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Monday, December 16, 2013


You need a score card or a good lobbyist — and we have both — in Washington these days to keep track of all the bills that affect what physicians will get paid for delivering care to Medicare patients. Here are some key moves from just the past week: 
  • The U.S. House passed the bipartisan budget compromise, designed to prevent another government shutdown. Included in the fine print is a 0.5-percent update in physician Medicare payments through March 31. If the Senate passes it this week, that will eliminate the 24-percent cut the Sustainable Growth Rate (SGR) had scheduled to begin Jan. 1.
  • That same budget bill continues the sequester cuts to Medicare for two additional years and adopts cuts in long-term care payments to acute-care hospitals.
  • The House Ways and Means Committee and Senate Finance Committee approved legislation replacing the SGR with a payment system that rewards quality over volume. The bill provides 0.5-percent updates for three years, then freezes physicians’ Medicare payments for seven years. U.S. Sen. John Cornyn serves on the Finance Committee. Four Texans — Reps. Kevin Brady (R-The Woodlands), Lloyd Doggett (D-Austin), Sam Johnson (R-Plano), and Kenny Marchant (D-Coppell) — have seats on the Ways and Means Committee. We’ll be calling on all five of them to help make some important changes in this legislation.
  • Writing on behalf of the Coalition of State Medical Societies, we asked congressional leaders to make some key changes to the bill: Provide positive automatic payment updates, eliminate the fee-for-service program penalties, and revise or scrap adoption of the ICD-10 coding system. “These are essential elements to positive and constructive Medicare payment reform,” we said.


The recent Center for Medicare and Medicaid Services (CMS) announcement of a one-year delay for some meaningful use requirements drew a lot of headlines. You’ve got to wonder why. “TMA is deeply disappointed that CMS has not recognized the importance of extending the 2014 meaningful use requirements and the start of the penalty period,” Joseph Schneider, MD, chair of the TMA Ad Hoc Committee on Health Information Technology, wrote to CMS executives. “Many of our members have not yet received their 2014 certified software from their ambulatory EHR vendors. Once they finally receive the upgraded software, it can take many months to test and install, including fixing the bugs that will surely exist as many EHR vendors have rushed this into production. For some, that will leave only the July-September 2014 attestation period for physicians to meet meaningful use and avoid the 2015 penalties. TMA considers this deadline to be dangerous to patient safety and physician practice viability.”


The health care marketplace is changing drastically for physicians of all stripes. What new demands will this place on your practice? What is the path forward for physicians who want to remain in private practice? How can physicians in all settings protect their clinical and financial autonomy? Join your colleagues at 2014 TMA Winter Conference in Austin Jan. 31-Feb 1 to find out how TMA can help you survive and compete in your changing environment. Texas Health and Human Services Executive Commissioner Kyle Janek, MD, with a panel of physician leaders and legislators, will discuss this health care transformation during the General Session. Register today.


We haven’t heard much about the Independent Payment Advisory Board (IPAB) lately. That’s only because the slowdown in growth of government health care expenditures has pushed IPAB’s trigger off for several years. But as Physicians Foundation CEO Tim Norbeck and I write in Forbes.com, “IPAB is a powerful disciplinarian with the potential to drastically influence how care is delivered over the next decade.” TMA, the American Medical Association, and many other medical societies have called for its repeal. We need to get rid of IPAB before it ever convenes.


 There are lots of significant changes among medical association leadership in Texas. Among them:
  • Sam Tesson has retired as executive director of the Texas Osteopathic Medical Association. His replacement will be former TEXPAC Director David Reynolds. 
  • Former Bexar County Medical Society CEO and Executive Director Stephen C. Fitzer returns to that position once again. Steve served in that role from 2003 to 2008.
  • The new director of continuing medical education (CME) at TMA is Casey Harrison, who was CME manager at the Seton Healthcare Family in Austin. Her predecessor, Billie Dalrymple, retires this month and leaves behind a huge national legacy of CME accomplishments.
  • Crystal Zuzek is the new editor of Texas Medicine. Larry BeSaw retires this month after 15 years at the helm of the magazine. Crystal has been an associate editor for seven years.


Thanksgiving and the Feast of Lights are in the rear view mirror. Christmas, Kwanzaa, and New Year’s Day lie ahead. Whichever of these you celebrate, may your holidays be merry. Volume 16 of EVPGram will begin arriving in your inbox on Jan. 6.

Tuesday, December 10, 2013


We promoted it as “Two Hours. Six Men. Tough Questions,” and that’s exactly what it was. Two candidates for the Republican nomination for attorney general and four men seeking the GOP nod for lieutenant governor faced the heat this weekend at TEXPAC forums.

  • For attorney general, State Sen. Ken Paxton (R-McKinney) and Railroad Commissioner Barry Smitherman took questions from Texas Tribune Editor Ross Ramsey. They both spoke about eliminating government and insurance company interference in the patient-physician relationship. State Rep. Dan Branch (R-Dallas) could not attend due to the death of his father, San Antonio neurosurgeon Charles Branch Sr., MD. Watch the tapes if you missed the event.
  • The candidates for lieutenant governor took off the gloves in a wide-ranging discussion moderated by Texas Tribune reporter Reeve Hamilton. The incumbent, David Dewhurst; Land Commissioner Jerry Patterson; State Sen. Dan Patrick (R-Houston); and Agriculture Commissioner Todd Staples all participated, discussing health care issues as well as how they would run the Texas Senate if elected. Again, you can watch the recording if you wish.


 Remember the outstanding results we were able to obtain from this year’s session of the Texas Legislature? That happens not only because of great physician leadership and strong grassroots involvement, but also because we elected outstanding senators and representatives who will take the time to listen to our concerns and help us craft real-world solutions. At this weekend’s TMA Advocacy Retreat, we presented the TMA Patient Protection Awards to 14 state legislators who met that high standard. The awards help us to cement strong relationships with men and women like State Rep. Todd Hunter (R-Corpus Christi), who said, “It’s always been an honor for this lawyer to represent the doctors of the Texas Medical Association.” The other recipients are State Reps. Carol Alvarado (D-Houston), Bill Callegari (R-Katy), Nicole Collier (D-Fort Worth), Sarah Davis (R-Houston), Craig Eiland (D-Galveston), Four Price (R-Amarillo), and Senfronia Thompson (D-Houston). From the other side of the rotunda, we honored State Sens. Kevin Eltife (R-Tyler), Juan “Chuy” Hinojosa (D-McAllen), Joan Huffman (R-Houston), Jane Nelson (R-Flower Mound), Robert Nichols (R-Jacksonville), and Royce West (D-Dallas). We will continue to recognize other legislative champions for medicine in the future, particularly those physician and alliance members who serve and are part of the “family of medicine.” Also, our county medical societies have already begun to issue their “best” awards to lawmakers from their areas. All of these fine legislators deserve our sincere thanks, appreciation, and continued support. Also at the advocacy retreat:
  •  Physician and staff leaders from county medical societies around the state shared their concerns and received a briefing on practice management and advocacy issues.
  • The TMA Board of Trustees approved a lean association budget for 2014 that includes no increase in TMA dues.
  • The board received an update on the status of the TMA Physician Services Organization project. We are still on track to launch in the first quarter of 2014. See January’s issue of Texas Medicine for more details.


A number of developments late last week on the repeal of Medicare’s Sustainable Growth Rate (SGR) formula will make for some interesting Washington watching over the next few days as Congress prepares for the December recess. “I expect the committee to consider the legislation before the end of next week,” said House Ways and Means Committee Chair David Camp (R-Mich.). The Senate Finance Committee has hearings scheduled for this week. The Congressional Budget Office cut the 10-year cost estimate for repealing the physician payment formula from $139 billion to $116.5 billion. We’re hoping that will add to the momentum to finally eliminate this albatross from around physicians’ necks. Also, the Ways and Means Committee and Finance Committee released a new framework for the repeal legislation. It still has no guarantee for any Medicare payment increases (“positive updates” in Washington parlance). However, the revised plan would reduce the potential penalties for the “value-based performance program” that would replace several existing bonus/penalty programs like meaningful use and the Physician Quality Reporting System. It also would give practices more time to transition away from fee-for-service and into “alternative payment models.” Absent any congressional action, the SGR mandates a 24-percent cut in physician’s Medicare payment rates beginning Jan. 1. Given the tight time frame, many Congress watchers are predicting that a full repeal bill will not pass before lawmakers go home for the holidays. Given all of that, here are TMA’s priorities:
  • Continue the progress toward full repeal of the SGR;
  •  Include positive updates for physicians who have been strapped with a decade-long freeze in their Medicare payments;
  • Ensure that any short-term “bridge” to forestall the 24-percent cut doesn’t cause payment delays, cash-flow problems, and accounting headaches for physicians — as we’ve seen in the past; and
  • Include relief for physicians from the growing multitudes of onerous regulations that add cost to medical practices but add no value to patient care.

Monday, December 2, 2013


As the Centers for Medicare & Medicaid Services officially announced the 24-percent cut in physician’s Medicare payment rates for 2014, the Coalition of State Medical Societies sent the following strongly worded message to Congress. Please contact Sens. John Cornyn and Ted Cruz and your representative (contact information) today. Share your personal story of what a decade of threatened cuts has meant to your practice. Let them know: No more patches.

The Coalition of State Medical Societies — representing nearly 160,000 members in nine states — calls on you to take immediate action to work together to repeal Medicare’s Sustainable Growth Rate (SGR) formula immediately. Another patch, another “doc fix,” is not acceptable.

Ladies and gentlemen, the track record for Congress is not very good. For 12 years, physicians have toiled under the SGR, which everyone knows is broken. Physician practices have been subject to short-term patches each year, crippling their ability to plan for the future, even making them wonder if they’ll be solvent for the current year. The decision to further delay only exacerbates the fiscal albatross around the necks of America’s physicians and the Medicare patients we serve. 

The vast majority of you say the SGR needs to be permanently fixed. Let’s do it.

Now is time for action. Congress and America’s physicians have an outstanding opportunity to end the SGR fiasco now. It’s time for us, for you, to be proactive rather than reactive.

  • The Senate Finance Committee has scheduled a conceptual markup of the bicameral, bipartisan SGR repeal bill for December 12.
  • Chairman Brady and the House Ways and Means Committee are set to move quickly thereafter.

Repeal the Medicare SGR formula immediately. Another patch is not acceptable.


Two days jammed full of politics, endorsements, candidates, education, and excitement mark the 2013 TMA Advocacy Retreat at the Barton Creek Resort in Austin. Hot breakout sessions include Putting on an Effective Fundraiser, First Tuesdays in the District, and Running for Office Yourself. Our noon luncheon Saturday honors those state lawmakers who stood the tallest for patients and physicians during the 2013 Texas Legislature. We’re excited about the TEXPAC Forums, where six of the seven candidates in the two most hotly contested statewide Republican primary races will share their views on medicine’s most important issues. Here’s who has lined up to speak:

  • For lieutenant governor: The incumbent, David Dewhurst; Land Commissioner Jerry Patterson; and Agriculture Commissioner Todd Staples. State Sen. Dan Patrick (R-Houston) would not respond to our invitation.
  • For attorney general: State Rep. Dan Branch (R-Dallas), State Sen. Ken Paxton (R-McKinney), and Railroad Commissioner Barry Smitherman.

Registration is still open. Contact TEXPAC or La’Shauna Maxwell at lashauna.maxwell@texmed.org or (512) 370-1453 with any last-minute questions. I hope to see you there.


Confused by all you’ve heard about the Affordable Care Act marketplace insurance plans? Do you know whether you’re in — or out — of the narrow networks? How will you tell if a patient is on an exchange plan? What happens to you if patients don’t make their premium payments? What, if anything, can you do about all of this? Registration is open for our live noon-time webcast, Thursday, Dec. 5, on how the new marketplace health plans will play out in your practice.


The Texas family of medicine lost two outstanding members over the past week. Maureen Priestner, the TMA Alliance dynamo and TEXPAC wonder lady from Abilene, left us after a long battle with cancer. Visiting hours are Tuesday and services are Wednesday for “Maureen from Abilene.” We don’t have any funeral details yet for services remembering Will “Tex” Bradley, MD. The Mansfield neurologist and past president of the Tarrant County Medical Society died far too young over the weekend. We send our deepest sympathies to Vince Priestner, MD; Baranda Bradley; and their families and friends.