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Monday, March 25, 2013

DRAFT BUDGETS BOOST GME, MENTAL HEALTH, WOMEN'S HEALTH FUNDING

State spending plans for 2014-15 took two more steps forward as both the House Appropriations Committee and the full Texas Senate passed their versions of the budget bill. Both bills take significant steps to reverse cuts in graduate medical education the legislature enacted in 2011. Both also offer big increases in spending for mental health and women’s health services. The full House is scheduled to debate the bill next week. Neither plan so far includes Medicaid payment increases for physicians or elimination of the cuts for services to dual-eligibles. TMA physician leaders continue their strong presence at the Capitol. Last week Arlo Weltge, MD, of Houston testified for a bill giving patients and family members more protections in disputes over end-of-life care; Immediate Past President Bruce Malone, MD, came to testify against a bill that would threaten independent review of Texas Medical Board complaints against physicians; and TMA Board of Trustees member Doug Curran, MD, testified on bills related to telemedicine and to how health plans calculate out-of-network payments. See the video.

TMA WINS GRANT TO HELP PHYSICIANS, PATIENTS CHOOSE WISELY

TMA is one of 21 physician organizations to win grants from the ABIM Foundation and the Robert Wood Johnson Foundation to promote the Choosing Wisely campaign. The program encourages physicians and patients to think and talk about medical tests and procedures that may be unnecessary, or even harmful. The lists of overused or inappropriate tests have been developed by 25 national medical specialty societies. The grant would allow TMA to share the Choosing Wisely program with Texas physicians in collaboration with county medical societies, the Texas Osteopathic Medical Association, and state medical specialty societies. A recommendation for TMA’s formal involvement in the campaign goes before the House of Delegates in May.

WILL ALL SPECIALTIES GO THE WAY OF CARDIOLOGY PRACTICES?

Like most cardiology practices around the country, Austin Heart has had to significantly restructure over the past three years. TMA staff and I met with the group’s president, Matt Phillips, MD, to learn how Austin Heart is adapting to changes in the health care environment and what that means to TMA and member physicians of all specialties.

OPTUMHEALTH SHOWS OFF NEW TOOLS FOR PHYSICIANS

TMA leaders and I made a trip to cold Minnesota to see OptumHealth’s state-of-the-art technology center and its analytic tools for helping physicians manage their practices and improve quality of care. Austin Regional Clinic CEO Norm Chenven, MD; former TMA Council on Practice Management Services Chair David Fleeger, MD; and Bridget McPhillips, TMA’s vice president for membership and business development, joined me in examining Optum’s electronic health record decision-support tools as well as products physicians can use for revenue cycle management. The visit is part of our project to identify the best tools for physicians to keep their practices viable in today’s rapidly changing health care environment.

PHYSICIANS FOUNDATION PREPS TO SHARE TOP 10 PRACTICE HASSLES

Following up on our widely shared 2013 Watch List of issues facing physicians and patients, the Physicians Foundation is identifying the top 10 hassles now affecting physician practices. We will use the list in an upcoming tour with news media in Washington, D.C., and editorial boards around the country. I am pleased to serve as president of the Physicians Foundation, which was formed as part of the settlement of our class-action lawsuits against for-profit health plans. Our research and grants support practicing physicians around the nation, especially those in solo or small practices.

DR. TEUSCHER MOVING UP AND OUT

Congratulations to Beaumont’s David Teuscher, MD (seems like we write that quite frequently in EVPGram). Dr. Teuscher was elected second vice president of the American Academy of Orthopaedic Surgeons (AAOS) Board of Directors, a move that will lead to his becoming AAOS president in 2015-16. AAOS has more than 37,000 members. Because of his new national responsibilities, Dr. Teuscher has announced he will not run for reelection to the TMA Board of Trustees in May.

Monday, March 18, 2013

PERRY, SENATORS LAY OUT MEDICAID REFORM CONDITIONS


In a letter to the Texas congressional delegation — followed up by a speech to the Conservative Political Action Conference (CPAC) — Gov. Rick Perry firmly rejected a one-size-fits-all Medicaid expansion and staked out the “Texas Medicaid Solution” negotiation parameters. Specific Medicaid reforms the governor mentioned in the letter include:
  • Cost sharing: establish copays, deductibles, and premium payments on a sliding scale;
  • Asset testing: ensure care is there for those who need it most;
  • Health savings accounts: improve patients’ control over health care spending; and
  • Promote the use of existing private coverage and employer-sponsored coverage.
The Senate Finance Committee attached a rider to its version of the 2014-15 state budget bill that says Medicaid expansion cannot come until the Texas Health and Human Services Commission “develops a plan to create more efficient health care coverage options for all existing and newly eligible populations.” It enumerates 11 principles with which the plan must comply, including reducing uncompensated coverage, promoting existing private coverage, wellness initiatives, cost-sharing, pay for performance, reducing nonemergency visits to the emergency department, and “creation of customized benefit plans for defined populations within Medicaid.” Both Governor Perry’s position and the Finance Committee’s incorporate portions of TMA’s. As TMA President Michael Speer, MD, wrote in a widely disseminated blog post, “Reform first, then expand only with a state-specific plan that targets the unique health care needs of our state’s population and that Texas taxpayers can afford.”

PAI FOCUSES ON BIG DATA

I spent part of the week on behalf of the Physicians Advocacy Institute (PAI) in St Louis. We met with leaders from the health care information technology firm TriZetto, which purchased Gateway/EDI, a claims clearinghouse and electronic health record for more than 200, 000 doctors. The company is interested in working with PAI on a data warehouse to help physicians negotiate with insurers.

BUDGET OUTLOOK BRIGHTENS; KEY TMA BILLS ARE MOVING


Here’s a quick recap of key bills we’re working and tracking in the 2013 Texas Legislature:
  • Budget (Senate Bill 1 and House Bill 1): The Senate Finance Committee approved its version of the state’s 2014-15 budget, and the House Appropriations Committee should finish its work in a few weeks. The draft Senate budget includes significant increases for graduate medical education, mental health, and women’s health; we’re still working hard to increase physicians’ Medicaid pay and to reverse the dual-eligible payment cut.
  • Senate Bill 406 by Sen. Jane Nelson (R-Flower Mound), which would improve access to health care by making it easier for physicians, advanced practice registered nurses, and physician assistants to work together to deliver services, passed the Senate without objection. The legislation is a delegated model and firmly supports a “physician-led medical team.” Rep. Lois Kolkhorst (R-Brenham) is carrying the bill’s companion, House Bill 1055.
  • House Bill 620 by Rep. Craig Eiland (D-Galveston) would place silent PPOs under state regulation. It has already had a hearing before the House Insurance Committee. The companion is Senate Bill 822 by Sen. Charles Schwertner, MD (R-Georgetown).
  • House Bill 772 by Rep. Donna Howard (D-Austin) had a House Public Health Committee hearing. It would make the state’s immunization registry (ImmTrac) an opt-out registry versus opt-in. 

DR. SPEER LEADS HOST OF TMA-MEMBER PHYSICIANS IN THE WITNESS CHAIR

Dr. Speer was among nearly two dozen TMA members who testified before legislative committees last week. He joined 15 other physicians in testifying at the House Public Health Committee for House Bill 15 by Representative Kolkhorst, which aims to improve the quality of care and birth outcomes for mothers and their babies. Thanks also to Drs. David Teuscher of Beaumont, Ari Brown of Austin, Janet Realini of San Antonio, Matthew Fox of Austin, Michael Wilkerson of Galveston, and George Hugman of Nacogdoches for testifying or writing formal comment letters on TMA’s behalf.

GOVERNOR PUTS DR. BUCKINGHAM ON TEACHER BOARD

Governor Perry appointed Austin ophthalmologist Dawn Buckingham, MD, a member of the TMA Council on Legislation, to the State Board for Educator Certification. It develops certification and continuing education requirements and standards of conduct for public school teachers.

ARE YOU GETTING PAID FOR PREVENTION?

Thanks to a grant from TMF, the TMA Council on Health Care Quality has developed 36 interactive calculators to help practices evaluate the billing codes associated with preventive health measures. Enter your data on patients seen and contracted rates for each identified code into the calculator. This allows you to see the benefits, and fiscal sustainability, of providing such care.

Monday, March 11, 2013

TALK MOVES TO ACTION ON TEXAS-STYLE MEDICAID REFORM

A strong push from House Speaker Joe Straus, key legislators floating several trial balloons, and an intense hearing in the House Appropriations Committee raised the profile of developing a Texas-style Medicaid reform plan. State Sens. Bob Deuell, MD (R-Greenville), and Charles Schwertner, MD (R-Georgetown), and Rep. John Zerwas, MD (R-Simonton), all filed bills. TMA supports a Medicaid solution for Texas that fixes our broken system and allows physicians to provide patient care in a more efficient and affordable fashion. We want to improve Medicaid patients’ access to timely and affordable medical care by increasing physician payments to equal Medicare rates, reducing red tape and administrative hassles, and ensuring fair fraud-and-abuse investigations. Legislation also has been filed to prohibit Medicaid expansion.

HUGE INSURER LOOKS AT SMALL PRACTICE NEEDS

I was invited to speak to senior management of the Health Care Service Corporation— which owns the Blue Cross plans in Texas, Illinois, New Mexico, and Oklahoma — on the data and technology needs of Texas physicians in general, and solo and small practice in particular. The company, which covers more than 13 million members, convened the strategy session on how the health care delivery system is changing due to the Patient Protection and Affordable Care Act and market consolidation.

SECRET INSURANCE CONTRACTS BILL GETS HEARING

A bill that would shine the light of state regulation on the murky world of so-called silent PPOs took center stage at the House Insurance Committee. TMA Council on Legislation member Dawn Buckingham, MD, an Austin ophthalmologist, testified for us on House Bill 620 by Rep. Craig Eiland (D-Galveston). The Texas Pediatric Society, the Texas Academy of Family Physicians, and Blue Cross and Blue Shield of Texas are also backing this key piece of our Healthy Vision 2020 agenda. Senator Schwertner will carry the bill in the Senate. It’s Senate Bill 822. The Insurance Committee also held a hearing on another of our red-tape buster bills. Sharon Blancarte, the office manager for Austin Internal Medicine Clinic, testified for House Bill 1032 by Representative Zerwas. It would require all insurers and health benefit managers to use a standard prior-authorization request form for prescription drug benefits. Additional information is available here.

 

HUNDREDS MARCH TO CAPITOL FOR FIRST TUESDAYS

White-coat-clad men and women swarmed House and Senate offices as more than 250 physicians, alliance members, and medical students took part in the year’s second First Tuesdays at the Capitol. The morning began with a briefing on TMA’s 2013 legislative agenda from our lobby team. The crowd spent the rest of the day at the Capitol visiting lawmakers and watching the Senate and House in action. Twenty young physicians from the TMA Leadership College attended the event.

CUTTING FOR STONE AUTHOR TO HEADLINE TEXMED 2013

Physician, ethicist, and best-selling author Abraham Verghese, MD, will deliver the General Session address at TexMed 2013, May 17-18 in San Antonio. Dr. Verghese emphasizes the importance of the physician’s touch and the patient-physician relationship in his two memoirs — My Own Country and The Tennis Partner — and in his best-selling novel, Cutting for Stone. I hope you will join us for his May 17 speech and book-signing reception, sponsored by Texas Medical Liability Trust. Registration is open now for our annual educational showcase and expo at the Grand Hyatt San Antonio and Henry B. Gonzalez Convention Center. For all the details, see the TexMed Advance Program. TMLT is the only medical professional liability insurance carrier exclusively endorsed by TMA .

2-PERCENT MEDICARE SEQUESTER CUT TO BEGIN APRIL 1

Medicare fee-for-service claims with dates of service on or after April 1, 2013, will be reduced by 2 percent, the Centers for Medicare & Medicaid Services announced. The cut is part of the across-the-board spending reduction required by the so-called federal budget sequestration, which took effect March 1 when Congress and the White House could not agree on any alternative spending cuts. Look for more details in the March 15 issue of TMA’s Action newsletter.

Monday, March 4, 2013

WORKING FOR A TEXAS-STYLE MEDICAID SOLUTION


Discussions in and around the state Capitol are moving away from a yes/no answer to Obama-style Medicaid expansion for Texas and toward development of a Texas-style Medicaid reform plan. TMA supports a Medicaid solution for Texas that fixes our broken system and allows physicians to provide patient care in a more efficient and affordable fashion. We want to improve Medicaid patients’ access to timely and affordable medical care by increasing physician payments to equal Medicare rates, reducing red tape and administrative hassles, and ensuring fair fraud-and-abuse investigations. For more details, see TMA President Michael Speer’s recent column on the topic. Keep up with the extensive press coverage of the Texas discussion and recent news from other state capitals on our curated Medicaid reform page.

THANKS FOR TESTIFYING


It was another busy week at the Capitol, and TMA-member physicians were busy representing your interests before House and Senate committees. You can stand up for your profession and your patients tomorrow at First Tuesdays at the Capitol. Thanks to last week’s legislative witnesses:
  • Buddy Swift, DO, of San Antonio and chair of TMA’s Council on Socioeconomics, testifiedfor a bill that would allow practices to check in patients using the electronic strip on the back of their Texas driver license. This is part of TMA’s Cut-the-Red-Tape legislative package.
  • Celia Neavel, MD, an Austin family physician, testified for a bill to allow a minor who is pregnant or is a parent to consent to her own immunizations.
  • Kimberly Avila Edwards, MD, an Austin pediatrician, testifiedfor a bill to require licensed childcare facilities to develop and implement an immunization policy for their employees.
  • Austin neurosurgeon T.J. Spinks, MD, testifiedin support of several bills that would ban texting while driving.
  • Edward Sherwood, MD of Temple, past chair of TMA’s Committee on Infectious Diseases, testified against a bill that would make raw milk more accessible.

TMA Statement Stands Up for Patient-Physician Relationship

TMA submitted an official comment letter outlining our concerns about Senate Bill 97 by Sen. Dan Patrick (R-Houston). The bill was left pending after a hearing in the Senate Health and Human Services Committee. The bill directs what a physician must do when selling, dispensing, and administering an abortion-inducing drug to a pregnant woman. TMA does not take a position on abortion. However, we do oppose legislation when it interferes in the patient-physician relationship, dictates how physicians should care for their patients, and could limit legitimate medical care unrelated to abortion. “The sanctity of the patient-physician relationship is the foundation of health care in America,” Dr. Speer wrote in the letter for TMA. “Patients must be able to trust that their physicians are always acting in each patient’s individual best interests.”

TMA Hosts Texas Tribune Health Care Talk

TMA's Healthy Vision 2020 sponsored a Texas Tribune TribLive conversation with Rep. John Zerwas, MD (R-Simonton), and Sen. Charles Schwertner, MD (R-Georgetown). Before a packed house of Austin leaders, the doctor-legislators shared their opinions on expanding Texas Medicaid, Medicaid’s 1115 Waiver program, funding for the Texas Women’s Health program, and more. Both agreed Medicaid is broken and needs reforms to attract more physicians to care for the millions of Texans covered under the program.

DR. TEUSCHER TAPPED FOR STATE BAR SLOT

The Senate Nominations Committee voted to confirm the appointment of TMA Board of Trustees member David Teuscher, MD, to the Board of Directors of the State Bar of Texas. Dr. Teuscher was appointed to the position by the Supreme Court of Texas. Congratulations.