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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.