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Monday, June 30, 2014

VA REGISTRY: "I WOULD PASSIONATELY APPEAL TO MY PHYSICIAN FRIENDS. WE NEED TO JOIN."

More than 250 TMA-member physicians have signed up for our registry of private-sector doctors willing to see patients from the Veterans Affairs Department (VA) in the ongoing crisis. Baytown surgeon Monira Hamid-Kundi, MD, is one of them. In this TMA video, Dr. Hamid-Kundi shares her frustration with caring for veterans in the emergency department. She and TMA President Austin King, MD, appeal to Texas physicians to enlist in the registry, despite VA’s long history of slow payment and low payment. “You have to pay back some people who have dedicated themselves to, at times, risking their very life for the lifestyles we have today,” Dr. King said. Neither TMA nor the American Medical Association has heard back yet from President Obama on our request that he “take immediate action” to provide timely access to care for veterans through the health care sector outside the VA system.

 

HELP TEXPAC GROW FOR 2014 ELECTION IMPACT

Guided by Board Chair Jerry Hunsaker, MD, and Executive Director Clayton Stewart, TEXPAC is determined to continue to make a big difference in this year’s elections. We do that with grassroots support for medicine-friendly candidates and, of course, political donations. Those contributions come only from TEXPAC members’ dues, so membership is critical. You can join at the Basic, 300 Club, or Capitol Club levels — or be a charter member of our new Patron Club. As TMA Alliance President Angie Donahue writes to her colleagues, “You have the power to advocate for change. You have the ability to be a hero for medicine and a hero for the patients who are unable to garner the strength to speak with one united voice. You have this ability because you have access to the political voice of the Texas Medical Association: TEXPAC.” Please join today.

TMA MEMBERS TESTIFY ON HEALTH AGENCY SUNSET REVIEW

TMA Board of Trustees member Gary Floyd, MD; former Council on Public Health Chair Chip Riggins, MD; and Houston neurologist Kim Monday, MD, took the witness stand as the Texas Sunset Advisory Commission ramped up its review of state health agencies. Under Texas law, every state agency must be reestablished by the legislature every 12 years, or it goes out of existence. As part of this sunset review, each agency undergoes extensive evaluation by the sunset commission to make sure it is effectively and efficiently meeting Texans’ needs. The commission is composed of five senators, five state representatives, and two public members — one of whom is TMA Council on Legislation Chair Dawn Buckingham, MD. Sen. Charles Schwertner, MD (R-Georgetown), is one of the senators on the panel. This cycle, the commission is examining the Texas Health and Human Services Commission, the Department of State Health Services, and all of the associated state health agencies. TMA is heavily involved, offering recommendations and testimony on how to improve these programs. We’re also on the lookout for recommendations that could weaken them. For details on last week’s testimony, see tomorrow’s issue of Action.

CONNECT WITH TMA SOCIAL MEDIA

Ever since those 35 Texas physicians gathered at Austin’s First Methodist Church in 1853 to organize TMA, the association has served to bring Texas doctors closer together. In the 21st century, that means not just TMA and county society in-person meetings. Stay in touch with your colleagues on TMA’s Facebook, Twitter, LinkedIn, and YouTube accounts. Dr. King recently launched the TMA president’s Twitter feed. Our Young Physician Section, Resident and Fellow Section, and Medical Student Section are all active on Facebook. The TMA Foundation has robust Facebook and Twitter accounts, and the TMA Alliance and TMA Payment Advocacy Department are both on Facebook. New to any or all of these tools? Check out TMA's Social Media Resource Center.

TMAIT SEEKS ADVICE FOR NEW RESIDENTS

And speaking of Twitter, the TMA Insurance Trust is using its Twitter account to solicit some sage advice for the class of incoming residents who start their new posts this week. The first two:
  • From Waco otolaryngologist Brad Holland, MD: “Your profession is what you make of it. Learn, absorb, give care, practice developing a true trusting relationship w/patients.”
  •  From Austin interventional cardiologist Osvaldo Gigliotti, MD: “Never forget what a privilege it is to be a physician. Work hard, learn, and always try to do what is best for your patient.”

EVPGRAM TAKES SUMMER BREAK

It’s that time of year again, time for EVPGram to take some time off for the summer. We’ll be back in your in-box right after Labor Day. But don’t worry, yours truly, the editor, and all the TMA staff will be here working for you and your practice. Stay in touch via Texas Medicine, Action, and the TMA website. And we’ll bring you special editions of the ‘Gram when the need arises.

Friday, June 27, 2014

TMA TO VA: TEXAS PHYSICIANS ARE HERE TO HELP

TMA President Austin King, MD, announced the registry of private physicians willing to see patients in the Veterans Affairs (VA) health care system in a letter to the director of every VA hospital, clinic, and veterans center in the state. “As the Department of Veterans Affairs health care system works to overcome the recently documented access-to-care problems, I am writing to tell you that the physicians of Texas are here to help you and the veterans you serve,” Dr. King wrote. Already, more than 200 TMA-member physicians have signed up for our registry. The action came after the American Medical Association House of Delegates, at the urging of Texas physicians, voted overwhelmingly to ask President Barack Obama to provide timely access to entitled care for eligible veterans through the health care sector outside the VA system until VA can provide care in a timely fashion. AMA immediately fired off a letter calling on the president to “take immediate action” to clear the way for private-sector physicians to help reduce the VA backlog. If you haven’t signed up for the registry yet, please go to the TMA website and check the I am willing to serve veterans box.

LEADERSHIP ACADEMY EXPLORES HEALTH CARE INNOVATION

TMA President-Elect Tom Garcia, MD, and I attended the Physicians Foundation Leadership Academy at Duke University. Using a combination of lectures and small-group exercises, the program examined the impact of health care innovation versus improvements in medical technology, behavioral economics, and other leadership topics. Every year since the academy began, TMA’s president-elect has attended along with one of our senior staff members. It’s excellent preparation for the challenges that lie ahead. (And speaking of The Physicians Foundation, there’s still time for you to take the foundation’s biennial survey of American physicians. Everyone who completes the survey will be entered into a drawing to win a $10,000 Travel Voucher, a $2,000 Apple voucher, or one of multiple iPad Airs.)

TMA CALLS FOR MEDICAL ASSISTANCE FOR CENTRAL AMERICAN REFUGEES

The Central American women and children streaming into South Texas need medical assistance, and they need it now, says Dr. King, who travelled to McAllen to personally survey the growing refugee crisis. TMA is calling on President Obama and Gov. Rick Perry to provide medical aid to the thousands of women and children who have traveled from Central America to Texas. “Communicable diseases know no borders, and it’s critical we make certain no one is traveling with tuberculosis, pertussis, measles, or any other contagious disease,” Dr. King said. “Medical aid not only protects the Central American refugees. It also protects U.S. residents from potential serious and deadly diseases.”

TMA CALLS FOR MEANINGFUL USE MORATORIUM

Because physicians “are feeling overloaded by the myriad new Stage 2 meaningful use measures imposed on them,” Congress should stop Medicare from requiring any new meaningful use criteria, a TMA leader wrote in a letter to the chair of the U.S. House Energy and Commerce Committee. Otherwise, Matt Murray, MD, the chair of TMA’s ad hoc Committee on Health Information Technology, wrote to U.S. Rep. Fred Upton (R-Michigan), “Texas physicians — out of frustration — will withdraw from the Meaningful Use program at alarming rates.” The letter also praised Chairman Upton for demanding answers from the National Coordinator for Health Information Technology about the future regulatory burden on physicians’ use of electronic health records (EHRs) “TMA strongly recommends that the Centers for Medicaid & Medicare Services (CMS) or Congress suspend the EHR penalties on Medicare charges that are scheduled to take effect Jan. 1, 2015,” Dr. Murray added. “We believe CMS will put patient safety at risk by requiring EHR vendors to meet overly burdensome certification requirements and physicians to implement complex EHR upgrades in a compressed period of time.”

Monday, June 16, 2014

ENLIST NOW TO SERVE OUR VETERANS

At the urging of Texas physicians, the American Medical Association House of Delegates voted overwhelmingly to ask President Obama to provide timely access to care for eligible veterans using the health care sector outside of the U.S. Department of Veterans Affairs (VA) health care system until the VA can provide care in a timely fashion. AMA also will urge Congress to enact long-term solutions rapidly so veterans can always have timely access to entitled care. “It is tragic that our veterans have been forced to wait for the health care they need and deserve, so Texas physicians and our colleagues across the nation want to help care for them until the VA can right the ship,” said TMA President Austin King, MD. As part of this plan, TMA is creating a registry of private physicians across the state who are willing to see veterans in their offices. We don't know payment specifics yet. However, when physicians agree to treat veterans currently, payments typically are made according to the Medicare fee schedule. TMA will share the registry (name, specialty, office address, and phone number) with community groups that work with Texas veterans and with medical directors of VA facilities in Texas. Sign up today for the registry. Check the “I am willing to serve veterans” box and click “SAVE.” Or call the TMA Knowledge Center at (800) 880-7955.

RUSS WINS!

With the election of Houston’s Russ Kridel, MD, to the AMA Board of Trustees, Texas candidates went three-for-three in races at the AMA house last week. (We previously reported Sue Bailey, MD’s, reelection as vice speaker of the house, and Asa Lockhart, MD’s, success in claiming a seat on the AMA Council on Medical Service.) From working with him as a leader of the Harris County Medical Society and the TMA Foundation, I know that Dr. Kridel is extremely dedicated to our physicians and your patients. He ran a great campaign and will be an outstanding board member. I want to send a special thanks to Dr. Kridel’s campaign team and to our campaign partners at the American Academy of Facial Plastic and Reconstructive Surgery and the Neurosurgery Delegation.

RIP, ROBERT G. MICKEY, 1930-2014

I am terribly sorry to report to you the passing of Bob Mickey, my immediate predecessor as TMA executive vice president. Bob served TMA for 29 years, including 11 years at the helm. The funeral was Thursday. Please join me in sending our most sincere sympathies to Anita Mickey and her children and grandchildren. The family suggests memorial contributions be sent to the Settlement Home for Children of Austin (1600 Payton Gin Rd., Austin, TX 78758 or www.settlementhome.org/donate).

VICTORIA PHYSICIANS EXPLORING ACO

Bridget McPhillips, TMA VP of membership and business development, and I met with physician leaders in Victoria to discuss their options for developing an accountable care organization (ACO). They are interested in exploring a Medicare Shared Savings ACO. The group included George Osuchukwu, MD, president of the Victoria-Goliad-Jackson County Medical Society; Rakesh Kathpalia, MD; and Armando Diaz, MD.

DELL MED SCHOOL INAUGURAL DEAN EXCITED ABOUT OPPORTUNITY

Karen Batory, TMA VP of public health and medical education, and I enjoyed an excellent visit with Clay Johnston, MD, the inaugural dean of the Dell Medical School at The University of Texas (UT) at Austin, and Ray Greenberg, MD, executive vice chancellor for health affairs at the UT System. Dr. Johnston discussed the rare opportunity that he and Austin physicians have to create a new medical school from scratch and his desire to build a unique institution. I believe that he and Dr. Greenberg were impressed with the breadth of services TMA offers. We encouraged them to take full advantage of TMA’s ongoing efforts to support physician workforce expansion, including the dire need to build more graduate medical education slots.

TAKE HALF OFF CME PODCASTS IN TMA EDUCATION CENTER

For a limited time, TMA members can take 50 percent off the cost of all continuing medical education (CME) podcasts in the TMA Education Center. Topics include fraud and abuse, HIPAA, RAC audits, meaningful use, cancer survivorship, tobacco counseling, and more. Download these portable CME courses and listen anywhere you find the time.

Monday, June 9, 2014

TEXAS, FLORIDA DELEGATIONS: WE NEED IMMEDIATE HELP FOR VETERANS

In the wake of the revelations of long delays in health care at Veterans Affairs (VA), the Texas and Florida delegations to the American Medical Association House of Delegates asked AMA to push President Obama for immediate action. In an emergency resolution that was cleared Sunday for debate at the AMA meeting, Texas and Florida asked that AMA “publicly insist (by June 12, 2014) that the President of the United States take immediate action to provide full health coverage financial benefits to ensure that United States veterans can rapidly access the medical care they need outside the VA until the VA can provide promised care.” Texas delegation Vice Chair Asa Lockhart, MD, of Tyler and Irag War veteran Ray Callas, MD, of Beaumont testified for the resolution Sunday at reference committee.

DRS. BAILEY, LOCKHART WIN AMA ELECTIONS

Two Texas physicians secured leadership positions at AMA without opposition; a third must wait until Tuesday’s elections. The House of Delegates unanimously reelected Sue Bailey, MD, of Fort Worth to a fourth term as vice speaker. As one of four candidates running for four available seats on the AMA Council on Medical Service, Dr. Lockhart won his post by acclamation. Meanwhile, Russ Kridel, MD, of Houston is among eight candidates seeking the four available spots on the AMA Board of Trustees. We’ll know the outcome Tuesday morning. Some younger Texans also won elections at the AMA meeting:
  • Nnenna Ejesieme, MD, of The University of Texas (UT) Southwestern Medical Center, is the newly elected chair of Region 3 of the AMA Resident and Fellow Section.
  •  Elected to the Medical Student Section Region 3 Executive Council were: Angie Hamouie, UT Medical Branch at Galveston, secretary; and Tennessee Bailey, UT Health Science Center at San Antonio, membership chair.

DR. MCCOY SHARES FATHER'S TALE TO IMPROVE CARE

Dan McCoy, MD, chief medical officer of Blue Cross and Blue Shield of Texas and a member of the TMA Board of Trustees, got a stark view of the other side of the patient-physician relationship when his 93-year-old father fell and broke his hip on a July 4 weekend on his Central Texas ranch. As Dr. McCoy explains in a gripping story on KERA Radio, the fall was the beginning of the end of “Daddy Bill” McCoy’s life. Visits to two different hospitals and emergency departments, a two-day delay in surgery, and an overall lack of coordination of care were the biggest contributing factors. “I know from being an observer in that system that we could have done better,” Dr. McCoy said. “I may be a part of that problem. I’m part of the system. … There was no captain of the ship. We had a model where no one had a relationship. No one knew my dad’s medical history.” In his father’s memory, Dr. McCoy is now crusading to change the health insurance system so physicians have incentives to work in teams, to coordinate care, and to honor patients’ final days.

GET FREE CLINICAL RESEARCH SUMMARIES

A new set of free tools on the TMA website puts the latest evidence-based research on topics like diabetes treatments at your fingertips. You also can share treatment information with your patients using a patient-friendly brochure. TMA is collaborating with the federal Agency for Healthcare Research and Quality (AHRQ) to support physicians in the practice of evidence-based medicine with a series of research summaries and patient brochures that you can download, print, or order online free through TMA. Initially, TMA is offering five such sets of summaries related to diabetes and cardiovascular disease. Additional topics are available through AHRQ.

STANDARD OF CARE BILL REINTRODUCED

U.S. Reps. Henry Cuellar (D-Laredo) and Phil Gingrey, MD (R-Georgia), reintroduced the Standard of Care Protection Act (HR 4750) to protect physicians from new causes of action. The bill, which was part of the Sustainable Growth Rate repeal bill that almost passed Congress earlier this year, ensures that no provisions of federal health care law may be inappropriately used to create new threats for medical liability cases in the country. Texas physicians send vigorous thanks to Representative Cuellar for his longstanding commitment to this issue.

TEXAS MED STUDENT WINS LEADERSHIP AWARD

Anu Atluru, a medical student at UT Southwestern, is a recipient of the AMA Foundation’s 2014 Leadership Award. This award recognizes students, residents, fellows, and early-career physicians for achievements in community service, medical education, and public health. Ms. Atluru is the product track codirector for the Dallas-area Innovating Healthcare Solutions program and leads a team of MD/PhD candidates to develop a medical device for use in complicated cesarean section deliveries. Anu envisions a multifaceted career as a clinician and an educator. She hopes to drive the creation of novel, impactful technologies and approaches to patient care. The AMA Foundation honored 15 outstanding individuals with Leadership Awards at its June 6 Excellence in Medicine Awards celebration.

Monday, June 2, 2014

HOUSE WINS, SENATE AND STATEWIDE LOSSES MARK END OF PRIMARY SEASON

First, the good news: TEXPAC won 75 percent of the state House races where we made endorsements in last week’s party primary runoffs. This is an amazing victory in such a volatile election year, and medicine should be very proud of that. However, in the statewide and state Senate races, TEXPAC was outspent. Particularly disappointing is the loss of Sen. Bob Deuell, MD (R-Greenville), by just 300 votes. We will miss his leadership on health care issues. Texas Right to Life wrongly took on Senator Deuell’s record, which makes the win by the TEXPAC-endorsed candidate in House District 16 a bit sweeter. In that race, Conroe businessman Will Metcalf trounced Ted Seago, whose son is a lobbyist for Texas Right to Life. Thank you to all the physicians, students, and alliance members who took the time to vote.

FOUR STEPS TO FIGHT ACA-INDUCED HEALTH CARE SPENDING SPIKE — MY LATEST ON FORBES.COM

Economists predicted the expanded access to care due to the Affordable Care Act (ACA) would lead to health care spending growth. The early numbers from the first quarter of 2014 bear out that prediction. In our latest blog post at Forbes.com — “Large Healthcare Cost Increases Are Built Into Obamacare Implementation” — Physicians Foundation CEO Tim Norbeck and I offer four ways to cut health care spending without hurting access:
  1. Eliminate the site-of-service differential.
  2.  Eliminate all government regulations that do not have a positive benefit-to-cost ratio. 
  3. Ask physicians to use only technologies with proven efficacy for patients. 
  4. Initiate programs that help patients make healthy lifestyle choices by supporting individual responsibility.

COORDINATING SERVICES AND ADVOCACY WITH NEW TMLT CHIEF

I spent some time visiting with Bob Donohoe, who will become the new president and CEO of Texas Medical Liability Trust (TMLT) on July 1. TMLT is the only medical professional liability insurer created and exclusively endorsed by TMA. I emphasized the importance of our two organizations working together on services we both provide — such as physician education programs — as well as our longstanding joint advocacy on medical liability issues in both Congress and the Texas Legislature. I look forward to working with Bob, who has decades of experience.

SPEAKING WITH THE SPEAKER

TMA House of Delegates Speaker Cliff Moy, MD, dropped by the office. We spent some time reviewing the outcomes of last month’s house meeting as well as what might be coming from this week’s meeting of the American Medical Association House of Delegates. Dr. Moy is vice chair of the AMA Council on Long Range Planning and Development, which develops AMA’s annual Health Care Trends analysis. He is also a longtime member of the Texas Delegation to the AMA.

TMA FIGHTS MEDICAID CUTS FOR PEDIATRIC OPHTHALMOLOGY

TMA President Austin King, MD, joined two other leaders of Texas medicine in opposing proposed Texas Medicaid rate cuts for cataract, strabismus, and vitrectomy surgery in the pediatric population. Dr. King — along with Texas Ophthalmological Association President Sidney K. Gicheru, MD, and Texas Association for Pediatric Ophthalmology and Strabismus President David Stager Sr., MD — argued that preserving current rates would help protect children’s access to care and ensure comprehensive treatment. They also pointed out the fallacy of relying on Medicare relative value units in setting rates for services for children.

FOLLOW THE AMA HOUSE ACTION ON TMA BLOG, SOCIAL MEDIA

As I mentioned in a recent EVPGram, the Texas Delegation is working to elect two candidates and pass six new policy positions at the meeting of the AMA House that convenes in Chicago on Saturday. I’ll bring you some updates in next week’s ’Gram, but you can keep up with all the action on TMA’s Blogged Arteries as well as on our Twitter feed and Facebook posts.