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Monday, September 29, 2014

TMA TO LEGISLATIVE LEADERS: RAISE MEDICAID AND CHIP RATES


TMA and 17 state specialty societies called on the Legislative Budget Board (LBB) to “take bold action” to increase “utterly inadequate physician payment rates” in Texas Medicaid and the Children’s Health Insurance Program (CHIP). In written testimony we asked LBB to:
  • Maintain Medicare parity in the 2016-17 state budget for primary care physicians currently receiving those higher rates. Congress enacted and funded the higher rates, but without legislative or congressional action, that increase will expire Dec. 31, 2014.
  • Extend the parity payments for primary care to services provided via CHIP.
  • Establish competitive Medicaid and CHIP payment rates for physician specialties that are not included in the Medicare parity increase.
  • Reverse the 8-percent payment reduction for physician assistants and advanced practice registered nurses practicing under physician supervision. The cut, which will take effect in early 2015, will undermine Texas’ efforts to promote team-based models of care, an essential element of reforming the Medicaid delivery system.
The testimony cites preliminary data from TMA’s 2014 physician survey, which indicates only 34 percent of physicians accept all new Medicaid patients, a 33-point decrease since 2000. TMA says “grossly inadequate payment is the single overriding reason physicians cite for why they or their colleagues limit or no longer participate in Medicaid.” LBB, chaired by House Speaker Joe Straus and Lt. Gov. David Dewhurst, sets the base state budget bill from which lawmakers will start working when they convene in Austin in January.

TEXPAC ANNOUNCES PATRICK, WILLIS ENDORSEMENTS, AND MORE


What’s a bipartisan PAC doing in an election cycle like this? Why, just what we’ve always done — supporting candidates who stand up for patients and medicine. With strong personal backing from physicians around the state and locally, State Sen. Dan Patrick (R-Houston) earned TEXPAC’s endorsement in the race for lieutenant governor, and Libby Willis (D-Fort Worth) picked up our approval for the open Senate District 10 seat. Those were the two most high-profile races in which TEXPAC issued formal endorsements this month. See the full list on the TEXPAC website. If you’re not registered to vote, be sure to sign up by Oct. 6 to be eligible to vote in the Nov. 4 elections.
  • “We know Dan will fight to increase graduate medical education funding so more medical students can finish their residency training in Texas,” TEXPAC Board Chair Jerry Hunsaker, MD, said about Senator Patrick. “We also can count on him to support the development of physician-led teams to provide high-quality health care to Texans. In addition we know he will work hard to ensure physicians get paid in a fair and timely manner.”
  • Of Ms. Willis, TEXPAC District Chair Rob Rogers, MD, a Fort Worth allergist, said, “We are confident Libby will work to protect the vitally important patient-physician relationship in Texas, keeping the government, big insurance, and other parties out of physicians’ exam rooms.”

ENROLL TODAY IN TMA'S BUSINESS BASICS SEMINAR


Passive financial management can rob you of the resources you need to care for your patients. Manage finances proactively to secure your future. Take charge of your practice finances at TMA’s newest live seminar. Our Business Basics seminar series begins Oct. 7 and runs through Nov. 12 in cities across the state. The seminar is partially underwritten by a grant from The Physicians Foundation to keep the cost low.

MAGAZINE RANKS TEXAS AMONG BEST STATES TO PRACTICE


According to Physicians Practice magazine’s annual survey (free account required to access), Texas is one of the four best states in the country to practice medicine. The top ranked state? Mississippi. The magazine says, “Texas did very well in our analysis, with a low physician density, low cost of living, and a low tax burden. Oh, and did we mention the ‘astonishing’ malpractice rates?”

DR. KING TALKS UP MEDICINE IN WICHITA FALLS

In a 90-minute meeting with the Wichita Falls Times Record News, TMA President Austin King, MD, laid out the problems that beset medical practices today and the solutions we propose in TMA’s Healthy Vision 2020, Second Edition. “Physicians in these areas, like every place else, are inundated by red tape and by hassles with all these different medical programs,” Dr. King said. “And in rural areas, most of the programs are government programs.” He was joined by two Wichita Falls-area physician leaders: Susan Strate, MD, vice speaker of the TMA House of Delegates; and Jonathan Williams, MD, chair of the TMA Committee on Rural Health. The visit was the first of many Dr. King will make across the state in coming months. Today he is meeting with the editors at his hometown Abilene Reporter-News.

Monday, September 22, 2014

SURVEY: U.S. PHYSICIANS OVERWHELMINGLY DISHEARTENED; TEXANS EVEN MORE SO


Overworked physicians, harried by mountains of federal regulations and the looming switch to ICD-10, seeing little help from electronic health records (EHRs), their clinical autonomy threatened, are pessimistic about the state of the medical profession, according to one of the largest and most comprehensive physician surveys conducted in the United States. Texas physicians were even more negative. The 2014 Survey of America’s Physicians: Practice Patterns and Perspectives, conducted by The Physicians Foundation, queried more than 20,000 physicians nationwide. More than 1,800 Texas physicians responded to the survey. Among the key findings:
  • Nationally, 55 percent are “very” or “somewhat” negative about the current state of the medical profession. Among Texas physicians, that figure is almost 64 percent.
  • Half of all physicians and 61 percent of Texas physicians are “very” or “somewhat” negative or pessimistic about the future of their profession.
  • About 80 percent of all physicians, and a like share of Texans, say they are “overextended and overworked” or “at full capacity.”
  • Physicians spend a staggering 20 percent of their time on nonclinical paperwork.
  • Half of all U.S. physicians, and 58 percent of the Texans, say the switch to ICD-10 next year will “create a severe administration problem.” Only 11 percent of U.S. doctors and 8 percent of Texas physicians say the shift will “improve diagnosis or quality of care.”
  • About 80 percent of Texas physicians — and 85 percent of the entire sample — say their practice has put an EHR system in place. Almost one-third of those nationally, and a quarter of the Texans, say the EHR has improved the quality of care. But across the board about one-fourth say it has detracted from the quality of care, nearly half say it has detracted from practice efficiency, and almost as many say it has detracted from the quality of patient interaction.
  • When it comes to clinical autonomy, almost 18 percent of Texas doctors and 15 percent of physicians nationwide say “my decisions often are compromised.”
I will drill down into some more specific data sets from the survey in coming weeks.

WHAT ABOUT REFILLS OF HYDROCODONE COMBINATION PRESCRIPTIONS?


Our phones continue to be swamped by calls from physicians and office managers concerned about the Oct. 6 switch from Schedule III to Schedule II for hydrocodone combination drugs. One of the most common questions: “If I write a prescription for a hydrocodone combination product on Oct. 5 (while it is still a Schedule III drug) and specify refills, will pharmacies honor those written under the Oct. 5 prescription, or must I rewrite the prescription as a Schedule II drug?” Here’s our answer: Prescriptions for hydrocodone combination products that are issued before Oct. 6 and that have authorized refills may be dispensed in accordance with U.S. Drug Enforcement Administration rules until April 8, 2015. Both the Texas Department of Public Safety and the Texas State Board of Pharmacy have indicated to us that refills authorized on prescriptions dispensed prior to Oct. 6 will be honored. For more answers, see the hydrocodone Q&A page on our website.

TEXANS IN D.C. CAUTIOUSLY OPTIMISTIC ABOUT SGR REPREAL THIS YEAR


We made a trip to Capitol Hill to talk about repealing Medicare’s Sustainable Growth Rate (SGR) formula and some of the other federal priorities in our revised Healthy Vision 2020 document. TEXPAC Board Chair Jerry Hunsaker, MD, and Lyle Thorstenson, MD — the Texan on the AMPAC Board — were joined by TMA Legislative Affairs Director Dan Finch and TEXPAC Director Clayton Stewart in a visit just before Congress adjourned until after the Nov. 4 elections. The most important SGR discussions, of course, were with U.S. Reps. Michael Burgess, MD (R- Lewisville), and Kevin Brady (R-The Woodlands). Both see a potential for revising and passing an SGR replacement bill during the lame duck session after the election. The devil, of course, is in the details, and the details always boil down to money.

TMA: CHIP MANAGED CARE PLANS RESPONSIBLE FOR OUT-OF-NETWORK PAYMENTS


Since federal law prohibits patients covered by the Children’s Health Insurance Program (CHIP) from paying anything other than a co-pay, the state of Texas should require managed care organizations in CHIP to cover the costs for out-of-network physicians. That’s the position TMA takes in a formal letter to the Texas Health and Human Services Commission. “The [health plans] are responsible, and should be held accountable, for setting rates at an appropriate level to attract an adequate number of physicians and other providers to join their networks and paying out-of-network providers at a rate sufficient to ensure balance billing does not occur,” TMA General Counsel Rocky Wilcox wrote in our comment letter. “Precluding medical providers from billing shifts the responsibility for the outstanding medical expense from the [plans] that voluntarily accepted network adequacy responsibilities and payment obligations under CHIP to physicians and other providers who never agreed to participate in CHIP or enter into a contract with the CHIP [plans].”

TMA OPPOSES BILL TO EXPAND AUDIOLOGISTS' SCOPE

TMA and more than 110 national organizations, state and local medical associations, and state and local specialty societies delivered a clear message to members of the U.S. Congress: Oppose any efforts to give audiologists direct, unlimited access to Medicare patients without a physician referral and to include audiologists in the definition of physician. The groups outlined their opposition to House Resolution 5304 in a letter to Congress. “Audiologists are not physicians and should not be considered as such under the Medicare program,” the letter states.

Monday, September 15, 2014

REVISED HEALTHY VISION SETS TMA ADVOCACY COURSE


The fields of engagement — the Texas Legislature, U.S. Congress, courts, state and federal bureaucracies — are many. The issues are all-encompassing. But TMA’s approach, as outlined in the new second edition of our Healthy Vision 2020 document, is clear. As TMA President Austin King, MD, writes in his welcome message, “Our government must make it easier — not more difficult — for us to care for our patients.” I encourage you to study the document, and share our healthy vision with lawmakers, business leaders, and your colleagues. You can order print copies from the TMA Knowledge Center at (800) 880-7955. Here’s our Top Ten List:
  1. Reverse recent cuts in physicians’ Medicare, Medicaid, and Children’s Health Insurance Program payments, particularly those that hurt access to care.
  2. Devise and enact a system for providing health care to low-income Texans with realistic payment to physicians, less stifling state bureaucracy, and no fraud-and-abuse witch hunts.
  3. Repeal the broken Sustainable Growth Rate formula. Enact a rational Medicare physician payment system that works and is backed by a fair, stable funding formula.
  4.  Increase funding for graduate medical education.
  5. Protect Texas’ landmark medical liability reforms.
  6. Stop any efforts to expand scope of practice beyond that safely permitted by nonphysician practitioners’ education, training, and skills.
  7. Standardize Medicaid managed care administrative processes.
  8. Ensure criteria used to measure physicians’ performance are evidence-based, fair and accurate, and truly evaluate quality and efficient care, not just cost.
  9. Stop Recovery Audit Program (RAC) bounty hunters. Eliminate adoption of the ICD-10-coding system.

SPEAKERS IGNITE TMA FALL CONFERENCE AUDIENCE


TMA and physicians have become political targets in Texas, and it’s time to fight back. That’s one of many key messages delivered at 2014 TMA Fall Conference. Dr. King used a multimedia display to illustrate the degree and intensity of the attacks. We need to grow TEXPAC’s treasury and membership so we can have the resources we need to counter what he called Orwellian doublespeak being used against us. Among the other conference speakers:
  • State Sen. Jane Nelson (R-Flower Mound), the newly appointed (and first women to hold that post) chair of the Senate Finance Committee, said the huge turnover in the Texas Legislature over the past three years creates a challenge for medicine to educate the newcomers on the nuances of our complex issues. But looking back to her first election to the Senate in 1992, she told the crowd, “I wouldn’t be here today without TEXPAC.”
  • TMA Council on Legislation Chair Dawn Buckingham, MD, of Austin walked through TMA’s Healthy Vision priorities for the 2015 Texas Legislature and urged the audience members to build relationships now with their state representatives and senators.
  • Dallas nephrologist Donald Wesson, MD, past chair of the ABIM Foundation, explained how physicians can gain the upper hand in the quality-of-care debate by embracing the Choosing Wisely® program. “Texas can be, and should be, a vanguard state,” he said.
  • Despite some strong candidates running good campaigns, 2014 won’t be the year a Democrat wins a statewide elected office in Texas, predicted Evan Smith, CEO and president of The Texas Tribune. “An asteroid could fall on all the Republican candidates this cycle, and they would all win,” he said, pointing to the GOP’s strong advantage among Texans who actually vote.
  • Pat Evans, retiring after 48 great years as executive director of the Big Country County Medical Society in Abilene, told the physicians, “God put you here to heal people. Remember, no government or hospital administrator or big insurance company can take that away from you.” 

IS THIS ANY WAY TO TREAT A DOCTOR?


Our Facebook page is exploding with likes, shares, and comments on our new Doctors Are Under Siege by the Federal Regulatory Barrage flyer. It has garnered rave reviews from physicians around Texas and around the country for accurately portraying the weight of federal demands on a practice today. Please download it, print it out, and share it with your patients and friends in high places. TMA’s lobby team will distribute it on Capitol Hill next week.

POST TORT REFORM, TEXAS STILL ATTRACTING RECORD NUMBERS OF NEW PHYSICIANS


The Texas Medical Board (TMB) licensed a record 3,994 new physicians for the fiscal year that ended last month. The number of new physicians applying for a Texas license also reached an all-time high of 5,149. Texas has averaged licensing 3,254 new physicians each year since the passage of our medical liability reforms 11 years ago. “The state medical board is now licensing twice as many doctors per year than in the medical crisis years before lawsuit reforms were enacted,” said Howard Marcus, MD, chair of Texas Alliance For Patient Access.

TMA DECIPHERING HYDROCODONE CHANGE CHALLENGES


The U.S. Drug Enforcement Administration’s decision to reclassify drugs that contain hydrocodone combinations from Schedule III to Schedule II continues to elicit questions and a good bit of anger from Texas physicians. TMA is working to get some solid answers from the maze of state and federal agencies with jurisdiction, and we’ll update our online Q&A document as we get them. I’ve also asked our lobby team to see what legislative remedies are available.

GOVERNOR NAMES NEW MEDICAL BOARD CHAIR

Gov. Rick Perry appointed Michael Arambula, MD, the new chair of TMB. Dr. Arambula, a TMA member, is a psychiatrist in private practice and an adjunct associate professor in the Department of Psychiatry at The University of Texas Health Science Center at San Antonio. The governor also appointed John Guerra, DO, an OB-Gyn from Mission, to TMB.

Monday, September 8, 2014

OUR HEALTHY VISION GROWS EVEN SHARPER


We wrote and published TMA’s Healthy Vision 2020 in 2012 as a roadmap for our advocacy efforts for the remainder of the decade. Two years and several awards later, our legislative and congressional destinations have shifted; we accomplished some of our original objectives, and new problems have emerged for us to solve on behalf of Texas physicians. That’s why our lobby, policy, legal, and communication teams rewrote the document over the summer. Every member who attends TMA’s 2014 Fall Conference this weekend will receive a copy of Healthy Vision 2020, second edition, at registration. And Dawn Buckingham, MD, chair of the TMA Council on Legislation, will discuss it during the conference General Session. It also will be available to read and download from www.texmed.org/healthyvision by then, or you can order print copies from the TMA Knowledge Center at (800) 880-7955. New this year are not only a comprehensive list of advocacy accomplishments from the first edition, but also separate sections on health information technology hassles to be solved and Medicaid red tape to be cut.

JOIN US THIS WEEKEND IN THE LOST PINES ALONG THE COLORADO FOR TMA FALL CONFERENCE


In addition to the great speakers I told you about last week, 2014 TMA Fall Conference on Friday and Saturday at the Hyatt Lost Pines near Bastrop will offer camaraderie, fun, and a few surprises in a delightful location. Physicians and alliance members who attend can get their 2014-15 flu shots on site Saturday or watch a live stream of the third and final day of TEDMED 2014 on Friday. The TEXPAC Board of Directors will consider some endorsements for the Nov. 4 general elections. (Have you seen the cover story in September’s Texas Medicine on “the new TEXPAC?”) You can earn nearly 4 hours of continuing medical education (CME) credit on Saturday. Online registration is closed, but you can still register onsite. The conference is free for TMA members. See you there.

NEW TMA MENTAL HEALTH TASK FORCE TO CONVENE


TMA’s Task Force on Behavioral Health, established by our Council on Science and Public Health, will meet for the first time Saturday at TMA Fall Conference. Chaired by Dallas psychiatrist Les Secrest, MD, the task force will prepare for mental health issues expected to arise in the 2015 Texas Legislature, including the Sunset Advisory Commission’s review of the Texas Department of State Health Services (DSHS). James G. Baker, MD, DSHS medical director for behavioral health, will present an overview of the Texas Public Behavioral Health System.

A HELMET GIVEAWAY OF STATEWIDE PROPORTIONS


Next month, TMA’s Hard Hats for Little Heads bike helmet giveaway program celebrates 20 years of keeping kids safe. You still have time to plan an event in your community to help us meet our goal of 50 helmet giveaways across the state during October. We provide everything you need for a successful event: free helmets, banners, event signage, promotional flyers, educational handouts, and media relations support. When you buy up to 50 helmets ($7.35 each, including shipping), TMA matches your purchase with free helmets. Check out these ideas for events or come up with another idea for your giveaway. To have your event included in TMA’s big media announcement, let us know about it by Friday, Sept. 19. To get started, contact Tammy Wishard, TMA’s outreach coordinator, or call (512) 370-1470.

TMA's HIPAA SECURITY SEMINAR SERIES BEGINS THIS WEEK


Register today for HIPAA Security: The Keys to Compliance, TMA’s new statewide seminar series. We will give you an overview of the HIPAA Security compliance rules, and explore techniques you can use to identify and address any HIPAA deficiencies in your practice. This is a perfect opportunity for you and your staff to jump ahead of the curve on HIPAA Security readiness. Those who attend this live program will receive a coupon code for $10 off the electronic version of our new publication, HIPAA Security: Compliance and Case Studies. Can’t make it in person? Register for the live webcast of the Sept. 25 seminar, complete with all the CME, bells, and whistles.

TMA PREPARES HOSPITAL MEDICAL STAFFS FOR NEW "MEGA-STAFF" RULES

Legal disputes between big hospitals and Texas physicians are heating up, and TMA is actively engaged. In addition to joining lawsuits against hospital systems by our member physicians, TMA’s Office of General Counsel is now educating physicians on Medicare’s new conditions of participation (CoPs) for hospital medical staffs. The biggest change, effective July 11, allows hospitals in multihospital systems “to have a unified and integrated medical staff for its member hospitals.” The previous rule required each hospital to have its own independent medical staff. In their presentation, our lawyers point out that it requires a majority vote of the medical staff of each separate hospital to opt in or opt out of this “mega-staff” structure. In a formal comment letter to the Centers for Medicare & Medicaid Services (CMS), TMA, the American Medical Association, and more than 80 other medical societies urged the agency to give hospital medical staffs more time to study and prepare to implement a new rule that makes “unprecedented changes to the Medicare hospital CoPs that will dramatically alter the make-up and efficacy of hospital medical staffs nationwide.” CMS turned us down. Look for more information on hospital medical staff issues in upcoming EVPGrams.

Tuesday, September 2, 2014

LEGISLATIVE INSIGHT, CHOOSING WISELY TOP FALL CONFERENCE AGENDA


We’ll unveil the second edition of TMA’s Healthy Vision 2020 document at 2014 TMA Fall Conference as we jumpstart our preparations for the 2015 sessions of the Texas Legislature and U.S. Congress. The conference, Sept. 12-13 at Hyatt Lost Pines between Austin and Bastrop, will feature updates from State Senate Finance Committee Chair Jane Nelson (R-Flower Mound), Evan Smith of The Texas Tribune, and TMA Council on Legislation Chair Dawn Buckingham, MD, on health care and legislation affecting Texas physicians. Donald E. Wesson, MD, immediate past chair of the ABIM Foundation Board of Trustees, will tell you about the Choosing Wisely campaign and how it promotes conversations between physicians and patients to ensure the right care is delivered at the right time. We also have Mike Deegan, MD, clinical professor for health care leadership and innovation at The University of Texas at Dallas, speaking on how Texas physicians can increase their community leadership. Plus … some special surprises. It will be a great way to get your TMA juices flowing again. Can’t wait to see you there.

TMA HELPS YOU PREPARE FOR HYDROCODONE RECLASSIFICATION


Over TMA’s objections, the U.S. Drug Enforcement Administration announced it will reclassify drugs that contain hydrocodone combinations from Schedule III to Schedule II. The change takes effect Oct. 6. We’ve already received numerous calls in the TMA Knowledge Center from physicians concerned about how this will affect their patients and their practices. TMA has prepared a short question-and-answer document that explains exactly what the change entails, how to get official Texas Prescription Program pads, and the status of e-prescribing for Schedule II drugs.

SUPREME COURT UPHOLDS TORT REFORM LIMITS


An attempt to overturn the limit for minors to file medical liability claims that was part of our 2003 tort reform law hit a brick wall at the Texas Supreme Court. The case, Tenet Hospitals v. Rivera involved an allegation of negligence on the part of the hospital during the birth of a child in 1996. Our tort reform law said claims of negligence that occurred before the law passed must have been filed by 2006. In 2004, an attorney for the mother notified the hospital of the minor’s claim, but no suit was filed until 2011. The court was asked to decide whether that part of the law was constitutional as applied to minors injured at birth who would never have the opportunity to sue on their own behalf (since they do not reach the age of majority until eight years after the 2006 deadline). The high court agreed with a brief filed by TMA, the Texas Alliance for Patient Access, and other health care groups that the legislature struck the appropriate balance between a person’s right to sue and the stability needed for medicine and the liability insurance industry. The court left open the possibility that it would revisit the issue in a case with different circumstances.

UNLOCK YOUR IMAGINATION VIA TEDMED


Once again this year, TMA is offering all members free access to the thought-provoking, way-outside-the-box talks from TEDMED Live. TEDMED is the annual, health care-focused conference sponsored by the internationally renowned TED Talks. Unlocking Imagination is the theme of TEDMED 2014, which will take place in Washington, D.C., and San Francisco, Sept. 10-12. We have three ways for you to get involved
  1. Download the TEDMEDConnect mobile app and watch the talks live or from the archives.
  2. Join us here for TEDMED week in Austin. We’re working with TEDxAustin, The University of Texas at Austin, and Seton Healthcare Family to present an HD live simulcast of TEDMED throughout the city and live speakers at each location to promote discussion and idea exchange around the topic Imagine the Future of Medicine: A Better, Smarter, Healthier Austin.
  3. If you’re coming to 2014 TMA Fall Conference, you can watch the live stream from TEDMED on Friday, Sept. 12, 7 am-7:30 pm in the Scribes Club at the Hyatt Lost Pines in Bastrop.

SUNSET COMMISSION ENHANCES REQUIREMENTS FOR SCHOOL SPORTS PHYSICALS

With all of the state’s health care agencies up for review this cycle, the deliberations of the Texas Sunset Advisory Commission are an important preview to the 2015 Texas Legislature. The commission voted to improve standards for preparticipation physicals of students wishing to play University Interscholastic League (UIL) athletics or cheerleading. In the face of mounting concerns about threats to student athletes such as cardiovascular and neurologic conditions, the sunset commission’s recommendation specifies that a physician, physician assistant, or nurse practitioner must sign off on the examination. UIL rules currently allow chiropractors, as well as physicians or their delegates, to perform these physicals. There is nothing in state law related to the physicals. The Sunset Advisory Commission recommendation is the first step toward putting this important patient protection into law.

DR. SCHWERTNER NAMED SENATE HEALTH COMMITTEE CHAIR

With Senator Nelson’s reassignment to chair the Senate Finance Committee, Lt. Gov. David Dewhurst appointed Sen. Charles Schwertner, MD (R-Georgetown), to head the Health and Human Services Committee. We’re still checking the legislative archives, but our best information says Senator Schwertner is the first physician to chair that critical committee.