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Monday, March 26, 2012

LIVE FROM MCALLEN: TMA HOUSE CALL ON DUAL ELIGIBLES

The state's new payment policy on services physicians provide to patients who are eligible for both Medicareand Medicaid coverage has prompted outrage from physicians across the state. The problem has been particularly acute in the Rio Grande Valley, where severe poverty makes many Medicare patients eligible for Medicaid as well. This Tuesday, from 7 to 9 pm (CT), TMA and the Hidalgo-Starr County Medical Society (HSCMS) are hosting a House Call in McAllen for physicians to express their concerns on this issue. This is a meeting between physicians, the Texas Health and Human Services Commission, and Texas legislators. Watch a live streaming broadcast of the House Call from our UStream page. Earlier in the day, TMA President Bruce Malone, MD; HSCMS President Victor Gonzalez, MD; and TMA Board Vice Chair Carlos Cardenas, MD, will hold a news conference and rally outside a McAllen Medicaid office to protest the dual-eligible policy. You can help by signing our online petitionurging the state to reverse the policy.

ACA ON TRIAL ALL WEEK; PHYSICIANS NEED END TO UNCERTAINTY

The U.S. Supreme Court today began three days of oral arguments on the constitutionality of the Affordable Care Act (ACA). Texas Attorney General Greg Abbott is among the plaintiffs urging the court to overturn the health care law. American Medical News has a nice rundown of the issues at play each day. While health care policy will continue to be a political whipping boy beyond this year’s elections, there’s no reason for physicians to be caught in the middle. First of all, we need an end to the uncertainty. We can’t plan for massive change if we don’t know what the change will be. Secondly, we need a clear voice for physicians on Capitol Hill. TMA argued against final passage of the bill, and we have regularly urged the Texas congressional delegation to follow our prescription to “Find What’s Missing. Keep What Works. Fix What’s Broken.” If our health care system is to change, as it must, we will continue to insist that lawmakers listen to practicing physicians so they can really understand what they are doing to and for you and your patients.

TEXPAC HOSTS VIRTUAL MEET AND GREET WITH TMA, ALLIANCE CANDIDATES

Don’t call us, we’ll call you. Stick by your home phone at 8 pm (CT) this Thursday to talk with four special candidates for the Texas Legislature. Using Tele-Town Hall technology, we’ll give you a chance to question State Rep. Charles Schwertner, MD, an orthopedic surgeon from Georgetown who is running for the Texas Senate District 5 seat; Sonal Bhuchar, a TMA Alliance member from Sugar Land who is running for the Texas House District 26 seat; neurosurgeon Greg Bonnen, MD, of Friendswood, who is running for the Texas House District 24 seat; and TMA Alliance member Susan Todd, who is running for the Texas House District 97 seat. We have a rare opportunity to make a big difference at the state Capitol in this year’s elections, as six physicians and two TMA alliance members endorsed by TEXPAC are running for Texas House and Senate seats. Join us.

WOMEN'S HEALTH — WHERE DO WE STAND?

Whether you call it the “war on women” or the “battle to stop abortion,” these perennially intense Texas issues are burning even brighter thanks to the heat of the 2012 state and national elections. The debates center on Texas’ new law requiring preabortion sonograms, the decision to exclude clinics run by Planned Parenthood or its affiliates from the Texas Women’s Health Program, and the Obama administration’s decision to require employers to cover birth control. I’m getting plenty of calls asking where TMA stands on these issues. Here’s a rundown of our policies and positions:
  • During the 2011 Texas Legislature, we urged lawmakers not to “prescribe the details of the practice of medicine.” We also testified in support of continuing the Women’s Health Program.
  • In October 2011, we called on the Health and Human Services Commission to modify proposed rule changes for the Women’s Health Program so more practicing physicians can participate.
  • TMA abortion-related policy: TMA guidelines for performance of abortion are based upon early and accurate diagnosis of pregnancy; informed and nonjudgmental counseling; prompt referral; skillful and understanding personnel working in a good facility; reasonable cost; and professional follow up. TMA opposes partial-birth abortion.
  • TMA family-planning-related policy: TMA supports full funding of family planning services for uninsured women in Texas, including physical examinations; a contraceptive method; and screenings for diabetes, breast and cervical cancer, hypertension, anemia, and other infections and diseases. TMA opposes redirection of family planning funds to nonmedical services for pregnant women, and will request that the Texas Department of State Health Services track how the shift of federal funds from family planning clinics to federally qualified health centers and alternatives-to-abortion programs affects (a) the use of preventive services, (b) the rate of births to low-income women, and (c) the rate of abortions among low-income women. TMA supports continuation of funding of family planning services for uninsured Texans. All adolescent and adult persons who are institutionalized at facilities of state, county, and municipal governments should be given, as feasible, full information on family planning and prevention of HIV and other sexually transmitted diseases prior to their discharge from the facility. The information should be communicated in a form that is appropriate for the cultural, linguistic, mental, physical, and developmental status of each person.

TMA TOOLKIT MAKES MEANINGFUL USE MEANINGFUL

Confused about “meaningful use” and how to get there using your electronic medical record system? Check out our Meaningful Use Toolkit for step-by-step, vendor-specific instructions.

Tuesday, March 20, 2012

HAVE YOU SIGNED THE PETITION TO REVERSE THE DUAL-ELIGIBLE RULE?

I am happy to report that we’ve made some — but not enough — progress on fixing the problems caused by the state’s new payment policy on dual-eligible patients. Health and Human Services Commissioner Tom Suehs and several key state senators had a very productive meeting with McAllen gastroenterologist Carlos Cardenas, MD, vice chair of the TMA Board of Trustees. The commissioner appears willing to ask the Legislative Budget Board for approval to revise or reverse the policy that says the state will pay no more than the Medicaid-allowable rate for services to patients who are eligible for both Medicare and Medicaid. We are keeping up the pressure. Our paper and online petitions urging strong action received more than 1,500 signatures in just a few days. TMA’s newest video on the dual-eligible problem features a pair of Houston physicians whose practices have been severely squeezed.

MEMBERS-ONLY APP MAKES PHYSICIANS BETTER, HAPPIER, SAFER

Imagine if you had a tool with you always that made it easier for you to care for patients while on call, kept your office clear of patients who really don’t need to be seen, and kept you out of legal hot water with the feds. If you’re one of the 80 percent of physicians who uses a smart phone, you have one of those tools in your purse or hanging on your belt. If you’re a TMA member, that is. TMA and our county medical societies are working with DocBookMD, an Austin company founded by TMA members Tim Gueramy, MD, and Tracy Haas, DO, to bring you that service for free. DocBookMD offers a HIPAA-compliant text messaging system that physicians can use for patient referrals. Using smart phones’ built-in cameras, physicians can safely share key data — like EKG strips or x-rays — to help them make better decisions. Sign up for DocBookMD today.

ONE-STOP SHOPPING FOR CME, WITH SPECIAL MEMBER PRICING

We now have 31 continuing medical education (CME) courses on the new TMA Education Center. The curriculum includes 24 classes with ethics credit and 14 that can help you earn a premium discount from the Texas Medical Liability Trust. You can buy TMA’s practice management publications, sign-up for a seminar, or watch a webinar if you need that CME credit instantly to renew your license.

PHYSICIANS FOUNDATION SURVEY WAITING FOR YOUR RESPONSES

Wharton ophthalmologist Priscilla Metcalf, MD, was very impressed after completing the Physicians Foundation’s survey of U.S. physicians’ satisfaction with the current state of medicine. “This is a very comprehensive survey to get our opinions,” she wrote in an email to me. “It would be good to encourage all TMA members to fill it out.” And that’s just what we’re doing. The survey asks about the state of your practice, your morale, your career plans, and whether you can continue providing services in light of escalating regulatory and financial burdens. We hope to get enough responses from Texas physicians to be able to isolate that data from the national answers. Please take a few minutes to complete the survey today. Thanks.

SAVE THE DATE — MARCH 29 AT 8 PM — FOR "VIRTUAL MEET AND GREET" WITH CANDIDATES

We have a rare opportunity to make a big difference at the state capitol in this year’s elections. For the first time ever, TEXPAC has endorsed six physicians and two TMA Alliance members running for Texas State House and Senate seats. TEXPAC is giving you the chance to meet four of them — Drs. Charles Schwertner of Georgetown and Greg Bonnen of Friendswood and alliance members Sonal Bhuchar of Sugarland and Susan Todd of Fort Worth — right in your house. Or at least on your house phone. Remember, don’t call us, we’ll call you, Thursday, March 29, at 8 pm CT for this tele-town hall meeting with four political members of the TMA family. Each candidate will discuss her or his platform for three minutes — then it will be your turn to ask questions. If you prefer that we call you on your cell or office telephone, please contact the TMA Knowledge Center by telephone at (800) 880-7955 or by e-mail by Tuesday, March 27.

AMA SAYS CMS WILL REHEAR E-PRESCRIBING PLEAS

The American Medical Association has won another bite at the apple for physicians who feel the government is unfairly penalizing them this year for their e-prescribing activity last year. “Even if you have already contacted CMS, contact CMS again,” AMA said in a statement. “They are willing to hear your case.” For more information, see TMA’s E-Prescribing Resource Center.

Monday, March 12, 2012

PHYSICIANS FOUNDATION SURVEY NEEDS YOUR STORIES

The Physicians Foundation is surveying you and your 650,000 physician colleagues across the country to determine how satisfied you are with the current state of medicine. The survey asks about the state of your practice, your morale, your career plans, and whether you can continue providing services in light of escalating regulatory and financial burdens. Please take a few minutes to complete the survey. The foundation wants to produce a “state of the union” report on the medical profession that can have a significant impact on both policy and public perceptions. A key question the survey poses, said Tim Norbeck, CEO of the foundation, is "Can physicians meet the needs of patients given current medical practice conditions?

HOW HAS DUAL-ELIGIBLE PAYMENT POLICY AFFECTED YOUR PRACTICE?

TMA’s fight to draw attention to the problems caused by the state’s new payment policy for dual-eligible patients hit the big time with an article in the New York Times. That piece, and a new TMA video, focus on the plight of La Joya family physician Javier Saenz, MD. But physicians across Texas have been squeezed by the decision to pay no more than the state’s Medicaid rate for services provided to patients who are eligible for both Medicare and Medicaid. State and federal officials say they have fixed a pair of computer problems that brought payments for many patients down to zero, but they haven’t announced when they will reprocess thousands of affected claims. TMA and the Hidalgo-Starr County Medical Society are hosting a March 27 town hall meeting on the issue in McAllen. In the meantime, we are collecting signatures on a petition asking lawmakers and the Health and Human Services Commission to “preserve access to quality health care.” We’re also asking all TMA-member physicians to share how the problem has affected their practice.

NONPHYSICIAN PRACTITIONER MANUAL KEEPS YOU OUT OF HOT LEGAL WATER

Do you employ a nonphysician practitioner (NPP)? Thinking about hiring one? Make sure you do it right. TMA’s new publication, Hiring, Billing, and Delegation of Duties for a Nonphysician Practitioner will help you avoid legal pitfalls, bill correctly, give patients more access to care, create a “team care” approach, and supervise and delegate correctly. It also includes credentialing information, sample job descriptions, waiver requests, billing guidelines, and case studies, and it offers 4.5 hours of continuing medical education ethics credit. Pick yours up from the TMA Education Center today at the special members-only price of just $89.

FORMER TEXPAC CHAIR NAMED TO NEW TEXAS HEALTH CARE QUALITY BOARD

Wichita Falls pathologist Susan Strate, MD, the former chair of the TEXPAC Board of Directors, is one of six TMA members whom Gov. Rick Perry appointed to the Texas Institute of Health Care Quality and Efficiency Board of Directors. The legislature created the institute last year to “improve health care quality, accountability, education, and cost to the state by encouraging health care provider collaboration, effective health care delivery models and coordination of health care services.” The governor named pediatrician Ben Raimer, MD, senior vice president and professor at The University of Texas Medical Branch at Galveston, to chair the board. Other TMA members he appointed to the panel are Austin internist Steven Berkowitz, MD, founder and president of SMB Health Consulting; Houston family physician Patrick Carter, MD, medical director of care coordination and quality improvement at Kelsey-Seybold Clinic; Houston family physician John Joe, MD, chief medical information officer at St. Luke’s Episcopal Health System; and New Braunfels family physician Beverly Nuckols, MD.

In other appointment news, Lt. Gov. David Dewhurst reappointed Austin oncologist Joe Bailes, MD, to the Cancer Prevention Research Institute of Texas (CPRIT) Oversight Committee.

TMA TO CONGRESS: CAN THE IPAB

Two key congressional committees voted to support a bill that would repeal the controversial Independent Payment Advisory Board (IPAB). Created by the Affordable Care Act, IPAB is a 15-member panel appointed by the president that would recommend cuts in fees to physicians if federal spending on health care reaches certain levels. The House Energy and Commerce Committee and Ways and Means Committee both OK’d the IPAB-killing bill last week. TMA joined 41 other state and specialty societies in encouraging Energy and Commerce to pass the bill. “While we recognize the need to reduce the federal budget deficit and control the growth of health care spending, the IPAB is simply the wrong solution for addressing these budgetary challenges,” the letter said. “We need a workable alternative that adequately reimburses physicians and ensures that patients will have timely access to quality care.”

TMA HOSTS WEBSITES FOR 31 COUNTY MEDICAL SOCIETIES


We now host 31 county medical society websites serving physicians in 47 counties. Find links to all Texas county medical societies on the TMA website.

Monday, March 5, 2012

DUAL-ELIGIBLE RULE WREAKING HAVOC IN PHYSICIANS' OFFICES

A combination of poorly informed government decisions and bureaucratic bungling is creating a medical emergency for thousands of Medicare-Medicaid eligible Texans and the physicians who care for them. One family physician in the Rio Grande Valley told TMA he has exhausted his life’s savings trying to make payroll because he has received no payments since the first of the year for seeing dual-eligible patients, who make up more than one-third of his practice. We also have heard from other physicians in the Valley, from an ophthalmologist in rural West Texas, and an orthopedist in Houston. TMA wants state leaders to take emergency action to protect our patients. As part of a cost-saving move the Texas Legislature ordered, the Texas Health and Human Services Commission adopted a new policy of not paying coinsurance and deductible payments for Medicare Part B services for patients eligible for both Medicare and Medicaid. TMA is asking Health and Human Services Commissioner Tom Seuhs and state and federal lawmakers to reexamine the new rule and the serious Medicare and Medicaid computer errors that compounded the situation.

TMA "ARDENTLY OPPOSED" TO NEW DRAFT OF NETWORK ADEQUACY RULES

The latest draft of Texas Department of Insurance (TDI) informal working rules regulating the adequacy of networks in preferred provider benefit plans (PPBPs) and the new exclusive provider benefit plans (EPBPs) is a step in the wrong direction. Late last year, Texas Insurance Commissioner Eleanor Kitzman suspended newly adopted rules, years in the making, that ensure adequate networks in PPBPs. She said she took that action to “align” the rules with regulations governing commercial EPBPs, which the Texas Legislature authorized for the first time in 2011. In a letter to TDI, TMA President Bruce Malone, MD, said the association is “ardently opposed” to the new approach the agency has taken in the working draft rules on network adequacy. He pointed out that:
  • Revisiting the PPBP rules does not serve an administrative simplification purpose or aid in compliance. If anything, it serves an “administrative complication purpose.”
  • This latest informal draft goes far beyond the stated purpose of “aligning” the rules governing PPBPs and EPBPs; and
  • The EPBPs lawmakers authorized last year are statutorily required to comply with the PPBP laws, not vice versa. 

FREE ONE-DAY PASS TO OFFICE STAFF TO TEXMED 2012 EVENTS

TMA members’ office staff can get a one-day free pass to the TexMed 2012 General Session and Expo Hall in Dallas on Friday, May 18. For just $75, office personnel also can attend the other education sessions, many of which focus on practice management. Have you registered yet for TMA’s annual meeting, which will be at the Sheraton Dallas on May 18-19?

PROPOSED FEDERAL SUNSHINE RULE GOES TOO FAR

 Daily doses of sunshine are necessary for good health, but too much time outdoors can give you sunburn and lead to skin cancer. That’s the position TMA, the American Medical Association, and more than 100 other medical societies took in comments protesting the Centers for Medicare & Medicaid Services (CMS) draft “sunshine rule.” The Affordable Care Act mandates that beginning this year, manufacturers of drugs, medical devices, and biologicals participating in federal health care programs must track any transfers of value or payments of $10 or more to physicians and teaching hospitals. Our letter says CMS “has exceeded its statutory authority with regard to at least one significant provision and misconstrued Congress’ overall intent and statutory requirements in other areas.” We support the goal of enhancing transparency, but the proposed rule would lead to “the publication of misleading information and impose costly and burdensome paperwork on physicians while shedding very little light on actual physician-industry interactions.”

ON THE ROAD WITH DR. MALONE

Like many of his TMA president predecessors, Dr. Malone devotes numerous days and nights each month spreading our message to members and the public. This week, he traveled to Longview, where he gave members of the Gregg-Upshur County Medical Society an update on the 2011 Texas Legislature and what lies ahead. Dr. Malone also met with the Texas Academy of Family Physicians Board of Directors to discuss Healthy Vision 20/20 and medicine’s agenda for the 2013 legislative session.

MEDICINE'S CANDIDATES PREPARE FOR MAY 29 PARTY PRIMARIES

Finally, we know when this year’s elections will be and where the Texas legislative and congressional district lines will fall. A federal three-judge panel ruled that our long-delayed primary elections will take place May 29, with runoffs on July 31. As an article in this month’s Texas Medicine explains, a record number of TMA and TMA Alliance members will be on the ballot this year. Read why men and women like Friendswood neurosurgeon Greg Bonnen, MD, are running for office for the first time, and what he and the rest of our “Special Nine” think they bring to the U.S. Congress and Texas Legislature.