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Monday, April 29, 2013

TMA CALLS FOR MEDICAID PAYMENT HIKE

“Like a rundown house in need of repair, you’ve got to pick up a hammer and start somewhere. Increasing Medicaid payment rates to Medicare parity is the nail that needs to be hit first.” That was the take-home line of a letter TMA President Michael Speer, MD, sent to the five state senators and five representatives who are hammering out the details of the 2014-15 state budget. “Over the past several months, there has been considerable attention paid to Texas’ ‘broken’ Medicaid system, with particular interest in the plummeting physician Medicaid participation rate and the impact that exodus is having on patients’ ability to obtain timely, medically necessary care,” Dr. Speer wrote. He pointed out that “grossly inadequate payment” is the single largest reason our members gave to TMA’s Physicians Medicaid Congress for not participating in the program.

DOCTORS TESTIFY FOR TMA's VACCINE, SCOPE OF PRACTICE BILLS

The House Public Health Committee worked late into the night last week considering five key, TMA-backed bills. Gary Floyd, MD, past chair of TMA’s Council on Legislation, testified in support of our bill to firmly establish a “physician-led medical team.” Senate Bill 406 creates a more collaborative, delegated practice that allows members of the health care team to practice to their level of education and training. Dr. Floyd also testified against House Bill 2938, which would allow pharmacists to vaccinate children 7 years of age and older. TMA Science and Public Health Council Chair Jason Terk, MD, stayed at the Capitol until 10:30 pm to testify on behalf of the Texas Public Health Coalition in support of three bills that already passed the Senate:
  • Senate Bill 62 aligns the requirements for college students entering college for the first time with the current federal guidelines for the bacterial meningitis vaccination.
  • Senate Bill 63 allows a minor who is pregnant or is a parent to consent to his or her own immunizations.
  • Senate Bill 64 requires licensed child care facilities to develop and implement an immunization policy for their employees, to protect the children in their care.
Another important piece of TMA’s immunization agenda is scheduled for a vote on the House floor today. HB 1310 creates a deduction in the state margins tax for the cost of buying vaccines.

 

PHYSICIANS FOUNDATION TACKLES PRACTICE HEADACHES


The Physicians Foundation (PF), which I serve as president, continues to search for ways to make it easier for doctors to care for patients in these turbulent times. Last week, PF decided to:
  • Develop a white paper on quality reporting issues, in collaboration with the Medical Group Management Association;
  • Conduct a survey on physician and patient preference for practice type; and
  • Begin research into the role of poverty and social determinants in health care costs. 

DR. MCCOY NEW CHIEF MEDICAL OFFICER FOR BLUE CROSS AND BLUE SHIELD OF TEXAS

Congratulations to TMA Board of Trustees member Dan McCoy, MD, who is the new vice president and chief medical officer for Blue Cross and Blue Shield of Texas. “My new role … will allow me to continue my lifetime focus on working to improve access and affordability to health care coverage that can help lead to positive health outcomes,” Dr. McCoy said in a news release.

MSO TASK FORCE SEEKS PRACTICES FOR PILOT PROJECTS

Are you interested in taking your practice to the next level — on your own terms and not by following a government-written script? TMA is looking for a few good practices to test some new ways of doing just that. As I’ve reported over the past few months, TMA’s Management Services Organization Task Force is working with a number of outside vendors to put together a package of support services to help physicians take advantage of new technology, improve care, and prosper financially. While we can’t take any official action until the TMA Board of Trustees approves the task force’s plan, I hope to move forward very quickly right after that. If you might be interested in participating in one of our pilot projects, please let me know at lou.goodman@texmed.org.

TMA PUBLICATIONS HELP RESIDENTS STARTING PRACTICE

Do you know some final-year residents who are out looking for a job — or even looking to start out on their own? Point them toward the TMA Education Center, where a pair of practice management publications are packed with advice for them. The Comprehensive Guide for Physician Employment is just what it sounds like — complete and loaded with information to help physicians make the best decision about employment, and then sign the right contract. The second book, Starting in a Medical Practice, covers everything from picking real estate to hiring staff to practice marketing. Both books have special member pricing, and both offer continuing medical education credit.

Monday, April 22, 2013

HOUSE LOOKS FOR "TEXAS SOLUTION" FOR THE UNINSURED

TMA Board of Trustees member Doug Curran, MD, was one of dozens of witnesses to testify at a House Appropriations Subcommittee hearing on a pair of bills to expand health care access for working-but-uninsured Texans. Dr. Curran testified in strong support of House Bill 3791 by Rep. John Zerwas, MD (R-Simonton). The goal of HB 3791 is to create a “Texas solution” for the working poor in Texas, including flexibility in administering the Medicaid program tailored to the needs of the state. Dr. Curran explained that for both economic and human reasons, Texas must find a way to improve Medicaid while simultaneously expanding coverage to low-income Texans. Representative Zerwas emphasized that his bill is not an expansion of the existing Medicaid program. The full House Appropriations Committee should consider the bill this week.

 

LEGISLATURE INVESTING MORE IN GME

The state House and Senate are both moving forward on bills to expand graduate medical education (GME) slots in Texas. The measures are intended to help keep graduating medical students — in whom the state has invested an average of $170,000 each — in Texas. The Senate passed Senate Bill 143 by Sen. Jane Nelson (R-Flower Mound), which is the vehicle for allocating $11.5 million in the 2014-15 state budget for GME expansion. It would establish a new grant program to encourage the development of new GME positions/programs. The bill also offers GME planning grants to help develop new hospital training partners for Texas’ medical schools that may be eligible to receive Medicare GME funding. It also establishes two primary care incentive programs for medical schools and expands the Physician Education Loan Repayment Program to allow participation by physicians who provide services to Medicaid and Women’s Health Program patients. Later this week, the House is scheduled to take up House Bill 1025 by Rep. Jim Pitts (R-Waxahachie). That measure, for now at least, would invest $17 million in GME expansion over and above the House-passed budget.

DUAL-ELIGIBLE RESTORATION STILL ON THE TABLE


Two leaders of the Border Health Caucus met with Health and Human Services Commissioner Kyle Janek, MD, to win his support for reversing the remaining cuts in payment for services to patients covered by both Medicare and Medicaid. Manny Acosta, MD, of El Paso and Luis Benevides, MD, of Laredo told Commissioner Janek that the dual-eligible cuts are still devastating many practices, especially along the Texas-Mexico border. The 2011 Texas Legislature ordered the cut in dual-eligible payments as a budget-saving move. The change effectively:
  1. Stopped Medicaid from covering all of the dual-eligible patients’ $140 annual Medicare deductible; and
  2. Prevented Medicaid from paying more than the Medicaid-allowable charge; this stopped Medicaid coverage of the Medicare copay.
Late last year, state leaders ordered the restoration of payment for the patients’ Medicare deductibles. We continue our work on reversing some or all of the rest of the cuts.

JOIN OUR AVOIDING-FRAUD-AND-ABUSE WEBINAR THURSDAY EVENING

Medicare and Medicaid now require physicians to establish a compliance plan that can effectively detect “criminal, civil, and administrative violations.” That means you must have a plan to address key compliance issues such as billing discrepancies and appropriate coding and documentation. Avoiding Fraud and Abuse, our new live webinar on April 25 from 6-7 pm (CDT), will help you improve your practice’s compliance readiness. Register today.

DR. SPEER REACHES OUT TO HOUSTON MEDICAL SCHOOL

TMA President Michael Speer, MD, and Harris County Medical Society (HCMS) President Russ Kridel, MD, met with Giuseppe Colasurdo, MD, the president of The University of Texas (UT) Health Science Center at Houston. Dr. Colasurdo spoke of the critical need for more funds for GME, saying he had 13,000 applicants for 200 GME spots this year and Texas is not keeping pace with physician needs, especially in psychiatry and primary care. Drs. Speer and Kridel discussed the advantages that TMA and HCMS membership could bring to the UT-Houston faculty, serving the sixth largest medical school in the country.

SOME QUICK LEGISLATIVE UPDATES

  • Thanks to last week’s TMA witnesses at the Capitol. In addition to Dr. Curran, Austin internist Howard Marcus, MD, and David Bryant, MD, a Dallas anesthesiologist, testified.
  • The Senate passed Senate Bill 303 by Sen. Bob Deuell, MD (R-Greenville), our end-of-life bill; and Senate Bill 822 by Sen. Charles Schwertner, MD (R-Georgetown), our bill to regulate silent PPOs.
  • The House also approved legislation to ban texting while driving — House Bill 63 by Rep. Tom Craddick (R-Midland).

Tuesday, April 16, 2013

Plan Would Protect Patients’, Physicians’ Right to Contract

Patients and physicians should always have the right to enter into private agreements for care above and beyond what state or federal health care programs allow. A TMA-backed amendment to the state constitution would preserve Texans’ right to free-market health care. Harris County Medical Society President Russ Kridel, MD, testified for the measure — House Joint Resolution 109 — at the House Select Committee on Federalism and Fiscal Responsibility. The plan would need approval by the state House and Senate — and then the voters. Meanwhile, in Washington, we joined the American Medical Association and more than 60 state medical associations and national specialty societies in a strong letter of support for HR 1310, the Medicare Patient Empowerment Act. We all pledged to work with the bill’s author — U.S. Rep. Tom Price, MD (R-Georgia) — to help pass the bill.


 

TMA STAKES THE ETHICAL HIGH GROUND ON MEDICAL BOARD BILL

Gary Floyd, MD, past chair of TMA’s Council on Legislation, came to the Capitol to testify against a bill that could undermine the beneficial effects our tort reform victories of 2003 and unduly interfere with the Texas Medical Board’s (TMB’s) and hospital peer review process. We support a strong, but fair, Texas Medical Board and continue to work to protect Texas doctors from unfair TMB prosecution. Weakening the medical board, however, could let us slip back to the days when far too many physicians were subjected to civil lawsuits, courtroom proceedings, and the iniquities of overly ambitious trial lawyers. Physicians have always imposed the highest ethical and professional values upon themselves, such as robust peer review. We oppose Senate Bill 1193 because it could keep good doctors from providing quality peer review of TMB complaints. “At TMA, for over 150, years we have vowed that we’d practice sound ethical medicine and protect patient safety,” Dr. Floyd said. “It’s very important that any observation that would threaten patient safety could be reported in a manner that whoever’s complaining … would be assured that there won’t be any type of retaliation.”

DR. SPEER: SPEND ANY NEW MEDICAID HMO MONEY ON PATIENT CARE

The Texas Health and Human Services Commission is asking state leaders to approve a nearly $60 million plan to increase premiums Texas pays to Medicaid HMOs. “At a time when physicians are forced to leave the Medicaid program in droves, it is critical that any new money be dedicated to improving patient care and the availability of that care,” TMA President Michael Speer told reporters who called for our reaction. “Any new money needs to be used to ensure Medicaid recipients have a medical home and that they can obtain needed care from specialists.”

TMA-BACKED MEDICAID FRAUD INVESTIGATION BILL PASSES SENATE

The Texas Senate unanimously approved Senate Bill 1803 by Sen. Joan Huffman (R-Houston). The measure takes numerous steps to improve due process for physicians and providers when accused by the state Office of Inspector General (OIG) of fraud or Medicaid overpayment. The bill includes a provision relating to the preliminary finding of fraud, defines “credible allegation of fraud,” and provides steps for better transparency in the process by requiring OIG to provide detailed information and material on its processes and findings both to providers and to the public.

BLUES NAME PRESIDENT FOR SAN ANTONIO REGION

I had an excellent meeting with Esteban Lopez, MD, the newly appointed president of the San Antonio Region of Blue Cross and Blue Shield of Texas (BCBSTX). Dr. Lopez, a pediatrician and member of the Bexar County Medical Society, is the first person to hold that position. I strongly encourage San Antonio-area physicians to get to know and work with Dr. Lopez.

WE'VE GOT ANSWERS TO PATIENTS' QUESTIONS ABOUT THE PPACA


As more and more provisions of the Patient Protection and Affordable Care Act take effect, we’re hearing from more and more physicians whose patients have questions about what the changes mean. Here are two good resources to help you answer those questions:
  • 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. Call the TMA Knowledge Center at (800) 880-7955 to order free copies.
  • Be Covered Texas is a new BCBSTX campaign to educate uninsured Texans about their rights, options, and requirements to obtain coverage through the new health insurance exchange. Open enrollment in the exchange begins in October and penalties for noncoverage begin next January. The program includes a booklet, website, and text-message campaign.

Monday, April 8, 2013

TMA PRIORITIES IN GOOD SHAPE IN BUDGET BILLS


The Texas House of Representatives spent a long day and evening debating its version of the 2014-15 state budget. On medicine’s key issues, the $194 billion document is quite similar to the state Senate’s $196 billion plan. Both would spend significantly more money on mental health services, and both would go a long way toward reversing the 2011 session’s cuts in graduate medical education, women’s health services, the Physician Education Loan Repayment Program, and smoking cessation. Neither plan, unfortunately would boost physicians’ Medicaid payments nor reverse the remaining cuts in payments for dual-eligible patients. The two bills now go to a 10-member House-Senate conference committee. In other legislative news:
  • Nearly 400 TMA physicians, medical students, and alliance members flooded the building for April’s First Tuesdays at the Capitol. Let’s have another huge crowd at the May 7 First Tuesday.
  • A key piece of TMA’s 2013 legislative agenda, House Bill 620 by Rep. Craig Eiland (D-Galveston), won approval from the House Insurance Committee. The bill would regulate silent PPOs — companies or networks that sell, lease, or share physician discounts without the physician’s knowledge or consent.
  • Luis Benavides, MD, of Laredo testified in support of a bill that would cut many of the physician hassles in dealing with Medicaid HMOs.
  • TMA Board of Trustees member Doug Curran, MD, testified against a bill to cut Medicaid payments for services delivered by an advanced practice registered nurse or physician assistant under the delegated authority of a physician.
  • James Humphreys, MD, a member of TMA’s Council on Legislation, testified in opposition to a bill that requires physicians and other health care providers to provide a binding quote as the amount that is accepted as payment in full for a service and to provide it in writing at least 48 hours prior to providing the service, or otherwise forfeit payment. 
Watch the video.

MSO TASK FORCE EXPLORING TWO PATHWAYS

TMA’s Management Services Organization (MSO) Task Force, chaired by TMA Trustee Dan McCoy, MD, has decided to consider two different approaches to helping our physician members adapt to the rapidly changing health care marketplace. One plan is to design a TMA MSO to provide member products and services that help physicians maintain autonomy and financial viability. The second approach is to pilot test a program that would align independent physicians in a collaborative care model to provide better care — especially for managing chronic diseases — and allow participating physicians to share in cost savings. To coordinate the test of the second pathway, TMA already has received tentative proposals from Aetna’s Practice IQ subsidiary, Blue Cross and Blue Shield of Texas’ Medecision platform, and OptumHealth.

DR. SPEER SERVES UP TMA MEMBERSHIP

TMA President Michael Speer, MD, met with the Cook Children’s Physician Network Board of Directors in Fort Worth at the invitation of its president, Britt Nelson, MD, and chair, Kevin D. Wylie, DO. He shared the value of TMA membership to the Cook Children’s System and asked the board members to all join TMA and to consider 100-percent membership for its physicians. He discussed his desire for continued input from pediatricians into TMA policies and advocacy efforts. Later in the week, in his hometown of Houston, Dr. Speer gave a legislative update and pushed for TMA membership in a presentation to the Texas Radiologic Society.

DR. SANCHEZ GOES TO HEART

Congratulations to Eduardo Sanchez, MD, vice president and chief medical officer at Blue Cross and Blue Shield of Texas. Effective April 15, Dr. Sanchez is the deputy chief medical officer of the American Heart Association. He will serve as a staff expert on issues related to public health and prevention and provide scientific and organizational expertise to heart association constituents.

SOME DATES TO REMEMBER


Mark your calendar for these important upcoming events:

Monday, April 1, 2013

PERRY, BURGESS, STATE LEADERS TO TALK MEDICAID EXPANSION TODAY

The question of whether Texas should expand Medicaid to cover more of the working poor returns to the state Capitol spotlight this week, beginning with a news conference this morning with Gov. Rick Perry. Most political observers expect the governor — who will be joined by U.S. Sens. John Cornyn and Ted Cruz, Lt. Gov. David Dewhurst, U.S. Rep. Michael Burgess, MD (R-Lewisville), and others — to reinforce his opposition to expanding Medicaid under the Patient Protection and Affordable Care Act (PPACA) and push for the federal government to give Texas more flexibility in how it manages the program. TMA supports a solution for Texas that fixes our broken Medicaid 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. The expansion question could come up again later in the week, when the Texas House of Representatives debates its version of the 2014-15 state budget. Among the 267 amendments prefiled for the debate is one saying that Medicaid payments to physicians and providers should increase if the state goes for expansion. State Rep. John Zerwas, MD (R-Simonton), the chief health and human services budget writer in the House, told the San Antonio Express-News that he welcomes the discussion. “There are a lot of people having conversations, but there hasn’t been a conversation on the floor of the House about that,” Dr. Zerwas said, “and the budget is a good time to possibly consider that.”

TMA PUSHES FOR MORE RED TAPE CUTS, FAIR MEDICAID FRAUD INVESTIGATIONS

TMA-member physicians once again hit the Capitol in our ongoing quest to cut the bureaucracy and red tape that get in the way of efficient medical practices. First-time witness Richard Benedikt, MD, of San Antonio testified for a bill to streamline renewal of physicians’ Controlled Substance Registration permits. And Buddy Swift, DO, chair of TMA’s Council on Socioeconomics, testified for a House bill that would allow physicians and their staff to check in patients using the electronic strip on the back of their Texas driver license. Dr. Swift previously spoke out on the other side of the Capitol for a similar bill that has now passed the Senate. John Holcomb, MD, chair of the TMA Select Committee on Medicaid, CHIP, and the Uninsured, testified in support of two bills that seek to ensure due process for physicians who are subject of a Medicaid payment hold and/or recoupment of potential overpayments. Council on Legislation Chair Les Secrest, MD, took the witness stand in support of increased funding for Texas’ Physician Education Loan Repayment Program. Thomas Kim, MD, a scholar in TMA Leadership College, testified for a bill to require insurance companies to pay physicians for after-hours telephone consultations. And Austin emergency physician Bruce Moskow, MD, shared our concerns with a bill that would allow telemedicine to replace the on-site physician member of the trauma team in Level IV trauma centers in small counties. Watch the video.

MSO TAKS FORCE EXAMINES BLUE CROSS OFFERINGS

Your Management Services Organization (MSO) Task Force continues to look for the tools and services you need to stay competitive and afloat in the changing health care environment. Task force chair Dan McCoy, MD, pulled together a team that included me, Bridget McPhillips — TMA’s vice president for membership and business development — and our consultants to look at what Blue Cross and Blue Shield of Texas has to offer individual physicians and group practices.

BIG CROWD EXPECTED FOR TOMORROW'S FIRST TUESDAYS

Bolstered by the usual throng of medical students and residents we always see in April, we are looking forward to a big army of white coats tomorrow for First Tuesdays at the Capitol. It’s not too late to sign up to spend the day talking to our senators and representatives about medicine’s key issues in the 2013 Texas Legislature. TMA’s legislative team will arm you with talking points and grassroots training; no prior lobbying experience needed. (And, don’t forget your umbrellas.)

TEXMED LIVE COMING TO TMA

Attention TED Talks fans: Get your fix with TEDMED 2013 from TMA. We’ve been accepted as a simulcast site for the event and are inviting members to join us at the TMA building on Wednesday, April 17, for exhilarating speakers and invigorating discussion. If you can’t make it to Austin, your TMA membership entitles you to watch any or all of the four-day conference — it runs from the evening of April 16 through noon on April 19 — from your desktop computer or mobile device. Details are in this week’s issue of TMA’s Action newsletter.

FOUNDATION'S 20TH ANNIVERSARY GALA CELEBRATES THE ROARING '20s

When was the last time you danced the Charleston or drank a little giggle water? Do both — and more — at the TMA Foundation Gala, Friday, May 17, at the Grand Hyatt San Antonio as part of TexMed 2013. Support some great causes and harken back, or discover, the Roaring ’20s.