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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.