About TMA Related Organizations TMA Calendar Site Map Contact Us

Monday, December 16, 2013

MEDICARE PAYMENTS: UP, DOWN, ACROSS, HOLD

You need a score card or a good lobbyist — and we have both — in Washington these days to keep track of all the bills that affect what physicians will get paid for delivering care to Medicare patients. Here are some key moves from just the past week: 
  • The U.S. House passed the bipartisan budget compromise, designed to prevent another government shutdown. Included in the fine print is a 0.5-percent update in physician Medicare payments through March 31. If the Senate passes it this week, that will eliminate the 24-percent cut the Sustainable Growth Rate (SGR) had scheduled to begin Jan. 1.
  • That same budget bill continues the sequester cuts to Medicare for two additional years and adopts cuts in long-term care payments to acute-care hospitals.
  • The House Ways and Means Committee and Senate Finance Committee approved legislation replacing the SGR with a payment system that rewards quality over volume. The bill provides 0.5-percent updates for three years, then freezes physicians’ Medicare payments for seven years. U.S. Sen. John Cornyn serves on the Finance Committee. Four Texans — Reps. Kevin Brady (R-The Woodlands), Lloyd Doggett (D-Austin), Sam Johnson (R-Plano), and Kenny Marchant (D-Coppell) — have seats on the Ways and Means Committee. We’ll be calling on all five of them to help make some important changes in this legislation.
  • Writing on behalf of the Coalition of State Medical Societies, we asked congressional leaders to make some key changes to the bill: Provide positive automatic payment updates, eliminate the fee-for-service program penalties, and revise or scrap adoption of the ICD-10 coding system. “These are essential elements to positive and constructive Medicare payment reform,” we said.

TMA CALLS OUT FEDS ON MEANINGFUL USE SLEIGHT OF HAND

The recent Center for Medicare and Medicaid Services (CMS) announcement of a one-year delay for some meaningful use requirements drew a lot of headlines. You’ve got to wonder why. “TMA is deeply disappointed that CMS has not recognized the importance of extending the 2014 meaningful use requirements and the start of the penalty period,” Joseph Schneider, MD, chair of the TMA Ad Hoc Committee on Health Information Technology, wrote to CMS executives. “Many of our members have not yet received their 2014 certified software from their ambulatory EHR vendors. Once they finally receive the upgraded software, it can take many months to test and install, including fixing the bugs that will surely exist as many EHR vendors have rushed this into production. For some, that will leave only the July-September 2014 attestation period for physicians to meet meaningful use and avoid the 2015 penalties. TMA considers this deadline to be dangerous to patient safety and physician practice viability.”

WINTER CONFERENCE REGISTRATION OPEN

The health care marketplace is changing drastically for physicians of all stripes. What new demands will this place on your practice? What is the path forward for physicians who want to remain in private practice? How can physicians in all settings protect their clinical and financial autonomy? Join your colleagues at 2014 TMA Winter Conference in Austin Jan. 31-Feb 1 to find out how TMA can help you survive and compete in your changing environment. Texas Health and Human Services Executive Commissioner Kyle Janek, MD, with a panel of physician leaders and legislators, will discuss this health care transformation during the General Session. Register today.

MY LATEST IN FORBES: IPAB, THE AGENCY WE DON'T NEED

We haven’t heard much about the Independent Payment Advisory Board (IPAB) lately. That’s only because the slowdown in growth of government health care expenditures has pushed IPAB’s trigger off for several years. But as Physicians Foundation CEO Tim Norbeck and I write in Forbes.com, “IPAB is a powerful disciplinarian with the potential to drastically influence how care is delivered over the next decade.” TMA, the American Medical Association, and many other medical societies have called for its repeal. We need to get rid of IPAB before it ever convenes.

COMINGS AND GOINGS IN MEDICAL ASSOCIATION LAND

 There are lots of significant changes among medical association leadership in Texas. Among them:
  • Sam Tesson has retired as executive director of the Texas Osteopathic Medical Association. His replacement will be former TEXPAC Director David Reynolds. 
  • Former Bexar County Medical Society CEO and Executive Director Stephen C. Fitzer returns to that position once again. Steve served in that role from 2003 to 2008.
  • The new director of continuing medical education (CME) at TMA is Casey Harrison, who was CME manager at the Seton Healthcare Family in Austin. Her predecessor, Billie Dalrymple, retires this month and leaves behind a huge national legacy of CME accomplishments.
  • Crystal Zuzek is the new editor of Texas Medicine. Larry BeSaw retires this month after 15 years at the helm of the magazine. Crystal has been an associate editor for seven years.

EVPGRAM TAKING HOLIDAY BREAK

Thanksgiving and the Feast of Lights are in the rear view mirror. Christmas, Kwanzaa, and New Year’s Day lie ahead. Whichever of these you celebrate, may your holidays be merry. Volume 16 of EVPGram will begin arriving in your inbox on Jan. 6.

Tuesday, December 10, 2013

CANDIDATES SWARM TO TEXPAC FORUMS

We promoted it as “Two Hours. Six Men. Tough Questions,” and that’s exactly what it was. Two candidates for the Republican nomination for attorney general and four men seeking the GOP nod for lieutenant governor faced the heat this weekend at TEXPAC forums.

  • For attorney general, State Sen. Ken Paxton (R-McKinney) and Railroad Commissioner Barry Smitherman took questions from Texas Tribune Editor Ross Ramsey. They both spoke about eliminating government and insurance company interference in the patient-physician relationship. State Rep. Dan Branch (R-Dallas) could not attend due to the death of his father, San Antonio neurosurgeon Charles Branch Sr., MD. Watch the tapes if you missed the event.
  • The candidates for lieutenant governor took off the gloves in a wide-ranging discussion moderated by Texas Tribune reporter Reeve Hamilton. The incumbent, David Dewhurst; Land Commissioner Jerry Patterson; State Sen. Dan Patrick (R-Houston); and Agriculture Commissioner Todd Staples all participated, discussing health care issues as well as how they would run the Texas Senate if elected. Again, you can watch the recording if you wish.

14 LAWMAKERS HONORED AS "PATIENT PROTECTORS"

 Remember the outstanding results we were able to obtain from this year’s session of the Texas Legislature? That happens not only because of great physician leadership and strong grassroots involvement, but also because we elected outstanding senators and representatives who will take the time to listen to our concerns and help us craft real-world solutions. At this weekend’s TMA Advocacy Retreat, we presented the TMA Patient Protection Awards to 14 state legislators who met that high standard. The awards help us to cement strong relationships with men and women like State Rep. Todd Hunter (R-Corpus Christi), who said, “It’s always been an honor for this lawyer to represent the doctors of the Texas Medical Association.” The other recipients are State Reps. Carol Alvarado (D-Houston), Bill Callegari (R-Katy), Nicole Collier (D-Fort Worth), Sarah Davis (R-Houston), Craig Eiland (D-Galveston), Four Price (R-Amarillo), and Senfronia Thompson (D-Houston). From the other side of the rotunda, we honored State Sens. Kevin Eltife (R-Tyler), Juan “Chuy” Hinojosa (D-McAllen), Joan Huffman (R-Houston), Jane Nelson (R-Flower Mound), Robert Nichols (R-Jacksonville), and Royce West (D-Dallas). We will continue to recognize other legislative champions for medicine in the future, particularly those physician and alliance members who serve and are part of the “family of medicine.” Also, our county medical societies have already begun to issue their “best” awards to lawmakers from their areas. All of these fine legislators deserve our sincere thanks, appreciation, and continued support. Also at the advocacy retreat:
  •  Physician and staff leaders from county medical societies around the state shared their concerns and received a briefing on practice management and advocacy issues.
  • The TMA Board of Trustees approved a lean association budget for 2014 that includes no increase in TMA dues.
  • The board received an update on the status of the TMA Physician Services Organization project. We are still on track to launch in the first quarter of 2014. See January’s issue of Texas Medicine for more details.

IT'S SHOWDOWN WEEK ON SGR REPEAL

A number of developments late last week on the repeal of Medicare’s Sustainable Growth Rate (SGR) formula will make for some interesting Washington watching over the next few days as Congress prepares for the December recess. “I expect the committee to consider the legislation before the end of next week,” said House Ways and Means Committee Chair David Camp (R-Mich.). The Senate Finance Committee has hearings scheduled for this week. The Congressional Budget Office cut the 10-year cost estimate for repealing the physician payment formula from $139 billion to $116.5 billion. We’re hoping that will add to the momentum to finally eliminate this albatross from around physicians’ necks. Also, the Ways and Means Committee and Finance Committee released a new framework for the repeal legislation. It still has no guarantee for any Medicare payment increases (“positive updates” in Washington parlance). However, the revised plan would reduce the potential penalties for the “value-based performance program” that would replace several existing bonus/penalty programs like meaningful use and the Physician Quality Reporting System. It also would give practices more time to transition away from fee-for-service and into “alternative payment models.” Absent any congressional action, the SGR mandates a 24-percent cut in physician’s Medicare payment rates beginning Jan. 1. Given the tight time frame, many Congress watchers are predicting that a full repeal bill will not pass before lawmakers go home for the holidays. Given all of that, here are TMA’s priorities:
  • Continue the progress toward full repeal of the SGR;
  •  Include positive updates for physicians who have been strapped with a decade-long freeze in their Medicare payments;
  • Ensure that any short-term “bridge” to forestall the 24-percent cut doesn’t cause payment delays, cash-flow problems, and accounting headaches for physicians — as we’ve seen in the past; and
  • Include relief for physicians from the growing multitudes of onerous regulations that add cost to medical practices but add no value to patient care.

Monday, December 2, 2013

COALITION TO CONGRESS: NO MORE SGR PATCHES

As the Centers for Medicare & Medicaid Services officially announced the 24-percent cut in physician’s Medicare payment rates for 2014, the Coalition of State Medical Societies sent the following strongly worded message to Congress. Please contact Sens. John Cornyn and Ted Cruz and your representative (contact information) today. Share your personal story of what a decade of threatened cuts has meant to your practice. Let them know: No more patches.

The Coalition of State Medical Societies — representing nearly 160,000 members in nine states — calls on you to take immediate action to work together to repeal Medicare’s Sustainable Growth Rate (SGR) formula immediately. Another patch, another “doc fix,” is not acceptable.

Ladies and gentlemen, the track record for Congress is not very good. For 12 years, physicians have toiled under the SGR, which everyone knows is broken. Physician practices have been subject to short-term patches each year, crippling their ability to plan for the future, even making them wonder if they’ll be solvent for the current year. The decision to further delay only exacerbates the fiscal albatross around the necks of America’s physicians and the Medicare patients we serve. 

The vast majority of you say the SGR needs to be permanently fixed. Let’s do it.

Now is time for action. Congress and America’s physicians have an outstanding opportunity to end the SGR fiasco now. It’s time for us, for you, to be proactive rather than reactive.

  • The Senate Finance Committee has scheduled a conceptual markup of the bicameral, bipartisan SGR repeal bill for December 12.
  • Chairman Brady and the House Ways and Means Committee are set to move quickly thereafter.

Repeal the Medicare SGR formula immediately. Another patch is not acceptable.

MEDICINE'S POLITICAL SEASON OFFICIALLY OPENS THIS WEEKEND

Two days jammed full of politics, endorsements, candidates, education, and excitement mark the 2013 TMA Advocacy Retreat at the Barton Creek Resort in Austin. Hot breakout sessions include Putting on an Effective Fundraiser, First Tuesdays in the District, and Running for Office Yourself. Our noon luncheon Saturday honors those state lawmakers who stood the tallest for patients and physicians during the 2013 Texas Legislature. We’re excited about the TEXPAC Forums, where six of the seven candidates in the two most hotly contested statewide Republican primary races will share their views on medicine’s most important issues. Here’s who has lined up to speak:

  • For lieutenant governor: The incumbent, David Dewhurst; Land Commissioner Jerry Patterson; and Agriculture Commissioner Todd Staples. State Sen. Dan Patrick (R-Houston) would not respond to our invitation.
  • For attorney general: State Rep. Dan Branch (R-Dallas), State Sen. Ken Paxton (R-McKinney), and Railroad Commissioner Barry Smitherman.

Registration is still open. Contact TEXPAC or La’Shauna Maxwell at lashauna.maxwell@texmed.org or (512) 370-1453 with any last-minute questions. I hope to see you there.


THURSDAY NOON WEBCAST TAKES ON MARKETPLACE MADNESS

Confused by all you’ve heard about the Affordable Care Act marketplace insurance plans? Do you know whether you’re in — or out — of the narrow networks? How will you tell if a patient is on an exchange plan? What happens to you if patients don’t make their premium payments? What, if anything, can you do about all of this? Registration is open for our live noon-time webcast, Thursday, Dec. 5, on how the new marketplace health plans will play out in your practice.

SAYING GOODBYE TO TWO SPECIAL FRIENDS

The Texas family of medicine lost two outstanding members over the past week. Maureen Priestner, the TMA Alliance dynamo and TEXPAC wonder lady from Abilene, left us after a long battle with cancer. Visiting hours are Tuesday and services are Wednesday for “Maureen from Abilene.” We don’t have any funeral details yet for services remembering Will “Tex” Bradley, MD. The Mansfield neurologist and past president of the Tarrant County Medical Society died far too young over the weekend. We send our deepest sympathies to Vince Priestner, MD; Baranda Bradley; and their families and friends.

Monday, November 25, 2013

22 TEXANS IN HOUSE PUSH FOR SGR REPEAL THIS YEAR

A majority of the Texans in the U.S. House of Representatives joined a majority of their colleagues from around the country in calling on House leaders to repeal Medicare’s Sustainable Growth Rate (SGR) formula this year. Congress “should not pass up this chance to repeal the SGR ... and enact a permanent solution,” they said in a letter to the speaker and minority leader of the House. “Continuing to enact short-term patches is bad fiscal policy — equivalent to paying the monthly minimum on a credit card bill — and increases the cost of full repeal.” Rep. Bill Flores (R-Bryan) was one of two congressmen to take the lead on the letter. Twenty-one of the 33 other Texans, from both sides of the aisle, put their name on it as well. A delegation of Texas physicians and medical students and TMA staff enjoyed productive conversations on the issue during visits with House members and Sen. Ted Cruz after the Washington meeting of the AMA House of Delegates. The Senate Finance Committee has scheduled a Dec. 12 “open executive session” on a draft SGR repeal proposal that has support from Democrats and Republicans, and in both the House and the Senate.

AMA PUSHES FOR SGR REPEAL THIS YEAR

In an increasingly rare show of unity on a difficult issue, the AMA House of Delegates endorsed a strong plan to repeal the SGR by the end of the year. The plan maintains support for AMA’s and TMA’s pay-for-performance principles and pushes to keep fee-for-service as an important Medicare payment model. Before approving the proposal, delegates insisted on adding language directing AMA to work for increases in the Medicare physician fee schedule. The agreement stems from what AMA President Ardis Hoven, MD, called “a new cause for optimism” on repealing the SGR in Congress and among physicians. In other action on the top issues defined by the Texas Delegation to the AMA, the House of Delegates:
  • Sent back to the AMA Board of Trustees for revision two proposed sets of policy on supervision of nonphysician practitioners. Both policies included the term “collaboration,” which caused significant consternation among the delegates. “Too many people want to do what we do without having done what we’ve done,” said Gary Floyd, MD, of Fort Worth.
  • Directed AMA to once again support delaying or canceling the implementation of ICD-10.
  • Called on the Centers for Medicare & Medicaid Services to repeal the “two-midnight rule” for hospital in-patient admissions.
  • Said health plans should be required to notify physicians that a patient is in the 90-day grace period for a subsidized Affordable Care Act exchange plan when the physician checks on the patient’s eligibility for services. 

SENDING PRAYERS AND HEARTFELT GOOD WISHES TO MARK KUBALA, MD

The funeral of Betty Kubala is today in Beaumont. All of us who know them will never forget the love and devotion that Dr. Kubala, a former TMA president, has shown for Betty over her decades of poor health. Even at the end, he wrote, “God sent his angels tonight and took Betty away from us.” For me, getting to know people like Betty and Mark — an outstanding physician, a great leader, and a fine man — is the No. 1 perk of my job.

IS YOUR PRACTICE READY FOR THE MARKETPLACE?

Registration is now open for our live noon-time webcast, Thursday, Dec. 5, on how the new marketplace health plans will play out in your practice. Do you know whether you’re participating in the plan(s) offered in your area? Do those plans affect your current payer contracts? Can you identify patients on the exchange plans? What happens if they don’t make their premium payments? Lee Spangler, TMA’s vice president of Medical Economics, will help you answer these questions and many more. Plus, get 1 AMA PRA Category 1 Credit™.

EXPLORING MEDICAID PROBLEMS WITH COMMISSIONER JANEK

Health and Human Services Commissioner Kyle Janek, MD, and some of his senior staff met with me, TMA General Counsel Rocky Wilcox, Advocacy VP Darren Whitehurst, and Medical Economics VP Lee Spangler to review a number of critical issues. We discussed the concerns we’ve been hearing about certain Medicaid managed care plans eliminating referrals to specialists and hospitals. We talked about streamlining the 1,800-plus pages of Medicaid rules and regulations physicians must follow. We examined the impact of the dual-eligible cuts on patient care for seniors, particularly in the Lower Rio Grande Valley and in rural Texas. We left very optimistic that Commissioner Janek will follow through and help us solve some of these problems.

CONGRATULATIONS TO DR. SHULMAN

The American Academy of Ophthalmology honored San Antonio ophthalmologist — and active TMA and TEXPAC member — David Shulman, MD, as its 2013 Hall of Fame Award recipient. Dr. Shulman was recognized for his lifelong commitment to preserving and protecting quality eye care and patient safety in Texas.

Monday, November 18, 2013

SGR REPEAL BILL: IS IT GOOD ENOUGH?

TMA Board of Trustees Chair Carlos Cardenas, MD, led a group of Texas physician leaders, TMA Vice President of Advocacy Darren Whitehurst, and me — plus senior staff and key physicians from eight other state medical societies — in an intense, three-day lobby visit to Capitol Hill. We met with congressional health care leaders like Reps. Michael Burgess, MD (R-Lewisville), and Kevin Brady (R-The Woodlands) plus Republican and Democrat staff of the key committees of jurisdiction. We also enjoyed audiences with Reps. Xavier Becerra (D-Calif.), John Fleming, MD (R-La.), and Bill Cassidy, MD (R-La.). Dallas orthopedic surgeon John Gill, MD, and Rep. Pete Sessions (R-Dallas) also set up lawmaker-physician meetings that included Drs. Carolyn Evans, Asa Lockhart, Russ Kridel, and Ray Callas. The major topic of conversation was the joint proposal from the House Ways and Means Committee and Senate Finance Committee to repeal the Medicare Sustainable Growth Rate (SGR) formula that has bedeviled physicians’ Medicare payments for more than a decade. The draft plan does away with the SGR but imposes a 10-year freeze on physicians’ Medicare payments and establishes several new pay-for-performance programs. While several national specialty societies are supporting the bill as is, TMA, the American Medical Association, and the Coalition of State Medical Societies is pushing for substantial improvements and elimination of a host of onerous federal health care regulations. An influential health care blog published a commentary from the coalition that outlines our concerns. The issue has generated a lot of debate at the AMA House of Delegates meeting that convened just outside Washington on Saturday. We suspect it will take at least several months for any final product to make its way through Congress — if that happens at all. That means we’ll need another short-term congressional patch to avoid the 24-percent cut scheduled to take effect in January.

ADVOCACY ISSUES DOMINATE AMA MEETING

Replacing the Medicare SGR formula, protecting physician practices from the ravages of the 90-day grace period in the Affordable Care Act (ACA) marketplace plans, scope of practice, and license recertification were the hottest topics in the opening days of the AMA House of Delegates meeting. As usual, members of the Texas delegation are actively engaged both in the open debates and in the behind-the-scenes negotiations. The three days we spent on Capitol Hill before the meeting have particularly informed our perspective. Look for a more complete report in next week’s EVPGram and in January’s Texas Medicine.

RIP MAVIS P. KELSEY SR., MD

On March 11, 1938, just two years after graduating from The University of Texas Medical Branch at Galveston, a young Mavis Kelsey, MD, joined the Texas Medical Association. He maintained his TMA membership over an amazing 75-year career in Houston medicine. The health care innovator, flight surgeon, and Mayo Clinic-trained internist died last week at the age of 101. In 1951, he founded the Kelsey Seybold Clinic with Bill Seybold, MD; his brother John Kelsey, MD; and others. I am pleased that the clinic continues Dr. Kelsey’s tradition in organized medicine with 100-percent membership in TMA and the Harris County Medical Society. Our deepest sympathies to his family and friends.

KEN MATTOX, MD, AND MARSHALL COTHRAN WIN AMA AWARDS

Two stalwart members of the Texas family of medicine were honored at the AMA House of Delegates meeting. Houston trauma surgeon Ken Mattox, MD, received the 2013 AMA Benjamin Rush Award for Citizenship and Community Service. The award is given “for outstanding contributions to the community for citizenship and public service above and beyond the call of duty as a practicing physician.” Dr. Mattox was recognized for his service in Houston’s medical response to several natural disasters, including hurricanes Katrina and Rita in 2005 and Tropical Storm Allison in 2001. Marshall Cothran, CEO of the Travis County Medical Society and the Blood and Tissue Center of Central Texas, received the Medical Executive Meritorious Achievement Award. AMA gives this award to a medical society executive who has provided exemplary and exceptional service that benefits and supports physicians in caring for their patients. This contribution “is exemplary beyond the normal scope of their duties or responsibilities.”

TWO STUDENTS WIN AMA SPOTS

Congratulations to a pair of medical students who won election as new Region 3 representatives to the AMA Medical Student Section. Raghuveer Puttagunta from the Baylor College of Medicine is a new Region 3 delegate, and Ben Karfunkle from The University of Texas Medical School at Houston is an alternate delegate.

DR. CHENVEN WINS AMGA POST

Norman Chenven, MD, founder and CEO of Austin Regional Clinic, is the new treasurer of the American Medical Group Association (AMGA). Dr. Chenven, a family physician, is a member of the steering committee of the TMA Physician Services Organization.

Monday, November 11, 2013

PHYSICIANS FOUNDATION LOOKS AT POLICY RESEARCH NEEDS

I spent nearly all of last week working at the meeting of The Physicians Foundation. As president of the foundation and TMA’s representative on its board, I am adamant that it produce outstanding research and fund high-quality projects so we continue to get a great return for Texas physicians. The foundation was created as part of the 2003 settlement of the class-action lawsuit that TMA and 21 other state and county medical societies brought against for-profit HMOs. The board at this meeting looked at studying quality metrics, integrated delivery systems, physician leadership, a University of North Carolina simulation model on workforce needs, and the foundation’s next nationwide survey of physicians.

NEW FORBES BLOG POST LEADS TO AMA RESOLUTION

I’ve really enjoyed writing the series of health care policy blogs for Forbes.com with Tim Norbeck, the CEO of The Physicians Foundation. Our most recent post, “Healthcare Is Turning Into An Industry Focused On Compliance, Regulation Rather Than Patient Care,” discusses the growth of what we call “the medical-industrial complex.” This complex is concerned, above all, with creating, enforcing, and compliance with government regulations of medical practice. A previous Physicians Foundation white paper, and the recent RAND Corporation study commissioned by the American Medical Association, focus on how this overregulation is damaging physicians’ morale and hurting health care in this country. To begin to combat this hyperregulation, which we cited extensively in TMA’s Healthy Vision 2020 document, the Texas Delegation to the AMA House of Delegates will carry an emergency resolution to the house meeting next week. Our resolution will call on AMA to convene “a multidisciplinary, multispecialty panel of practicing physicians and practice managers to scientifically assess the cost and benefit of the myriad regulations physicians face today.” The purpose of the panel will be to focus AMA advocacy to keep what’s working and fix what’s not.

SCALDING HOT: WHAT YOU NEED TO KNOW ABOUT THE EXCHANGE PLANS

I wish we could answer every question Texas physicians have right now about participating in the insurance plans offered through the Affordable Care Act marketplace. Based on our email and phone traffic — plus the meetings we had with large group leaders in Austin, Dallas, and Fort Worth — the issue is at the top of your minds. Do I have to participate? Am I already signed up? Will I get a new contract? What will they pay? What about the 90-day grace period for patients who don’t keep current on their premiums? To address as many of those questions as possible, as quickly as possible, we pushed out early an article that will appear in the December issue of Texas Medicine. I hope you’ll find “Marketplace Means Decisions for Doctors” to be helpful. We’re also planning a live webinar and other tools to help you better understand the marketplace plans and make the best decisions for your practice. Stay tuned for details. And don’t forget TMA’s “Hey, Doc” campaign — chock-full of answers to questions your patients have about the marketplace. This week, we look at the platinum, gold, silver, and bronze plans and what those categories mean for patients.

NEW TRIAL LAWYERS' PAC — AND MORE

Texans approved a water plan and eight other constitutional amendments; voters in a suburban Austin House district sent two candidates to a runoff; and a splinter group of Texas trial lawyers has created a new political action committee. Read about the Texas Association of Consumer Lawyers PAC and all the rest in the new weekly newsletter from TEXPAC Director Clayton Stewart.

TAPA: LIABILITY REFORMS PROTECTED

“For the fifth consecutive legislative session, our 2003 medical tort reforms remained unscathed.” That’s the message the leaders of the Texas Alliance for Patient Access (TAPA) shared at the organization’s annual meeting, which also commemorated the 10th anniversary of the Texas liability reforms. A report on the current battle in California to protect Medical Injury Compensation Reform Act caps gave it all a sense of urgency. The membership reelected TAPA Board Chair Howard Marcus, MD, of Austin. Among those elected to the board were TMA Advocacy Vice President Darren Whitehurst, and Jim Cox, MD, and Monte Troutman, DO, of Fort Worth. A bylaws change gives TMA, which helped found the organization, a permanent seat on the TAPA board.

ON THIS VETERANS DAY, WE REMEMBER

A road sign I passed on the way to the office this morning read, “They cared not for themselves but for the country they served. Thank a veteran today.” I cannot say it any better.

Monday, November 4, 2013

NEW SGR REPLACEMENT PLAN UNVEILED

Once again, Texans in Congress are playing key roles in fixing our broken Medicare payment system. The latest joint proposal comes from the House Ways and Means Committee and Senate Finance Committee. Rep. Kevin Brady (R-The Woodlands) chairs the Ways and Means Committee’s Subcommittee on Health, and Sen. John Cornyn sits on the Senate Finance Committee and its Subcommittee on Health Care. Another bill, sponsored by Rep. Michael Burgess, MD (R-Lewisville), has already passed the House Energy and Commerce Committee with bipartisan support. We will work with all three of them, and the rest of the Texas Delegation to Congress, to come up with the best bill we can to replace Medicare’s Sustainable Growth Rate (SGR) formula. Your TMA leaders will be “on the Hill” meeting with these Texas leaders before, during, and after the upcoming American Medical Association House of Delegates meeting.

MGMA CHIEF COMES TO TEXAS

I enjoyed an excellent visit with Sue Turney, MD, president and CEO of the Medical Group Management Association (MGMA). Dr. Turney, who is an old friend from her days at the helm of the Wisconsin Medical Society, came to Austin to discuss our plans for the TMA Physician Services Organization (PSO). We explored potential collaborations with MGMA on physician-developed quality measures, physician-directed integrated delivery systems, and how best to involve practice administrators in transforming medical practices. Set to launch early next year, the TMA PSO will offer practices the business services and information technology they need to provide demonstrably better and more efficient patient care and compete in today’s health care marketplace. Because MGMA is a national leader in group practice management, Dr. Turney and her team are natural collaborators for this new TMA business.

MODERN HEALTHCARE INVITES COMMENTARY FROM DR. BROTHERTON

TMA President Steve Brotherton, MD, has become a regular source for quotes in Modern Healthcare stories about issues ranging from the Affordable Care Act to Medicare to tort reform. The editors were impressed enough to ask him to pen a commentary for the magazine. Under the headline, “Obamacare needs changes to be more physician friendly,” Dr. Brotherton outlines our “fix what’s broken, find what’s missing, keep what’s good” approach to health care reform. He writes about repealing the SGR, putting ICD-10 “on permanent hold,” and passing the Medicare Patient Empowerment Act. “If our lawmakers have the same concern for their constituents as we have for our patients, they will pass these measures,” he says. If you’re a print subscriber, you’ll see the article in the December edition. If you have online access, you can read it here. If you have neither, you’ll just have to take my word for it — he represents Texas well.

BRIEFINGS FOR 100-PERCENT GROUPS BEGIN

We offer some special benefits to large group practices in which every physician is a member of TMA. Every year, for example, we send our senior staff around the state for some high-level discussions with leaders of our 100-percent groups. As Dr. Brotherton says, “Because we value our relationship with you, we want to understand better the challenges your organization will face in the coming year and how TMA can best help you. Additionally, we’ll talk about our newest and most innovative products and services, including those that can help you manage in a ‘value-based’ environment.” We began our briefings for the 100-percent groups in San Antonio last week. We’ll be in Austin, Dallas, and Fort Worth this week, and Houston the beginning of December. For more information on the briefings or 100-percent membership, contact Dora Tanton.

TWO CORRECTIONS FROM LAST WEEK

Your EVPGRAM editor rarely admits to mistakes. When he does, we publish his corrections here and make him submit to ceaseless humiliation at the hands of his peers. Herewith:

  •  The headline on the first story from last week’s EVPGRAM should have read, “Three-Fourths of Texas Counties Have Just One or Two Insurance Companies in the Marketplace.”
  •  A statement in the final story of last week’s EVPGRAM should have read, “In 2012, the most current year for which data are available, Texas reached an all-time high of 169.2 direct patient care physicians per 100,000 population.”

Monday, October 28, 2013

THREE-FOURTHS OF TEXAS COUNTIES HAVE JUST ONE OR TWO INSURANCE COMPANIES IN THE MARKETPLACE

The Affordable Care Act health insurance marketplace has been open — sort of — for nearly a month. The Obama administration is ready to announce that Americans will have until the end of March, rather than the first of January, to get health insurance or face a penalty. At a congressional hearing on the problems with the Healthcare.gov website, everyone seemed to agree that the main culprit was a person named “somebody else.” So far in Texas, about a dozen insurance companies are participating in the marketplace, selling roughly 100 different plans across the state. In some counties, insurer choice is quite limited. Of the 254 counties in Texas, 76 had only one health insurer (Blue Cross and Blue Shield of Texas) providing benefits through the marketplace when it opened in October. One hundred-eleven counties had just two insurers offering coverage — Blue Cross and Scott & White Health Plan. Those 187 counties are mostly in rural areas; the more populated counties have more choices. TMA’s “Hey, Doc” educational campaign is now focusing on the health plans and on subsidies for low-income buyers. We hope you and your patients find this program helpful.

NOW TMA'S MEDICARE 2014 SEMINAR COMES TO YOU

 Skip the hassles. No driving, no parking, maybe even no shaving. It’s time to start thinking about what’s going to change in Medicare next year, and you can soak in TMA’s popular annual Medicare update seminar right from your home or office. For the first time, you and your staff can tune in to the TMA Medicare 2014 seminar as a live webcast, on Tuesday, Nov. 5, 8:30-12:30 pm (CT). Find out important changes coming for next year, and how to make your current Medicare processes more efficient. Register now for a virtual seat and get the same interactive experience as in-person participants. You’ll watch the seminar as it happens, be able to ask questions in real time, and receive electronic handouts and other supplements — all without the hassle and cost of travel.

MAIL A CHECK; GRAB A FRIEND

It’s TMA membership season. We mailed dues statements earlier this month, and I hope that you — as a TMA leader — were one of the first to write your 2014 membership check. Let the process of mailing the check, or renewing online, remind you to invite a friend or colleague to renew — or join — as well. Everyone knows that word of mouth and personal invitations are the most effective recruiting techniques. But too often we just forget to tell other physicians about TMA’s tremendous legislative wins and our great practice management services. Now’s the perfect time to remember.

VOTE THIS WEEK FOR TEXAS WATER PLAN

Early voting runs all this week for the Nov. 5 constitutional amendment election. I urge everyone to vote. Pay special attention to Proposition 6 — the amendment creating the State Water Implementation Fund for Texas — which has TMA’s support. Nine amendments are on the ballot.

DR. CARDENAS NAMED MAN OF THE YEAR BY MCALLEN CHAMBER OF COMMERCE

Congratulations to Carlos Cardenas, MD. The chair of the TMA Board of Trustees has been chosen the 2013 Man of the Year by the McAllen Chamber of Commerce. Dr. Cardenas is CEO and chair of the board at Doctors Hospital at Renaissance.

PER-CAPITA DIRECT PATIENT CARE PHYSICIANS IN TEXAS HITS ALL-TIME HIGH

It’s yet another piece of evidence on the success of our liability reforms — and a direct rebuttal of the trial lawyers’ arguments to the contrary. The per-capita number of direct patient care physicians in Texas stagnated and then declined during the liability crisis period. Post-crisis, we’ve seen a per-capita gain in six of the past seven years. In 2012, the most current year for which data is available, Texas reached an all-time high of 169.2 direct patient care physicians per capita. For years, we’ve argued that the Texas Medical Board’s figures on the number of new medical licenses applied for and granted were proof that our 2003 liability reforms were attracting new doctors to the state — even faster than our exploding population. The trial bar pooh-poohed those numbers, pointing instead to conflicting evidence in the per-capita number of direct patient care physicians reported by the Department of State Health Services. Wonder what they’ll say now.

Monday, October 21, 2013

SENATOR CRUZ LAYS OUT HIS HEALTH CARE "CRITICAL REFORMS"

I’m continually impressed by our medical students. You know, we invited U.S. Sen. Ted Cruz to the 2013 TMA Fall Conference as part of our continuing desire to have conversations with our elected officials from both sides of the aisle. After the audience spent nearly an hour hearing the senator’s views on the recent meltdown on Capitol Hill and the deficiencies of the Affordable Care Act (ACA) — and we agree with a number of his views in that regard — the chair of the governing council of TMA’s Medical Student Section went to the microphone. “Politics aside, in your frank and personal opinion, are there inadequacies, are there deficiencies, in health care that merit attention?” Baylor College of Medicine student Arindam Sarkar asked. Senator Cruz responded by listing three “critical reforms”:
  1. Allow the interstate purchase of health insurance “to create a true, 50-state, national marketplace” free from the various states’ coverage mandates.
  2. Expand health savings accounts to cover more routine and preventive care.
  3. Uncouple health insurance from employment to make it portable and less dependent on shifts in the economy. 

BOARD CLARIFIES TMA'S MEDICAID EXPANSION POSITION

To eliminate any confusion over TMA’s position on Medicaid expansion, the Board of Trustees adopted the following statement:

It is the vision of the Texas Medical Association to improve the health of all Texans. Too many Texans, too many of our patients, cannot afford the health care they need. This hurts their health, the economic growth and prosperity of our state, and taxpayers all across Texas.
At its 2013 Annual Meeting, the TMA House of Delegates adopted two policy statements regarding expanded coverage for the uninsured. The TMA Board of Trustees believes that both of the adopted policy statements can be read in harmony. Regardless of political and legislative cycles, TMA supports:
  • The state’s participation in the Medicaid expansion option of the Affordable Care Act, and
  • Clearing away Medicaid’s financial, administrative, and regulatory hurdles that are increasing costs and driving Texas physicians away from the program.
The TMA Board of Trustees believes that Medicaid reform and significant improvement are necessary to ensure that those who would receive coverage under expansion would actually have access to the care that they need. TMA will continue to work with the Texas Legislature, the Texas Health and Human Services Commission, the U.S. Congress, and the U.S. Department of Health and Human Services to achieve those reforms and incremental improvements.
TMA also will continue to look to create — or take advantage of — politically feasible opportunities to effect the state’s participation in Medicaid expansion under the ACA.

The TMA Board of Trustees further charged the Council on Legislation; the Council on Socioeconomics; and the Ad Hoc Committee on Medicaid, CHIP, and the Uninsured to implement the actions of the House of Delegates.

TMA PSO AIMS TO PUT MORE OF THE HEALTH CARE DOLLAR IN YOUR POCKET

Whether it’s by increasing quality of the care you provide, making your practice more efficient, or helping you deliver better value in the marketplace, TMA’s Physician Services Organization’s (PSO’s) goal is to put more of the health care dollar in the physician’s pocket. That’s the assessment Dan McCoy, MD, chair of the PSO Steering Committee, delivered as the group took a big breath and reviewed its progress to date. We’ve reviewed dozens of responses to our Request for Information and identified nearly 100 potential service offerings for physicians. We’ve identified which products and services will be most needed by practices at various stages of sophistication, from the simplest to the most mature. Basically, the health care marketplace is at the point where, in the old days, physicians would be looking for new services to provide, new procedures to perform, and new ways to see more patients each day. But the paradigm has shifted. It is no longer “more is better.” Now it’s “better is more.” And the TMA PSO can help our members get there. Look for the formal launch of the PSO in the first quarter of 2014.

AMA FOLLOWS UP ON TEXAS MEDICARE OPT-OUT RESOLUTION

At its annual meeting in June, the American Medical Association House of Delegates adopted a resolution from Texas to simplify — and remove potential legal landmines from — the Medicare opt-out process. As part of that plan, AMA CEO James Madara, MD, asked Marilyn B. Tavenner, the administrator of the Centers for Medicare & Medicaid Services, to allow physicians to opt out of Medicare without having to officially reaffirm that decision every two years. “After the two-year minimum required by law, the opt-out period should be effective indefinitely unless and until the physician chooses to terminate his or her opt-out status and private contracts with patients in order to rejoin Medicare as a participating or nonparticipating physician,” Dr. Madera wrote. Russ Kridel, MD, of Houston initially brought the issue to the TMA House of Delegates in May.

TEXAN TAKES LEAD IN PUSHING BIPARTISAN SUPPORT FOR SGR REPEAL

U.S. Rep. Bill Flores (R-Bryan) has joined with a Democratic congressman in urging House leaders to repeal Medicare’s Sustainable Growth Rate (SGR) formula this year. Representative Flores and Rep. Dan Maffei (D-N.Y.) are asking their colleagues to sign on to a bipartisan letter to House Speaker John Boehner and Minority Leader Nancy Pelosi. “We should not pass up this chance to repeal the SGR — with fiscally responsible offsets — and enact a permanent solution,” they wrote. “This year represents a great opportunity to repeal the flawed SGR formula, reform health care delivery to drive quality and efficiency, and set Medicare on a more stable and predictable course for current and future generations of patients and physicians.” Two Texans — Reps. Blake Farenthold (R-Corpus Christi) and Mike Conaway (R-Midland) already have signed on.

Monday, October 14, 2013

SEE YOU FRIDAY IN AUSTIN

The unveiling of the TMA Physician Services Organization (PSO), U.S. Sen. Ted Cruz’s first appearance at a TMA event, a lawmakers’ panel, and a legislative recap from Texas Tribune Editor-in-Chief and CEO Editor Evan Smith are just some of the highlights of TMA 2013 Fall Conference this weekend in Austin. TMA boards, councils, and committees will meet; the TMA Leadership College Class of 2014 convenes; and our fall flu shot clinic and social media lab will vaccinate and teach. Join us Friday and Saturday at the TMA building and the AT&T Conference Center.

CMS EXTENDS PQRS PENALTY-AVOIDANCE DEADLINE FOR THREE DAYS

Physicians have three more days to register for the Physician Quality Reporting System (PQRS) and avoid a 1-percent cut in your 2015 Medicare payments. The American Medical Association says it convinced the Centers for Medicare & Medicaid Services (CMS) to extend the registration deadline from Oct. 15 to Oct. 18 because several hundred large group practices were threatened with fee cuts. CMS says the deadline extension applies to individual physicians and group practices of all sizes. AMA says it is working for a longer extension, but the government shutdown may prevent it. Individual physicians can register here and group practices can register here. See the TMA website for more information on the PQRS penalty.

IF WE'RE GOING TO TRANSFORM HEALTH CARE, WHAT WILL IT LOOK LIKE?

 I had the pleasure of attending a day-and-a-half-long summit in Washington, D.C., hosted by AMA, the American Hospital Association, and Health Affairs. The Joint Leadership Conference on New Models of Care brought together physician, hospital, and government leaders from around the country to explore what cost-effective, high-quality health care delivery systems look like, how we can get there, and what will make them work. The conference included in-depth discussions with trendsetting organizations such as Geisinger Health System, The Permanente Medical Group, and Advocate Health Care. I found the conversations insightful and believe some of what I learned can help to inform the development of the TMA PSO.

AMA STUDY LOOKS AT SOURCES OF PHYSICIAN DISSATISFACTION

You really care about delivering the best care possible to your patients, and anything that gets in the way really frustrates you. And nothing seems to get in the way more right now than the electronic health record (EHR) beast. Those are the biggest findings in “Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems and Health Policy,” a RAND Corporation study AMA commissioned. “The AMA is committed to leading a national dialog regarding the major factors driving many physicians to feel increasingly disconnected from what really matters — their patients,” said AMA President Ardis Dee Hoven, MD. For the study, RAND interviewed a wide variety of physicians around the country, including former TMA Board of Trustees member Travis Bias, DO, of Pflugerville.

BUT WHAT WILL THE EXCHANGE PLANS PAY?

As the health insurance marketplace created by the Affordable Care Act (ACA) stumbled through its second week of operation, TMA fielded numerous calls and emails from physicians concerned about the particulars. It’s important to remember that these are private health plans — not government-run payers — so there will be no national or statewide fee schedule once the plans start operating on Jan. 1. Your contracts with these insurance companies — existing contracts or new ones for the exchange plans — will determine how much you get paid. So far in Texas, Blue Cross and Blue Shield of Texas (BCBSTX) is the only insurer we know of that has offered new contracts for the exchange plans. BCBSTX created new networks for its exchange products and sought agreement from physicians through separate contracts. But we don’t know what network BCBSTX will use. It may use its established network for some products and the new network for others. TMA will continue to monitor the marketplace in the marketplace. We also continue to produce our weekly “Hey, Doc” series to give your patients no-nonsense answers to their questions about this program. This week we explore who can enroll in the marketplace plans. We’ve also posted a new question-and-answer handout, Who Can Enroll, Who Must Enroll, What Happens If You Don’t Enroll.

THE ECONOMIC TRUTHS OF HEALTH CARE REFORM

Forbes.com has published another installment of health care policy commentaries written by Physicians Foundation CEO Tim Norbeck and me. “The Promise (and Reality) of Healthcare” looks at some of the faulty assumptions behind the health reform law. As we wrote, “While putting aside the question of cost and focusing instead on the common good may be politically appealing, it sidesteps some economic truths.” Forbes has also set up a page to catalogue all of the commentaries from Tim and me.

Monday, October 7, 2013

LEARN ABOUT OUR PSO PLANS AT FALL CONFERENCE

I am more and more excited about the coming TMA Physician Services Organization after spending an intense several days with some potential partners. We continue to develop the PSO, with an anticipated launch date in the first quarter of 2014. The PSO will offer technology and business services designed to meet the needs of physicians in all practice settings. Focuses are practice operations, care management, quality measurement and development, and support for clinically integrated networks and accountable care organizations. You can learn more at the Dawn Duster session during 2013 TMA Fall Conference, when the PSO design team will discuss the health care delivery and payment models to be supported by the PSO.

BLUES FLOOD TEXAS ACA MARKETPLACE

Not surprisingly, consumers saw a plenty of bumps and “glitches” in the first week of sales of health insurance plans through the Affordable Care Act (ACA) marketplace. Supporters blame the problems on huge demand for the new plans; ACA opponents say it’s just one more example of government ineptitude. The truth is probably somewhere in between.

Meanwhile here in Texas, one analysis found that Blue Cross and Blue Shield of Texas (BCBSTX) is selling 4,572 plans across the bronze, silver, gold, and platinum tiers, plus some limited catastrophic plans for those under 30. That means BCBSTX is selling almost 70 percent of the 6,722 different plans that Texans could buy through the marketplace. The 10 other insurers selling products through the marketplace here are: First Care Health Plan (selling 540 plans), Scott & White Health Plan (408), Aetna (343), Cigna (337), Centene (324), Humana (120), Community Health Choice (27), Sendero (24), Molina (18), and Community First (9).

Finally, be sure to keep with TMA’s “Hey Doc” campaign, which is providing objective answers to marketplace questions for you and your patients. This week’s content focuses on the nuts and bolts of signing up.

MEDICAID: FIX IT FIRST

I had a great visit with TMA Board of Trustees member Doug Curran, MD — a powerful advocate for a strong Texas Medicaid system. Despite the progress we made in the legislative session — better due process protections for physicians suspected of fraud, slashing away at some of the most vexing red tape — we still have a long, long way to go before Texas Medicaid is ready to take on any more patients. And that’s the policy the TMA House of Delegates adopted in May: Texas must fix Medicaid’s problems before we expand it. Overall payment rates remain dismal, payments for patients eligible for both Medicare and Medicaid is particularly problematic, and — as the cover story of this month’s Texas Medicine documents — we have many problems with Medicaid HMOs. All of these troubles are driving physicians out of Texas Medicaid. Thanks to the leadership of physicians like Dr. Curran, TMA continues to work very closely with key legislators and Health and Human Services Commissioner Kyle Janek, MD, to improve the system for you and your patients.

FIRMS OFFER PROMPT PAY ENFORCEMENT HELP

This year is the 10th anniversary of two important Texas health care laws. You’ve heard plenty, of course, about the remembrances surrounding our 2003 medical liability reforms. But don’t forget the prompt pay law that TMA got passed that year as well. Senate Bill 418 requires electronically filed clean claims to be paid within 30 days; clean paper claims must be paid in 45 days. The law also makes slow-paying insurers liable to a physician for a graduated penalty in addition to paying the full contracted rate. TMA provides sample letters for members to use in prying payment out of reluctant carriers. We’ve also met recently with several law firms and collection agencies that offer services to enforce the clean claims law. I urge you to look closely at the firms, their services, and rates before you sign.

SHUTDOWN DOESN'T SHUT DOWN HEALTH PAYMENTS

As TMA and the American Medical Association reported last week, the congressional budget stalemate hasn’t stopped the government from paying for Medicare, Medicaid, or Children’s Health Insurance Program services. We now have our hands on a more comprehensive document that shows precisely what the Department of Health and Human Services will keep open through the government “shutdown.” That’s primarily all direct services to patients through government programs. What’s shut down, among other things, are block grants, most food safety programs, and the Centers for Disease Control and Prevention’s seasonal influenza surveillance.

Monday, September 30, 2013

LEARN HOW TO BE THE PHYSICIAN LEADER YOUR HOSPITAL NEEDS

Physician leaders can — and should — make a huge difference in how a hospital operates, if they have the tools to get it done. Consider this an invitation to pick up your toolbox at the IMQ/PACE Platinum Level Training Program for Physician Leaders, Nov. 7-9, at the Grand Hyatt Hotel in San Antonio. Whether you’re the chief of staff, a department head, or chair of a committee, this conference provides information that any physician in any leadership position needs. You also get practical training on how to accomplish your goals. A Physicians Foundation grant helps lower conference prices to $595. Go to http://physician-leadership.org to register.

RULING PROTECTS INTEGRITY OF TEXAS MEDICAL BOARD

A federal judge in Austin ruled against a rogue medical association and ordered that it “take nothing” in its broad lawsuit against the Texas Medical Board (TMB). In my opinion, the suit the American Association of Physicians and Surgeons (AAPS) brought against TMB in 2007 was one of many attempts to weaken our 2003 liability reforms. We need a strong and fair medical board to keep complaints out of the courtroom and prevent a return to the days of lawsuit abuse. In his ruling, District Judge Lee Yeakel said he found no “legal merit to any of the [AAPS] allegations.”

"HEY, DOC" CAMPAIGN GAINING TRACTION

Hey, Doc,” our multimedia campaign to give you and your patients answers to questions about the Affordable Care Act (ACA) insurance exchanges — called the health insurance marketplace —has been picking up lots of publicity. We stand out because our goal is to provide objective, nonpoliticized information about the online marketplace and the health plans it sells. Look for a new video and a new Q&A every week between now and the end of the year. The latest additions to the project are these (week 1 and week 2, so far) downloadable and embeddable slide and video decks.

BAD NEWS ON ACA EXCHANGE PLANS

The first health insurance plans in the ACA marketplace go on sale tomorrow. The government says most Texans will have an average of 54 plans to choose from at low prices. But there’s a cost to pay for that. News reports seem to confirm some of our biggest concerns about the plans: The networks will be very narrow, and payments will likely be on the low side. The New York Times, for example, reported growing concerns over narrow networks that are leaving out many physicians and hospitals. “Decades of experience with Medicaid, the program for low-income people, show that having an insurance card does not guarantee access to specialists or other providers,” Times reporter Robert Pear wrote, echoing a statement we’ve been making for years. And a MedPageToday story carries this headline: “Expect Low Pay for Docs in Exchange Plans.” Here in Texas, we’ve heard anecdotally from some physicians that the offers are lower, but we can't quantify what that means. Lower for that practice? Lower for the market?

TMA 2014 DUES STATEMENTS COMING THIS WEEK

Did we earn your trust again this year? Texas physicians “vote” with their checkbooks starting this week, and I’m confident most of you will give us a resounding“yes!” when the 2014 TMA dues statements arrive in your mailbox this week. Here’s why. This was one of our best state legislative sessions in recent memory, with strong victories on scope of practice, graduate medical education, red-tape reduction, and public health improvement. Thanks to leadership from two Texans who listen to what their doctor-constituents tell them, Congress is finally making some real progress on repealing Medicare’s Sustainable Growth Rate (SGR) formula. And right here in the TMA building, we’re putting together a Physician Services Organization that will deliver the survival tools you need to compete in today’s health care environment. As TMA President Steve Brotherton, MD, says, “These successes prove what we can accomplish when we unite in one voice. Please renew your TMA membership. It’s an important investment in your future and that of your patients.”

PHYSICIANS FOUNDATION OFFERS WEBINAR ON PRACTICE INNOVATION

I want to personally invite you to participate in the Physicians Foundation's webinar, "Practice Innovation: New Models for the 21st Century," from noon to 1 pm CT on Wednesday, Oct. 2. Learn about new practice models being tested and used around the country. Three organizations that have received Physicians Foundation grants will share what they are doing to provide physicians with the tools and strategies to remain viable in the market. Register online.

Tuesday, September 24, 2013

COUNTIES REPORT HOSPITALS ARE FLEXING THEIR MARKET MUSCLE

Hospital systems are playing rough as they work to control physicians in markets all across the state. That’s the unfortunate conclusion I have to draw after our annual meeting with senior staff of Texas county medical societies. Seventeen staff members from 15 counties gathered in Dallas for the meeting. They came prepared to address health care issues from the perspectives of their local markets, and what I would call “hospital system aggression” was the common theme that came through. Although I believe we are much more effective when medicine and hospitals work together, I also know that the hospitals can’t take care of patients by themselves. They need physicians. One of the goals of the TMA PSO project is to give physicians the tools they need to survive independently or to negotiate with hospitals from a position of strength. Be sure to catch the formal kickoff of the PSO project at TMA’s 2013 Fall Conference next month in Austin.

MEDICAID PRIMARY CARE PAYMENT BONUS COMING — NEXT YEAR

One of the few pieces of the Affordable Care Act that I thought made a good bit of sense is the plan to pay Medicare rates to primary care physicians for providing primary care services to Medicaid patients. (Actually, Medicare parity — as meager as it is — would make sense for all Medicaid services.) The bonus is intended to attract more primary care physicians to Medicaid and encourage them to open up their practices to more Medicaid patients. Since it’s all federal money, the two-year incentive isn’t a drain on the Texas treasury. But here’s the rub. The feds and the state are dragging their feet so badly that the program may be almost over before the first bonus gets paid. The latest word from the Texas Medicaid Program — as we reported in a special issue of Action — is that the first payments should come on March 1 of next year and that they should be retroactive to Jan. 1 of this year. Texas isn’t alone in these delays. All in all, this is a terribly poor way to run an incentive program, and it likely won’t recruit many new doctors to Medicaid.

MENTORS WANTED FOR TOMORROW'S PHYSICIAN LEADERS

Remember your first professional mentor? The physician who introduced you to all the right people? The one who shared invaluable tricks of the trade? The one who helped to steer you away from trouble? It’s time to repay the favor. The fourth class of the TMA Leadership College begins its year of studies at 2013 TMA Fall Conference. As part of the learning experience, scholars are matched with established physician leaders to serve as mentors. All it takes is a phone call or two each month, a few introductions to your colleagues, and a helpful hand every now and again. Then you can stand proudly when your mentee graduates from Leadership College at TexMed 2014. If you’re interested, please sign up today.

LIABILITY REFORMS STILL ATTRACTING NEW DOCTORS TO TEXAS

The Texas Medical Board (TMB) received a record number of new applications for new physician licenses during the fiscal year that ended last month. The 4,610 new applications is 357 more than the previous record and 80 percent more than the board received at the height of Texas’ medical liability crisis in 2003. TMB also licensed 3,594 new physicians in fiscal 2013; that’s the third highest number on record and only 1 percent less than the historic high we set a year ago. Texas has licensed nearly 32,000 new physicians since the passage of lawsuit reforms 10 years ago.

TEXAS ONCOLOGY LATEST GROUP TO COMMIT TO 100-PERCENT MEMBERSHIP

When a group of more than 350 outstanding physicians decides that every one of its doctors will be members of TMA and their county medical society, it’s time to celebrate — or at least have a meeting. In recognition of Texas Oncology’s commitment to 100-percent membership, we sat down with Steve Paulson, MD, its president and board chair, to discuss the group’s needs and priorities and how TMA could meet them. The meeting included other Texas Oncology leaders as well as Don Read, MD, vice chair of the TMA Board of Trustees; Greg Bernica, executive vice president of the Harris County Medical Society; Michael Darrouzet, EVP of the Dallas County Medical Society; and TMA General Counsel Rocky Wilcox. See the full list of 100-percent membership groups on the TMA website at www.texmed.org/100.

STEIN TO RETIRE FROM TMAIT

After 29 years of sensational service to physicians and their families (both personal and professional), Larry Stein has decided to retire as TMA Insurance Trust (TMAIT) administrator and president of TMAIT Financial Services on Dec. 31. “I have enjoyed working at the trust and sincerely appreciate the support provided me during that time,” Larry said in a message to the TMAIT Board. “I will do everything I can to provide a smooth transition to the new administrator and president.” Exclusively endorsed by TMA, TMAIT helps physicians, their families, and their employees get the insurance coverage they need.

Monday, September 16, 2013

AETNA TO PAY $120 MILLION IN OUT-OF-NETWORK CLAIMS DISPUTE

A federal judge tentatively approved a $120 million settlement of the class-action lawsuit against Aetna by TMA and our organized medicine partners. Final approval is scheduled for March. TMA, the American Medical Association, and the medical societies of nine other states sued Aetna in 2009 over its use of databases licensed from Ingenix, a UnitedHealth Group Inc. subsidiary. Ingenix underpaid physicians for out-of-network services, the lawsuit said. It also challenged other ways Aetna determined out-of-network payment rates and accused Aetna of failing to disclose how it figured those rates.

"HEY DOC," DEBUTS THIS WEEK IN ADVANCE OF OCT. 1 OPENING OF INSURANCE MARKETPLACE

Plenty of recent news stories have documented the confusion among Texans over the coming opening of the Affordable Care Act (ACA) health insurance marketplace. Starting Oct. 1, people can buy insurance from the marketplace to comply with the ACA’s “individual mandate,” which requires everyone to be covered next year. To do our part to calm the confusion, we are launching our “Hey, Doc” campaign this week. “Hey, Doc” will provide objective and nonpartisan answers to Texans’ most frequently asked questions about the marketplace. We want to ensure all Texans understand what the marketplace does and what steps they need to take.

Today’s “Hey, Doc” tidbit: Patients who have Medicare don’t need to do anything through the marketplace. Like Medicaid, VA benefits, TRICARE, many individual health plans, and most health plans provided by employers, Medicare insurance satisfies the mandate. In fact, the Obama administration now says it’s illegal to sell marketplace plans to Medicare beneficiaries.

WELCOME OUR NEW TEXPAC DIRECTOR

I am pleased to announce the hiring of Clayton Stewart as the new director of TEXPAC. Clayton most recently served as the director of governmental affairs for the Texas Society of Anesthesiologists. He brings nine-plus years of impressive campaign and legislative experience in his stints as legislative and research assistant, office manager, and campaign manager for three members of the Texas House of Representatives. He received his bachelor’s degree in government from The University of Texas. David Reynolds left TMA to embark on a new journey into the consulting world. He started his own company, Reynolds Solutions. Please join us in welcoming Clayton to the TMA staff and wishing David all the best in his new business.

GET FLU SHOTS AND MORE AT TMA FALL CONFERENCE

The regular and quadrivalent influenza vaccine, the nasal spray, and Tdap and MMR immunizations will be available to TMA members, their families, and office staff at 2013 TMA Fall Conference. Our vaccination clinic will be 7:30-8:30 am, Saturday, Oct. 19, in the Grand Ballroom Foyer on the third floor of the AT&T Center in Austin. With flu season around the corner and Texas in the midst of pertussis and measles outbreaks, now is the time to protect yourself and your patients. Sign up for your vaccination when you register for the conference; pay with cash or check on site. The clinic is sponsored by TMA’s Committee on Infectious Diseases and Be Wise — Immunize SM.

LEADERS COMMEMORATE TORT REFORM'S 10TH ANNIVERSARY

Gov. Rick Perry and TMA leaders all sung the same tune as we celebrated the 10th anniversary of the implementation of our landmark 2003 medical liability reforms. The message was simple: The reforms have kept the promises we made to Texans 10 years ago. Some sample sound bites:
  • Governor Perry: “I’m continually surprised some people still want to argue the case that tort reform hasn’t worked; they’re swimming upstream against a flood of hard data. … The best thing we can say about tort reform in Texas is also the most basic thing: It’s made people’s lives better.”
  • TMA President Steve Brotherton, MD: “My mom taught me that you’re only as good as your word. We’ve kept our word. Mom would be proud. And the patients of Texas are so much better off because of it.”
  • TMA Board of Trustees Chair Carlos Cardenas, MD: “The landmark law and accompanying constitutional amendment have assured good Texas physicians they can take on the most complicated illnesses and serious injuries without fear of facing a groundless lawsuit in return. And they have attracted record numbers of new physicians to the state.” 

Monday, September 9, 2013

TENTH ANNIVERSARY STUDY DOCUMENTS TORT REFORM'S HEALTHY BENEFITS

At noon today, TMA leaders will join with Gov. Rick Perry and others to celebrate the 10th anniversary of our 2003 medical liability reforms. They will gather in the Lower Rio Grande Valley, where outraged physicians sparked the battle against lawsuit abuse 10 years ago. Board of Trustees Chair Carlos Cardenas, MD, will represent TMA; Chevy Lee, MD, will represent the Hidalgo-Starr County Medical Society. We will release the results of a special TMA physician survey that shows the tremendous progress we’ve made in expanding access for sick and injured Texans thanks to the liability reforms and Proposition 12. Especially when compared with a critical survey we ran in 2003, the new study documents that medical liability reform has kept its promises. It has:
  • Assured good Texas physicians they can take on the most complicated illnesses and serious injuries without fear of facing a groundless lawsuit in return, and
  • Attracted record numbers of new physicians to the state. 

YOU CAN HELP DESIGN TMA'S NEW PSO

As regular EVPGram readers know, TMA is establishing the TMA Physician Services Organization (PSO), a physician-led organization that will offer services that bolster your clinical and financial autonomy. But what does that mean? What services do you need most? How can we structure and design the PSO to bring you the most benefit? Next week, we’re conducting four online focus groups where you can confidentially share your thoughts about the challenges of being a physician in Texas today. See the TMA website for times.

FORBES RUNS FOURTH COLUMN FROM PHYSICIANS FOUNDATION LEADERS

Forbes.com has published another op-ed written by me and Tim Norbeck, the CEO of The Physicians Foundation. This article, “Obamacare ‘Navigators’ Will Get $58 For Every Individual They Sign Up,” examines the complexity of the U.S. health care system and its effects on patient care. It looks closely at Affordable Care Act provisions such as the health insurance exchanges, at electronic systems, and at the growing power of large hospital systems.

BORDER HEALTH CONFERENCE DRAWS CROWD IN LAREDO

More than 150 politicians, physicians, public health officials, and health care professionals from both sides of the Rio Grande gathered in Laredo for the Eighth Annual Border Health Conference, sponsored by the Border Health Caucus. U.S. Rep. Henry Cuellar (D-Laredo), TMA President Steve Brotherton, MD; Texas Health and Human Services Commissioner Kyle Janek, MD; and Luis Benavides, MD, president of the Webb-Zapata-Jim Hogg County Medical Society, were among the featured speakers. They covered topics ranging from international public health collaboration to graduate medical education to Medicare funding to border security. This is the first year the conference was held on the border rather than in Washington, D.C.

TECH TUESDAY LOOKS AT GOING MOBILE

Is mobile technology changing how you practice? TMA’s next Tech Tuesday webinar, The Mobile Movement: Technology on the Go on Sept. 17, noon-1 pm (CT), will discuss how smartphones and tablets can fit into your workflow, communications, patient care — and HIPAA. Register now for this live webinar and mark your calendar for more Tech Tuesday webinars Oct. 15 and Nov. 19.

TEXAS' TWO LARGEST PAPERS ENDORSE SGR CHANGES


First The Dallas Morning News then the Houston Chronicle published editorials supporting major changes in how Medicare pays physicians. The Morning News piece, “Rep. Burgess’ plan to better pay Medicare physicians,” lauds Congressman Michael Burgess, MD (R-Lewisville), for his leadership in trying to solve the decade-long disaster caused by the Sustainable Growth Rate (SGR) formula. The Chronicle printed “Medicare needs repair” just two days after TMA and the Harris County Medical Society (HCMS) arranged a meeting among U.S. Rep. Kevin Brady (R-The Woodlands), TMA and HCMS leaders, and the Chronicle editorial board. Of note, the Morning News pointed out “Several medical groups say they see this proposal as a work in progress. Undoubtedly, there are ways to tweak it.” True. The bill is not perfect. We are concerned that payment increases won’t keep up with the cost of running a practice. We are concerned with the potential for a new set of bureaucratic hassles to spring up. But we are pleased with the bill’s growing support.

Tuesday, September 3, 2013

KEEP MEDICARE PAYMENT REFORM MOVING

Difficult as it may be to believe, it’s barely September and Congress is actually making some progress on replacing Medicare’s broken Sustainable Growth Rate (SGR) formula. Thanks to the leadership of two Texans ― U.S. Reps. Michael Burgess, MD (R-Lewisville), and Kevin Brady (R-The Woodlands) ― an SGR replacement bill is moving through the House with bipartisan support. H.R. 2810 repeals the SGR and replaces it with annual 0.5-percent rate increases. Beginning in 2019, physicians could report quality-of-care data under a new program and earn up to an extra 1-percent increase ― or possibly face a 0.5-percent cut. The bill says medicine will play a central role in designing the quality metrics. It also sets up ways for physicians to establish alternate payment models that would be exempted from the new quality reporting program. The bill is not perfect. We are concerned about the size of the payment increases and the potential for a new set of bureaucratic hassles to spring up around the quality reporting program. We don’t know yet how Congress will decide to pay for the bill. But it’s been years since we’ve seen this much progress toward repealing the SGR. I don’t want to lose this opportunity to fix the bill and pass it into law. Please contact Sens. John Cornyn and Ted Cruz and your representative and ask them to keep H.R. 2810 moving so we can repeal the SGR this year.

PHYSICIAN SERVICES ORGANIZATION ATTRACTING INTEREST FROM KEY VENDORS

Dozens of outstanding service and software vendors responded to the request for information (RFI) we issued for TMA’s Physician Services Organization. “We are looking for the very best vendors, the ones who can help us build the support organization Texas physicians need,” said TMA President Steve Brotherton, MD. “We are looking for firms whose skills and expertise can complement TMA’s outstanding brand image and credibility among Texas doctors.” The PSO is a physician-led organization that will offer services that bolster physicians’ clinical and financial autonomy. To learn more, come to our rollout at the TMA 2013 Fall Conference.

WITH "HEY DOC" SERIES, TMA WILL HELP ANSWER PATIENTS' MARKETPLACE QUESTIONS

Oct. 1 marks the opening of the health insurance marketplace under the Affordable Care Act (ACA), and all the signs point to a lot of confusion ensuing. As usual, TMA is jumping in to keep you and your patients informed. Using a combination of video, the Internet, traditional news media, and social media outlets, TMA’s “Hey Doc” project will bring answers to the most frequently asked questions about the new ACA insurance marketplaces directly to your patients. The project also will provide member physicians with monthly fact sheets to help you answer those questions that come up as the ACA marketplaces begin accepting applications on Oct. 1. The ACA’s requirement that all Americans have health insurance (the “individual mandate”) kicks in Jan. 1, 2014. And Because Your Doctor Cares is an easy-to-understand TMA brochure that addresses the questions asked by uninsured patients and those covered by Medicare, Medicaid, and private insurance. Email TMA Knowledge Center or call (800) 880-7955 to order free copies to hand out.

ICD-10 SUCCESS SEMINARS KICK OFF NEXT WEEK

What you do in September 2013 can make a big difference in how your practice fares come Oct. 1, 2014. That’s the mandatory date ― unless Congress acts, and we’re still working on that ― for all physicians, hospitals, and insurers, and Medicare and Medicaid, to switch to the ICD-10 coding system. If you haven’t started planning for that transition yet, you’re already behind. But TMA’s half-day workshop can help you catch up. Achieving ICD-10 Implementation Success will walk you through the first three steps to start the ICD-10 transition and detail exactly what you need to do in all areas of your practice. It will cover all the basics from initial organizational setup through post-implementation assessment. The seminar series will cover the state, from Amarillo to Harlingen, from Sept. 9-27. Register today at the special member price.

SENATOR CRUZ TO HEADLINE TMA 2013 FALL CONFERENCE

U.S. Sen. Ted Cruz, the freshman Republican who’s been making waves since he arrived on Capitol Hill in January, will kick off the General Session at the TMA 2013 Fall Conference, Oct. 18-19 in Austin. Other confirmed speakers include Texas Tribune Editor-in-Chief Evan Smith; and State Reps. Susan King (R-Abilene), Sarah Davis (R-West University Place), and Nicole Collier (D-Fort Worth). Register and book your room at the AT&T Conference Center online.

HOT STORIES YOU MIGHT HAVE MISSED

Some news items that might have slipped your radar while the EVPGRAM was on summer break:

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

Monday, July 1, 2013

TMA PSO SURGING FORWARD

I’m very excited about the strong steps our nascent Physician Services Organization for Patient Care is taking. The project’s steering committee, chaired by TMA Board of Trustees member Dan McCoy, MD, convened for the first time to make some key strategic decisions. Other members of the steering committee are TMA Board Chair Carlos Cardenas, MD; Trustee David Fleeger, MD; Austin Regional Clinic CEO Norm Chenven, MD; and Bruce Malone, MD, the former TMA president. The Dallas and Harris county medical societies are key players along with a number of senior TMA staff members. We will announce the hiring of a general consultant later this week. By next Monday, we will issue a request for information to service and software providers who may want to participate.

CONGRESSIONAL COMMITTEE RELEASES NEW MEDICARE PAYMENT PLAN

Leaders of the U.S. House Energy and Commerce Committee released the framework of a plan that, in their words, “would repeal SGR and, in return, replace it with an improved fee for service system in which providers develop quality measures that will lead to better care in a more efficient manner.” For several years, the panel has worked with members of the House Ways and Means Committee to draft a solid replacement for Medicare’s faulty Sustainable Growth Rate (SGR) formula. Two Texas congressmen — Energy and Commerce Health Subcommittee Vice Chairman Michael Burgess, MD (R-Lewisville), and Ways and Means Health Subcommittee Chairman Kevin Brady (R-The Woodlands) — have played major roles in drafting this legislation. Representative Burgess called it “a common sense solution that keeps doctors in practice and maintains access for their patients.” Replacing the SGR is one of the key elements in TMA’s federal advocacy agenda. Look for an action alert after the July 4 holiday asking you to contact Sens. John Cornyn and Ted Cruz and your representative in support of repealing the SGR, stopping ICD-10, and allowing Medicare beneficiaries to contract directly with physicians for care.

RIP, BOB DONALD, MD

I am extremely sad to report the passing of Bob Donald, MD. The former chair of the TMA Board of Trustees was an outstanding physician, a great leader, and a man of utmost integrity. So many of us learned so much at his knee. An internist, Dr. Donald is probably remembered most for his contributions to emergency medicine. He was a force in the development of Houston’s first municipal ambulance service and a founder of the American College of Emergency Physicians. Contributions in Dr. Donald’s memory may be made to the TMA Foundation.

SPECIAL LEGISLATIVE SESSION CONVENES TODAY

Gov. Rick Perry has called the Texas Legislature back for another 30-day special session beginning today. Items on the agenda include road funding, juvenile justice, and abortion regulation. TMA policy on abortion is neither for nor against the controversial procedure. However, we will continue to express our opposition to legislative intrusion into the patient-physician relationship and the details of the practice of medicine, and to legislatively created standards of care.

HAND OUT A TMA CARROT FOR BETTER HEALTH CARE JOURNALISM

Yes, it’s true, some reporters out there really do get the story right. And don’t you think they need some encouragement to keep it up? For the first time, TMA’s Anson Jones, MD, Awards program is accepting nominations from the family of medicine. Send an email to ansonjones@texmed.org to recognize reporters in your area for hard work and great health care reporting. We’ll let the reporters know their work’s been recognized and enter it into the competition.

HAPPY SUMMER, FROM EVPGRAM

After this issue, your EVPGram begins its annual summer break. We’ll return to your in-box after Labor Day. In the meantime, keep up with TMAvia Texas Medicine, Action, and other e-publications. Of course, we’ll bring you a special EVPGram whenever necessary. Happy summer.

Monday, June 24, 2013

AMA HOUSE ENDORSES TMA POLICY PROPOSALS

Texas physicians took six resolutions to the American Medical Association House of Delegates annual meeting in Chicago and won positive responses on all six. Unfortunately, we didn’t fare quite so well in the elections, as Austin anesthesiologist Joe Annis, MD, lost an extremely close race for AMA president-elect to Robert Wah, MD, an OB-Gyn from Maryland. On the six Texas resolutions, the house:
  • Agreed that AMA needs to provide more detail on its positions of various pieces of the Patient Protection and Affordable Care Act (PPACA), and directed the AMA Board of Trustees to issue a report by November that focuses specifically on the budgetary, coverage, and physician-practice impacts of the law;
  • Agreed with our call for a plan to simplify — and remove potential legal landmines from — the Medicare opt-out process;
  • Directed AMA to push to remove sugar-sweetened beverages from the Supplemental Nutrition Assistance Program, which provides food stamps to 46 million Americans;
  • Approved our recommendation that the Bridges to Excellence program should align the time periods of its recognition program with those of the National Committee on Quality Assurance recognition programs;
  • Asked for more study on initiatives promoting open access to scientific literature; and
  • Called for further research into what vendors and government agencies need to do to make it easier for physicians to transfer data from one electronic medical record system to another.  

TMA: KEEP GOVERNMENT OUT OF THE EXAM ROOM

Whether it’s the Obama Administration, the Texas Legislature, or city hall, government has no place telling physicians how to practice medicine. That’s the purview of your profession and scientific evidence. And that’s the message TMA delivered to lawmakers in Austin debating a series of bills to add new state regulations to abortion. “Our concerns with Senate Bill 5 and House Bill 60 are not based on any position on abortion,” TMA President Steve Brotherton, MD, wrote in a letter distributed to Texas House members Sunday before a marathon debate that extended past 4 am. “Rather, our concerns are with legislative intrusion into the patient-physician relationship and the details of the practice of medicine, and with a legislatively created standard of care. … TMA is concerned this legislation sets a dangerous precedent of the legislature prescribing the details of the practice of medicine. These are determinations to be made by the medical community and science, not by the legislature.”

"WE GOT RESULTS"― LEGISLATURE DELIVERS FOR PATIENTS AND PHYSICIANS

Texas patients and their physicians won big at the state Capitol during the 2013 regular session. We had more wins than in recent sessions across all issues affecting patient care, as outlined in TMA’s Healthy Vision 2020. In fact, nearly every TMA bill made it to the finish line, either intact or as an amendment. And every bill TMA wanted stopped was stopped. Darren Whitehurst, TMA's vice president of Advocacy, and the TMA lobby team discuss our results in this 11-minute video. Watch the video below to learn what lawmakers did that will help you, your practice, and your patients.

 

HEALTHY VISISON 2020 BRINGS HOME SOME PRIZES

TMA’s Healthy Vision 2020 is not only our strategic roadmap for advocacy through the end of this decade; it’s now our award-winning strategic roadmap for advocacy through the end of this decade. The shiny hardware we’ve gathered recently includes:
  • A Platinum Hermes Creative Award (the highest honor) for design and publication, from the Association of Marketing and Communication professionals;
  • A Bronze Quill (the highest honor), from the Austin Chapter of the International Association of Business Communicators (IABC), for communication management in government relations; and
  • An Award of Merit from IABC Austin for creative publication design. 

Monday, June 17, 2013

GOVERNOR PERRY SIGNS STATE BUDGET, TMA RED TAPE BILLS, MANY MORE

In a flurry of black ink, Gov. Rick Perry signed into law more than a dozen TMA-backed bills, cementing 2013 as one of our most effective legislative sessions in decades. The bills:

  • Stop silent PPOs’ theft of physician services; 
  • Cut red tape and excessive regulations; 
  • Rein in Medicaid fraud-and-abuse investigations; 
  • Gain tax relief for physicians; 
  • Establish a more streamlined, less bureaucratic way of supervising allied health practitioners; 
  • Protect your independent medical judgment; 
  • Battle physician shortages; 
  • Reverse budget cuts, and invest more state money into mental health and women’s health care services; and 
  • Protect young Texans.

Meanwhile, we rejected every single attack on our 2003 liability reforms and every single inappropriate attempt to expand scope of practice. For more details on all of this, see the special issue of TMA Action coming out this week and August’s edition of Texas Medicine.