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Tuesday, March 25, 2014

TMA, MEMORIAL HERMANN TEAMS EXPLORE COMMON GROUND

TMA Secretary/Treasurer Art Klawitter, MD, joined me, TMA senior staff, and Harris County Medical Society CEO Greg Bernica in an outstanding set of meetings with the leaders of the Memorial Hermann Health System and Memorial Hermann Physician Network. I really appreciate the positive reception from system President and CEO Dan Wolterman; D. Keith Fernandez, MD, president of the physician network; and Christopher Lloyd, CEO of the network. We discussed common advocacy issues, the changing health care market, and Memorial Hermann’s strategy in the Houston area. Also on the agenda was a review of the physician network’s commitment to quality and value, and the underlying information technology infrastructure it has built. The network directly employs fewer than 200 of its roughly 2,000 network physicians. They use physician-developed standards of care and quality measurements for network physicians. I look forward to continued dialogue with their team.

TEXPAC FOCUSES ON SENATOR DEUELL, OTHERS IN MAY 27 RUNOFFS

In the old days — before this year, that is — only 30 days or so separated Texas’ party primaries and the runoff elections in races where no candidate garnered a majority of the votes. That gave a decided advantage to the top vote getter in the primary. A change in state law has added almost two months to the runoff campaign. This year, the runoffs for the March 4 primaries fall on Tuesday, May 27. That changes the political calculus, giving the second-place finisher a lot more time to raise funds and contact voters. TEXPAC’s endorsed candidates from the primaries fall into both camps. Some, like State Sen. Bob Deuell, MD (R-Greenville), led in the March 4 results. With 48 percent of the vote, Senator Deuell almost won without a runoff. TEXPAC and local physicians will be working hard to protect and expand his lead. Other candidates — like Lt. Gov. David Dewhurst and State Senate candidate Mark Shelton, MD — will be looking to make up ground. Your TEXPAC leaders also will be evaluating the candidates in runoffs for legislative races in which we made no endorsement in the primary. Be on the lookout for what you can do to help us elect more medicine- and patient-friendly candidates in this new marathon primary season.

ONE WEEK LEFT FOR SGR REPEAL ACTION

Congress returns to the Capitol today after a one-week recess and just one week away from a 24-percent cut in physicians’ Medicare payments. We’ll be watching the U.S. Senate, where the Democrats and Republicans are backing competing bills to repeal Medicare’s Sustainable Growth Rate (SGR) formula. The health care policy components of the two bills are almost the same — and both are close to the SGR-repeal bill authored by Rep. Michael Burgess, MD (R-Lewisville), which the House passed earlier in the month. The differences come in how the various measures would finance the repeal. Without consensus, we may be looking at yet another short-term patch to stave off the looming cuts.

AETNA TRIES TO KILL SETTLEMENT IN OUT-OF-NETWORK SUIT

Aetna, Inc. has asked a federal court to let it back out of a proposed $120 million settlement in a class-action lawsuit over how it pays physicians and providers for out-of-network services. The settlement would have covered physicians and providers who delivered out-of-network services to Aetna subscribers between June 3, 2003, and Aug. 30, 2013, and received less than the billed charge. TMA was one of 10 medical societies that brought the suit. Less than a week before the scheduled hearing on final approval of the settlement, Aetna told the court it was backing out because too many of the plaintiffs had opted out of the proposed settlement. Our lawyers in the case are in the process of determining whether Aetna has properly terminated the settlement. If it did, the lawsuit will resume toward trial.

TMA HELPS CLINIC REACH SETTLEMENT ON MEDICAID ALLEGATIONS

What began as a $22 million Medicaid fraud case against the Austin-based Carousel Clinic has ended as an agreement for the clinic to pay the state $3.75 million for alleged errors in billing. The clinic focuses almost exclusively on serving the poorest children in the Austin area. Following the initial fraud allegations, Carousel Clinic was dying a slow death as the state ordered a hold on its Medicaid payments. Through our Patient-Physician Advocacy Committee, TMA reviewed the medical records and facts in the case. Our support helped to substantially reduce the settlement amount. The case also served as evidence in our push last year to convince the Texas Legislature to grant better due-process protections to physicians facing Medicaid fraud allegations.

SHORT TAKES: ICD-10 CLASSES AND ACA GRACE PERIOD LINK

Our hands-on, ICD-10 documentation training seminars continue in Tyler, Dallas, Fort Worth, Wichita Falls, Houston, and Beaumont. The Dallas and Houston sessions are sold out. Registration is still open for the other sites.

Also, some readers had difficulty finding the American Medical Association toolkit on the Affordable Care Act grace period that we mentioned last week. Try this link: http://bit.ly/ACAgrace.

Monday, March 17, 2014

DR. BURGESS' SGR REPEAL BILL PASSES U.S. HOUSE

Repeal of Medicare’s Sustainable Growth Rate (SGR) formula passed a huge milestone on Friday when the U.S. House of Representatives voted 238 to 181 to pass H.R. 4015, the SGR Repeal and Medicare Provider Payment Modernization Act of 2014. The bill not only repeals the SGR but also guarantees 0.5-percent Medicare increases for physicians for five years, removes potential causes of liability against doctors, and eliminates some bureaucratic red tape that prevents physicians from concentrating on patient care. It pays for the SGR repeal by delaying for five years the Affordable Care Act penalties for individuals who do not purchase health insurance. That has drawn a veto threat from the White House. However, TMA joins with the American Medical Association and bill author Rep. Michael Burgess, MD (R-Lewisville), in calling for a continuation of the bipartisan, bicameral cooperation that has made SGR repeal an almost-tangible reality this year. “The House has finally declared that we cannot continue to kick the can down the road and patch the SGR each year — we must repeal it, and we did,” Representative Burgess said after the vote. “Please don’t stop here,” said TMA President Steve Brotherton, MD. The Senate is expected to vote on a similar bill — likely with a different method of financing — before the next SGR-driven, 24-percent cut in physicians’ Medicare payments is scheduled to kick in on April 1.

A LESSON FROM FLORIDA: WHY WE HAD TO PASS PROPOSITION 12

Eleven years ago, when TMA and the physicians of Texas won passage of landmark health care liability reforms, we knew that enacting a strong new law — while great — wasn’t enough. We had won similar reforms in 1977, but then we watched the Texas Supreme Court overturn them as unconstitutional. While TEXPAC has since been an instrumental force in helping to throw out those activist judges, we knew that success at the ballot box can wax and wane. That’s why we insisted on a constitutional amendment — Proposition 12 in 2003 — that ratified the legislature’s authority to enact caps on noneconomic damages. That’s why we organized physicians across the state to get out the vote and help pass Proposition 12 by a narrow margin. And that’s why Texas doctors and your patients continue to enjoy the healthy benefits of our reforms. We remind you of all of that as we share the unfortunate news that the Florida Supreme Court on Thursday ruled that a 2003 state law limiting damages in medical liability cases violates the Florida Constitution. Florida did not amend its constitution. We did. Tell that to your nonmember colleagues the next time they say our fight against health care lawsuit abuse is old news. And tell them to join TMA.

ORGANIZED MEDICINE TAKES ON THE ACA GRACE PERIOD

U.S. doctors are having a tough enough time integrating into their practice patients covered by the Affordable Care Act (ACA) marketplace health plans. They don’t need to be operating in the dark as to whether those patients have actually paid their premiums. That’s the message TMA, AMA, and 80 other medical societies delivered in a letter to the feds. We demanded that the Centers for Medicare & Medicaid Services require insurers who offer those ACA marketplace health plans to provide immediate notice when patients enter the first month of the 90-day grace period. If patients go 90 days without paying their premiums — after paying at least the first month’s — they are dropped from the plan. The insurance company has to eat the cost of any services provided in the first 30 days of the grace period. But physicians and providers are responsible for the next 60 days. Here are some resources that can help you make the best of a potentially bad situation: 

DR. BROTHERTON WOOS AND WOWS TEXARKANA GROUP

Dr. Brotherton met with the CEO and board of the Collum & Carney Clinic in Texarkana to introduce them to TMA and invite them to be 100-percent members. About half of the 94 physicians at the clinic belong to TMA. Dr. Brotherton talked about the importance of physician leadership and involvement in TMA, and about TMA’s successes during the 2013 Texas Legislature. Robert Clark Green, MD, president of the clinic, and the other Collum & Carney leaders discussed the unique features of their practice on the Texas-Arkansas border, the importance of medical liability reform to their practice, and the need to improve the Texas Medical Board licensing process. They invited TMA back for their June all-staff meeting and their July board meeting.

KUDOS TO DR. TEUSCHER

David Teuscher, MD, the orthopedic surgeon from Beaumont and former TMA trustee, became first vice president of the American Academy of Orthopaedic Surgeons (AAOS) Board of Directors at its annual meeting. The election marks the second of a four-year term of volunteer service that culminates with Dr. Teuscher’s presidency of AAOS in 2015-16.

CATCH OUR ICD-10 TRAINING WEBINAR IN YOUR OFFICE TOMORROW

If our ICD-10 training seminar for office staff isn’t coming to your town — or if you can’t get away to join us when it does — we’ve got another option for you. From 8:30 am to 12:30 pm tomorrow, Tuesday, March 18, we’re live streaming the event straight to your office computers. Register now for ICD-10 Documentation and Auditing: Success Is in the Details. Skip the parking and driving hassles but enjoy all the benefits of the live seminar. The live event is still coming to Austin, Tyler, Lubbock, Dallas, Fort Worth, Wichita Falls, Houston, and Lubbock. Registration is open.

Monday, March 10, 2014

SGR REPEAL WITHIN GRASP IF WE ACT NOW

Hundreds of physicians from Texas and around the country met with their U.S. senators and representatives last week as part of the Coalition of State Medical Societies and the American Medical Association’s National Advocacy Conference. David Henkes, MD, chair of the Texas Delegation to the AMA, led our group, which focused on repealing Medicare’s Sustainable Growth Rate (SGR) formula and on the avalanche of problems coming with the transition to the ICD-10 coding system in October. SGR repeal, of course, is the most pressing problem, as we face a 24-percent cut in Medicare payments April 1 if Congress takes no action. We’re excited about the prospects of SGR repeal through H.R. 4015/S. 2000, sponsored by Rep. Michael Burgess, MD (R-Lewisville). But while organized medicine and much of Congress support the policy positions in the bill, its passage is by no means certain. First, it lacks bipartisan support on how to finance its 10-year, $138 billion price tag. Secondly, congressional leadership seems loath to schedule any tough votes this election year. All of this points to the need for even more grassroots lobbying from TMA members. So far, you’ve sent more than 1,400 emails through TMA’s Grassroots Action Center and made hundreds of calls through the AMA’s (800) 833-6354 hotline. But we can’t let up now. Please call and write today, and solicit your partners, colleagues, patients, and friends as well. In 12 years of this fight, we’ve never seen such a good chance for success.

TEXPAC WINS MOST, BUT NOT ALL; LOOKS TOWARD MAY 28 RUNOFFS

The Party of Medicine performed exceedingly well in the March 4 party primaries. Several candidates from the TMA family — like State Reps. J.D. Sheffield, DO (R-Gatesville), and Susan King (R-Abilene), a TMA Alliance member — blew away their Empower Texas-backed opponents. All of the judicial candidates we backed — including the three sitting Supreme Court justices who faced trial lawyer-financed challengers — easily won their party nominations. Overall, 91 percent of the slate of TEXPAC-endorsed legislative candidates won. Some, however, are headed for May 28 runoff elections. That includes State Sen. Bob Deuell, MD (R-Greenville), and former State Rep. Mark Shelton of Fort Worth, who is seeking the Senate District 10 nomination. Even worse, we lost 11 races outright, and some very good friends of medicine will not be coming back to Austin next year. As TEXPAC Director Clayton Stewart told me, “We were simply unable to fund many of these candidates at the level needed for them to prevail. This is a problem, but it’s a problem we can solve from within, not something we can blame on ‘forces beyond our control.’ ” The solution, of course, is for more physicians and alliance members to join TEXPAC and recruit your colleagues.

TMA WORKING WITH BLUE CROSS TO CLEAN UP THE MARKETPLACE MESS

 We continue to hear horror stories of how much trouble physicians are encountering as they try to provide care to patients covered by the federal Affordable Care Act (ACA) marketplace exchange plans. We’re seeing difficulties in confirming patients’ coverage and trouble referring patients to specialists. TMA’s Payment Advocacy staff has begun weekly calls with Blue Cross and Blue Shield of Texas — which has marketplace plans in all 254 Texas counties — to address these issues, improve service, and help make the exchange better for patients and doctors. Blue Cross continues its efforts to reduce long hold times for practices attempting to verify eligibility for patients who have new coverage through the exchange. Through the TMA Hassle Factor Program, we are putting offices that are experiencing these difficulties directly in contact with senior Blue Cross personnel to resolve the problems. Have questions? See our updated, members-only question-and-answer white paper on the marketplace exchange plans.

MY LATEST ON FORBES.COM: THE TYRANNY OF THE MOUSE CLICK

If “meaningful use” were really meaningful, maybe the push for all physicians to adopt electronic health records would be tolerable. In “Technology Is Interfering With Your Doctor's Visit — And It’s Driving Physicians Crazy,” the latest Forbes.com blog post from Physicians Foundation CEO Tim Norbeck and me, we examine how the bull rush to technology by government and private payers and hospital systems is building a new wall between patients and their physicians. “The Department of Health and Human Services values EHR technology and its role in the doctor’s office — referred to as meaningful use — as the standard of care; thereby undervaluing our most important asset — the physicians’ knowledge, education, training, and intelligence,” we write. “The physician is demoted to a keyboard operator so that the government’s Holy Grail — personal information — can be entered into its massive database.”

DR. TENERY REVISITS BEDSIDE MANNERS WITH 99 AXIOMS

The profession of medicine is much more than the practice of medicine, former TMA President Rob Tenery, MD, reminds us in his new book Bedside Manners. Through a series of easy-to-read but thought-provoking essays, accompanied by 99 guiding axioms, Dr. Tenery walks us through physicians’ interactions with patients, colleagues, payers, bureaucrats, politicians, even the news media. He constantly refers back to the art of medicine — perceived by patients and others as a physician’s bedside manner. “The pioneers of medicine were introduced to this profession in an era when taking care of patients was considered an act of beneficence and not just a transaction,” he writes in a blog post the launches his new book. “When undesirable outcomes were accepted as ‘acts of God’ and not misdiagnoses. When medicine was a calling to most and not just a vocation. Advances in the science, third-party payment systems, marketing and fear of reprisals have changed all that. Unfortunately, there is no going back! What have not changed are the patients. Although they are no longer all accepting, they are still afraid. They still are in pain. They still want their physicians and the other medical professionals who care for them to care about them too.”

Monday, March 3, 2014

DOCTORS' ORDERS NO. 1: VOTE TOMORROW

If you didn’t vote early in Tuesday’s party primary elections, be sure to vote tomorrow. Texas medicine’s strength flows from the grassroots involvement of our 47,000-plus physician and medical student members: policy development, legislative testimony, media interviews, calling Congress, and — most grassroots of all — voting. TEXPAC, your political action committee, has endorsed an exceptional slate of candidates who have strong physician support, who understand our issues, and who have a good chance of winning. By helping to elect these candidates, you’re helping TEXPAC protect your patients and your profession from the intruders who want to tell you how to practice medicine. Whether you’ve already voted or you’re headed to the polls on Tuesday, share the experience. Remind your spouse, your colleagues, your staff, your patients, your friends, and your family to vote, too. The Party of Medicine needs your support.

DOCTORS' ORDERS NO. 2: CALL CONGRESS TO REPEAL THE SGR

TMA Board of Trustees Chair Carlos Cardenas, MD, leads a high-powered Texas physician delegation to Washington this week. In conjunction with the Coalition of State Medical Societies and the American Medical Association National Advocacy Conference, we’ll be lobbying Congress to pass the bill to repeal the Medicare Sustainable Growth Rate (SGR) formula. To support our team on the ground, we’re calling on all Texas physicians to flood Capitol Hill on Wednesday with SGR-repeal phone calls. Call AMA’s toll-free hotline, (800) 833-6354, Wednesday to tell Sens. Ted Cruz and John Cornyn and your representative that you want an SGR repeal, not another a short-term patch for the 17th time. Or, you can send an email through the TMA Grassroots Action Center. Joining Dr. Cardenas and TMA staff on the trip will be AMA House of Delegates Vice Speaker Sue Bailey, MD; AMA Trustee Joe Annis, MD; Texas Delegation to the AMA Chair David Henkes, MD; AMA Council on Science and Public Health Chair Russ Kridel, MD; and Texas Delegation members Drs. Asa Lockhart, Les Secrest, Michelle Berger, and Dawn Buckingham.

TRAIL LAWYERS INFILTRATE REPUBLICAN SUPREME COURT RACES

If you can’t beat ’em, join ’em seems to be the trial bar’s latest tactic. Long the sugar daddies of Texas Democrats, the trial lawyers realize that no Democrat has won a statewide race here in two decades. An excellent Wall Street Journal article (subscription required) details how Houston plaintiffs’ attorney John Eddie Williams and his friends are bankrolling candidates challenging Texas Supreme Court Chief Justice Nathan Hecht, and Justices Phil Johnson and Jeff Brown. For physicians who’ve worked hard to pass and defend health care lawsuit reform, this is a scary development. Check out this analysis from Austin lawyer Mike Hull — and read it before you vote.

TMA BUILDS GRASSROOTS CONNECTIONS WITH LUBBOCK LEADERS, TMLT STAFF

Demonstrating the value of two different types of strategic partnerships, TMA provided in-depth orientations to the leaders of the Lubbock-Crosby-Garza County Medical Society (LCGCMS) and nine new sales representatives from the Texas Medical Liability Trust (TMLT). We reviewed our advocacy and policy development work, as well as TMA products and services, for the TMLT team and LCGCMS President Naidu Chekuru, MD; President-Elect Joe Cordero, MD; and Executive Director Juanema Christensen. TMLT is the only medical professional liability insurance provider created and exclusively endorsed by TMA.

FALCON TO BE NAMED TO HEALTH AND HUMAN SERVICES COUNCIL

We’ve received word that Gov. Rick Perry is appointing Tony Falcon, MD, the always-involved family physician from Rio Grande City, to the Texas Health and Human Services Council. The council assists Health and Human Services Executive Commissioner Kyle Janek, MD, in developing rules and policies for the commission. A TEXPAC-stalwart, Dr. Falcon has previously served on the Governor's Committee on Medicaid and the Texas Parks and Wildlife Commission.

NAME CHANGE: IT'S NOW BIG COUNTRY COUNTY MEDICAL SOCIETY

The Taylor-Jones-Haskell-Callahan County Medical Society is no more. The Abilene-based society is now the Big Country County Medical Society. It still serves 300-plus West Texas physicians. Its executive vice president is still the incomparable Pat Evans. The new name better expresses Big Country’s broad service area — without all the hyphens.