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Monday, April 28, 2014

TEXMED GENERAL SESSION GIVES YOU TWO SPEAKERS IN ONE

A health care reformer and a rapper. A practicing physician and an Internet sensation. A hospitalist turned primary care physician. Zubin Damania, MD, brings all of his personalities to Fort Worth Friday afternoon as our General Session speaker at TexMed 2014. Dr. Damania, also known as ZDoggMD, is the founder of Turntable Health, a Las Vegas-based practice that fosters primary care focused on prevention by offering nutrition classes and group therapy along with regular patient visits. In his presentation, Redefining the Culture of Medicine, Dr. Damania will delve into the ethical challenges to delivering excellent care in a troubled health care system, and he will propose ways to revitalize it. He’ll also share some of ZDogg’s hilarious, satirical videos. Read all about both of him in the April issue of Texas Medicine. Can’t make it to Fort Worth? Catch the “almost live” webcast, 5:30-6:30 pm Friday on our The Future of Texas Health Care Internet channel.

FIVE THINGS NOT TO MISS AT TEXMED 2014

Dr. Damania’s speech is only one of many highlights at TexMed 2014, TMA’s annual educational showcase and expo, May 2-3 in Fort Worth. Here are five more can’t-miss events: 

TMA OPPOSES PROPOSED AGENCY RULES THAT OVERREACH

TMA President Steve Brotherton, MD, wrote formal comment letters for the association opposing two state agencies’ proposed rules that go too far. 
  • First, TMA wrote a formal letter opposing a Texas State Board of Dental Examiners’ proposal to allow dentists to diagnose and treat sleep apnea. “If a dentist practices outside the scope of dentistry, such as diagnosing or independently treating a sleep disorder, he or she is, by definition, practicing medicine unlawfully,” Dr. Brotherton wrote. “It is imperative that diagnoses of the presence or the absence of sleep disorders, including but not limited to benign snoring and sleep apnea, be made by a qualified Texas-licensed physician, in order to protect the health and safety of Texas’ patients.”
  • Also, TMA wrote to oppose a proposed Texas Medical Board (TMB) rule that would require the supervisor of a physician assistant temporary license holder not only to be a Texas-licensed physician with an unrestricted license but also to not have been the subject of a disciplinary order, other than one administrative in nature. “A Texas-licensed physician who holds an unrestricted medical license is, by the TMB’s own assessment, authorized to perform any medical service or procedure that falls within the scope of his or her license in the state of Texas,” Dr. Brotherton wrote. “Thus, he or she should be capable of providing ‘adequate supervision’ of a physician assistant temporary license holder. The fact that a physician once, perhaps many years ago, had a disciplinary order does not change this assessment.”

TAKE THE PHYSICIANS FOUNDATION'S 2014 NATIONAL PHYSICIAN SURVEY

What do you think of medicine today? How are things working for you? Your practice? Your patients? Don’t keep your opinions to yourself! Complete the 2014 National Physician Survey, sponsored by The Physicians Foundation. Your responses to what may be the most comprehensive survey of American physicians ever undertaken will help the foundation provide a state of the union of the medical profession  to policymakers, political leaders, and the public so that physicians’ perspective can command the attention it deserves. It is critical that a large number of Texas physicians answer the survey so we can break out and compare Texas responses to the rest of the nation. Bonus: When you take the survey and include your email address, you’ll be entered into a drawing for a $10,000 travel voucher, a $2,000 Apple voucher, or an iPad Air.

PHYSICIANS: STEP UP AND LEAD PAYMENT REFORM

A primary cause of the nationwide push for physician employment is a lack of physician leadership on payment reform. That’s what Harold Miller, president and CEO of the Center for Healthcare Quality and Payment Reform, told The Physicians Foundation. Mr. Miller, who has decades of experience in health care delivery and finance systems, said physicians must take charge of value-based payment models and lead the evolution in payment if they want to keep their autonomy.

TMA TO GOVERNOR PERRY: SUPPORT CHIP FUNDING

TMA signed onto a March of Dimes and Texas Pediatric Society letter asking Gov. Rick Perry to urge the Texas congressional delegation to support continued Children’s Health Insurance Program (CHIP) funding beyond 2015. Though the program runs through 2019, federal funding for CHIP expires Oct. 1, 2015, unless Congress extends it.

Monday, April 21, 2014

MEDNAX TEAM ALIGNS WITH TMA

TMA senior staff and I enjoyed a very positive meeting with the Texas leaders of MEDNAX, the national neonatal, maternal-fetal, pediatric, and anesthesia group. They affirmed their commitment to 100-percent membership in TMA and the county medical societies. We discussed mutual advocacy priorities and physician leadership development opportunities, and they described the practice's clinical research and quality initiatives. The MEDNAX team included Regional President Tony Lacaze; Regional Vice President Curt Pickert, MD; Hanoch Patt, MD, the practice medical director; San Antonio neonatologists Michael Battista, MD, and Alex Kenton, MD; and Fort Worth neonatologist Robert Ursprung, MD. Dr. Battista is a member of the TMA Council on Socioeconomics, and Dr. Kenton serves on the Council on Health Care Quality and the TEXPAC Board of Directors.

TEXMED 2014: IT'S WHAT'S FREE (TO MEMBERS)

The House of Delegates. More than 80 hours of clinical and practice management CME. More than 100 top-notch vendors in the Expo Hall. ZDogg, MD. Networking opportunities, business meetings, and social activities. TexMed 2014 is TMA’s annual meeting, May 2-3, at the Fort Worth Convention Center. And it’s free for TMA members. If you’ve never been to TexMed, make 2014 your year to start. Watch this short video to see what it’s all about. If it’s been awhile, now’s the time to come back. And if you’re always there, I look forward to seeing you in Fort Worth. Did I mention it’s free?

PHYSICIANS HELP CREATE A HEALTHY TEXAS ECONOMY

Texas’ practicing physicians are worth billions to the state's economy and $1.6 trillion to the whole country, according to a new report from the American Medical Association. The economic impact study found Texas physicians support 522,619 jobs and generate $78.6 billion in economic activity, including $43 billion in wages and benefits, and $2.5 billion in local and state tax revenues. “Unlike last week's Medicare payment data dump, these numbers are supported by solid analysis and reported in rich context,” said TMA President Steve Brotherton, MD. “The bottom line is that Texas' physician practices, without a doubt, are good for the economic health of our communities and our state.” IMS Health prepared “The National Economic Impact of Physicians” for the AMA.

THE HEALTH CARE "BUSINESS" — GOOD FOR EVERYONE BUT PHYSICIANS

 My latest post at Forbes.com talks about the tremendous investment opportunities health care reform is bringing to nearly every sector of the health care economy. Pharmaceutical companies have more patients to buy drugs; insurers have more lives to cover; for-profit hospitals have more people to put in their beds or run through their imaging centers; electronic health records vendors have government clout to force physicians to buy their products. Doctors, however, aren’t quite positioned to put such a positive spin on the outsized increase in demand for health care services. “From the physicians’ perspective, it means more patients in need of even more services in an era of over-regulation, incessant red-tape, and stagnant incomes,” Physicians Foundation CEO Tim Norbeck and I write in “Why Healthcare Is A Good Investment For Insurance, Pharmaceutical And Technology Companies - But Not For Physicians.” Do you agree? Let me know.

BLUE CROSS LEADERS EXAMINE POTENTIAL NEW PAYMENT MODELS

TMA staff and I met with some of the senior team at Blue Cross and Blue Shield of Texas (BCBSTX) to discuss how payers can help medical practices successfully participate in quality initiatives and innovative new payment models. BCBSTX President Bert Marshall led the group that also included Dan McCoy, MD, the chief medical officer; and Bob Morrow, MD, the senior medical director.

SOUTHWEST MEDICAL VILLAGE OPENS ITS DOORS

I attended the open house at the new Southwest Medical Village in Austin. Led by Kevin Spencer, MD, of Premier Family Physicians, the 80,000-square-foot facility houses about 70 physicians representing 20 specialties and features a pharmacy and optometry practice. The team-based practice is modeled after Chris Crow, MD’s, Village Health Partners in Plano. We featured Southwest Medical Village in the cover story of March’s issue of Texas Medicine.

Monday, April 14, 2014

THREE THINGS YOU NEED TO KNOW ABOUT THE DOC DATA DUMP

The release of physicians’ 2012 Medicare payment data has generated a lot of anger, stress, and confusion in the medical profession. Our phone lines have been jammed with physicians asking, “Why did this happen? Can I correct any inaccuracies? What are we doing about it?” We put out a special issue of TMA’s Action newsletter to address as many concerns as we can, but here some important answers for you. The Centers for Medicare & Medicaid Services (CMS) had to comply with several federal laws when it gave the public unprecedented access to physician Medicare payments and charges for services and procedures. The CMS online database contains information on more than 880,000 physicians and other health care professionals who collectively received $77 billion in Medicare Part B payments in 2012. Organized medicine won a court victory more than 30 years ago that kept the data private. But a judge reversed it in 2013, leading to last week’s release. CMS has no process for physicians to correct errors they find in the data. The biggest problem, as TMA President Steve Brotherton, MD, pointed out in numerous media interviews, is the presentation of the raw information out of context. The data do not account for physician expenses, such as drug and medical supply acquisition costs, investments in health information technology, and other expenses associated with operating any small business. We are very concerned that this will mislead patients, the general public, and elected officials. TMA is developing some talking points you can use to answer patients’ questions and will share them with you promptly.

TMB NUMBERS POINT TO RECORD NUMBER OF NEW TEXAS PHYSICIANS

More than 5,000 physicians will apply for new Texas medical licenses in fiscal 2014 if current trends hold up, according to statistics from the Texas Medical Board (TMB). Halfway through the fiscal year, TMB has received 3,162 applications; that's running a healthy 11 percent ahead of last year’s record and projects to 5,046 applications by Aug. 31. While Texas’ booming economy and rapid population growth is certainly attracting more new physicians here every day, we’ve also proven that our landmark 2003 liability reforms have been a powerful draw. By comparison, in 2003, TMB received barely more than 2,500 license applications during the entire year. We’re poised to double that number now.

METRO COUNTIES SET MEMBERSHIP PLANS

The twin pillars of TMA’s strength are our 47,000+ members and our outstanding relationship with Texas county medical societies. We focused on combining those two assets at our semi-annual meeting with CEOs, membership staff, and field representatives of the metropolitan county societies. We looked at current membership trends, discussed our next targets for 100-percent-membership large groups and our next recruitment campaigns, and examined local market issues that affect membership. It’s always an exceptional and productive meeting.

SEMINAR OFFERS POINTERS ON CHANGES IN SUPERVISING MIDLEVEL PRACTITIONERS

One of TMA’s biggest successes in the 2013 Texas Legislature was passing a law that sets up a more collaborative, delegated practice among physicians and advanced practice nurses or physician assistants. The law firmly establishes the physician-led medical team, allows all involved to practice at their level of education and training, and places more authority and responsibility on the physician to supervise. TMA is launching a new statewide seminar series May 7 to help you make the most of the new law and comply with its requirements. We’ve also updated our publication, Nonphysician Practitioners: Hiring, Billing, and Delegation of Duties for an NPP to reflect all the changes.

TEXMED PRACTICE TRANSFORMATION TRACK PREPARES YOU FOR TOMORROW

TexMed 2014, our annual meeting in Fort Worth, May 2-3, offers more than 80 hours of continuing medical education credit — all free to members. The TMA Physician Services Organization is sponsoring a five-hour Practice Transformation Track from 8:30 am to 3 pm May 2 that you won’t want to miss. You’ll learn how to identify the risks facing your practice today and how to make plans to mitigate them, how to prepare your practice to take advantage of value-based payment trends, and how to collaborate with other independent practices to manage population health and contract for new payment models. Our guest speakers come from McKesson Coding Services, McKesson Enterprise Intelligence, and McKesson Business Performance Services.

OTTO TO LEAVE AS TMLT CHIEF

Charles R. “Chip” Ott Jr. is stepping down as Texas Medical Liability Trust (TMLT) president and CEO effective June 30 to dedicate more time to his family. TMLT is the largest medical liability provider in the state, and the only medical professional liability insurance provider created and exclusively endorsed by TMA. “Under Chip’s leadership, TMLT has grown even stronger by creating more ways to protect Texas doctors,” said TMLT Board Chair Arthur Evans, MD. We wish him the best.

Monday, April 7, 2014

CLOSE, BUT NO SGR CIGAR; WE'RE NOT GIVING UP

If you’re big on frustration and aggravation, then Medicare’s Sustainable Growth Rate (SGR) formula is the gift that keeps on giving. As we, unfortunately, predicted correctly last week, the U.S. Congress applied yet another patch on the SGR, averted a big cut in physicians’ Medicare fees, and threw away a great opportunity to fix this mess once and for all. As TMA President Steve Brotherton, MD, said, “After an admirable bipartisan and bicameral agreement to end the farcical funding flaw that perpetually leaves doctors unsure of their ability to participate in Medicare and senior patients unsure of their access to their physicians, Congress could not find an equally collegial solution to the funding mechanism.” While we had high hopes that the momentum would be enough to carry the bill to passage this time, we’re not going to sit around and mope. Look for TMA to work with our champions — like U.S. Rep. Michael Burgess, MD (R-Lewisville), and others —to get the repeal train back on the track.

ICD-10: DON'T DELAY BECAUSE OF THE DELAY

Please don’t let your guard down because of the one-year extension of the ICD-10 deadline that Congress passed with the SGR patch. While TMA will continue to fight for a “never” start date for ICD-10, I still urge all of you to plan on having to put the new coding system in place on Oct. 1, 2015. For many physicians, especially those in small practices, the extension probably amounts to a reprieve. The research we’ve seen shows that most practices just hadn’t taken all the tough and complex steps needed to switch to this brand new coding language by the first of this October. See next month’s Texas Medicine and our ICD-10 Resource Center for guidance on what to do when and how to get started. Check out the tools, courses, and free videos we’ve compiled.

DISGUISE YOURSELF AT TMA FOUNDATION'S 21ST ANNUAL BENEFIT GALA

The TMA Foundation’s annual benefit gala is always a highlight of our annual meeting. This year won’t disappoint. Cochairs Joe Todd, MD, and Susan Todd, are hosting A Masqued Ball, Friday, May 2, at the Omni Fort Worth. Enjoy an evening of revelry — a carnival of incognito party goers — with two guest receptions, a silent auction, special entertainment, and dinner. Buy your tickets or table now. VIP tickets are $225, and regular tickets are $175 through April 30. Gala proceeds benefit TMA health promotion programs, including Be Wise ─ ImmunizeSM, Hard Hats for Little Heads, the Ernest and Sarah Butler Excellence in Science Teaching Awards, Choosing Wisely, and the Minority Scholarship Program. For more information or to buy your tickets, visit the TMAF website, email Sean Dunham, or call (800) 880-1300, ext. 1664, or (512) 370-1664.

MY LATEST FORBES.COM POST: REMEMBERING WASHINGTON, D.C., 2010

When we remember the Affordable Care Act’s (ACA’s) birth pains, we’re not surprised by the invective that dominates our discussions of the ACA today. Everyone remembers House Speaker Nancy Pelosi’s famous line about having to pass the bill before you could read it. But it was the shifting, razor-thin partisan margin in the Senate that left us with a piece of legislation that was even more flawed than we originally expected. Physicians Foundation CEO Tim Norbeck and I return to the Capitol Hill of late 2009 and early 2010 in our latest blog post for Forbes.com: “A Look Back At How The President Was Able To Sign ObamaCare Into Law Four Years Ago.” Along the way, we trace the sources of today’s rancor. “Republicans invoked Thomas Jefferson’s observation that ‘great innovations should not be forced on a slender majority — or enacted without broad support.’ … They complained that one fewer vote in the Senate or a change of four votes in the House would have been enough to defeat ObamaCare. Democrats responded just as vociferously and passionately that this health care reform package was too important and overdue to delay or compromise.” And the fight goes on.

Wednesday, April 2, 2014

SENATE TO VOTE ON SGR PATCH, ICD-10 DELAY

The bill the U.S. Senate is scheduled to consider this evening is a decidedly mixed bag for medicine. It doesn’t repeal Medicare’s Sustainable Growth Rate (SGR) formula. After months of bipartisan progress in both the House and the Senate, this last-minute stall is most frustrating. Instead, the bill slaps yet another (the 17th) Band-Aid on Medicare to stave off the SGR-driven, 24-percent cut in physicians’ Medicare payments currently set for April 1. It sets the next SGR cliff for April 1, 2015. On the other hand, the measure shows Congress has been listening to what TMA has been saying about the Oct. 1 mandatory transition to the ICD-10 coding system. Survey after survey document that physicians are nowhere near ready for this ridiculously expensive and unnecessary shift to a brand new coding language. The legislation delays the ICD-10 start date for one year, to Oct. 1, 2015. The bill passed the House of Representatives Thursday, with opposition from the American Medical Association and some other physician organizations. Adding to the confusion, we have word that the Centers for Medicare & Medicaid Services (CMS) has ordered Medicare contractors like Novitas to hold physicians’ claims for two weeks after the April 1 deadline.

NEW MEDICARE ADVANTAGE NETWORK TERMINATION RULES PROPOSED

Spurred by legal action involving TMA and the subsequent media coverage, CMS released new Medicare Advantage rules that would safeguard patients when health plans significantly reduce their physician networks. The proposed rules follow UnitedHealthcare’s termination of thousands of Texas physicians from its Medicare Advantage plans last fall. The rules would require Medicare Advantage organizations to give physicians and providers at least 60 days’ notice of a contract termination and beneficiaries at least 30 days’ notice of network changes. The rules could be finalized as early as April 7.

TEXAS PUBLIC HEALTH COALITION HONORED

The Texas Public Health Coalition, of which TMA is a charter member, received this year’s Jessie A. Yoas Award from the Texas Public Health Association for distinguished work on the legislative scene. The coalition’s 2013 legislative agenda included immunizations, tobacco, and obesity.

DON'T MISS CHOOSING WISELY TRACK AT TEXMED ON MAY 2

TexMed 2014 is just a month away, and you definitely want to make room on your schedule for the Choosing Wisely® continuing medical education (CME) track Saturday, May 3, from 10 am-2 pm at the Fort Worth Convention Center. The keynote speaker is David H. Johnson, MD, chair of the American Board of Internal Medicine (ABIM) Board of Directors and chair and professor of the Department of Internal Medicine at The University of Texas Southwestern Medical School. Lisa L. Ehrlich, MD, chair of the TMA Health Quality Council, and Frank Villamaria, MD, will co-chair the CME program. Choosing Wisely promotes conversations between physicians and patients based on evidence provided by specialty societies that have identified tests or procedures that should be discussed. The ABIM Foundation awarded TMA and the TMA Foundation a grant to advance the Choosing Wisely campaign among Texas physicians. Check out the list of all the TexMed CME programs. TexMed — and the CME — is free to TMA members.

TMA OPPOSES AUDIOLOGY SCOPE EXPANSION

Audiologists lack the “medical training necessary to perform the same duties as physicians” and aren’t able to “provide patients with the medical diagnosis and treatment options they require.” That’s the message TMA, the American Academy of Otolaryngology-Head and Neck Surgery, 38 state and local medical associations, and dozens of specialty societies and national organizations sent in a letter to U.S. House and Senate leaders. The letter says we strongly oppose HR 4035 by Rep. Jim McDermott (D-Wash.) and S 2046 by Sen. Sherrod Brown (D-Ohio).

SHORT TAKES

With so much news to report this week, we have to combine these items so they fit:
  • TMA President Steve Brotherton, MD, keeps up his busy travel schedule. He drove to Jacksonville to speak to the Cherokee County Medical Society.
  • Dr. Brotherton’s pen was also busy. The Wall Street Journal published his letter to the editor, a rebuttal to some of Ezekiel Emanuel, MD’s, musings on the “value” of bundled payments authorized under the Affordable Care Act. The main effect, Dr. Brotherton wrote, “will be to give hospitals increased leverage over physicians.”
  • And Gil Handel, MD, came from El Paso to Austin to testify to the House Human Services Committee about ongoing problems with Medicaid. Only by making Medicaid payments competitive, he said, can the state attract an adequate provider network. Dr. Handel said the one-year delay in boosting primary care Medicaid payments to Medicare levels further discouraged physician participation in the program.