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Monday, November 24, 2014

VISIT REVEALS A CHANCE, HOWEVER SLIM, OF SGR REPEAL THIS YEAR


Sustainable Growth Rate (SGR) formula repeal this year is a definite maybe. That’s the feedback 16 members of the Coalition of State Medical Societies received from our visits on Capitol Hill last week. Congressional leaders remain committed to repealing Medicare’s SGR formula, we heard. The big question remains whether the stars will align for that to happen in the few legislative days that remain before Congress adjourns for the year early next month. The SGR will mandate a 21-percent cut in physicians’ Medicare payments on April 1, 2015, if Congress doesn’t intervene. The Texas delegation for the visits included former TMA Board of Trustees Chair Carlos Cardenas, MD; our chief lobbyist, Darren Whitehurst; and me. The other states in the coalition are California, Arizona, Oklahoma, Louisiana, Florida, South and North Carolina, New Jersey, and New York.

TEXAS RETAINS CLOUT ON KEY HOUSE HEALTH PANELS


Committee appointments in the U.S. House of Representatives for next year were announced while we were in Washington, D.C. Three good friends of Texas medicine will be very well placed to influence issues like SGR reform and the repeal of onerous federal regulations. Rep. Kevin Brady (R-The Woodlands) will remain as chair of the Subcommittee on Health of the House Ways and Means Committee. Rep. Gene Green (D-Houston) will become the “ranking member,” or lead Democrat, on the Health Subcommittee of the House Energy and Commerce Committee, and Rep. Michael Burgess, MD (R-Lewisville), will be the third-ranked Republican on the subcommittee. TMA has excellent relationships with all three congressmen and their staffs.

LINEUP SET FOR TMA ADVOCACY RETREAT, DEC. 5-6


We have some special treats in store for the TMA 2014 Advocacy Retreat, Dec. 5-6, at Barton Creek Resort in Austin. The highlight, as always, will be the round-robin sharing of key legislative priorities from TMA and the state specialty societies. (Our priorities are outlined in Healthy Vision 2020, Second Edition.) Friday night’s dinner speaker, giving an update on the political landscape and a preview of the 2015 legislative session, is James R. Henson, PhD, director of the Texas Politics Project at The University of Texas at Austin. For our closing luncheon Saturday afternoon, we’ve secured four physician members of the Texas Legislature: Sen. Donna Campbell, MD (R-New Braunfels; and Reps. Greg Bonnen, MD (R-Friendswood); J.D. Sheffield, DO (R-Gatesville); and John Zerwas, MD (R-Simonton). Saturday morning’s agenda features breakout sessions for media training, lobby training, and social media advocacy training. Hope to see you there.

TMA WINS APPEALS COURT RULING IN SCOPE CASE


The Texas Third Court of Appeals sided with TMA in our challenge of a Marriage and Family Therapists Board rule that would have allowed therapists to diagnose. “We conclude that the diagnosis of mental diseases or disorders is excluded from the statutory scope of practice for licensed marriage and family therapists,” the court ruled. This case is one of an ongoing series of legal challenges we have mounted to stop state regulatory agencies from expanding allied health practitioners’ scope of practice beyond the authority granted by the Texas Legislature. In the legislature, we continue to oppose expansion of practitioners’ scope beyond what is safely permitted by their education, skills, and training.

PHYSICIANS FOUNDATION PANEL AIRS HEALTH CARE CHALLENGES FOR D.C. AUDIENCE


Former TMA President Sue Bailey, MD, took part in a three-physician panel organized in D.C. by The Physicians Foundation. Denton OB-Gyn Joe Valenti, MD, moderated the panel, which explored the changing dynamics of medical practices and how those changes are affecting practicing physicians and patients. The audience included U.S. Rep. Phil Roe, MD (R-Tenn.), a variety of congressional staffers, and several reporters. The discussion keyed off of the findings of the foundation’s biennial physicians survey, which shows more than 80 percent of America’s physicians are overextended or at full capacity. The survey “reflects a mood among doctors that is still uncertain and sometimes dispirited, but which is evolving. Relative to the national surveys The Physicians Foundation conducted in 2012 and 2008, doctors are somewhat more positive in their outlook.”

HAPPY THANKSGIVING

We all have so much to be thankful for — I’m thankful that we’ve reached the 48,000 mark in TMA membership. That means we can do so much more for you. EVPGram will take its annual Turkey Day Holiday next Monday. We’ll be back in your in box on Dec. 8.

Wednesday, November 19, 2014

COALITION HEADS TO CAPITOL HILL TO WORK SGR AND OVERREGULATION


The 10 members of the Coalition of State Medical Societies are off to Washington this week to lobby the lame duck Congress on two of medicine’s key issues. We’ll be asking, once again, for repeal of Medicare’s Sustainable Growth Rate formula, which will mandate a 21-percent cut in physicians’ Medicare payments on April 1, 2015, if Congress doesn’t intervene. We’ll also be pushing for the repeal of onerous federal regulations — like the ICD-10 conversion, big improvements in the Recovery Audit Program (RAC program), and standard electronic prior authorization processes for all insurance companies. The Texas delegation will include former TMA Board of Trustees Chair Carlos Cardenas, MD; our chief lobbyist, Darren Whitehurst; and me. The other states in the coalition are California, Arizona, Oklahoma, Louisiana, Florida, South and North Carolina, New Jersey, and New York. I’ll report on our progress next week.

ASK CONGRESS TODAY FOR TWO-YEAR ICD-10 DELAY


Have you faxed or mailed your letter to your U.S. representative yet, asking him or her to support a two-year delay in ICD-10? Texans in House leadership tell us there’s a good chance we can move the mandatory ICD-10 implementation date backward two more years from Oct. 1, 2015. But it will take a grassroots show of support from medicine. Cut and paste our sample letter onto your personal stationery, then send it to your representative by mail or by fax. It’s important the letter is on your personal stationery. And please add your own reasons why ICD-10 is a bad idea.

AMA HOUSE ADDRESSES MOC, MEANINGFUL USE, AND INADEQUATE NETWORKS


Some of medicine’s thorniest issues received serious attention last week when the American Medical Association House of Delegates met in Dallas. The delegates:
  • Adopted new policy that maintenance of certification (MOC) exams should be evidence-based and relevant to clinical practice, and not be a “mandated requirement for licensure, credentialing, payment, network participation or employment.”
  • Called on the Centers for Medicare & Medicaid Services (CMS) to suspend all penalties for failing to meet meaningful use criteria.
  • Said the states need to continue to be the enforcers of inadequate network rules for health insurance plans and called on insurers to publish “accurate, complete directories of participating physicians” on paper and electronically. Plans with inadequate networks, the house said, should “treat patient visits to out-of-network physicians the same as in-network visits.” 
  • Said minors should not be allowed to buy e-cigarettes.
  • Backed interstate compacts to make it easier for physicians to obtain licenses in multiple states.

OUR DEEPEST SYMPATHIES TO DR. FITE AND HER FAMILY


I am very sad to have to share the news that Anna Floyd, the daughter of TMA Board of Trustees member Diana Fite, MD, died suddenly last week. Mrs. Floyd, age 33, had three young children, including a 1-year-old baby. The family will receive visitors tomorrow from 5 to 7 pm at One Life Church, 16920 N. Texas Ave. in Webster, Texas. A service will follow at 7 pm.

TMA TO FEDS: SUSPEND BAD MEANINGFUL USE MEASURES


This is one of the many reasons physicians are starting to call it “meaningless use.” Many patients, especially elderly ones, have no desire to access their health records online, and physicians should not be forced to coerce them to do it, TMA President Austin King, MD, said in a letter to CMS Administrator Marilyn Tavenner. But that’s what meaningful use core measures 7 and 17 try to do, and physicians’ inability to meet them is responsible for the very low levels of doctors attesting to stage 2 of meaningful use. Dr. King asked CMS to suspend those measurers immediately and to “work with Congress to suspend all meaningful use physician penalties set to begin Jan. 1, 2015.”

VALLEY WINS APPROVAL OF NEW SURGERY RESIDENCY

A new general surgery residency program will open next summer in the Rio Grande Valley. Congratulations to The University of Texas Health Science Center San Antonio and Doctors Hospital at Renaissance. The Accreditation Council for Graduate Medical Education has approved the program, which will have four surgical residency slots.


Tuesday, November 11, 2014

AMA SETS POST-ELECTION ACA STRATEGY


Two key Texas congressmen in the battle to replace Medicare’s Sustainable Growth Rate (SGR) formula told the American Medical Association House of Delegates they will push to finish the job when Congress reconvenes next week. Reps. Michael Burgess, MD (R-Lewisville), and Kevin Brady (R-The Woodlands) asked for AMA’s help to win final passage of the SGR repeal bill, which stalled earlier this year, in the lame duck session of Congress. (Dr. Burgess said he prefers the term “extra innings.”) Replacing the SGR is one of AMA’s legislative priorities, Sue Bailey, MD, of Fort Worth, vice speaker of the AMA House, told the Texas Delegation to the AMA. The others are:
  • Achieve permanent Medicare-parity in Medicaid payments; first for primary care physicians providing primary care services, then for all of medicine;
  • Repeal the Independent Payment Advisory Board, a change Sen. John Cornyn of Texas has been promoting; and
  • Streamline the regulatory mess surrounding value-based purchasing, the Physician Quality Reporting System, and other Medicare quality programs.

REPUBLICANS SWEEP THE BALLOT


TEXPAC did very well with our endorsed candidates last week. As our polling data predicted, this was a very Republican election cycle. The governor’s race decidedly set the tone for the rest of the ballot with Attorney General Greg Abbott beating State Sen. Wendy Davis by 20 points. In fact, the biggest surprise was the handful of Democratic incumbents who lost their seats in this Republican wave. I know some say that the state is turning purple, but the results in key races strongly contradict that statement. The battle to replace Senator Davis in Fort Worth was probably the most-watched race not only by our physicians but also by the state in general. While this was a hard loss for TEXPAC, the superb efforts led by Robert Rogers, MD, and Tarrant County Medical Society Executive Director Brian Swift made a significant impact. A Republican in that district should have run at 56 percent but instead only earned 53 percent of the vote.

A "BRIGHT NEW DAY" FOR VA HEALTH CARE?


The issue of veterans’ access to timely health care returned to the American Medical Association House of Delegates this weekend in a far more positive light than it enjoyed five months ago. In June, in the wake of scandals over excessive wait times in the Department of Veterans Affairs (VA) health care system, the AMA House pushed for President Barack Obama and Congress to make it easier for private practice physicians to care for VA patients. TMA was at the forefront of that fight, led by TMA Delegation Vice Chair Asa Lockhart, MD, of Tyler. New VA Secretary Robert McDonald appeared before the AMA House on Saturday. He spent an hour telling delegates about changes in his agency and answering physicians’ questions. Watch Secretary McDonald’s speech and see Dr. Lockhart’s assessment of the progress VA has made since June.

MED STUDENTS WIN AMA LEADERSHIP POSTS


Congratulations to three Texas medical students elected to leadership positions at the AMA Medical Student Section (MSS) this weekend:
  • Jennifer Nordhauser, a first-year student at The University of Texas (UT) Health Science Center at San Antonio, is the new MSS Region 3 legislative chair.
  • Romero Santiago, a second-year student at UT-Southwestern, is a new MSS Region 3 delegate; and Jared Bell, a second-year student at the Texas Tech University Health Science Center Paul L. Foster School of Medicine in El Paso, was elected a Region 3 alternate delegate.

TEXAS ADOPTS EBOLA MONITORING PLAN

Gov. Rick Perry has directed Texas Health Commissioner David Lakey, MD, to implement a four-stage monitoring plan for Texans suspected to have been exposed to Ebola in West Africa. The plan, devised by the governor’s Texas Task Force on Infectious Disease Preparedness and Response, does not require mandatory, government-imposed strict quarantine for cooperative asymptomatic health care workers unless they meet the "high-risk" category. “The guidance is based on science and on doing what’s right for the people of Texas and for the health care workers who travel abroad to fight this disease,” Dr. Lakey said. The Dallas County Medical Society Infection Prevention and Control & Antimicrobial Stewardship Committee also issued a letter applauding the Texas Task Force recommendation and urging elected officials not to quarantine health care workers who care for Ebola patients.

Monday, November 3, 2014

VOTE TUESDAY FOR THE PARTY OF MEDICINE


If you didn’t vote early, remember … you can’t “vote late.” Tuesday is Election Day. With Gov. Rick Perry’s decision not to seek another term, just about every statewide executive office is an open race. TEXPAC, your political action committee, recommends outstanding candidates for all of those seats as well as in legislative and judicial races. “Many Texas physicians see their practices as under attack from multiple outside forces, few of which really understand what it means to take care of a patient,” said TEXPAC Board Chair Jerry Hunsaker, MD, of Corpus Christi. “Here at TEXPAC, we like to think of ourselves as a shield that protects our practice by trying to elect candidates who will take away from — or at least not add to — that multitude of outside forces. It’s up to you, tomorrow, on Election Day, to put some real muscle behind that shield.” Polls are open 7 am-7 pm. You must vote in your home precinct, and a picture ID is required.

AMA HOUSE OF DELEGATES COMES TO DALLAS


The 2014 Interim Meeting of the American Medical Association House of Delegates convenes Saturday afternoon at the Hilton Anatole in Dallas and runs through Tuesday, Nov. 11. The agenda for the interim meeting is limited to public and private sector advocacy issues. Reports and resolutions will focus on issues like Medicare reform, regulatory relief, and public health. The TMA House of Delegates is sending no new resolutions to Dallas, but your Texas delegation will be busy testifying on the items that affect Texas physicians and patients. We’ll also be gearing up for former TMA President Sue Bailey, MD’s, race for speaker of the AMA House next June.

COUNTY EXECS TACKLE THORNY ISSUES


The executive officers of Texas’ 10 largest county medical societies came to Austin for a two-day meeting with me and senior TMA staff. We addressed and developed action plans for some of the biggest challenges facing organized medicine in Texas: How can we continue to grow membership? How can we remain strong in the political and legislative arenas? What key services do Texas physicians expect of us? As a grassroots-driven organization, TMA’s strength has and always will come from the counties. I am committed to preserving a state-county relationship that is the envy of the nation.

TMA EXPLORING ACCOUNTABLE CARE LEADERSHIP PROGRAM WITH UT-DALLAS


"Physician-led” is a hot buzzword in health care reform circles, as it should be. Only physician-led programs can ensure that patient care is everyone’s top priority in the new accountable care environment. But do you have what it takes to take charge? We want to make sure, so TMA is developing a physician leadership program to teach skills needed for success in the new marketplace. TMA staff met with Michael J. Deegan, MD, clinical professor of healthcare leadership and innovation in the Naveen Jindal School of Management, The University of Texas at Dallas, to explore affiliating with the school’s Healthcare Leadership and Management for Physicians Certificate Program. A TMA Council on Practice Management Services task force will meet with Dr. Deegan later this month to discuss program design and curriculum, and to develop mutual goals for the 10-month program. It is anticipated that the first TMA class cohort would be accepted in March.

"HEY, DOC" RETURNS


More than 730,000 Texans have purchased health insurance coverage through the Affordable Care Act health insurance marketplace. Since April, many people have used their coverage for the first time but don’t understand what they purchased, what it covers, or how to use it. They are confused. Last fall, TMA launched our “Hey, Doc” educational campaign to provide answers to patients’ most frequently asked questions about the ACA marketplace. We answered 32 questions in the six-month series. As the confusion continues about these new plans, and a new round of open enrollment begins Nov. 15, many of the “Hey, Doc” Q&As are more relevant today than when we first published them. So “Hey, Doc” is back. We are updating and re-issuing our videos, blog posts, and news releases weekly. Feel free, once again, to use the material to educate your staff and answer your patients’ questions.

TMA'S BUSINESS BOOT CAMP LIVE WEBCAST, TOMORROW AT 9 A.M.:

If you haven’t been able to make it to any of our Business Boot Camp seminars across the state, sit down with your staff in front of the computer tomorrow at 9 am (CT) for some CME without the travel hassles. Live from Austin, this three-and-a-half hour webinar shows you how to monitor revenues and expenses, bill smart and collect what’s due, fine-tune your payer mix, and avoid incentive program penalties. Register now.