About TMA Related Organizations TMA Calendar Site Map Contact Us

Monday, January 26, 2015

SEE YOU IN AUSTIN THIS WEEKEND AT TMA 2015 WINTER CONFERENCE


A strong lineup of speakers and programs is waiting for you Friday and Saturday at 2015 TMA Winter Conference at the Hyatt Regency Austin. Our theme this year is Leading the Way Through Crisis and Change, because that’s what TMA and you — our physician leaders — are doing in this strange new health care world. Our boards, councils, and committees have a long day of hard work scheduled for Friday. We kick off Saturday morning with our Dawn Duster presentation: How Physicians, Hospitals, Patients, and Payers Can All Benefit From Health Care Payment and Delivery Reform, from the always-interesting Harold Miller, head of the Center for Healthcare Quality and Payment Reform. TMA President Austin King, MD, leads us into the meat of the morning followed by an update from Mary Anne McCaffree, MD, of the American Medical Association Board of Trustees. I’m really looking forward to hearing Dallas public health specialist John Carlo, MD, tell us: What We Learned from Ebola. Next, State Sen. Charles Schwertner, MD (R-Georgetown), chair of the Senate Health and Human Services Committee, brings us a look at the hot issues in the 2015 Texas Legislature. We close with the political memories of Paul Burka of Texas Monthly, who is retiring as dean of the Capitol press corps.

NEW STATE SENATE COMMITTEES LOOK FAVORABLE FOR MEDICINE


Newly minted Lt. Gov. Dan Patrick released his State Senate committee appointments for the 2015 session late on Friday. I am pleased to report that all three of the major committees that will handle our priorities are chaired by senators who work well with their local physicians and TMA: 
  • Lieutenant Governor Patrick retained Senator Schwertner — the first physician to chair the Health and Human Services Committee — in that post. Sen. Donna Campbell, MD (R-New Braunfels), the only other physician in the Senate, also will serve on that committee. 
  • Sen. Jane Nelson (R-Lewisville), who previously chaired the Health and Human Services Committee, will lead the Senate Finance Committee. Dr. Schwertner is also on that committee.
  •  The Business and Commerce Committee, which we expect to handle health insurance bills, will be chaired by Sen. Kevin Eltife (R-Tyler). Dr. Schwertner will serve on that committee as well. 

DON'T MISS THE FIRST, FIRST TUESDAYS AT THE CAPITOL — FEB. 3


First Tuesdays at the Capitol returns in eight days, and your patients and colleagues need you to be there. The “White Coat Invasion” has been the key to physicians’ successes in the Texas Legislature since the inception of First Tuesdays in 2003. Our senators and representatives listen when their hometown doctors appear in their offices. Our influence is so much greater when physicians and alliance members arrive en masse in the House and Senate galleries. It’s time again to bring out Texas medicine’s strongest weapon. Mark your calendar for the 2015 First Tuesdays at the Capitol and register today: Feb. 3, March 3, April 7, and May 5.

TMA ASKS CONGRESS TO REFORM RAC AUDITS


On behalf of the Physicians Advocacy Institute (PAI), I wrote several Texas leaders in Congress, asking them to support the PAI plan to relieve the bureaucratic burden on physicians caused by the Recovery Audit Program audits. Our proposal: 
  • Create new clinical and educational standards to ensure recovery audit contractors (RACs) have necessary expertise in determining medical necessity and coding issues;
  • Mandate that RACs provide timely and detailed notification to physicians and providers;
  • Delay contingency payments for RACs until the third level of appeal is exhausted;
  • Require RACs to educate and provide notice on common coding and billing errors; 
  •  Provide physicians with a meaningful opportunity to decide whether to file an appeal; Reduce the look-back period for RAC audits to two years; and
  • Add specific extrapolation standards to the statistical sampling pilot. 

STAY IN TOUCH WITH TMA'S LEGISLATIVE NEWS HOTLINE


What happens in the Texas Capitol between now and the June 1 end of the 2015 regular legislative session can have a profound effect on what happens in your practice for many years. With TMA Legislative News Hotline, you get daily or weekly — or both — updates on the progress of the state budget and bills that promote or hinder our Healthy Vision 2020 agenda. If you’re not already subscribed, sign up for Hotline today. It’s your finger on the pulse of your future.




 

GET READY FOR 2015 MANDATES AT TMA'S ANNUAL MEDICARE SEMINAR SERIES; SAVE $20

The new year is bringing a rash of new Medicare quality measurements, payment formulas, and pay cuts. Make sure your practice is prepared. Sign up for one of TMA’s live Medicare 2015 seminars running Feb. 3-25 in cities across the state. Hot topics we’ll cover include: compliance and audits, how to prepare for quality-based payment, meaningful use, and the Physician Quality Reporting System. Use coupon code EPROMO to save $20 when you register on the TMA website.

NEW LEADERS AND OUR HEALTHY VISION


Gov. Greg Abbott and Lt. Gov. Dan Patrick took their oaths of office today, the first time in more than a decade that Texas has had new top leaders. House Speaker Joe Straus (R-San Antonio), who was easily reelected to his fourth term last week, provides a degree of continuity as the 2015 Texas Legislature begins its work. The second edition of TMA’s Healthy Vision 2020 lays out our agenda for the session. Here are our top 10 recommendations: Increase funding for graduate medical education; improve physicians’ Medicaid and Children’s Health Insurance Program payments to more appropriately reflect the services they provide to patients; hold health insurance companies accountable for creating and promoting adequate physician networks; devise and enact a system for providing health care to low-income Texans that improves efficiencies by reducing bureaucracy and paperwork; stop any efforts to expand scope of practice beyond that safely permitted by nonphysician practitioners’ education, training, and skills; promote government efficiency and accountability by reducing Medicaid red tape; protect physicians’ ability to charge for their services; improve the state’s public health defense to better respond in a crisis; preserve Texas’ landmark medical liability reforms; and protect the patient-physician relationship from corporate and political intrusions.

TMA EYES HEALTH CARE FOR STATE WORKERS


As the increasing cost of health care for state employees and retirees — particularly hospitalizations and outpatient services — grabs state budget writers’ attention, TMA senior staff met with Ann Bishop, executive director of the Employees Retirement System of Texas (ERS), and members of her executive team to discuss potential issues for the legislative session. Ms. Bishop stated that physician services were not the driver of increased costs in ERS health care services. We also discussed the development of narrow networks for state workers and the need to hold UnitedHealthcare accountable for the adequacy of its network and for ensuring undue costs were not being placed on state employees. TMA will continue to work with ERS and other state agencies during the legislative process to ensure enrollees receive adequate coverage and access and that physicians are paid timely and appropriately for the services they deliver.

TMLT AND TMA WORK TO PROTECT LIABILITY REFORMS


TMA and Texas Medical Liability Trust (TMLT) leaders met to discuss prefiled legislation and potential issues that the Texas Legislature might consider over the next 132 days. Our principal concern is ensuring that no legislation passes that would negatively impact the hard-fought tort reforms enacted in 2003. With strong support from the big three — Governor Abbott, Lieutenant Governor Patrick, and Speaker Straus — as well as widespread support from members of the Texas Senate and Texas House, we are optimistic these reforms can be protected. TMLT was created by the Texas Legislature in 1979 to provide medical liability coverage to TMA members. TMLT is the largest and most respected medical liability provider in the state, protecting more than 17,000 Texas physicians of all specialties, practice types, and locations.

DR. KING WELCOMES NEW COUNTY SOCIETY LEADERS


TMA President Austin King, MD, is in the middle of a whirlwind tour of Texas this month, helping to install new county medical society leaders and sharing TMA’s Healthy Vision 2020 legislative agenda. He started in Tyler, where cardiologist Kyle Smith, MD, is the new president of the Smith County Medical Society, and then went to Amarillo for the installation of nephrologist Tarek Naguib, MD, as the new president of the Potter-Randall County Medical Society. The next night, in Houston, Dr. King celebrated the installation of Bradford Patt, MD, an otolaryngologist and facial plastic surgeon, as the 114th president of the Harris County Medical Society, and internist Lisa Ehrlich, MD, as the new president of the Houston Academy of Medicine. After that, he made legislative presentations to the Henderson and the Midland county medical societies. Dr. King is on the road again this week. We’ll update you as soon as we catch our breath.

PUBLIC HEALTH COALITION SETS 2015 PRIORITIES


The TMA-led Texas Public Health Coalition, which now has grown to 30 member organizations, has established its 2015 legislative agenda to “promote good health and save taxpayers’ dollars.” The priorities are: stop texting while driving (a new agenda item for 2015), support state funding for cancer prevention and research, improve immunizations for Texans of all ages, support physical activity and healthy food initiatives in Texas schools and underserved communities, and support smoke-free legislation and regulation of e-cigarettes.

WINTER CONFERENCE HEADLINER OPINES ON SGR

Harold Miller, who will deliver the Dawn Duster at 2015 TMA Winter Conference on Jan. 31, offers some insightful suggestions for Congress on how to pay for the repeal of Medicare’s Sustainable Growth Rate (SGR) formula in a new white paper. “The way to pay for repealing the SGR isn’t to cut physician payments in another way, cut payments to other providers, refuse to pay for services Medicare beneficiaries need, or make cuts in other programs,” he writes. “The solution is to change the way Medicare pays for health care so that physicians can change the way they deliver care, thereby enabling patients to get better care with less total spending.”


Monday, January 12, 2015

TEXAS LEGISLATURE CONVENES TOMORROW; HERE'S OUR HEALTHY VISION


The 84th Texas Legislature begins its 140-day regular session in Austin tomorrow with a new lieutenant governor (Dan Patrick) and a new governor (Greg Abbott) waiting to be inaugurated next week, and a host of new senators and representatives. From the opening gavel at noon on Tuesday through sine die on June 1, TMA will be your very active voice at the Texas Capitol. The second edition of TMA’s Healthy Vision 2020 lays out our agenda for the session. As TMA President Austin King, MD, says, “Our government must make it easier — not more difficult — for us to care for our patients.” Here are our top 10 recommendations:
  1. Increase funding for graduate medical education.
  2. Improve physicians’ Medicaid and Children’s Health Insurance Program payments to more appropriately reflect the services they provide to patients.
  3. Hold health insurance companies accountable for creating and promoting adequate physician networks.
  4. Devise and enact a system for providing health care to low-income Texans that improves efficiencies by reducing bureaucracy and paperwork.
  5. Stop any efforts to expand scope of practice beyond that safely permitted by nonphysician practitioners’ education, training, and skills.
  6. Promote government efficiency and accountability by reducing Medicaid red tape.
  7. Protect physicians’ ability to charge for their services.
  8. Improve the state’s public health defense to better respond in a crisis.
  9. Preserve Texas’ landmark medical liability reforms.
  10. Protect the patient-physician relationship from corporate intrusions. 

TMA, ALLIANCE MEMBERS GAIN LEGISLATIVE CLOUT WITH SENIORITY


When the 2015 legislative session convenes here tomorrow, five physicians and one TMA Alliance member will be among the 181 senators and representatives taking the oath of office. Five of the six are returning legislators, gaining power with seniority and experience. Sen. Charles Schwertner, MD (R-Georgetown), has been serving as chair of the Senate Committee on Health and Human Services. The other TMA member in the upper chamber is Sen. Donna Campbell, MD (R-New Braunfels). On the House side, Reps. John Zerwas, MD (R-Simonton), and Susan King (R-Abilene) are both beginning their fifth term in office and can expect to play key roles in drafting the state budget. Reps. Greg Bonnen, MD (R-Friendswood), and J.D. Sheffield, DO (R-Gatesville), are coming back for their second term. A newcomer, Stuart Spitzer, MD (R-Kaufman), is a surgeon.

TMA CALLS FOR TOUGHER HMO NETWORK ADEQUACY RULES


TMA and 11 state specialty societies filed a 34-page letter with the Texas Department of Insurance  (TDI), commenting on the network adequacy and out-of-network payment provisions of TDI’s informal working draft rule proposal on HMOs. The letter says the draft proposal would reduce the value of HMO products available to consumers and increase consumer out-of-pocket expenses. “If health plans are not inclined to prioritize network adequacy requirements, as is implied by plan failure to comply with the most basic network adequacy reporting requirement, then it becomes much more important for the Department to make the health plans prioritize network adequacy through strong regulatory and enforcement actions,” TMA President Austin King, MD, and the presidents of the 11 other societies wrote. It is important to note that the working draft proposal is subject to further revision before publication of a final rule proposal. TMA and the specialty societies will continue to monitor the rule’s development and will provide additional comments when TDI proposes the rule formally, which is not expected until after the legislative session.

TMLT PUTS ANOTHER $15 MILLION INTO POLICYHOLDER LOYALTY PROGRAM


The Texas Medical Liability Trust (TMLT) has set aside $15 million for the Trust Rewards Program for 2015. TMLT uses these funds to reward policyholders for their loyalty. This year’s additional allocation brings the Trust Rewards total to $165 million. Funds are distributed to policyholders at the time of retirement or other qualifying event. “No other carrier offers this much to Texas physicians,” said TMLT President and Chief Executive Officer Robert Donohoe. TMLT is the only medical professional liability insurance provider created and exclusively endorsed by TMA.

DR. LAKEY STEPPING DOWN AS TEXAS HEALTH COMMISSIONER


David Lakey, MD, commissioner of the Department of State Health Services (DSHS) for the past eight years, is leaving his post Jan. 30 to join the Office of Health Affairs at The University of Texas System and the leadership team at The University of Texas Health Science Center at Tyler. “The goal of both positions is to improve population health, especially in East Texas and the areas of most need in our state,” Dr. Lakey said in an email to DSHS employees.

DR. MOY NAMED NEW BEHAVIORAL HEALTH MEDICAL DIRECTOR FOR TMF


Cliff Moy, MD, the speaker of the TMA House of Delegates, is the new medical director for behavioral health at TMF Health Quality Institute. Dr. Moy will support TMF’s medical directors on the Texas Medicaid Healthcare Partnership project and help TMF develop and implement behavioral health quality improvement opportunities.

REP. MICHAEL BURGESS, MD, WINS NATHAN DAVIS AWARD


Among the pile of letters waiting on my desk last week was one real thrill. American Medical Association CEO James Madara, MD, wrote to tell me that our nominee for the 2015 Dr. Nathan Davis Awards, Rep. Michael Burgess, MD (R-Lewisville), was selected by AMA’s panel of judges as the winner for Outstanding United States Representative. The Davis awards recognize career and elected government officials “for outstanding public service in the advancement of public health.” Dr. Burgess, the only TMA member in Congress and a steadfast champion of physicians and patients, certainly fits that description. “Given the many nominations submitted this year, it is a high testimony to the caliber of your presentation and the superb level of public service of your nominee,” Dr. Madara wrote. Dr. Burgess will receive the award next month in Washington, D.C.

GET READY TO PLAY YOUR ROLE IN THE TEXAS LEGISLATURE


State lawmakers pour into Austin next week for the start of their biennial, five-month show. The session will be a challenging one for medicine on several fronts. This month’s Texas Medicine includes several excellent articles that show us the lay of the land. And, of course, our Healthy Vision 2020, Second Edition, outlines our legislative agenda. But as hard as our physician leaders and lobby staff work, you’re the one who can make the difference in whether we succeed or fail. Here are five ways you can play a key role in the 84th Texas Legislature:
  1. Stay informed. Subscribe to the daily or weekly version of TMA’s Legislative News Hotline.
  2. Be social. Follow TMA and your state lawmakers on Twitter, and join the #TMASMA (TMA Social Media Advocacy) campaign.
  3. Engage. Share a copy of Healthy Vision with your state senator and representative when they are home during the early weeks of the session. Contact TMA Public Affairs to set that up.
  4. Engage again. Come to First Tuesdays at the Capitol to lobby in person. Mark your calendar for one or more of these dates: Feb. 3, March 3, April 7, and May 5. Register today.
  5. Speak out. Watch for TMA action alerts and be ready to call, write, or visit your legislators before critical votes on key issues.

SUNSET COMMISSION SAYS REDEFINE MEDICAID FRAUD


TMA and Texas physicians won a major victory in the fight against overzealous Medicaid “fraud and abuse” investigators. The Sunset Advisory Commission agreed with us in recommending that the legislature enact significant changes in the operation of the Texas Health and Human Services Commission (HHSC) Office of Inspector General. A workgroup chaired by Sen. Juan “Chuy” Hinojosa (D-McAllen) recommended — and the commission adopted — a change in the definition of Medicaid fraud “to clarify that the term does NOT include unintentional technical, clerical, or administrative errors. The amended definition would be read as follows: ‘Fraud’ means an intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to that person or some other person, but does not include unintentional technical, clerical, or administrative errors.” Additionally, the commission adopted the recommendation of Sen. Charles Schwertner, MD (R-Georgetown), directing HHSC to strengthen oversight for Medicaid HMO network adequacy, which TMA requested.

ACCOUNTABLE CARE, EBOLA, AND LEGISLATURE ON WINTER CONFERENCE AGENDA


Opening with Win-Win-Win Approaches to Accountable Care: How Physicians, Hospitals, Patients, and Payers Can All Benefit From Health Care Payment and Delivery Reform from the nationally renowned Harold Miller, TMA’s 2015 Winter Conference offers a delectable intellectual smorgasbord for leading Texas physicians. The Jan. 31 General Session also includes a What Did We Learn From Ebola? presentation and an exploration of the 2015 Texas Legislature. The conference is Jan. 30-31 at the Hyatt Regency in downtown Austin. Register and make your hotel reservations today.

DR. KING WELCOMES NEW LEADER IN CORPUS CHRISTI, VISITS EDITORIAL BOARDS


Dr. King put in a few busy weeks on the road prior to the December holidays. He was joined by TMA Alliance President Angie Donahue at the installation of Daniel Vijjeswarapu, MD, a Corpus Christi pediatrician, as the new president of the Nueces County Medical Society. Dr. King shared TMA’s Healthy Vision 2020, Second Edition, with the editorial boards of the Corpus Christi Caller-Times and the San Antonio Express-News. He also visited with The University of Texas Health Science Center at San Antonio medical school faculty and students, and with the Bexar County Medical Society large group practice forum.

MY LATEST AT FORBES.COM: FIVE KEY ISSUES TO WATCH FOR 2015

Hospital and health system consolidation, regulatory overload, the ICD-10 transition, health care cost transparency, and access to physician care are the major national health care issues for 2015 that I outlined in my latest column on Forbes.com. “Are doctors ready to navigate the ever changing medical landscape?” Physicians Foundation CEO Tim Norbeck and I wrote. “To help them prepare, The Physicians Foundation identified five critical areas that health care analysts, lawmakers, physicians, patients and the public need to closely watch in the New Year.”