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Monday, April 30, 2012

DECISION ON OFF-SHORE MEDICAL SCHOOL DELAYED

 I’m very pleased to report that the Texas Higher Education Coordinating Board, at the last minute, backed away from approving the American University of the Caribbean’s (AUC’s) bid to bring its third- and fourth-year medical students to Texas for training clerkships. We appreciate the leadership of TMA trustee and coordinating board member David Teuscher, MD. With TMA and several key lawmakers arguing that it had no legal authority to grant AUC’s request, the coordinating board decided to ask Attorney General Greg Abbott for a legal opinion on the issue. That could delay any action for about six months. We remain very concerned that approving the AUC proposal could hurt the quality of medical education in Texas and make it even more difficult for in-state medical schools to expand their class sizes to help meet Texas’ physician shortage.

TMA REACHES OUT TO TYLER PHYSICIAN GROUPS

TMA President Bruce Malone, MD, and I met in Tyler with the medical staffs of the city’s two largest physician groups: East Texas Medical Center and Trinity Mother Frances. We discussed with them the value that organized medicine brings to large physician groups and why we, in turn, need their leadership and participation. At the Smith County Medical Society meeting, Dr. Malone presented a continuing medical education program on health system reform, and I shared the results of The Physicians Foundation national survey of young physicians.

TMA HOSTS MEDICAL EDUCATION SUMMIT TODAY

Dr. Malone is bringing together a host of legislative staffers and state agency leaders to hear what we can do about Texas’ growing physician shortage. The lineup of expert speakers includes Jordan Cohen, MD, president emeritus of the Association of American Medical Colleges; Texas Higher Education Commissioner Raymund Paredes, PhD; and the top leaders of all the Texas medical school systems. The purpose of the Where Are All the Doctors Going summit is to educate these key decisionmakers in advance of our 2013 legislative push to strengthen undergraduate and graduate medical education funding. The physician workforce shortage is a key component of our Health Vision 2020 document.

DUAL-ELIGIBLE CONFAB SLATED FOR HARLINGEN

The Cameron-Willacy County Medical Society called a general membership meeting this week to discuss the state’s Medicare-Medicaid dual-eligibility policy and what it’s doing to patient care and physicians’ practices in the Rio Grande Valley. As they did for the rally and town hall meeting last month in McAllen, Dr. Malone and TMA staff will travel south for the event. Despite assurances from Health and Human Services Commissioner Tom Suehs that he wants to help, we need to keep up the pressure on state lawmakers to reverse the cut. Use TMA’s Grassroots Action Center to email your story to your state senator and representative. Tell your lawmakers to ask the Legislative Budget Board to rescind the dual-eligible cut.

TEXAS ACP WINS TOOKER AWARD

Congratulations to Robert E. Jackson, MD, FACP, and Sue S. Bornstein, MD, FACP, and the Texas Chapter of the American College of Physicians (ACP) for winning ACP’s prestigious 2012 John Tooker Evergreen Award for its Texas Medical Home Initiative. The award recognizes the valuable contributions of individual chapters to enrich, educate, and enlighten the membership while improving recognition of ACP and chapter efforts at the local level. TMA is proud to support the initiative.

GET YOUR VOTER REGISTRATION CARD IN THE MAIL TODAY

Today is the last day to register to vote if you want to take part in the May 29 party primaries. 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. We can’t do it without your vote. If you need to register, or to find out if you are currently registered, please visit the secretary of state’s website. You may fill out a voter registration application online, print it, and mail it (postmarked today) to the voter registrar in your county.

Monday, April 23, 2012

PHYSICIANS FOUNDATION HEARS STRATEGIES FOR SAVING PRIVATE PRACTICE

“The stream of physicians leaving private practice for employment has become a torrent,” according to a report presented to The Physicians Foundation, but that doesn’t mean private practice is dead. The same forces driving doctors out of traditional forms of practice also make possible some innovative new models. “Robust models of private practice exist that are viable, sustainable, and professionally rewarding, even in today’s health care environment,” the 53-page report concluded. A separate study from health care analyst Jeff Goldsmith, PhD, says The Physicians Foundation should “create a Center for Medical Practice Innovation to foster and help replicate successful innovations in physician practice.” Dr. Goldsmith’s paper found that the pending retirement of the baby boom generation of physicians and the entry of millions of boomers into Medicare are responsible for “much of the turmoil in the physician market over the past five years.”

COORDINATING BOARD TO VOTE ON OFF-SHORE MEDICAL SCHOOL THIS WEEK

A powerful state senator has added her voice to the chorus opposing the American University of the Caribbean’s bid to bring its third- and fourth-year medical students to Texas for training clerkships. The Texas Higher Education Coordinating Board is scheduled to vote on the proposal on Wednesday. State Sen. Judith Zaffirini (D-Laredo), chair of the Senate Higher Education Committee, wrote a strongly worded letter asking the coordinating board to forego action and let the Texas Legislature review the issue next year. “Once foreign institutions are allowed to provide third- and fourth-year clinical training, students from publicly funded medical schools may lose access to critical rotation slots,” Senator Zaffirini wrote. “The Texas Legislature may never have intended to authorize the [coordinating board] to allow foreign medical schools to participate in third- and fourth-year clinical rotations at Texas hospitals.”

TEXPAC ADDS DOZENS OF ENDORSEMENTS, LAUNCHES MEMBERSHIP CAMPAIGN

With just five weeks remaining until the May 29 party primaries, the TEXPAC Board of Directors endorsed more congressional, legislative, and judicial candidates. Look for news soon on how you can help your local candidates. Meanwhile, our print shop worked all weekend to print thousands of judicial slate cards — those famous “little red cards” you can share with your patients, family, and friends. Order your free cards online. Finally, look for TEXPAC’s 2012 membership solicitation, Operation Health Texas 2012, in your snail mailbox this week. Please share it with colleagues who may not be politically active and remind them: “If Texas physicians don’t get involved, then others will turn health care into a game.”

IS DUAL-ELIGIBLE DEBACLE HURTING YOUR PRACTICE?

 We’ve heard and seen lots of examples (see our videos from La Joya and Houston) of how the state’s new dual-eligible payment policy is wreaking financial havoc in physicians’ practices across the state. Many doctors have told us the cash-flow problems have forced them to dip into their retirement accounts or take out commercial loans to keep their practices afloat. The only way we can reverse this disaster is to convince state leaders what it means to patients and practices across Texas. Look for a TMA action alert this week to share your story with your state senator and representative. We will keep the pressure up, but we need grassroots help to make it work.

DON'T LEAVE MONEY ON THE TABLE; CODE CORRECTLY

OB-Gyns, pediatricians, family physicians, orthopedic surgeons, and internists: Are you coding correctly for your specialty? TMA’s new half-day interactive seminar provides a comprehensive, up-to-date, specialty-specific coding curriculum using real-world practice examples. We’re coming to Arlington, Houston, McAllen, and San Marcos. Join us; it will be worth your while.

TEXMED HOTEL DEADLINE EXTENDED UNTIL FRIDAY

We learned this morning that the Sheraton Dallas has given you until Friday, April 27, to get the conference rates for TexMed 2012. You can register for the May 18-19 event and book your hotel room online. Check out the TexMed advance program to see for yourself all the excitement we have planned, including TEXPAC’s 50th Anniversary Dinner, the annual TMA Foundation Gala, a very busy House of Delegates policymaking and election agenda, more than 100 hours of continuing medical education credit, and an outstanding exhibit hall. I can’t wait to see you there.

Monday, April 16, 2012

TMA BATTLES TO STOP OFF-SHORE MEDICAL SCHOOL'S TEXAS INCURSION

Following a trend that led to bidding wars for clerkship spots in New York, the American University of the Caribbean is seeking state approval to bring its third- and fourth-year medical students to Texas for training clerkships. TMA and all nine Texas medical schools have expressed our serious concerns about the proposal now before the Texas Higher Education Coordinating Board. Particularly as we work to increase the state’s capacity to produce more home-grown physicians, Texas cannot afford to pay more for — or lose — slots of students’ clinical training. “We believe our citizens and students would expect none other than for us to take a firm position on the need to ensure there is sufficient capacity for core clerkships for our students in the state, that our schools are not compromised by forces beyond their control in upholding our nation’s rigorous accreditation standards, and that we are afforded adequate oversight of our clinical faculty and students in clinical settings,” the nine schools wrote in a letter to the coordinating board.

HEALTHY VISION 2020 BECOMING CLEARER

The final form of TMA’s Healthy Vision 2020, our strategic roadmap for TMA’s state and federal advocacy initiatives for the remainder of the decade, is coming into focus. We sent a draft of the detailed document to TMA’s policy councils for their review and comment. The next stop is the Board of Trustees, which we will ask to forward the plan to the TMA House of Delegates next month. Healthy Vision makes eight key recommendations for improving health care and maintaining the viability of physicians’ practices in Texas. They are:
  1. Ensure an adequate health care workforce;
  2. Protect physicians’ independent medical judgment;
  3. Promote efficient and effective new models of care;
  4. Repeal harmful and onerous state and federal regulations;
  5. Invest in prevention;
  6. Protect and promote a fair civil justice system;
  7. Provide appropriate state and federal funding for physician services; and
  8. Establish fair and transparent insurance markets for patients, employers, taxpayers, and physicians.

REGISTER TO VOTE BY APRIL 30

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. We can’t do it without your vote. To vote, you must be registered. Texas’ 2012 party primary elections will occur on Tuesday, May 29; early voting will last from Monday, May 14, to Friday, May 25. The deadline to register to vote in your 2012 party primary is April 30. If you need to register, or to find out if you are currently registered, please visit the Secretary of State’s website. You may fill out a voter registration application online, print it, and mail it to the voter registrar in your county.

TMA STANDS UP FOR DEFAMED PHYSICIAN

A former leader of TMA’s rural medicine advocacy activities has been severely criticized by a so-called “investigative report”by a Houston television station over his use of over-the-counter medications to treat patient wounds. Daniel Dugi, MD, of Cuero sued KPRC-TV for defamation over its highly inaccurate series of reports. Dr. Dugi won at both the trial court and Court of Appeals. KPRC appealed to the Supreme Court, arguing that physician-plaintiffs in defamation lawsuits must prove a higher standard of negligence. TMA filed a formal legal brief with the court, rejecting KPRC’s argument on libel and also outlining typical standards of care for over-the-counter drugs.

SURVEY FINDS YOUNG PHYSICIANS WORRIED ABOUT THE FUTURE

Primarily because of the Affordable Care Act, a majority of U.S. young physicians are quite pessimistic about the future of health care in this country, new research from The Physicians Foundation found. As president of the foundation, I was quoted in an exclusive story by Reuters news saying, “Young doctors are finding upheaval and transition in the way the health care system is structured right now. ... And when our doctors are dissatisfied, we’ve got a problem with the system.” The foundation’s nationwide findings mirror TMA’s research into Texas physicians.

ANNUAL TMA CANCER SYMPOSIUM COMING APRIL 27

TMA’s Physician Oncology Education Program sponsors its annual cancer symposium at the Central Texas Medical Center in San Marcos on Friday, April 27, from 9 am to 1:30 pm. Topics include intimacy during and after cancer, genetic risk assessment for hereditary cancers, the Texas Cancer Registry, how to use online tools, and exercise for cancer survivors. Registration is $50 for physicians; $25 for nurses, physician assistants, social workers, and pharmacists; and $10 for medical and nursing students and community members.

Monday, April 9, 2012

ABILENE PHYSICIANS TESTING VIRTUAL MEDICAL COMMUNITY WITH BLUE CROSS

Members of the Taylor-Jones-Haskell County Medical Society are working with Blue Cross and Blue Shield of Texas (BCBSTX) to pilot-test a new method of sharing information among local physicians. The project, arranged by TMA, will test how a virtual medical community that uses existing relationships among physicians in Abilene can improve patient care and help physicians better demonstrate the value of the care they provide. The pilot likely will involve several small practices as well as a large practice. It combines several health information technology products that will permit physicians to obtain information, from appointment setting through verification of eligibility to payment. It will allow physicians to exchange information with BCBSTX and other payors. We’re excited about this pilot project, and we’ll keep you apprised of progress.

APPEALS COURT BACKS TMA ON CHIROPRACTIC RESTRICTIONS

Texas chiropractors may not perform needle electromyography (EMG) or manipulation under anesthesia (MUA), the Third Court of Appeals ruled. The appellate court decision supports arguments from TMA and others that the Texas Board of Chiropractic Examiners had exceeded its legal authority in adopting rules that would have allowed chiropractors to perform needle EMGs and MUA. The appeals court, however, sent a portion of the case back to the lower court for additional work. It said chiropractors may“analyze, examine, and evaluate” conditions that are within their statutory scope of practice: “biomechanical conditions of the spine or musculoskeletal system.” Our legal team is still studying the 58-page order in detail.

PHYSICIAN IN EYE OF KATRINA LEGAL HURRICANE IS TEXMED 2012 KEYNOTE SPEAKER

When Hurricane Katrina roared through New Orleans in 2004, it struck the hospital where Anna Pou, MD, worked and the critically ill patients under her care. Then it struck her professional reputation. Dr. Pou, a professor with the Louisiana State University Health Sciences Center, is the keynote speaker May 18 at TexMed 2012 in Dallas. During her presentation, “Legal and Ethical Considerations in Crisis Care,” Dr. Pou will relay her experiences during Katrina, when she and her colleagues cared for their patients under horrific and extremely austere conditions. Later charged with murder for the death of patients, Dr. Pou's experience underscores the need for crisis standards of care, as well as legal protections for health care professionals and hospitals. She has since championed precedent-setting legislation that is now Louisiana law. It’s must-see TexMed, sponsored by the Texas Medical Liability Trust.

LAST CHANCE: PHYSICIANS FOUNDATION SURVEY NEEDS YOUR STORIES

The Physicians Foundation survey of 650,000 physicians nationwide is wrapping up. If you haven’t answered yet, please do. The purpose of the project is 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. 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. We hope to get enough responses from Texas physicians to be able to isolate our data from the national answers. Please take a few minutes to complete the survey today. Thanks.

MAPS, REPORTS HIGHLIGHT TEXAS HEALTH STATS, PHYSICIAN SHORTAGES, COUNTY BY COUNTY

For those who like to dig through data, a treasure-trove of county-level (and lower) health statistics has been published recently on the Internet. The Robert Wood Johnson Foundation’s “County Health Rankings & Roadmaps” looks at health indicators in every county in the country. Collin County – north of Dallas – is the healthiest county in the state, and Marion County in Northeast Texas is the least healthy. Those numbers are based on mortality and morbidity rates. But when you look at health factors like smoking, diabetic screening, air pollution, and poverty, Kendall County in the Hill Country takes the top spot and Starr County in the Rio Grande Valley is in the basement. Meanwhile, geomapping company ESRI has produced an interactive map showing U.S. counties’ needs for all physicians and for primary care physicians. Using 2009 census data, the ESRI map shows the dozens of Texas counties with no physicians and those with a “very high need” or a “high need”for more doctors. Finally, the Kaiser Family Foundation issued a new report on the primary care health professional shortage areas (HPSAs) in each state. Our 397 HPSAs, second only to California, serve nearly 5.6 million Texans or nearly one-fourth of the state. Those areas need almost 600 primary care physicians to escape HPSA status. Easing the state’s severe physician workforce shortage is a key component of TMA’s Healthy Vision 2020, which will guide our work for you in Austin and Washington over the next several sessions.

KEEP UP WITH YOUR TMA COLLEAGUES ON TWITTER

138 Texas physicians can’t be wrong; at least they’re not lacking in opinions. The TMA Member Physicians Dailybrings you a once-a-day “newspaper” of all the Twitter posts your colleagues have shared in the past 24 hours. Check out their views, photos, and videos on health and politics, arts, entertainment, and otherwise uncategorical Tweets. If your posts are missing from the daily feed, send your Twitter handle to Steve Levine, TMA VP for communication, and he’ll add you.

Monday, April 2, 2012

HUNDREDS RALLY TO STOP DUAL-ELIGIBLE CUTS

Hundreds of patients, physicians, and office staff joined forces in McAllen (watch video) urging state legislators to rescind budget cuts that are harming access to care for thousands of dual-eligible patients — those who qualify for both Medicare and Medicaid. Later that evening, about 130 South Texas physicians gathered at a House Call on the topic, sponsored by TMA and the Hidalgo-Starr County Medical Society. (Watch House Call video.) Deputy Health and Human Services Commissioner Billy Millwee, fielding questions and complaints at the evening event, pledged to work to provide “some relief”to the cuts. Texas’ new payment policy on services physicians provide to dual-eligible patients has created a medical emergency across the state. The problem has been particularly acute in the Rio Grande Valley, where severe poverty makes so many Medicare patients eligible for Medicaid as well. Because the Texas Legislature mandated the cuts last year, the Health and Human Services Commission has no authority to reverse them entirely without direction from the Legislative Budget Board, which is composed of senior leaders from the House and Senate. You can help by signing our online petition.

AMA LOOKING FOR NEXT CHANCE TO REPEAL SGR

TMA Vice President for Advocacy Darren Whitehurst is in Washington today for the American Medical Association’s SGR/Physician Payment Reform Legislative Strategy Task Force. The group of senior medical society staff from around the country is exploring strategy and tactics for our next chance to seek permanent repeal of Medicare’s Sustainable Growth Rate (SGR) payment formula, including new ways to approach Congress, engage patients, and energize physician grassroots. Without action from Congress, the SGR will mandate a 32-percent cut in physicians’ Medicare payments next year. We’ll keep you posted on what comes out of the meeting and on next steps

TMA EXPLORES OPTIONS WITH OPTUM

Four top TMA leaders met with representatives of OptumHealth to begin a long-term planning process on how we might be able to work together. Optum is a nationwide firm that “provides the information, tools, and solutions that people use to help navigate the health care system.” TMA President Bruce Malone, MD, led the discussion on how Optum and TMA can build an infrastructure for physicians to support accountable care activities, including health information exchanges (HIEs), and financial and outcomes-of-care management systems. TMA President-Elect Michael Speer, MD; Trustee Dan McCoy, MD; and former Council on Socioeconomics Chair Susan Strate, MD, also participated. We expect to conduct a much larger planning session later in the year.

CANDIDATES FEEL THE LOVE

Almost 2,600 TMA and TMA Alliance members listened in to TEXPAC’s first virtual meet-and-greet session. Dr. McCoy served as host for the Tele-Town Hall event, which featured State Rep. Charles Schwertner, MD, an orthopedic surgeon from Georgetown running for the Texas Senate District 5 seat; Sonal Bhuchar, a TMA Alliance member from Sugar Land running for the Texas House District 26 seat; neurosurgeon Greg Bonnen, MD, of Friendswood, running for the Texas House District 24 seat; and TMA Alliance member Susan Todd of Fort Worth, running for the Texas House District 97 seat. We are excited about our prospects in this year’s elections, where six physicians and two TMA alliance members endorsed by TEXPAC are seeking Texas House and Senate seats.

TMA OFFERS NEW WHITE PAPER ON PATIENT-PHYSICIAN RELATIONSHIP

Physicians’ legal responsibilities to their patients begin with the creation of the patient-physician relationship and continue as long as that relationship exists. A physician is potentially liable for medical professional liability only where there is a patient-physician relationship. To help you better understand your risks and responsibilities, TMA’s Office of the General Counsel has published a new white paper, “Creation of the Patient-Physician Relationship.” It’s available for free for members only on the TMA website.

HARD HATS PROGRAM TAPPED FOR SAFETY AWARD

Congratulations to Hard Hats for Little Heads. The TMA and TMA Alliance program, funded by the TMA Foundation, won the JC Montgomery Child Safety Award from the Texas Office for Prevention of Developmental Disabilities. Since its inception in 1994, Hard Hats has given away more than 100,000 bicycle helmets. Get involved by sponsoring a helmet giveaway in your community. The award is named after the president of the Texas Scottish Rite Hospital for Children in Dallas.