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Monday, January 27, 2014

POLITICS AND POLICY, THIS WEEKEND, LIVE AND ON TMA-TV

I hope to see you at the Hyatt Regency Austin this weekend for 2014 TMA Winter Conference. The schedule of speakers is outstanding. In case you can’t make it in person, though, we will live stream three exciting segments on TMA’s The Future of Texas Health Care channel:
  •  GOP Comptroller Candidate Forum: 7-8 pm, Friday, Jan. 31. TEXPAC will host a forum for the candidates for Texas comptroller of public accounts. We have confirmed all four 2014 Republican primary candidates will participate. This should provide for an exciting hour of political conversation and entertainment.
  • U.S. Sen. John Cornyn: 9-9:45 am, Saturday, Feb. 1. Our senior United States senator will share a personal update on the latest goings-on in Congress and Washington, D.C.
  • The Transformation of Health Care: 10:15 am-noon, Saturday, Feb. 1. TMA Board of Trustees Chair Carlos Cardenas, MD, will moderate this in-depth panel discussion on trends and challenges, innovation, and transformation.

NEW BOSS IN THE BIG CHAIR AT DALLAS COUNTY MEDICAL SOCIETY

TMA President Steve Brotherton, MD, administered the oath of office to Dallas plastic surgeon Todd Pollock, MD, the new president of the Dallas County Medical Society (DCMS). Dr. Pollock succeeds Cynthia Sherry, MD. DCMS gave the 2014 Health Leadership Award to Larry James, CEO of the Dallas poverty-fighting organization City Square.

TMAF BOARD MEMBER WINS GROUNDBREAKING, $20 MILLION TOBACCO REGULATION GRANT

What laws, rules, programs, and approaches help to curb smoking? And which ones don’t? A leader of the TMA Foundation (TMAF) is on the receiving end of a $20 million grant from the U.S. Food and Drug Administration (FDA) and National Institutes of Health to help find the answers. The grant will establish The University of Texas (UT) Tobacco Center of Regulatory Science on Youth and Young Adults. The principle investigator is Cheryl Perry, PhD, professor and regional dean of the UT School of Public Health Austin Regional Campus. Dr. Perry is a public member of the TMAF Board of Directors. TMA and the Texas Public Health Coalition are eagerly awaiting the results of Dr. Perry’s research to help inform our antitobacco advocacy efforts.

TEXPAC ENDORSES BRANCH IN GOP ATTORNEY GENERAL RACE, ISRAEL IN HD 50

TEXPAC is throwing our support behind State Rep. Dan Branch (R-Dallas) in the three-way race for the 2014 Republican nomination for Texas attorney general. “For the past decade in the Texas House of Representatives, he has demonstrated he’s dedicated to Texas’ patients and their physicians on many important issues,” said TEXPAC Chair Jerry Hunsaker, MD. “He consistently listened to organized medicine and worked hard on its behalf to make a difference — and he has.” Representative Branch grew up in a medical household in San Antonio, and it shows. In tomorrow’s special election in State House District 50 in Austin, TEXPAC has endorsed realtor Celia Israel. Turnout makes all the difference in special elections, so please take the time to vote.

NEUROLOGIST PICKED AS INAUGURAL DEAN OF AUSTIN MEDICAL SCHOOL

Come March 1, there’ll be a new dean in town. Clay Johnston, MD, is the inaugural dean of the Dell Medical School at The University of Texas at Austin. Dr. Johnston is associate vice chancellor of research at the University of California, San Francisco. He is a practicing neurologist who specializes in preventing and treating stroke. He will begin March 1 at the Dell Medical School, which plans to enroll its first class of students in fall 2016. Good luck, Dr. Johnston, and welcome to Texas. We look forward to a great relationship as you get that new school rolling.

BIGGER AIN'T BETTER IN HEALTH CARE — MY LATEST AT FORBES.COM

My newest post at Forbes.com warns against the wave of consolidation that’s sweeping the health care marketplace. “Giant Healthcare Systems: Higher Prices, Fewer Choices And Impersonal Care” looks for but doesn’t find many advantages for physicians and patients amidst the mergers, acquisitions, and gobble-ups. “It is relatively easy to predict what will occur in our health care system based on what consolidation has done in the other sectors of our economy,” my coauthor — Physicians Foundation CEO Tim Norbeck — and I write. ”Prices will rise significantly, consumers will face fewer choices, and government regulations will increase dramatically.” Not a pretty picture.

Tuesday, January 21, 2014

DR. BROTHERTON WELCOMES NEW LEADERSHIP IN EL PASO, HOUSTON

TMA President Steve Brotherton, MD, earned his frequent flier miles this week. First, Dr. Brotherton traveled west from his Fort Worth home to help install cardiologist Juan Escobar, MD, as the new president of the El Paso County Medical Society. He takes the reins from Patricio PazmiƱo, MD. A few days later, Dr. Brotherton was in Houston for the installation of internist Elizabeth Torres, MD, as the 113th president of the Harris County Medical Society. She replaces Russ Kridel, MD. Neurologist Kim Monday, MD, is the new president of the Houston Academy of Medicine. Pediatrician and virologist Samuel L. Katz, MD, received the John P. McGovern Compleat Physician Award for his pioneering work on the measles vaccine.

SENATOR CORNYN HEADS WINTER CONFERENCE SPEAKER LIST

It looks like we’ll have back-to-back U.S. senators delivering the keynote addresses at TMA conferences. After the state’s junior senator spoke at our fall event, Sen. John Cornyn will take the dais during the General Session of the 2014 TMA Winter Conference on Saturday, Feb. 1. Other confirmed speakers include American Medical Association President Ardis Dee Hoven, MD. TMA Board of Trustees Chair Carlos Cardenas, MD, will moderate an in-depth panel discussion, on The Transformation of Health Care. Participants include Texas Health and Human Services Executive Commissioner Kyle Janek, MD; Bert Marshall, president of Blue Cross and Blue Shield of Texas; John Wallace, senior vice president for McKesson Health Solutions; and Palmer “Pal” Evans, MD, senior advisor to Tucson Medical Center and the Southern Arizona Accountable Care Organization. Speaking at the early-morning Dawn Duster about the troubled launch of the Affordable Care Act’s health insurance marketplace is Randy Farris, MD, consortium administrator for the Centers for Medicare & Medicaid Services. I hope to see you there amidst this star-studded cast of health care leaders. You can register online and call the Hyatt Regency Austin at (888) 421-1442 for hotel room availability.

TEN YEARS OF "WHAT HAS TMA DONE FOR ME LATELY?"

Jim Bob Brame, MD, the former TMA president and still fiery family physician from Eldorado, is working to fire up his Concho Valley County Medical Society. In a speech last week, he gave his colleagues 10 years’ worth of reasons for belonging to TMA:

  • 2003 — Passed strong liability reform that’s working. 
  • 2003 — Passed prompt pay law that’s working. 
  • 2005 — Generated $1 billion-plus in relief for physicians through national class action suits against for-profit insurance companies. 
  • 2006 — Prevented onerous taxes on medical practices. 
  • 2007 — Won 25-percent increase in Texas Medicaid payments for physicians. 
  • 2008 — Convinced Blue Cross and Blue Shield of Texas to rescind plan to rate physicians on how cheaply we care for our patients. 
  • 2009 — Won passage of a bill defining fair ratings plans for physicians. 
  • 2010 — Opposed passage of President Obama’s Affordable Care Act (that doesn’t seem to be working very well at all). 
  • 2011 — Defended physicians’ clinical autonomy by protecting the ban on corporate practice of medicine. 
  • 2011 — Outlawed anonymous complaints to the Texas Medical Board. 
  • 2012 — Restored state payment of Medicare Part B deductible for patients covered by both Medicare and Medicaid. 
  • 2013 — Won passage of a bill defining physician-led, team-based care — stopping nurse practitioners’ drive for independent practice. 
  • 2014 — Preparing to launch TMA Physician Services Organization, which will provide products and services that help physicians survive against the big-money hospitals and insurance companies that want to gobble us up.

"HEY, DOC" LIVES

This week originally was supposed to mark the end of TMA’s “Hey, Doc” campaign to inform patients about the Affordable Care Act marketplace exchange health plans. Given the vast amount of confusion among patients — and difficulties in physician offices — we’ve decided to keep the project rolling. Over the next six to eight weeks, look for “Hey, Doc” segments on such topics as “What are the real deadlines now?” and “Why is it important for me to pay my premiums on time?” If you have an idea for a question “Hey, Doc” needs to answer, please send me an e-mail.

Monday, January 13, 2014

CONGRESS RETURNS; SO DOES SGR FIGHT

The U.S. House and Senate have returned to session, and the March 31 deadline to act on Medicare’s faulty Sustainable Growth Rate (SGR) formula is back in the spotlight. When we last left our heroes, they had averted the 23.7-percent cut in physicians’ Medicare fees that was scheduled for Jan. 1 and approved a three-month, 0.5-percent increase through the end of March. (If only the current Medicare fee schedule were so easy to calculate. See the latest TMA e-tip on what Medicare will pay you in 2014.) At about the same time, the House Ways and Means Committee and the Senate Finance Committee passed bills to completely replace the SGR with a payment system that rewards quality over volume. The House bill provides 0.5-percent updates for three years, then freezes physicians’ Medicare payments for seven years. The Senate bill keeps payment rates the same through 2016, then imposes progressively deeper cuts starting at 4 percent in 2017 and increasing to 10 percent by 2020. Neither bill spells out how to finance its roughly $150 billion, 10-year price tag. Working with the Coalition of State Medical Societies, TMA is asking congressional leaders to keep the SGR repeal train moving but to make sure that it:

  • Provides positive automatic payment updates,  
  • Eliminates the fee-for-service program penalties, and 
  • Revises or eliminates adoption of the ICD-10 coding system.  


TMA OFFERS HIPAA TRAINING FOR YOU AND YOUR STAFF

It’s not quite a HIPAA stay-out-of-jail card, but it’s the closest we could come up with. On back-to-back Wednesdays starting this week, TMA is offering comprehensive privacy law webinars during the lunch hour. They cover both HIPAA and the more stringent Texas state law. This week’s session provides an overview of both laws, recent changes, and what to watch for from the enforcers. The Jan. 22 event focuses on the mandatory training requirements for office staff. Each session comes with special member pricing of less than $50 and an hour of CME ethics credit.

THE TMA FLU FIGHTERS ARE BACK

With influenza now widespread across Texas, our Committee on Infectious Diseases has resurrected the TMA Flu Fighters. The project provides physicians timely advice on how to prevent, recognize, diagnose, and treat influenza. Our first email update went out last week. The Flu Fighters are John Carlo, MD, of Dallas, chair of TMA’s Council on Science and Public Health; Wendy Chung, MD, Dallas County Health and Human Services’ chief epidemiologist and chair of TMA’s Committee on Infectious Diseases; Lisa Cornelius, MD, from the Texas Department of State Health Services; Bruno Granwehr, MD, and Seema Shah, MD of Houston; Gil Handal, MD, of El Paso; Philip Huang, MD, medical director at Austin/Travis County Health and Human Services; Charles Lerner, MD, of San Antonio; and Donald Murphey, MD, of Fort Worth.

TEXPAC ENDORSES LT. GOV. DAVID DEWHURST FOR GOP NOMINATION

“Lt. Gov. David Dewhurst values and welcomes the input of Texas physicians in developing health care policy for the state,” TEXPAC Board Chair Jerry Hunsaker, MD, said in announcing our endorsement in the 2014 Republican primary race. “We know we can trust Lieutenant Governor Dewhurst to do the right thing for Texas’ patients and their physicians.” Dewhurst passed and staunchly protected Texas’ landmark medical liability reforms, passed one of the nation’s strongest prompt pay bills, substantially increased Medicaid and Children’s Health Insurance Program payments for Texas physicians, eliminated anonymous complaints about physicians to the Texas Medical Board, and passed legislation allowing physicians to be employed by hospitals while strengthening Texas’ ban on the corporate practice of medicine. Last session he supported bills to reduce red tape and administrative hassles for physicians. TEXPAC sponsored an hour-long discussion among the four GOP candidates for lieutenant governor at last month’s TMA Advocacy Retreat. You can watch the video if you missed the live event.

Monday, January 6, 2014

TMA OUT TO PROTECT YOUR MARKETPLACE PAYMENTS

Hassles and red tape from the new health insurance marketplace rang in the New Year. Most concerning are new Affordable Care Act (ACA) requirements that could deny or delay your payments, such as the 90-day grace period and lack of identification on patients’ insurance cards clearly indicating they are participating in the marketplace.
  • As many of you know, the 90-day grace period is triggered once a patient with subsidized marketplace coverage misses a premium payment. Instead of immediately terminating the policy, health plans must give the patient 90 days to catch up. Federal rules allow health plans to pay, hold, deny, or later recoup payment of claims for services incurred in the second or third month of that window if patients are delinquent on their premium payments. However, insurers must pay physicians for services provided to a patient in the first 30 days of the grace period, and insurers still must comply with Texas law requiring prompt payment of claims submitted at any point in the grace period. 
TMA talked to the Centers of Medicaid and Medicare Services (CMS) about the faulty law. CMS acknowledged it’s problematic but didn’t take steps to fix it. Recognizing this is not an acceptable solution, TMA reached out to Texas carriers directly to ensure you get paid. The good news is that Blue Cross and Blue Shield of Texas (BCBSTX) stepped up to the plate.
BCBSTX recognized the fault in the current law, and rather than hold or deny claims filed during the grace period, BCBSTX will pay physicians. TMA is calling on other insurers to follow suit.
  • TMA also is talking with the carriers about clearly identifying patients in the health insurance marketplace on their ID cards. For specific information on what carriers are doing, check out ACA Exchange Plans: Questions and Answers for Texas Physicians on the TMA website. We will continue to update this page as changes arise. 
TMA is listening and taking action to fix ACA requirements affecting your practice. Please feel free to call me or my staff any time to report problems.

DO THE MATH; DON'T SELL YOUR PRACTICE SHORT

Feel like the new health care market is pressuring you to sell your practice to the local hospital? A new white paper from the TMA Physician Services Organization warns that many physicians are selling cheap because they don’t realize the power they hold today. “This new valuation model identifies the upside potential of physicians practicing in an accountable care organization (ACO)-type environment that values building long-term patient-physician relationships, more patient interaction, preventive medicine, and better management of the environment where care is given and of testing and treatment protocols,” TMA PSO consultant John Nackel, PhD, writes in “Now Worth More Than Ever.” Learn more about the products and services the TMA PSO will offer at 2014 TMA Winter Conference, Jan. 31-Feb. 1, in Austin.

TMA TELLS FEDS: DON'T FORCE PHYSICIANS INTO EXCHANGE PLANS

Just as we’re finally starting to get a handle on silent PPOs here in Texas, the feds are coming up with a new kind of surprise network for physicians who don’t want to participate in ACA exchange marketplace health plans. But we’re not going to let them get away with it. We wrote a tough letter to the U.S. Department of Health and Human Services (HHS) strongly opposing a proposed new federal policy that amounts to a “government grab at discount health care services.” The proposed policy “strongly encourages” health plans to treat any out-of-network physician as in-network if the plan incorrectly lists that physician in its directory. We all know how notoriously inaccurate those directories are — and there’s no telling how much worse they might be for the exchange plans. This policy would be bad news for patients and physicians. We call on HHS to rescind it and to enact new rules that would make sure out-of-network physicians get paid based on billed charges. Our legal and policy staff were busy throughout December. We also filed comment letters with the Texas Department of Insurance expressing concerns about changes in prompt pay rules and about proposed regulations governing captive insurance companies.

PHYSICIANS FOUNDATION WATCH LIST FOR 2014 — MY LATEST ON FORBES.COM

Some new problems and the resurgence of some old ones are on The Physicians Foundation’s 2014 Watch List for U.S. physicians. In our newest blog on Forbes.com, foundation CEO Tim Norbeck and I outline “five key areas … that are going to have major effects on practicing physicians, and their ability to deliver professional and high quality care in 2014.” Those areas are: consolidation moving toward monopolization, the ever-present regulatory burden, confusion over health insurance exchanges, health information technology that falls short, and Washington gridlock.

THURSDAY IS HOTEL DEADLINE FOR TMA WINTER CONFERENCE

If you’re coming to Austin for 2014 TMA Winter Conference at the end of the month — and of course you are — then make sure to make your reservations at the Hyatt Regency Austin by Jan. 9 to get the special conference rates. The conference is all about the changing health care marketplace and how TMA can provide physicians the tools and services you need to remain competitive so you can give your patients the high-quality care they need and deserve.