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Wednesday, May 30, 2012


If your practice isn’t all it should be, maybe you need a little expert help. The experienced team at TMA Practice Consulting Services — available only to TMA members — can diagnose your problems and prescribe the right treatment. From tiny offices to huge practices, you’ll be pleasantly surprised at the great price and overwhelmed by the outstanding service. The consultants, all TMA staff members with great credentials, specialize in operations assessments, billing and coding assessments, and coding and documentation reviews. Call (800) 523-8776 or send an email.


“Currently, we are nearly 46,000 members strong. I want 50,000,” new TMA President Michael Speer, MD, said in his installation address. “I challenge you and every TMA physician to go out and multiply.” That’s a big number, 50,000. It’s what best-selling author Jim Collins calls a BHAG: a big, hairy, audacious goal. It’s an objective “so clear, compelling, and imaginative that it fuels progress,” Mr. Collins says. Dr. Speer laid out his vision of testifying at the Capitol in support of one of our Healthy Vision 2020 goals, and seeing “the head-turning, eye-opening impact that the 50,000 number has.” You can do your part, as a TMA leader, not only by selling the power of TMA membership to all your colleagues who don’t belong but also by continuing to build TMA into the kind of organization that Texas physicians would be crazy to pass up. You also can invite Dr. Speer to your meetings — he says he is “prepared to meet any and all non-TMA physicians … one-on-one, in pairs, or in large groups … anywhere across this great state of ours.”


Last week’s TexMed 2012 wrap-up issue of EVPGram was too packed with news for me to take the time to thank Immediate Past President Bruce Malone, MD, for an absolutely outstanding year. As documented in the huge scrapbook we give each of our outgoing presidents, Dr. Malone crisscrossed the state and the nation on your behalf. He was never too busy to talk to a member physician one-on-one or to respond to a news media call. In his final six weeks in office, Dr. Malone made a pair of trips to the Rio Grande Valley to urge reversal of the dual-eligible payment cut, and he made two extended visits with groups of Indo-American physicians who asked him to speak. On behalf of the entire TMA staff, thank you, Dr. Malone, for a great year!


TMA is joining with Texas Medical Liability Trust (TMLT) and others in support of HR 816, The Provider Shield Act, sponsored by U.S. Reps. Phil Gingrey (R-GA) and Henry Cuellar (D-Laredo). The law would clarify that the Patient Protection and Affordable Care Act (PPACA) does not create new theories of liability or alter the rules governing medical professional liability lawsuits. “We are concerned that certain provisions of the law could be used by judges and personal injury lawyers to establish a national ‘standard of care’ to prove negligence in such lawsuits when a physician’s personalized care for his or her patients may not adhere to the federal payment or billing/coding guidelines,” the group wrote in a letter to the chair and ranking minority member of the House Energy and Commerce Committee. Supporting HR 816 is part of our aggressive federal agenda:


When the claims clearinghouse Availity inadvertently cut its connection to the Texas Medicaid & Healthcare Partnership (TMHP) last month, more than 30,000 claims totaling $23 million filed by physicians and other healthcare professionals in just four days were in danger of disappearing. And the number of claims was increasing by the hour. But Availity knew whom to call: Genevieve Davis, director of TMA’s Payment Advocacy Department. She notified TMA Director of Government Affairs Helen Kent Davis, who immediately found someone at TMHP who could resolve the issue. Job well done, behind the scenes, for TMA members across the state.

Monday, May 21, 2012


Neonatologist Michael Speer, MD, and longtime political activist Linda Adkins — both of Houston — are the new presidents of TMA and the TMA Alliance. Dr. Speer was installed as TMA’s 147th president and Mrs. Adkins as the 95th TMA Alliance president at TexMed 2012 in Dallas. Dr. Speer told the TMA House of Delegates that his goal is to increase TMA membership from nearly 46,000 to 50,000 by the end of his one-year term. “Because the more physician boots on the ground and the more physician voices in the air when discussing medical issues with mothers, fathers, grandfathers, grandmothers, aunts, cousins, and … by the way … legislators, the more we are heard, and respected,” he said. “Go out and multiply.”


Wading through a lengthy handbook of reports and resolutions, the House of Delegates set Smoke-Free Texas, more residency slots, and restored funding for the Texas Physician Education Loan Repayment Program and the Statewide Preceptorship Program as priorities for the 2013 legislative session. Among the other highlights, the house:
  • Asked for restoration of funding for the state family planning program and Texas Women’s Health Program;
  • After extensive debate, voted to study whether general hospitals in urban counties should have a physician on site to respond to emergencies 24 hours per day, seven days per week;
  • Said only licensed physicians or their appropriately supervised physician assistants or advanced practice nurses should conduct athletics-participation physicals for Texas schoolchildren;
  • Set policy to make Medicare’s Value-Based Purchasing Program fair and financially sound;
  • Adopted a new plan to help physicians who belong to inactive county medical societies;
  • Supported efforts to prevent elective deliveries prior to 39 weeks of gestation;
  • Said TMA should work to require allied health professionals to clearly display proper identification;
  • Called for new regulations against, and education about, the dangers of distracted driving;
  • Said the state should use only scientifically accurate information in the brochure physicians must give to all patients requesting an abortion, and lawmakers should reduce the loss-of-license penalty for physicians who do not comply with the new abortion-sonogram law; and
  • Adopted strong new policy to protect clinical training opportunities for Texas medical students.


In one of the day’s few uncontested elections, the House of Delegates unanimously chose Fort Worth orthopedic surgeon Steve Brotherton, MD, as TMA president-elect. Dr. Brotherton, who has served as speaker and vice speaker of the house for seven years, will be installed as TMA president at TexMed 2013 in San Antonio. In other election results, delegates:


Early voting for the May 29 party primaries continues through Friday. Please don’t forget to vote for the TEXPAC-endorsed candidates on your ballot, and bring along your family, neighbors, and friends. The confusion over election dates, no real presidential nominating contest, and a Memorial Day weekend voting date are conspiring to hold down turnout. That means the men and women who do go to the polls will wield a more powerful voice than usual at the ballot.


At age 99, Virginia Connally, MD, has certainly kept her sense of humor. Taking the stage to receive TMA’s 2012 Distinguished Service Award after Abilene ophthalmologist Paul Thames, MD, read a lengthy history of her accomplishments, Dr. Connally said, “If I could hear what he said, I’d be blushing.” The trailblazer was the first female physician in Abilene, practicing as an eye, ear, nose, and throat doctor for 42 years. Among other awards bestowed at TexMed 2012:
  • Former TMA President Josie Williams, MD, won the Young Physician Section’s Young at Heart Award;
  • Waco family physician Jackson Griggs, MD, received the J. T. “Lamar” McNew, MD, Award from the Resident and Fellow Section;
  • The Medical Student Section (MSS) gave its C. Frank Webber, MD, Award to Steve Robinson, MD, a family physician from Lubbock;
  • Texas Tech University Health Sciences Center won the MSS Chapter of the Year Award; and
  • MSS Student of the Year was Alexandra Iacob, from The University of Texas Medical School at Houston.


We distributed the first draft of TMA’s Healthy Vision 2020, the strategic roadmap for our state and federal advocacy initiatives for the remainder of the decade, at TexMed 2012. But this is the first draft, and we are already at work making it better. We want your ideas, suggestions, and improvements. A blog has been established at www.texmed.org/vision to allow members of the TMA official family to add comments and suggestions, which will be incorporated into later versions of the document. Please read Healthy Vision 2020 and give us your feedback.


Teachers who inspire students’ love of science got some love of their own at TexMed 2012. Six of them received TMA Ernest and Sarah Butler Awards for Excellence in Science Teaching, which include cash prizes for them and their schools. “These dedicated educators help create the physicians of tomorrow by inspiring students of today with the possibilities available in the field of science,” Dr. Speer said as he presented the awards. First-place winners are Paula Bagwell of Belmar Elementary School in Amarillo, Elizabeth Klammer of St. John’s Episcopal School in Dallas, and Matthew Wells of Cypress Lakes High School in Katy. Second-place winners are Jo Williams of Spicewood Elementary in Austin, Elizabeth Freeman of Westwood Junior High in Dallas, and Kimberly Beck of Seymour High School in Seymour.


Now in its 13th year, the TMA the Minority Scholarship Program has awarded 74 scholarships totaling $370,000 since 1999. That includes the nine most recent winners, announced at TexMed 2012. The scholarship encourages minority students to enter medicine by lightening the financial burden of medical school. As proud as we are of the winners, I want to use this space to thank the individuals and organizations who underwrote this year’s scholarships: Wendell Daniels, MD, of Longview; Betty and Mark Kubala, MD, of Beaumont; Alan and Sarah Losinger of Dallas; Cecilia and Tim Norwood, MD, of Dallas; Susan M. Pike, MD, and Harry T. Papaconstantinou, MD, of Georgetown; Irvin Robinson, MD, of Fort Worth; Charli and Jim Rohack, MD, of Bryan; Dana and Jamie Ronderos, MD, of Frisco; Cathy Scholl, MD, of Austin; the Bell, Dallas, El Paso, Hidalgo-Starr, McLennan, Midland, Nueces, Tarrant, and Travis county medical societies; Harris County Medical Society/Houston Academy of Medicine; Blue Cross and Blue Shield of Texas; H-E-B; and the Khushalani Foundation of Humble. Thank you all very much.


U.S. Rep. Michael Burgess, MD (R-Lewisville), the only TMA member in Congress, needs your vote — even if you don’t live in his district. Dr. Burgess is on the list of nominees to be considered as one of Modern Healthcare’s 100 Most Influential People in Healthcare. Voting runs through June 15. Please go to the Modern Healthcare website and register a vote for Dr. Burgess (and four others of your choice — you must vote for five.) Dr. Burgess has been and continues to be one of the most effective and influential advocates for physicians in Washington. Give him your vote.

Monday, May 14, 2012


You can probably feel the pre-meeting buzz in the TMA building. We’re packed and ready to move the operation to the Sheraton Dallas forTexMed 2012. Business meetings begin on Thursday before the show really blooms on Friday and Saturday. In addition to the great exhibit hall and 100-plus hours of continuing medical education (CME) classes, here’s what I’m looking forward to:
  • The installation of Michael Speer, MD, and Linda Adkins as TMA and TMA Alliance presidents;
  • TEXPAC’s 50th Anniversary Celebration Thursday night, and the TMA Foundation gala – Going Gold for Great Health – on Friday (you can still buy tickets to both);
  • Some stimulating policy debates and intriguing elections in the House of Delegates (see below);
  • Abilene’s Virginia Connally, MD, receiving the TMA Distinguished Service Award; and
  • Saturday’s day-long CME session from the Council on Health Care Quality: “Quality: Building a Practice That Will Work for You in the Future.” Look for tools and instruction on how to improve the quality of care provided in your practice — while minimizing the costs of getting there.


After numerous delays, the 2012 party primary elections are here. Early voting for the May 29 election starts today and runs through Friday, May 25. In 2013, the U.S. Congress and Texas Legislature will have many opportunities to make things better — or worse — for you and your patients. Look for a customized email today listing the TEXPAC-endorsed candidates who will be on your ballot. Today I want to remind you of the nine TMA and TMA Alliance members running for Congress and the Texas Legislature: U.S. Rep. Michael Burgess, MD (R-Lewisville), the only TMA member in Congress, is running for reelection. So are State Sen. Bob Deuell, MD (R-Greenville) and State Reps. Susan King (R-Abilene) and John Zerwas, MD (R-Simonton). Looking to move up to the Texas Senate are State Reps. Charles Schwertner, MD (R-Georgetown) and Mark Shelton, MD (R-Fort Worth). Dennis Bonnen, MD (R-Friendswood); Sonal Bhuchar (R-Sugar Land); and Susan Todd (R-Fort Worth) are seeking their first elections to the Texas House. Good luck.


I have a feeling this year’s session of the House of Delegates will be one of the most interesting in recent memory. Saturday features contested elections for speaker and vice speaker of the house, the TMA Board of Trustees, and the Texas Delegation to the American Medical Association. The house agenda is packed with some of the hottest issues in medicine today. Among the 103 resolutions are those that would direct TMA to:
  • Work to repeal the dual-eligible payment cuts;
  • Make smoke-free Texas a top legislative priority for 2013;
  • Work to make sure rules governing the Women's Health Program “do not interfere with physicians’ ethical and legal obligations to provide medically accurate, candid, and unbiased advice to obstetric patients”;
  • Restore funding for state family planning services and the Women’s Health Program;
  • Lobby to generate more residency slots and regain full funding for the Physician Education Loan Repayment Program;
  • Advocate repeal of the Patient Protection and Affordable Care Act and Medicare’s Independent Payment Advisory Board (these are among several items the Texas delegation could take to the AMA meeting in Chicago next month);
  • Support allowing physicians to balance bill Medicare and Medicaid patients; and
  • Work with the Department of Public Safety to streamline processing of controlled substance permit applications.


The TMA Council on Health Care Quality isn’t even a year old yet, but the group led by Frank Villamaria, MD, has made serious progress. Some 48 member physicians in 17 practices across Texas took part in the council’s Diabetes Reporting Pilot Program. The pilot taught physicians how to decide if their practice could benefit from the work needed to participate in incentive programs like Medicare’s Physician Quality Reporting System (PQRS) and Blue Cross and Blue Shield’s Bridges to Excellence (BTE). PQRS rewards equal 1 percent of total 2012 Medicare Part B billing. BTE is a two-year program that rewards $100 per attributed diabetic or cardiac care patient each year. The council also received a $50,000, three-year grant from TMF Health Quality Institute to develop more than a dozen interactive calculators that will help practices figure out how they can bill for preventive services ranging from childhood vaccinations to screenings for substance misuse. For an example, check out TMA’s Tobacco Cessation Calculator.


 The TMA Division of Medical Economics has begun work on an initiative to shelter physician practices’ vaccine purchases from the state franchise tax, and to fix a technical error in the definition of health care provider. We will work to get those changes included in any legislative effort to revise the franchise tax. Look for the 2013 legislature to consider completely replacing the tax due to concerns about how much money it brings in, the impact on small business, and other reported inequities. TMA will evaluate every proposal to determine how it could affect physician practices, and we will continue to advocate against undue tax burden on physician practices.

Monday, May 7, 2012

RICO Suits Bring Physicians More Than $2 Billion

Physicians have received more than $2 billion in benefits from national settlement agreements reached with Aetna, Cigna, Health Net, Humana, Anthem/WellPoint, and many Blue Cross and Blue Shield plans in class action lawsuits that 19 state and county medical associations and physician representatives brought against these insurers. TMA was an active plaintiff in many of these suits. The greatest benefit for most physicians came from the business changes the settlements required these insurers to implement. These included paying claims promptly, recognizing and paying for modifiers 25 and 59, notifying physicians 90 days before any material adverse contract changes, and limiting the time in which insurers could recover alleged overpayments. TMA actively monitors the insurers’ compliance with these requirements.

Huge Gift to Boost Science Education

To recognize outstanding science educators and ensure their students have the learning tools they need, Dr. Ernest and Mrs. Sarah Butler of Austin donated $500,000 to the TMA Foundation’s Ernest and Sarah Butler Endowment for Excellence in Science Teaching. The Butlers established the endowment in 1998 to support the awards, which annually recognize an elementary, middle, and high school teacher for highly effective methods of engaging students in the sciences. This generous contribution brings their endowment to more than $1 million. You can do your part for the TMA Foundation at its 19th annual gala, Going Gold for Great Health, on Friday, May 18, at TexMed 2012 in Dallas. Tickets and table sponsorships are still available.

TMA: Women Have Right to Know the Facts

The Woman’s Right to Know booklet that Texas law requires physicians to give to all patients considering an elective abortion is factually inaccurate and not science-based, the chair of TMA’s Maternal and Perinatal Health Committee wrote to state public health officials. “When it comes to abortion, our policy supports informed and nonjudgmental counseling between the patient and the physician,” Yasser Zeid, MD, wrote in formal comments on proposed state rules for how to revise the Woman’s Right to Know materials. “Unfortunately, the existing materials do not reflect these principles.” The TMA letter called for “a more rigorous approach to reviewing these materials, to help ensure that language is rooted in science and evidence-based clinical literature.”

Me and My Doctor Blog, Be Wise, Grandma Video, Hard Hats Win Awards

TMA’s communications and graphics teams’ winning streak continued as they brought home six new national awards. The Hermes Creative Awards, which recognize outstanding concept, writing, and design, bestowed platinum recognition on TMA’s new blog, Me and My Doctor, and on the physician toolkits for our Be Wise — ImmunizeSM program. Our Grandma and the Big, Bad SGR! video took home a gold Hermes award. The design of Me & My Doctor and a TMA news release on the troubling impact of health reform both received honorable mention. Meanwhile, TMA’s Hard Hats for Little Heads program won the Making A Difference Communitas Award, named for Latin phrase for people coming together for the good of a community. That award is sponsored by the Association of Marketing and Communication Professionals.

Be Wise — Immunize is a service mark of the Texas Medical Association.

TEXPAC’s Full Slate of Endorsements Published

As leaders, we are responsible for helping the Texas Legislature and U.S. Congress adopt the best health care policy solutions available. That responsibility starts at the ballot box in the May 29 primary elections. Starting with Lt. Gov. David Dewhurst’s bid for the U.S. Senate, TEXPAC has endorsed a strong slate of legislative and judicial candidates on the May 29 ballot. Please take the time to learn about and get to know your local TEXPAC-endorsed candidates and encourage your family, employees, friends, and patients to vote for them.


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 July 13. The college can put physicians age 40 or under or in the first eight years of practice on the path to becoming a leader 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 will graduate at TexMed 2012 this month in Dallas — and many of them will move immediately into spots on TMA boards, councils, and committees.