, who also are working on plans to extend the payroll tax cut and unemployment benefits, are less than unanimous on that approach. And some are saying it might violate congressional budget rules.

MALONE-CARMEL TEXAS TRIBUNE INTERVIEW LIGHTING UP THE INTERNET

As 2012 TMA Winter Conference was beginning, TMA President Bruce Malone, MD, and American Medical Association President Peter Carmel, MD, sat down for a lengthy interview with the Texas Tribune. The story that followed — which touched on the SGR, Medicaid cuts, and the state’s new law requiring a sonogram before an abortion may be performed — has garnered a ton of national attention and lit up the Twittersphere. Dr. Carmel called the sonogram law “needless, dangerous interference with the practice of medicine by politicians,” which tracks TMA’s position on the bill.

ANNOUNCING THE TMA EDUCATION CENTER

Something good is now even better. TMA’s great practice management courses are now easier than ever for you to find and take online. The TMA Education Center offers convenient, one-stop access to the CME Texas physicians need. It features:

  • Instant CME,
  • One-hour ethics courses,
  • Mobile-friendly delivery,
  • Member pricing, and
  • Start-and-stop capability.

TMA RECRUITING TEXANS FOR EPIC CANCER STUDY

Fifty years ago, the American Cancer Society sponsored research that first proved the link between smoking and lung cancer. TMA is helping to recruit Texans to participate in a new national American Cancer Society study that aims to make equally groundbreaking findings. Dr. Malone participated in a news conference launching the American Cancer Society’s Cancer Prevention Study-3 (CPS-3) in Texas. “Scientific research is the crux of our profession,” he said. “It’s what helps us extend life and save life.” Watch the video of the news conference.

TEXPAC HELPING CANDIDATES AMIDST UNCERTAINTY OVER DISTRICT LINES

While we wait for all the judges to straighten out — legally, not literally — the new lines for Texas’ legislative and congressional districts, TEXPAC works to help our friends win election in uncertain districts. We’re especially building grassroots strength for our TMA and TMA Alliance members who are running for office. The TEXPAC Alliance Volunteer Days program is back. As of TEXPAC’s Jan. 27 meeting, here are the candidates we’ve endorsed for the 2012 legislative primaries:

  • For the Texas Senate: Incumbent Sens. Kevin Eltife (R-Tyler), Bob Deuell, MD (R-Greenville), Robert Nichols (R-Jacksonville), Jane Nelson (R-Flower Mound), Joan Huffman (R-W. University Place), Carlos Uresti (D-San Antonio), Juan Hinojosa (D-Edinburg), Jeff Wentworth (R-San Antonio), Robert Duncan (R-Lubbock), and Kel Seliger (R-Amarillo).
  • Senate candidates — all current state representatives: Charles Schwertner, MD (R-Georgetown), Ken Paxton (R-McKinney), and Mark Shelton, MD (R-Fort Worth).
  • For the Texas House: Incumbent Reps. Lance Gooden (R-Kaufman), Leo Berman (R-Tyler), Byron Cook (R-Corsicana), Jim Pitts (R-Waxahachie), Chuck Hopson (R-Jacksonville), John Raney (R-College Station), Rob Eissler (R-Conroe), John Otto (R-Dayton), Allen Ritter (R-Nederland), Craig Eiland (D-Galveston), John Zerwas, MD (R-Simonton), Ryan Guillen (D-Rio Grande City), Todd Hunter (R-Corpus Christi), Rene Oliveria (D-Brownsville), J.M. Lozano (D-Kingsville), Paul Workman (R-Austin), Elliot Naishtat (D-Austin), Mark Strama (D-Austin), Eddie Rodriguez (D-Austin), Larry Gonzalez (R-Round Rock), Harvey Hilderbran (R-Kerrville), Ralph Sheffield (R-Temple), Jim Keffer, (R-Eastland), Myra Crownover (R-Denton), Susan King (R-Abilene), Doug Miller (R-New Braunfels), Naomi Gonzalez (D-El Paso), Marisa Marquez (D-El Paso), Lon Burnam (D-Fort Worth), Barbara Nash (R-Fort Worth), Todd Smith (R-Hurst), Vicki Truitt (R-Southlake), Rafael Anchia (D-Dallas), Dan Branch (R-Dallas), Angie Chen Button (R-Garland), Joe Straus (R-San Antonio), Dan Huberty (R-Houston), John Davis (R-Houston), Alma Allen (D-Houston), and Sarah Davis (R-Houston).
  • House candidates: Chris Paddie (R-Longview), Sonal Bhuchar (R-Sugar Land), Greg Bonnen, MD (R-Friendswood), Mike Hamilton (R-Mauriceville), Trent Ashby (R-Lufkin), and Susan Todd (R-Fort Worth).
In other races, we’ve endorsed incumbent Michael Burgess, MD, and candidate David Dewhurst for the U.S. House of Representatives, and incumbents Nathan Hecht, David Medina, and Don Willett the Texas Supreme Court.