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Monday, March 30, 2015

SGR Repeal Flies Through House, Stalls in Senate

Behind the strong leadership of Rep. Michael Burgess, MD (R-Lewisville), and the bipartisan support of our Texas congressional delegation, the bill to repeal Medicare’s hated Sustainable Growth Rate (SGR) formula won overwhelming approval in the U.S. House of Representatives. Leaders in the upper chamber promise the Senate will take up the bill quickly when Congress returns April 13 from its Easter recess. See Wednesday’s edition of TMA’s Action newsletter for details on how Medicare will handle claims for services provided after April 1.

Reps. Kevin Brady (R-The Woodlands) and Gene Green (D-Houston) also cosponsored the bill, and Rep. Henry Cuellar (D-Laredo) pushed hard to ensure it included language protecting Texas’ medical liability reforms. In addition to Reps. Burgess, Brady, Green, and Cuellar, each of the following Texas members of Congress deserve thank-you letters or calls for their “yes” votes on HR 2, the Medicare and CHIP Reauthorization Act (see the TMA Grassroots Action Center for addresses and phone numbers for your representative): Reps. Ted Poe, Jeb Hensarling, Joe Barton, John Culberson, Al Green, Michael McCaul, Mike Conaway, Kay Granger, Mac Thornberry, Randy Weber, Beto O’Rourke, Bill Flores, Sheila Jackson Lee, Randy Neugebauer, Joaquin Castro, Lamar Smith, Pete Olson, Will Hurd, Roger Williams, Blake Farenthold, Eddie Bernice Johnson, John Carter, Pete Sessions, Marc Veasey, Filemon Vela, Lloyd Doggett, and Brian Babin.

TMA also appreciates the support of Senate Majority Whip John Cornyn of Texas, and will work with him during the two-week recess to ensure the Senate passes the bill and quickly puts a stake into the SGR. I also urge you to send calls and letters of support into Sen. Ted Cruz’s office.

Another Round of Thank-Yous for TMA Members Testifying at the Legislature

Ten TMA member physicians took time away from their practice and took turns testifying for medicine in front of House and Senate committees last week. I send my wholehearted thanks and praise, and I think they deserve yours as well. In chronological order:
  • John Holcomb, MD, of San Antonio, and Frank Cho, MD, of Austin testified before the Senate Health and Human Services Committee on the sunset bills to reorganize Texas health and human services agencies. Dr. Holcomb also testified before the same panel for Senate Bill 207 by Juan “Chuy” Hinojosa (D-McAllen), which specifies that unintended billing errors or coding mistakes are decidedly not Medicaid fraud.

  • Keller pediatrician Jason Terk, MD, testified before the House Public Health Committee in support of two bills by Rep. J.D. Sheffield, DO (R-Gatesville), to improve immunizations. Dr. Terk also testified for five bills before that committee to curb minors’ access to e-cigarettes.

  • Council on Legislation Chair Dawn Buckingham, MD, and Houston anesthesiologist Sherif Zaafran, MD, testified before the Senate Business and Commerce Committee on Senate Bill 481 by Sen. Kelly Hancock (R-North Richland Hills). They expressed our serious concerns that the legislation eliminates the $1,000 threshold for mediation over bills from facility-based physicians for services provided out of network.

  • Pain management specialists C.M. Schade, MD, of Mesquite and Richard Hurley, MD, of Waco testified before the Senate Health and Human Services Committee for Senate Bill 195 by Sen. Charles Schwertner, MD (R-Georgetown), which, among other things, does away with the state’s controlled substance registration.

  • Leslie Secrest, MD, a Dallas psychiatrist, and Robert Greenberg, MD, a Temple emergency medicine physician, came before the Senate Health and Human Services Committee to urge passage of Senate Bill 359 by Sen. Royce West (D-Dallas). The bill would permit physicians to initiate a four-hour hold on patients who have voluntarily sought care at a hospital or freestanding emergency medical center but then want to leave, though the treating physician believes the patient is a danger to self or others.

  • Houston emergency medicine physician Arlo Weltge, MD, testified at the House State Affairs Committee hearing on House Bill 614 by Rep. Sarah Davis (R-West University Place), which would require the state to establish a registry in which patients could submit their advance directives.

On the Road With Dr. King

With just more than a month left in his term, TMA President Austin King, MD, continues his nonstop travels on behalf of Texas physicians. His recent stops included a legislative update to the McLennan County Medical Society; the installation of Austin gastroenterologist Pradeep Kumar, MD, as the new president of the Travis County Medical Society; and a panel discussion at the leadership meeting of the Texas Society of Clinical Oncology that also included State Rep. Stephanie Click (R-Fort Worth) and TMA Trustee Lewis Foxhall, MD.

TMA's Choosing Wisely Campaign Has Made a Difference

We’ve closed the books on a very successful two-year campaign in support of the Choosing Wisely® program. The TMA Foundation received a grant from the ABIM Foundation to promote Choosing Wisely among Texas physicians. The program encourages physicians to discuss with patients the wisdom of many common tests or treatments that national specialty societies have identified as frequently unnecessary or inappropriate. Ninety-three percent of Texas physicians surveyed said they will continue to use Choosing Wisely in their practices. More than 600 physicians earned continuing medical education credit from our free — and ongoing — Choosing Wisely CME Bundle.

Monday, March 23, 2015

Flood Capitol Hill With SGR Calls Tomorrow

Over the years, every member of the Texas Delegation in Congress has told us that he or she supports repeal of Medicare’s noxious Sustainable Growth Rate (SGR) formula. Now is the time to hold them to their promises. We have just one week to get it done before Congress goes on recess and the 22.4-percent cut kicks in on April 1. HR 1470, the SGR Repeal and Medicare Provider Payment Modernization Act of 2015, by our own U.S. Rep. Michael Burgess, MD (R-Lewisville), will be up for a vote on the House floor this week. It eliminates the SGR immediately, ensures solid — if nonspectacular — Medicare rate increases the next five years, and offers a bonus for physicians who participate in alternative payment models and meet certain thresholds. Any of us could find fault with one or more provisions in the bill, but, bottom line, it’s immensely better than the status quo. As TMA President Austin King, MD, said in his email Action Alert to all of our members, “We physicians are tired of the never-ending uncertainty; the never-ending threats to cut Medicare pay; the never-ending need to lobby Congress on the same, never-ending problem. Our patients are tired of the never-ending fear of losing their doctor. Eighteen years and 17 patches is enough.” If you didn’t already respond to the Action Alert, you have another chance to help us turn up the heat on the House. Tomorrow is National Call to Action Day on the SGR, organized by the American Medical Association, TMA, and medical societies nationwide. Contact your senators and representative and urge them to support HR 1470 (and its companion, S 810) by: 
  • Calling via AMA’s toll-free Physicians Grassroots Hotline at (800) 833-6354.
  • Using the TMA Grassroots Hotline to send an urgent email.
  • Contacting legislators directly through their own social media channels, and then sharing your message with your own Facebook friends and Twitter followers.

Legislature Gets a Healthy Dose of Health Vision

It was a busy and productive week for medicine’s priorities in the 84th Texas Legislature:
  • The Senate Finance Committee took up Senate Bill 18 by Sen. Jane Nelson (R-Flower Mound) Thursday. The measure aims to allocate an additional $60 million for graduate medical education (GME) expansions. The funding would sustain the 2013 GME expansion programs while building other programs to improve access to care.

  • San Antonio pediatrician Ryan Van Ramshorst, MD, continued his all-star work on the witness stand for TMA and the Texas Pediatric Society. He told the Senate Health and Human Services Committee that Texas physicians strongly support Senate Bill 760 by Sen. Charles Schwertner, MD (R-Georgetown), which would improve oversight and accountability of Medicaid HMOs’ physician networks. He also testified on Senate Bill 791 by Sen. Lois Kolkhorst (R-Brenham) requiring the state to develop and distribute educational materials for pregnant women or women planning a pregnancy about congenital cytomegalovirus. He explained physicians support the education and outreach components outlined in SB 791, but we have concerns with the state dictating specific medical treatments.

  • The Senate Education Committee approved Senate Bill 96 by Sen. Juan “Chuy” Hinojosa (D-McAllen), prohibiting the use of e-cigarettes on school property.

  • The House Judiciary and Civil Jurisprudence Committee took up House Bill 1433 by Rep. John Smithee (R-Amarillo) to prevent insurance company delays in adopting appropriate payment for immunizations, serums, and vaccines. The bill was negotiated by TMA to protect the basis for prompt-pay penalties and to prevent efforts to reduce the penalty to 18 percent per year.

TMA PracticeEdge Board Appoints CEO, Elects Officers

The Board of Managers of TMA PracticeEdge, our new physician services organization, met for the first time. The board chose me to be the new company’s CEO. Board officers are Don Read, MD, of Dallas, chair; Shara McClure of Dallas, vice president for network management of Blue Cross and Blue Shield of Texas, vice chair; and Doug Curran, MD, of Athens, secretary/treasurer. Drs. Read and Curran are also chair and vice chair, respectively, of the TMA Board of Trustees. The other members of the Board of Managers are TMA Trustee David Fleeger, MD, of Austin; TMA Trustee Dan McCoy, MD, of Dallas; and Rob Morrow, MD, of Houston. We will be making some important announcements about our first clients, affiliations, and services in the next few weeks.

Two New TMA Publications Help You Get Social, Get Answers, Get CME

I’m pleased to announce two new practice management publications — written by the TMA staff — now available in the TMA Education Center:
  • More than a decade ago, we established the TMA Knowledge Center to answer members’ questions about everything from maintaining medical records to closing a practice to filling out government forms. Now we’ve collected the best of those questions and answers into a new book. You’ve Got Questions? We Have Answers: A Collection of FAQs From the TMA Knowledge Center offers 1.5 AMA PRA Category 1 Credits™ and has been designated for 1.5 credit(s) of education in medical ethics and/or professional responsibility. Of course, the Knowledge Center will still answer all of your fresh questions. Call (800) 880-7955 or send an email.

  • Twitter, Facebook, YouTube, blogs. Who knew they would go from young peoples’ playthings to serious marketing tools? Get Social: Put Your Practice on the Social Media Map is about you and your practice and your patients, and how you can make these tools help you do a better job of building your practice and your reputation and caring for your patients. It’s also about 1.75 hours of continuing medical education.

Monday, March 16, 2015

House Budget Writers Move to Reinstate Medicaid-to-Medicare Primary Care Parity

For two years ending Dec. 31, 2014, the Affordable Care Act mandated that Medicaid pay primary care physicians at Medicare rates for certain primary care services. The federal government picked up the entire tab. The goal was to shore up the crumbling Medicaid physician network, and it worked. In 2000, 67 percent of Texas physicians reported accepting all new Medicaid patients; by 2012, only 34 percent did, according to TMA surveys. But TMA’s 2014 Physician Survey showed that physician participation in Medicaid rebounded by 5 points, a jump we attribute almost entirely to the primary care payment increase. The Texas House Appropriations Committee saw the value in that. At the urging of TMA and Rep. Four Price (R-Amarillo), the committee voted to reinstate those Medicaid-to-Medicare primary care parity payments starting Sept. 1, 2015, using both state and federal funds. Senate budget writers and the full House must still follow suit, but the committee vote is a major step in a key piece of TMA’s 2015 Medicaid agenda.

Is the Medicare SGR a Goner?

News reports at least partially confirmed by our Capitol Hill sources say a bipartisan plan by U.S. House of Representatives leaders to repeal Medicare’s Sustainable Growth Rate (SGR) formula is picking up steam. The package reportedly would repeal the SGR, replace it with the proposal U.S. Reps. Michael Burgess, MD (R-Lewisville), and Kevin Brady (R-The Woodlands) worked out in 2013, and extend funding for the Children’s Health Insurance Program for two years. A bill to accomplish all of this is expected to be introduced this week. With House Speaker John Boehner and Minority Leader Nancy Pelosi supposedly behind it, the bill stands a good chance in the House. Questions remain on how to pay for the package, how the Senate and White House will respond, and whether anything can happen before physicians’ Medicare payment rates are scheduled to be cut by 22.4 percent on April 1.

Dr. King Touts TMA's Academic Advocacy Work at Med School Visits

TMA President Austin King, MD, and TMA senior staff visited the leaders of two Texas medical schools to hear about the schools’ priorities, discuss TMA membership among academic faculty, and highlight TMA’s legislative agenda. Karen Batory, TMA vice president of public health and medical education, coordinated the meetings and accompanied Dr. King.
  • At the Texas Tech University Health Sciences Center El Paso, Dr. King met with new Founding President and Medical Dean Richard Lange, MD; and Manny De La Rosa, MD, the provost and vice president for academic affairs. El Paso County Medical Society President Syed Usoof, MD, and Executive Director Patsy Slaughter joined in the discussions. Dr. Lange emphasized the school’s focus on border and Hispanic health including obesity, diabetes, Hispanic cancers, and infectious diseases.

  • The next day in Fort Worth, Dr. King met with Michael Williams, DO, MD, president of the University of North Texas Health Science Center; Don Peska, DO, chief medical officer; and the school’s senior leadership team. Tarrant County Medical Society President Rob Rogers, MD, and EVP Brian Swift also took part. 

TMA Testifies on Interstate Licensure, Chiropractic Scope

Russell Thomas, DO, an Eagle Lake family physician, testified before the House Public Health Committee on the administrative hassles physicians would avoid if they choose to obtain medical licensure in multiple states if House Bill 661 becomes law. The bill by Rep. John Zerwas, MD (R-Richmond), would let Texas join an Interstate Medical Licensure Compact. Check out TMA’s Quick Facts about HB 661 and its companion legislation, Senate Bill 190 by Sen. Charles Schwertner, MD (R-Georgetown). Sara Austin, MD, an Austin neurologist, told the same committee why giving chiropractors the ability to issue disabled parking placards is not a good idea. She said determining who may or who should use a placard requires a medical diagnosis of the patient’s disability. Chiropractors have neither the breadth of education nor the training necessary to make these critical evaluations, she said in opposing House Bill 126.


Register for Western Health Care Leadership Academy

Looking to gain the skills you need to set the pace and succeed in today’s rapidly changing health care marketplace? Check out the 18th Annual Western Health Care Leadership Academy, May 29-31 in Hollywood, Calif. Online registration is now open.

You Have Three More Chances to Be a Lobbyist for a Day

We have two more First Tuesdays at the Capitol — plus a bonus opportunity at TexMed 2015 — for you to take medicine’s message to our state lawmakers. Please mark your calendar for:

Monday, March 9, 2015

Second First Tuesdays a Big Hit

Despite the rain and fog, more than 200 physicians, medical students, and TMA Alliance members flocked to visit with state lawmakers during our second First Tuesdays at the Capitol of 2015. Top discussion items included stopping a host of inappropriate scope of practice expansion bills; promoting more funding for graduate medical education (GME), women’s health care, and mental health services; and pushing improvements in Texas’ immunization tracking system. See how the news and social media covered the event. Register today for the next First Tuesdays on April 7.

Physicians Testify for Medicine's Priorities

In addition to the First Tuesdays crowd, several TMA member physicians came to the Capitol to testify before legislative committees for us. Thanks, first, to Austin pediatrician Kimberly Avila Edwards, MD, who testified before the House Public Health Committee in support of House Bill 465 by Rep. Donna Howard (D-Austin) and Rep. J.D. Sheffield, DO (R-Gatesville). The legislation would change ImmTrac, the state’s immunization registry, from an opt-in to an opt-out system. Dr. Avila Edwards sat through a boisterous hearing where most of the misguided opponents to the bill thought it would somehow affect the law on exemptions from required school vaccinations. Short answer: It doesn’t. 
  • Two days later, TMA Trustee Gary Floyd, MD, of Fort Worth, participated in a panel before the House County Affairs Committee. Dr. Floyd discussed GME funding as well as the Medicaid 1115 waiver and how these dollars should be used to improve patient care at the local level.
  • That same day, Donald Murphey, MD, medical director of infectious diseases at Cook Children’s Health Care System in Fort Worth, testified before the Senate Health and Human Services Committee in support of Senate Bill 538. The measure, by Sen. Charles Schwertner, MD (R-Georgetown), aims to improve Texas’ emergency response for infectious disease outbreaks.


Dr. Garcia Picks TMA's Next Leadership Team

TMA President-Elect Tom Garcia, MD, continues the painstaking work of selecting physicians to lead and serve on TMA councils and committees. Our county medical societies have recommended so many good candidates for Dr. Garcia to consider as he tries to select a diverse group of physicians for each panel. All council appointments — which must be approved by the TMA House of Delegates — and new committee members will take office after TexMed 2015.

TMA Leaders Meet With New Lite Guy

A trio of TMA leaders joined chief lobbyist Darren Whitehurst and I in a fruitful discussion of key health care issues with new Lt. Gov. Dan Patrick. The group included Dr. Garcia; TMA Trustee Diana Fite, MD; and Council on Legislation Chair Dawn Buckingham, MD. Lieutenant Governor Patrick has a good working relationship with a number of physicians in Houston and throughout the state. Our talks covered:
  • The work of Senate Finance Committee Chair Jane Nelson (R-Lewisville) and that committee to craft an appropriate state budget for 2016-17. We talked about the importance of Medicaid and how the state can redefine the program and determine appropriate coverage; about the need to create additional GME slots to address shortages and keep pace with medical school growth; and about the Finance Committee’s focus on tax relief and TMA’s openness to proposals relating to both personal and business tax reductions.
  • Lieutenant Governor Patrick’s appointment of Dr. Schwertner to chair the Health and Human Services Committee and our mutual confidence in his ability to craft good state health policy.
  • The need to reduce red tape and bureaucracy for physicians and other health providers.
  • The importance of protecting our medical liability reforms, which reopened high-risk specialties and brought new physicians to the state.

TMA Truestee Gets TMA PracticeEdge Pitch

I had an enjoyable conversation with TMA Trustee Linda Villarreal, MD, about TMA PracticeEdge, the new services company we developed to bring physicians the technology, expertise, and investment they need to take advantage of new health care payment models. Physician groups from around the state are expressing interest in signing up for these services. You can learn more on the TMA PracticeEdge website, by email, on Twitter, or by calling (888) 900-0334.

Monday, March 2, 2015

Medicine Lobbies Congress for SGR Repeal, Regulatory Relief

TMA leaders and members of the Coalition of State Medical Societies met with key members of Congress and staff to the Senate Finance Committee and the House Ways and Means and House Energy and Commerce committees to push our federal agenda. The Capitol Hill consensus is that we’re looking at another short-term patch for Medicare’s Sustainable Growth Rate (SGR) formula next month — rather than repeal — to avoid a 24-percent cut in physicians’ Medicare payments on April 1. However, the outlook is better for some relief from onerous and bureaucratic federal regulations of physicians’ practices. To further our campaign, please send me stories  of how Medicare rules and audits are interfering with patient care. The Texans included David Henkes, MD, chair of the Texas Delegation to the American Medical Association; AMA Vice Speaker Sue Bailey, MD; AMA Trustee Russ Kridel, MD; Texas Delegation Vice Chair Asa Lockhart, MD; TMA Trustee Gary Floyd, MD; ophthalmologist Lyle Thorstenson, MD; Dallas medical student John Corker; TMA’s chief lobbyist Darren Whitehurst; and me. The coalition includes medical societies from Texas, California, Arizona, Oklahoma, Louisiana, Florida, South Carolina, North Carolina, New Jersey, and New York.

The Truth About Balance Billing

A pair of newly developed TMA resources examine how insurance plans’ network designs and payment decisions are leaving many Texans with “surprise bills” for health care services. Inadequate and limited physician networks that insurers sell today are leaving patients with unpaid bills and making the news. A new TMA white paper, “Network Inadequacy and Unfair Discrimination in Insurance,” explains how insurers limit their losses at the expense of the consumer. TMA staff also have prepared a detailed spreadsheet of network information gathered from Blue Cross and Blue Shield of Texas (BCBSTX), Humana, and United Healthcare health plans as of December 2014. To use the spreadsheet, click on the tab for the insurer at the bottom of the spreadsheet for the information for that carrier. You may sort by hospital/facility, city, county, or provider(s) in anesthesiology, pathology, radiology, and/or emergency medicine.

First Tuesdays Returns to the Capitol Tomorrow

Tomorrow is our second First Tuesdays at the Capitol for the 2015 Texas Legislature. We expect several hundred physicians, students, and TMA Alliance members to walk the halls in support of our 2015 legislative agenda. Scope of practice will be a hot topic, with 10 bills already filed that would expand nonphysician practitioners’ scope beyond what is safely permitted by their education, skills, and training. We’ll be lobbying in support of House Bill 1514 by Rep. J.D. Sheffield, DO (R-Gatesville), and Senate Bill 644 by Sen. Brandon Creighton (R-Conroe), which would require health insurers to uniformly designate on patients’ insurance ID cards whether they are covered by Affordable Care Act (ACA) insurance exchange products and whether they have a federal tax subsidy to help pay for it. Those patients have the 90-day grace period for paying premiums, which is creating havoc in some physicians’ offices. We’ll also be talking to senators and representatives about Medicaid reform, the state budget, and immunizations and other important public health topics. If you can’t make it tomorrow, come to First Tuesdays on April 7 and May 5.

Dr. Burgess Receives AMA Government Service Award

The Texans who traveled to Washington, D.C., last week, gave a standing ovation for a long-overdue honor given to U.S. Rep. Michael Burgess, MD (R-Lewisville), the only TMA member in Congress. As the outstanding U.S. representative, Dr. Burgess received a 2015 Dr. Nathan Davis Award for Outstanding Government Service — AMA’s highest award for elected officials and government employees. The award, named for the founding father of AMA, recognizes elected and career officials in federal, state, or municipal service whose outstanding contributions have promoted the art and science of medicine and the betterment of public health. TMA nominated Dr. Burgess for the award.

Tax Relief in Sight

This week’s Legislative News Hotline video brings you news on the Senate’s tax relief package, a bill that would eliminate your $200 annual occupation tax, and why e-cigarettes are a danger to Texas’ children. TMA Lobbyist Troy Alexander explains what repealing the occupation tax means for you. Joel Dunnington, MD, past chair of TMA’s Council on Science and Public Health, stopped by the studio this week before testifying at the Capitol to explain why e-cigarettes must be banned from public schools.


Appeals Court Says "No," Again, to Chiropractic Board

Sometimes you have to fight in court just for the right to fight in court. The Texas Third Court of Appeals denied the Board of Chiropractic Examiners’ request for a rehearing. That action left standing the Third Court’s earlier decision that the trial court has jurisdiction to hear TMA’s challenge to the chiropractic board’s rules. Those rules would allow chiropractors to diagnose and treat vestibulo-ocular nystagmus cases. The case will now proceed to a trial on the merits.