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Monday, February 25, 2013


With more than three months still to go in the 2013 Texas Legislature, it’s too early to get your hopes up. But we’ve certainly seen some very positive developments so far. The Texas House unanimously passed an emergency supplemental appropriations bill to provide the $4.5 billion Medicaid needs to continue operations for the last half of this fiscal year. The Senate Health and Human Services Committee voted 5-0 for our bill firmly establishing the physician-led medical team. Budget writers in both chambers have shown serious interest in improving funding for graduate medical education and mental health. I’ve had some very productive meetings with key committee chairs and the physician and alliance members of the legislature. Please help us further advance TMA’s legislative agenda by registering for the March 5 First Tuesdays at the Capitol.


“Good morning, Mr. Chairman and members of the committee. My name is Dr. … and I am here today representing the 47,000 physician and medical student members of the Texas Medical Association.” That’s the way a host of TMA members have begun their testimony, sharing TMA’s legislative agenda before House and Senate committees. Health care issues are hot this year, especially early in the session as lawmakers draft the 2014-15 state budget. Physician witnesses bring real-world validity to the often tedious discussions of funding for Medicaid, graduate medical education, mental health, and immunizations. Thanks to these TMA members who already have given up time from their practices to stand up for patients and physicians at the Capitol:
  • Ralph Anderson, MD, a Fort Worth obstetrician and gynecologist;
  • Travis Bias, DO, a family physician in Pflugerville;
  • Luis Calo, MD, a family physician from Harlingen;
  • Gary Floyd, MD, a Fort Worth pediatrician;
  • Robert Greenberg, MD, an emergency medicine physician in Temple;
  • Manuel Jovel, MD, an oncologist from Laredo;
  • Joyce Mauk, MD, a developmental pediatrician in Fort Worth;
  • Thomas Parker, MD, an Austin internist;
  • Janet Realini, MD, a family physician from San Antonio;
  • Les Secrest, MD, a Dallas psychiatrist and chair of TMA’s Council on Legislation;
  • Theodore James (T.J) Spinks, MD, a neurosurgeon from Austin;
  • Jason Terk, MD, a Fort Worth pediatrician;
  • David Teuscher, MD, TMA Board of Trustees member and Beaumont orthopedic surgeon;
  • Nhung Tran, MD, a pediatrician in Temple;
  • Hector Treviño, MD, an Eagle Pass family physician;
  • David Wright, MD, an Austin family physician; and
  • Rodney Young, MD, an Amarillo family physician.


TMA’s newest seminar series, Truths and Myths About Medical Records and HIPAA, begins its statewide run this week. These limited-seating events are filling up fast. Physicians, medical office managers, privacy/security compliance officers, and administrative staff all can benefit from this course, which covers both state and federal privacy law compliance and penalties. Separate the myths from the facts and you’ll get clarity on common misconceptions.


The CEOs and senior staff from the Harris, Dallas, Travis, Tarrant, and Bexar county medical societies gathered with TMA staff at the TMA building. They discussed changing practice arrangements and how we can help physicians in integrated delivery systems and other organizations as well as those in small and solo practices. Speaking of the counties, we were remiss lately in not highlighting the installation of Gabriel Ortiz, MD, the new president at Bexar County Medical Society. The family physician takes over from Roberto Treviño Jr., MD.


After a hometown visit with faculty, senior staff, and residents at the Baylor College of Medicine in Houston, TMA President Michael Speer, MD, traveled to Lubbock where he met with Lubbock-Crosby-Garza County Medical Society leaders as well as faculty and administrators at the Texas Tech University Health Sciences Center. In each of those meetings, he discussed expanding TMA membership as well as TMA’s legislative agenda and key issues that affect the medical schools.


We will meet soon with state leaders about how to proceed on the $2.9 million health care innovation design grant from the U.S. Department of Health and Human Services. Texas is one of 16 states selected to design a multiplayer plan to improve health care collaboration and quality.

Tuesday, February 19, 2013


One week after our first First Tuesdays at the Capitol of the year in Austin, the American Medical Association’s National Advocacy Conference brought a “white coat invasion” to Washington, D.C. Texans joining TMA President Michael Speer, MD, and me on Capitol Hill to push TMA’s 2013 federal advocacy agenda were AMA presidential hopeful Joe Annis, MD; TMA Trustee Carlos Cardenas, MD; TMA Council on Legislation Chair Les Secrest, MD; Texas Delegation to the AMA Chair Lyle Thorstenson, MD; AMA Council on Science and Public Health member Russ Kridel, MD; Travis County Medical Society President Michelle Berger, MD; TMA Alliance President Linda Adkins; AMA Alliance President Pat Hyer; University of Texas Southwestern Medical School student Amy Ho; and TMA’s chief lobbyist, Darren Whitehurst. Also with us was Justin Berk, a medical student from the Texas Tech University Health Sciences Center, who received the Leadership Award from the AMA Foundation. We worked closely throughout our trip with physician leaders from the eight other states in our new national grassroots advocacy coalition.


While we were traipsing around Washington, the Texas Senate Committee on Health and Human Services voted 5-0 to approve a key piece of our 2013 state legislative agenda (Senate Bill 406 by Sen. Jane Nelson [R-Flower Mound] and its companion filed by Rep. Lois Kolkhorst [R-Brenham], House Bill 1055).The measure would improve access to health care by making it easier for physicians, advanced practice registered nurses (APRNs), and physician assistants (PAs) to work together to deliver services. More important, the legislation is a delegated model and firmly supports a “physician-led medical team.” The bill is a result of months of discussion among TMA, the Texas Academy of Family Physicians (TAFP), APRNs, and PAs. “Many years have gone into this. It represents a significant improvement in access to care for Texans across the state,” Gary Floyd, MD, past chair of the TMA Council on Legislation, told the committee. He testified for TMA, TAFP, and the Texas Pediatric Society.


The No. 1 issue of our Washington trip was replacing Medicare’s Sustainable Growth Rate (SGR) formula. As Health Subcommittee chair of the House Ways and Means Committee, U.S. Rep. Kevin Brady (R-The Woodlands) is a leading proponent of a three-phase Republican plan that would eliminate the SGR and institute a payment system that rewards physicians first on physician-endorsed quality measures and later on efficiency. Progress on this perennial issue so early in the year is a good sign. Meanwhile, across the Capitol, U.S. Sen. John Cornyn of Texas is one of the top sponsors of a bill to repeal the Independent Payment Advisory Board (IPAB). Deleting this one-sided cost-cutting board that was created by the Patient Protection and Affordable Care Act is an important provision in TMA’s Healthy Vision 2020. “As we’ve seen with the SGR, it’s obvious that cuts the IPAB enacts will devastate Medicare beneficiaries’ ability to find physicians to care for them,” Healthy Vision states. “The issue of Medicare spending for 3.8 million Texans is too important to be left in the hands of an unaccountable board that makes decisions based solely on cost.”


Last week’s EVPGram story, where I shared an abbreviated version of our state legislative agenda, omitted a key priority that we have a good chance of achieving: the restoration of funds cut from graduate medical education (GME). Texas has a big shortage of physicians today — and it will get worse as our population continues to grow quickly. Physicians tend to stay and practice where they complete their residency training. Currently in Texas, our medical school classes are growing while the number of residency slots is not keeping pace. Graduating medical students who leave Texas for GME take our $170,000 investment in their medical school education with them. To ensure stable access to health care for all Texans, we need to restore funds cut from GME and support new GME programs in the specialties that best reflect the state’s health care needs.


Developing and using procedures in your practice to prevent, detect, contain, and correct security violations is the subject of a live TMA webinar on Wednesday. Complying With HIPAA Security, from noon to 1 pm CST, Feb. 20, covers the new HIPAA Security Rule, enforcement, and penalties, as well as security provisions of the new state privacy law. It offers 1 hour of continuing medical education credit in ethics. Physicians who are insured with Texas Medical Liability Trust (TMLT) may earn professional liability insurance discounts by participating in this webinar. TMLT is exclusively endorsed by TMA.


Don’t forget, March 5 is the next First Tuesdays at the Capitol. While we always love to see as many physicians, medical students, and alliance members as possible, this month we’re making special outreach to young physicians. If you’ve always wanted to make a difference in the profession you’ll practice for the rest of your life, here’s your chance. Register today.

Monday, February 11, 2013


More than 230 TMA physicians, medical students, and TMA Alliance members visited with their local legislators during First Tuesdays at the Capitol. The day started with TMA lobbyists outlining key issues and messaging. It ended with a news conference at the Capitol. TMA and Border Health Caucus physicians asked state leaders to reverse funding cuts that harm access to care for thousands of Texas’ dual-eligible patients. Dual-eligible patients are old enough to qualify for Medicare and also qualify for Medicaid assistance because of their income. “We’re asking state leaders and lawmakers to fully restore the funding for our Medicaid-Medicare dual-eligible patients,” said Luis Benavides, MD, of Laredo, Border Health Caucus vice chair. “Our patients need us.” TMA is especially encouraging young physicians to take part in the next First Tuesdays at the Capitol on March 5. Register today.


TMA and the Texas Academy of Family Practice held firm against the advance practice registered nurses’ (APRNs’) call for independent practice and prescribing authority. We negotiated an innovative new care model to make it easier for physicians, APRNs, and physician assistants (PAs) to work together to deliver services. The agreement, filed as a bill sponsored by Senate Health and Human Services Committee Chair Jane Nelson (R-Flower Mound) and House Public Health Committee Chair Lois Kolkhorst (R-Brenham), firmly establishes a “physician-led medical team.” TMA President Michael Speer, MD, said, “This bill establishes a more collaborative, delegated practice that allows members of the health care team to practice to their level of education and training.”


I’ve been meeting lately with key state senators and representatives ― committee chairs and members ― who have influence over our 2013 legislative agenda. Here, in brief, is my spiel:
  • Expand Coverage, Reform Medicaid: We need to be creative in how we address the huge number of uninsured in Texas. We are calling on Austin and Washington to work together to devise a benefits plan that fits the needs of childless adults, with copays and deductibles that put some responsibility on the patient. This is NOT expansion of traditional Medicaid. To bring Texas physicians back to Medicaid, we also need to improve payment rates, cut the stifling administrative bureaucracy, and rein in the overzealous fraud investigators.
  • Restore the Cuts: The 2011 legislature did some serious damage to our health care delivery and public health systems. We have to reverse the devastating cuts to payments for dual-eligibles, and funding for graduate medical education and the Physician Education Loan Repayment Program. We have to invest in tobacco-cessation and obesity-reduction programs. These will pay tremendous benefits in the long-run.
  • Delegation and Team Care: Supported by physicians as well as APRNs and PAs, this plan firmly establishes a physician-led medical team and allows all involved to practice at their level of education and training. It places more authority and responsibility on the physician to supervise. The bill focuses on team-building, appropriate quality assurance, improved access, and efficiency.
  • Protect Tort Reforms: With strong support from Gov. Rick Perry, we will ― of course ― hold firm in defense of our 2003 health care liability reforms.
  • Cut Red Tape and Hassles: We’ve joined with other professions and a group of bill authors to reduce the confusing, bureaucratic red tape that so frequently frustrates your practices and takes away your time from patients. We need to eliminate multiple paper forms and replace the really necessary ones with easy-to-use standard and electronic forms that work.
  • Stop Theft of Physicians’ Services: We’re once again working to identify and prevent PPOs from stealing the contract discounts physicians have agreed to with other insurers. It’s just not right.


Dr. Speer leads a delegation of Texas physicians and alliance members and TMA staff to share our 2013 federal advocacy agenda on Capitol Hill. We are in Washington as part of the American Medical Association’s National Advocacy Conference. Items on our congressional talking list include replacing Medicare’s sustainable growth rate (SGR) formula ― of course, repealing the switch to ICD-10 and other costly overregulation, bringing some real-world sense to Medicare’s “value-based purchasing” program, and repairing the most obvious faults in the Patient Protection and Affordable Care Act. I will bring you a full report in next week’s EVPGRAM

Monday, February 4, 2013


Austin and Washington should work together to find a way to expand health care coverage to the working poor, the TMA Board of Trustees said in a policy statement adopted at 2013 TMA Winter Conference. At the same time, the board said, Texas should improve Medicaid payment rates, clear away frustrating red tape, and rein in overzealous fraud prosecutors if it wants to attract physicians back to the program. “We should not accept the option of simply expanding that broken program,” the statement read. “On the other hand, we cannot reject the federal government’s offer to help us care for the working poor of Texas. We need to take this money and use it for our people, our patients.” The board’s decision, which will be forwarded to the TMA House of Delegates, stems from the recommendations of our Physicians Medicaid Congress, which, in turn, were vetted by the Council on Legislation and Council on Socioeconomics.


Hailing from the largest (Harris) to some of the smallest (Rusk), presidents of dozens of Texas county medical societies (CMSs) gathered at 2013 TMA Winter Conference to share ideas and their nagging questions. Their how-to lists were amazingly similar despite the large disparity in the number of physicians they serve: recruiting new members, advancing medicine’s legislative agenda, bringing together independent and hospital-aligned physicians, and communicating better. American Medical Association President Jeremy Lazarus, MD; TMA President-Elect Steve Brotherton, MD; and DocbookMD co-founder Tim Gueramy, MD, addressed the crowd before the physicians broke up into work groups to discuss the greatest challenge and the single greatest opportunity their societies face in 2013. As Dr. Brotherton reminded the participants — and I tell everyone who asks — TMA’s strength flows from our excellent relationship with strong county societies all across the state.


The Senate Finance Committee continues to develop its draft 2014-15 state budget, with plenty of help from TMA member physicians. Travis Bias, DO, a family physician in Pflugerville, urged the committee to fund medical schools and graduate medical education and the Texas Physician Education Loan Repayment Program. Les Secrest, MD, chair of TMA’s Council on Legislation, testified for increased mental health funding. Hector Trevino, MD, president of the Maverick CMS, and Luis Calo, MD, president of the Cameron-Willacy CMS, urged committee members to reverse the 20-percent payment cut for physicians who care for dual-eligible patients. Jason Terk, MD, chair of TMA’s Council on Science and Public Health, testified in support of funds the Department of State Health Services needs for adult vaccinations, tobacco prevention and cessation, chronic disease prevention programs, and mental health. And Janet Realini, MD, chair of the Texas Women’s Healthcare Coalition, asked the committee for additional funding for state family planning services and the Texas Women’s Health Program.


TMA and TMA Alliance members in the Texas House of Representatives are well placed to influence health care legislation thanks to Speaker Joe Straus’ committee appointments. TMA Alliance member Rep. Susan King (R-Abilene), Rep. John Zerwas, MD (R-Simonton), and new Rep. Greg Bonnen, MD (R-Friendswood), have seats on the Appropriations Committee. Representative King and new Rep. J.D. Sheffield, DO (R-Gatesville), are on the Public Health Committee. Dr. Zerwas is also on the Human Services Committee, and Dr. Bonnen is on the Insurance Committee.


Anglo Texans will soon be a vanishing species, fixing Medicaid requires innovation and hard work, and TMA Foundation donors make a big difference, speakers at our 2013 winter conference said:
  • “People who look like me are dying off, and we will not be replaced,” former State Demographer Steve Murdock said in a data-packed presentation that paints a picture of significantly increasing demand for health care services over the next 40 years.
  • Dr. Lazarus highlighted AMA’s advocacy victories and its search for medical education reforms.
  • Health and Human Services Commissioner Kyle Janek, MD, said physicians can loosen some of Medicaid’s strict regulations by devising promises to improve quality of care. Dr. Zerwas and a panel of physician experts discussed the problems with Medicaid and prospects for change.
  • The TMA Foundation (TMAF) presented its 2013 John P. McGovern Champion of Health Awards to Austin’s Hope Medical Clinic and the Pediatric Obesity Symposium of New Braunfels. TMAF announced new physician major donors and recognized Dr. and Mrs. Ernest C. Butler of Austin for donations totaling more than $1 million


Texas Medical Liability Trust (TMLT) is now providing employment practices liability insurance in all TMLT policies at no extra cost. It covers lawsuits caused by such employment-related events as harassment, discrimination, hostile work environment, and wrongful termination.