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Monday, February 23, 2015

Physicians Take the Witness Stand for Medicine

Nothing grabs lawmakers’ attention like a physician taking time away from his or her practice to travel to the Capitol to deliver a message. I’m personally grateful to the eight TMA-member physicians who testified last week before state House and Senate committees in support of medicine’s agenda to increase physicians’ Medicaid payments; improve funding for Texas’ women’s health programs and mental health services, and for the Department of State Health Services’ (DSHS’) tobacco and obesity prevention programs; and improve DSHS’ ability to respond to infectious disease outbreaks. In chronological order:
  • San Antonio pediatrician Ryan Van Ramshorst, MD, testified Monday before a House Appropriations Subcommittee on why it’s essential to improve physicians’ Medicaid and Children’s Health Insurance Program (CHIP) payments.
  • Janet Realini, MD, chair of the Texas Women’s Healthcare Coalition, testified Monday and Thursday to ask lawmakers to support an additional $50 million in funding for women’s health care services to ensure women have access to physicians and health care providers.
  • Athens family physician Doug Curran, MD, vice chair of TMA’s Board of Trustees, testified before the Senate Finance Committee Thursday. He urged the committee to end the 2011 funding cut for services to Medicaid-Medicare, dual-eligible patients.
  • Edinburg pediatrician Martin Garza, MD, testified before the Senate Finance Committee members on the need to enact competitive physician payments in Medicaid and CHIP.
  • Dallas psychiatrist Les Secrest, MD, took the stand at the Senate Finance Committee to support DSHS’ funding requests for mental health and substance abuse prevention, early intervention, and treatment.
  • A member of TMA’s Committee on Infectious Disease, Philip Huang, MD, of Austin, testified on Wednesday and Thursday. He asked House Appropriations Subcommittee and Senate Finance Committee members to support additional DSHS funding for tobacco cessation, infectious disease control, and obesity prevention programs.
  • Lewis Foxhall, MD, a member of TMA’s Board of Trustees, was a resource witness for MD Anderson Hospital at the House Appropriations Subcommittee and Senate Finance Committee Wednesday and Thursday to discuss the importance of the DSHS tobacco Quitline.
  • Joel Dunnington, MD, a former member of TMA’s Council on Public Health, also was on hand both days to testify in support of additional funding for DSHS’ anti-smoking programs.


TMA PracticeEdge Hires Chief Operating Officer

I’m pleased to announce that we’ve hired industry veteran Dave Spalding to serve as the chief operating officer of TMA PracticeEdge. During his 15-year career as a health care executive, Dave has specialized in managing new ventures and high-growth businesses, including a management services organization (MSO) company, a national telehealth network company, a five-star Medicare Part D administrator, and one of the largest health savings account banking companies in the country. He is currently the chair of the board for Availity, LLC, a trusted intermediary of information exchange between physicians, providers, and health plans. For more information on TMA PracticeEdge, the services company we built to help physicians succeed under new health care payment models, see the website or email info@TMAPracticeEdge.com.

Texans Trek to Capitol Hill to Lobby for SGR Repeal, Regulatory Relief

Seven TMA physician leaders, a medical student, chief lobbyist Darren Whitehurst, and I are traveling to Washington, D.C., this week to lobby along with the Coalition of State Medical Societies for repeal of Medicare’s Sustainable Growth Rate (SGR) formula and relief from onerous federal regulations. The visits to Congress coincide with the American Medical Association’s National Advocacy Conference. We’ll meet with Texas’ two U.S. senators and our House members. I’ll give you a full report in next week’s EVPGram.

Texas Public Health Coalition Honored for Advocacy Work

Congratulations to the TMA-led Texas Public Health Coalition. For the second year in a row, the coalition was chosen by the Texas Public Health Association to receive its Jessie A. Yoas Memorial Advocacy Award for continued advocacy for key public health issues. The coalition’s 2015 advocacy agenda includes: enacting a ban on texting while driving; supporting cancer research and prevention; and fighting tobacco, obesity, and vaccine-preventable illnesses.

Mark Your Calendar for These Coming Events

I hope to see you and all TMA leaders at these upcoming events in Austin: 
  • First Tuesdays at the Capitol — March 3, April 5, and May 7.
  • TexMed 2015 — May 1-2 at the Austin Convention Center and Hilton Austin. Bring your white coat and come early for TexMed at the Capitol lobby day, April 30. 

Tuesday, February 17, 2015

TMA PracticeEdge Draws Great Response From Physicians

Almost 175 physician practices from around the state have called or emailed to inquire about how TMA PracticeEdge, our new physician services company, can help them. Our team has provided each of these practices additional information about the company, and we have begun to schedule follow-up meetings with those who are most interested. We developed TMA PracticeEdge to bring physicians the technology, expertise, and investment they need to succeed under new health care payment models. I believe PracticeEdge will provide Texas physicians real options to design their own future. TMA PracticeEdge will offer:
  • Accountable care services: the technology platforms, care coordination teams, physician-led network development and management, and contracting expertise necessary to participate in accountable care activities, and to meet market demands to document quality, cost-effective health care.
  • Practice transformation services: Physicians can strengthen their practices operationally and financially by optimizing them using TMA PracticeEdge services, including education and consulting from certified professional coders, medical auditors, and compliance officers.
Interested in learning more about TMA PracticeEdge? Email TMAPracticeEdge@texmed.org.


Just past the one-month mark, the 2015 Texas Legislature is starting to pick up a head of steam. Both chambers are spending significant amounts of time tackling the state budget bills. The Senate Finance Committee examined the section of the budget dealing with education, including funding for graduate medical education (GME). Curtis Mirkes, DO, a Temple internist and pediatrician, was on hand to testify on behalf of TMA. He explained to committee members why funding the Higher Education Coordinating Board in its efforts to expand GME is important. Dr. Mirkes underscored why GME funding is needed to reach the target 1:1.1 ratio of entry-level positions per medical school graduate. In the Senate Health and Human Services Committee, San Antonio pediatrician Ryan Van Ramshorst, MD, testified for TMA and the Texas Pediatric Society in support of Senate Bill 97 by Sen. Juan “Chuy” Hinojosa (D-Harlingen), which would regulate the sale, distribution, possession, use, and advertising of e-cigarettes.



We continue our two-front war on the mandatory transition to the ICD-10 coding system, now set for Oct. 1 of this year. While we are still urging Congress to put a stake in the beast, we have a responsibility to help physicians prepare for the massive change if we can win no more delays or an absolute deferral. Our six-city seminar tour, ICD-10: Will You Just Survive, or Will You Thrive? begins March 3. Register today. The half-day events include:
  • Presenting expense planning strategies, 
  • Discussing ICD-10 documentation and staffing issues, 
  • Offering instruction on end-to-end testing,  
  • Showing you how to gauge practice vendor preparedness, and 
  • Distinguishing what to do if there’s another delay.


Given the size of the Texas budget, the House Appropriations Committee divides itself into smaller groups to study pieces of the budget and make recommendations for state spending over the next two fiscal years. The subcommittees begin their work in earnest this week. Take a close look to see if your representative has a seat one of these two key subcommittees:
  • The subcommittee for health and human services spending (Article II) is: Rep. Four Price (R-Amarillo), chair; Rep. Dawnna Dukes (D-Austin), vice chair; and Reps. Cindy Burkett (R-Sunnyvale); Sarah Davis (R-West University Place); J.D. Sheffield, DO (R-Gatesville); and Armando Walle (D-Houston).
  • The subcommittee for education spending — including medical schools and GME (Article III) — is: Rep. Trent Ashby (R-Lufkin), chair; Rep. Helen Giddings (D-DeSoto), vice chair; and Reps. Donna Howard (D-Austin), Marisa Márquez (D-El Paso), Dade Phelan (R-Beaumont), John Raney (R-College Station), and Gary VanDeaver (R-Clarksville).


I spent the better part of last week meeting with key senators and representatives on TMA’s 2015 legislative agenda. I was very pleased with the positive response our proposals are receiving at the Capitol. Darren Whitehurst, TMA’s VP for Advocacy, and I also met with Texas Health and Human Services Executive Commissioner Kyle Janek, MD. We discussed the Department of State Health Services’ recent decision to suspend the new fluoroscopy training requirement rules, as well as ways to remove red tape for physicians who want to participate in the Medicaid program and how we can improve physicians’ Medicaid payments to more appropriate levels.

Monday, February 9, 2015


First Tuesdays at the Capitol Chair Susan Todd, TMA President Austin King, MD, and TMA Alliance President Angela Donahue kicked off our first major lobby day this session. More than 300 physicians, medical students, and alliance members filled the hallways of the Capitol and Senate and House galleries, and attended a lunch with their colleagues. It starting with a legislative briefing by TMA lobby staff and remarks from Dr. King. The white-coated hordes then shared TMA’s 2015 legislative agenda with their representatives and senators. The top 10 on our list: 
  • 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 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.
  • Protect the patient-physician relationship from corporate intrusions. 
Register now for the March 3 First Tuesdays.


At a Capitol news conference, TMA and the Border Health Caucus asked state leaders and lawmakers for major improvements to Texas Medicaid. Physicians from across the state joined Dr. King; Doug Curran, MD, TMA Board of Trustees vice chair; Luis Benavides, MD, Council on Legislation member and Border Health Caucus vice chair; and Michael Battista, MD, a San Antonio neonatologist, to urge support for our six-part plan
  • Improve physicians’ Medicaid payments; Cut Medicaid red tape and administrative hassles;
  • Hold Medicaid HMOs accountable for establishing adequate physician networks;
  • Restore funding for Medicaid-Medicare “dual-eligible” patients; Stop unfair and unreasonable fraud and abuse audits; and
  • Find a creative solution to pull down federal dollars to ensure access to health care for working, poor adults. 


Don’t think for a second, from reading those first two stories, that TMA is limiting our lobby activities to the Texas Legislature. In conjunction with our Coalition of State Medical Societies and the American Medical Association, we have a full slate of requests for Washington. We’re watching the new Republican majority in Congress for opportunities to push repeal of the Medicare Sustainable Growth Rate (SGR) formula. With leaders like Reps. Michael Burgess, MD (R-Lewisville), and Kevin Brady (R-The Woodlands) and Sen. John Cornyn (R-Texas) well-positioned to have an impact, we’re even more hopeful to win physicians some relief from bureaucracy-laden programs like Meaningful Use, the Physicians Quality Reporting System (PQRS), and value-based purchasing. Noncompliance with those complex regulations this year will bring cuts in Medicare payments in 2016 and 2017. We’ll be on Capitol Hill next week to push our federal agenda.


You like it, so we’ll keep it up. Due to the popularity of the Choosing Wisely continuing medical education (CME) webinars, TMA will continue to offer the CME bundle to members at no cost for a limited time. The bundle includes five videos or presentations by Texas physicians at TexMed 2014. Choosing Wisely aims to promote conversations between physicians and patients about the need — or lack thereof — for many frequently ordered tests or treatments. National specialty societies created all of the discussion lists. The ABIM Foundation gave TMA and the TMA Foundation a grant to advance Choosing Wisely among Texas physicians. Support for the grant comes from the Robert Wood Johnson Foundation.


Each year, we ask every student in our TMA Leadership College to complete a special project before graduation. Jason Marchetti, MD, of the Texas Back Institute in Denton, will likely get an A+ for developing and executing his project. Check out the TMA website for the “Fist Bump Your Doc” campaign; see the science behind Dr. Marchetti’s plan; and download the cold- and flu-preventing posters to display in your office. The TMA Leadership College was designed for active TMA members under the age of 40 or who are in the first eight years of practice. Watch for details about the Class of 2016 and the application process to be posted later this year.

Thursday, February 5, 2015

Announcing ... TMA PracticeEdge

Organization Created by Texas Medical Association and Blue Cross and Blue Shield of Texas

TMA PracticeEdge to Offer Physicians Options to Remain Independent

The Texas Medical Association (TMA) and Blue Cross and Blue Shield of Texas (BCBSTX) are launching TMA PracticeEdge to help empower a strong base of independent physicians to provide quality, cost-effective care to their patients. This first-of-its kind joint effort leverages the strengths of TMA’s statewide physician membership and BCBSTX’s resources to benefit the entire Texas health care community, including patients, hospitals, payers, and other physicians.

TMA’s membership includes more than 48,000 Texas physicians and medical students. BCBSTX serves more than 5 million members in all 254 Texas counties.

TMA PracticeEdge, LLC, will offer physicians access to enhanced patient care tools and resources so they can better provide cost-effective patient care. Physicians working with TMA PracticeEdge will be able to take advantage of the opportunities available in the rapidly changing health care marketplace.

TMA and BCBSTX share the goals of increased quality and cost-effective care found in existing physician-led accountable care organizations (ACOs). TMA PracticeEdge similarly will provide tools to reduce physicians’ growing data-entry burden to allow them to focus on taking care of their patients. The goal is to establish a system that pays physicians and providers based on the quality of patient outcomes and patient care.

While most ACOs are constrained by a specific hospital system, TMA PracticeEdge will help connect physicians centered on the needs of their specific patients. TMA PracticeEdge will offer participating physicians the means to provide coordinated collaborative care, including prevention and management of chronic disease.

According to the 2014 TMA Survey of Texas Physicians, approximately two-thirds of Texas physicians work for themselves or in practices that are wholly owned and controlled by other physicians. Most of these independent physicians traditionally have not had access to the tools and resources needed to participate in an ACO.

“BCBSTX will work with TMA to give physicians alternatives to today’s fee-for-service system,” said TMA President Austin I. King, MD. “With today’s announcement, BCBSTX becomes the first health insurer to stand by independent Texas physicians in support of 21st century patient care.”

“This represents a significant investment in our relationship with the TMA and Texas physicians, and will benefit our members, who value their relationships with their independent physicians,” said Bert Marshall, President of Blue Cross and Blue Shield of Texas.

TMA PracticeEdge will help physicians lead health care innovation in today’s evolving marketplace. PracticeEdge will offer participating physicians several services, including:
  • Consultations to help reduce administrative burdens so they can spend more time focusing on patient care.
  • Help for practices wishing to create care management teams to better serve patients with complex or chronic health problems.
Physicians and office managers who are interested in learning more about TMA PracticeEdge should contact TMAPracticeEdge@texmed.org by email.

Monday, February 2, 2015


Two of the state’s top physicians urged their colleagues at 2015 TMA Winter Conference to jump feet first into advocating for their patients and their professions. Sen. Charles Schwertner, MD (R-Georgetown), chair of the Senate Health and Human Services Committee, recalled how he lobbied for tort reform in 2003 as an orthopedic surgeon participating in TMA’s very first, First Tuesdays at the Capitol. “I come from your world,” he said. “I understand your issues.” TMA President Austin King, MD, reminded his colleagues that perceptions trump reality in many places, including the Texas Legislature. He called on physicians to share their realities of patient care with their elected representatives. Among other conference speakers: 
  • John Carlo, MD, chair of the Dallas County Medical Society’s (DCMS’) Emergency Response Committee, talked about the “infectious fear” that accompanied the Ebola virus cases in Dallas last fall. All while trying to battle the actual outbreak, he said, physician leaders had to overcome “the primal fear of infectious disease stoked by the swirl of antiscience beliefs, media exploitation, and political theater.” He credited DCMS leadership with persuading several area schools districts to keep their campuses open. “If the school districts closed, with no evidence of risk, how would they ever know when to open again?” he asked.
  • A member of the American Medical Association Board of Trustees told the conference AMA is pushing to regain last year’s momentum to replace Medicare’s flawed Sustainable Growth Rate formula. Oklahoma City pediatrician Mary Anne McCaffree, MD, praised the leadership of Texans in Congress on the issue. She also said AMA is working to undo the “regulatory tsunami of meaningful use, PQRS [Physician Quality Reporting System], and value-based modifiers” before they swamp physicians’ practices.
  • Paul Burka, senior executive editor of Texas Monthly magazine and dean of the Texas Capitol Press Corps, shared tales of his 40 years in Texas politics and his insights into the current crop of state leaders. “Texas physicians and TMA are important to Texas and its future,” he said. Mr. Burka called our 2003 medical liability reforms “a turning point in Texas political history,” and he said Gov. Gregg Abbott is on his way to being one of Texas’ best governors.


TMA member physicians who stepped up to battle national public health emergencies are the first recipients of Dr. King’s TMA Presidential Awards this year: 
  • In the Rio Grande Valley, Dr. King honored Edinburg pediatrician Martin Garza, MD; Sister Norma Pimentel, executive director of the Catholic Charities of the Rio Grande Valley; Eduardo Olivarez, chief administrative officer of the Hidalgo County Health Department; and the Hidalgo-Starr County Medical Society, who all came to the rescue of thousands of Central American immigrants who entered Texas last year and continue to do so today.
  • In El Paso, the award went to the El Paso County Medical Society, which coordinated care for 140 immigrants a day who arrived in the border city via airplane. Dr. King also installed internist Syed Yusoof, MD, as the new county society president.
  • Dr. King also honored the physicians who calmed the fears of Dallas, and the nation, in the wake of the country’s first Ebola virus infection: former Texas Health Commissioner David Lakey, MD; Wendy Chung, MD, chief epidemiologist for Dallas County Health and Human Services; Dr. Carlo; and DCMS. 


Darren explains it all. The budget, that is. In this week’s Legislative News Hotline video, Darren Whitehurst, TMA’s vice president for advocacy, delves into the details of the Senate and House draft budget bills — Senate Bill 2 and House Bill 1 — estimated spending of each, and what they mean for medicine. Senate Finance Committee Chair Sen. Jane Nelson (R-Flower Mound) has scheduled committee hearings on SB 2 starting today. Article 2 — the part of the budget that tackles health and human services — is scheduled for the week of Feb. 16. Senator Nelson plans to finish SB 2 hearings by the end of February. The House will start hearings on HB 1 once House Speaker Joe Straus makes Appropriations Committee chair and committee appointments.



Fort Worth Mayor Betsy Price’s campaign to overcome her city’s obesity epidemic won the TMA Foundation’s top John P. McGovern Champion of Health Award. Focusing on nutrition, physical activity, and workplace wellness, the FitWorth Healthy City Initiative pushes awareness of healthy choices for Fort Worth students and adults. The Medical Miles Mentorship, where Baylor College of Medicine students mentor Houston middle schoolers in fitness, was the secondary winner. The annual McGovern Award honors exceptional projects that address urgent threats to the public's health, address TMA science and public health priorities, and further the foundation’s mission: to help physicians create a healthier future for all Texans.


To boost grassroots involvement in TMA’s political activities, the TEXPAC Board of Directors voted to double its size and give more slots to young physicians, medical students, and TMA Alliance members. The TEXPAC board sets policy for the PAC and determines which candidates will receive medicine’s endorsements. The move is part of a yearlong effort to grow the PAC and enhance its influence in Texas politics. TEXPAC also unveiled a new mobile app, an exclusive, private social network that allows TEXPAC members to connect with each other and stay engaged with the Texas Legislature and U.S. Congress. The app, for TEXPAC members only, can be downloaded from the Apple App Store now. It will be available on Google Play for Android users later this week. The TMA Board of Trustees also voted to appropriate funds for a complete redesign of the TEXPAC website by the end of the year.


Your first chance to be a lobbyist for a day at the 84th Texas Legislature comes tomorrow. Bring your white coat and be a part of TMA’s First Tuesdays at the Capitol. No advance training is required. We’ll help you educate your senator and representative about TMA’s Healthy Vision 2020, Second Edition.