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Monday, April 27, 2015

State Budget Writing Moves to Negotiation Please


The work of crafting the 2016-17 state budget is now at a critical juncture. The Texas Senate and House of Representatives have each drafted and passed a spending plan of about $210 billion. House Speaker Joe Straus appointed a five-member team led by Appropriations Committee Chair John Otto (R-Dayton) to work out the budget details in a conference committee. Lt. Gov. Dan Patrick named five senators to the committee, led by Finance Committee Chair Jane Nelson (R-Flower Mound). We’re pleased the 10 negotiators include some longstanding friends of medicine and patients. TMA sees some big positives in each version that we will work to maintain in the final budget. The House budget, for example, includes funds to restore Medicaid payments to Medicare levels for certain primary care physicians and services, and the Senate plan has $57 million to grow and expand graduate medical education programs. We’ve posted the list of the budget negotiators from each chamber, along with a contact phone number, and TMA’s budget priorities.

TexMed 2015 Hits Austin This Weekend; Don't Miss It


Thousands of Texas physicians, medical students, and TMA Alliance members flock to Austin this weekend for TexMed 2015. Advance registration is now closed, but you can still register on site. The meeting is free for TMA members. Here are some highlights you won’t want to miss:
  • TexMed at the Capitol – 1-4 pm, Thursday. Lobby, mingle, and eat some ice cream.
  • More than 80 hours of free continuing medical education – Friday and Saturday.
  • House of Delegates meeting – Starts 8 am Friday and 8:30 am Saturday. Celebrate the SGR repeal with special guest, U.S. Rep. Michael Burgess, MD (R-Lewisville), 10 am Saturday.
  • Expo Hall – Nearly 160 exhibitors with products and services you need to see. Opens at 7 am Friday and 6 am Saturday.
  • Ira Byock, MD – Opening General Session speaker, 4 pm Friday, the future of end-of-life care. Can’t make it in person? Watch the live stream on TMA TV or catch the replay at 7 pm, May 4.
  • A Lawn Party – The TMA Foundation’s annual gala, 7-11 pm Friday.
  • Trisha Shands, MD – Closing General Session speaker, 1:30 pm Saturday. Journey through breast cancer and the Alaskan tundra. Also live on TMA TV; replay at 7 pm, May 5.  

TMA PracticeEdge Inks Deals With Initial Physician-Led ACO Customers


TMA PracticeEdge is announcing service agreements with Houston Regional Accountable Care Organization and Alliance ACO in rural, south central Texas. We anticipate these physician-led ACOs will initially represent 50-plus physicians providing care and managing the population health for more than 12,000 patients. These physician-led organizations can use the tools offered by TMA PracticeEdge to grow and remain independent. Want to learn more about TMA PracticeEdge? Visit www.TMAPracticeEdge.com, email info@TMAPracticeEdge.com, or call (888) 900-0334.

Physicians Travel to Captiol to Testify on Medicine's Agenda


TMA member physicians again answered the call to testify before House and Senate committees for and against key pieces of legislation. This week, we send our thanks out to these volunteers:

  • Hanoch Patt, MD, an Austin pediatric cardiologist, asked the Senate Business and Commerce Committee to support Senate Bill 229 by Sen. Kel Seliger (R-Amarillo), which would prohibit health plans from using virtual credit cards to pay for health care services.
  • Temple emergency physician Robert Greenberg, MD, testified at the House Public Health Committee for House Bill 3677 by Rep. Paul Workman (R-Austin). The bill permits physicians to initiate a four-hour hold on patients who voluntarily seek care at a hospital or emergency medical center but then want to leave, though the treating physician believes the patient is a danger to self or others.
  • Houston obstetrician-gynecologist Eugene Toy, MD, told the Public Health Committee that medicine supports House Bill 3433 by Rep. J.D. Sheffield, DO (R-Gatesville), which would add rural representation to the state’s Perinatal Advisory Council.
  • Stephen Pont, MD, a pediatrician from Austin, testified at the House Public Education Committee against House Bill 1227 by Rep. Rodney Anderson (R-Grand Prairie), which would eliminate state measurement of the effectiveness of physical education programs in schools.

 

Dr. Garcia Marks SGR Repeal at White House Event

TMA President-Elect Tom Garcia, MD, joined leaders of organized medicine and our congressional champions in the White House Rose Garden for a reception celebrating the repeal of the Medicare Sustainable Growth Rate (SGR) formula. “We crossed one of Washington’s perennial ‘cliffs’ off the list for good,” President Barack Obama said. “My hope is, is that that helps build a little more momentum to get some other good stuff done.”

Monday, April 20, 2015

It's Time to Say Thank You for SGR Repeal


Texans in Congress played a huge role in getting HR 2, the bill that repealed Medicare’s Sustainable Growth Rate (SGR) formula, passed into law. These leaders, and all who voted for the bill, deserve our thanks. (Here’s the list — with phone numbers to call.) We must start, of course, with Rep. Michael Burgess, MD (R-Lewisville), the primary author of the bill and the driving force for SGR repeal since he first was elected to Congress in 2003. Sen. John Cornyn, the Senate majority whip, used his mastery of Senate rules and expert negotiating to get us over the final hurdle in the Senate. Reps. Kevin Brady (R-The Woodlands) and Gene Green (D-Houston) cosponsored the bill and kept the wheels on the bus when they threatened to fall off. Rep. Henry Cuellar (D-Laredo) included a provision that protects Texas’ medical liability reforms and ensures that the care standards and guidelines in federal law cannot be used to create new causes of legal action against physicians. Please take just a moment today to make some thank-you calls.

Insurance ID Card and Tax Cut Bills Move Forward


Several of medicine’s top-priority bills gained some traction in the Legislature last week. The Senate approved its $211.4 billion plan for the 2016-17 state budget, including $60 million to grow and improve graduate medical education in Texas. (See TMA’s budget priorities.) House Bill 1514 by Rep. J.D. Sheffield, DO (R-Gatesville), TMA’s bill to make it easier for physicians to identify patients who are receiving subsidies for coverage under Affordable Care Act exchange plans, won unanimous approval from the House Insurance Committee. The move to eliminate physicians’ annual $200 state occupation tax advanced when the House Appropriations Committee passed House Bill 7 by Rep. Drew Darby (R-San Angelo). Thanks to this week’s TMA witnesses:
  • In the House Public Health Committee, Fort Worth pediatrician Gary Floyd, MD, testified on House Bill 2602 by Rep. Garnet Coleman (D-Houston), which revisits several of the Schedule II controlled substance delegation requirements from last session’s agreed-upon bill with nurse practitioners and physician assistants.
  • Louise Bethea, MD, an allergist from The Woodlands, testified at the House Public Education Committee in support of House Bill 2847 by Rep. Myra Crownover (R-Denton), which requires schools to stock epinephrine auto-injectors for school staff to use on any student who suffers an anaphylactic reaction at school.

TMA House of Delegates 2015 Agenda Now Online


The TMA House of Delegates meets Friday and Saturday, May 1 and 2, at TexMed 2015 in Austin. The work of the house includes a contested race for TMA president-elect and several other leadership positions; more than 100 handbook reports and resolutions; the installation of Tom Garcia, MD, as the new TMA president; and the recognition of Donald W. Seldin, MD, winner of the 2015 TMA Distinguished Service Award. The complete and updated handbook is now online.

Physicians Foundation Issues Leadership Grants


I always enjoy my meetings of The Physicians Foundation, of which I am honored to serve as president. The foundation released grants to six state medical societies to fund innovative leadership programs for physicians, students, and residents. Tailored to the environment and needs of the specific state, the grants will help prepare physicians for leadership positions within the state society and in new health care delivery systems. The foundation has been a longtime supporter of the highly successful TMA Leadership College.

TDI Adopts Standard Drug Preauthorization Form


Following through on the second of two major TMA victories from the 2013 legislative session, the Texas Department of Insurance (TDI) has adopted rules establishing a standard form for all insurance and Medicaid preauthorization requests for prescription medications. Earlier this year, TDI set the standard form for medical care preauthorizations. The standard forms cover everything but Medicare, the state workers’ compensation program, and self-funded employer plans. They do away with hundreds of separate forms insurers currently make physicians’ offices use. Both rules take effect Sept. 1.

Major Announcements Coming From TMA PracticeEdge

Be alert for some big announcements in the next few weeks from TMA PracticeEdge, our new physician services organization. We’re finalizing the contract details for our first clients, affiliations, and services. Learn more about TMA PracticeEdge and what it may be able to offer your practice on the website.

Monday, April 13, 2015

SGR Repeal on Tap as Congress Reconvenes Today


Congress returns from its two-week Easter recess today with some very important unfinished business on the U.S. Senate agenda. Senators left town without taking up the bill to repeal Medicare’s Sustainable Growth Rate (SGR) formula that the House passed March 26 by an overwhelming margin. “HR 2, the Medicare Access and CHIP Reauthorization Act, is vital to Texas physicians,” TMA President Austin King wrote in a letter to Texas Sens. John Cornyn and Ted Cruz. “Texas physicians are counting on you.” The Senate must pass the bill by tomorrow to stop the 21-percent Medicare payment cuts from kicking in. If you haven’t asked Senator Cruz to support the bill yet, please call his office at (202) 224-5922 or send an email through TMA’s Grassroots Action Center. To help counteract the campaign of disinformation about the measure, TMA published Top 10 Myths About HR 2, the SGR Repeal Bill; please share it with your skeptical colleagues.

Texas Physicians Stand Up for Medicine at the Capitol


Organized medicine’s voice rang out at the third installment of TMA’s First Tuesdays at the Capitol this year. More than 250 physicians, residents, students, and TMA Alliance members marched to the Capitol and urged lawmakers to support TMA’s 2015 legislative agenda. Once again, many thanks to those doctors who testified — some into the early morning hours — for medicine before House and Senate committees:
  • Portland radiologist Isabel Menendez, MD, testified at the House Insurance Committee against House Bill 3133, which would remove the $1,000 threshold for mediation on out-of-network bills from facility-based physicians.
  • Scott Holliday, DO, an anesthesiologist from Dallas, testified at that same hearing against House Bill 1638, which prohibits physicians from balance billing in emergency care situations
  • Also at the House Insurance Committee, Austin psychiatrist Thomas Kim, MD, testified in support of House Bill 2348 by Rep. Four Price (R-Amarillo), which would stop health plans from discriminating against physicians who provide telephone consultation services for patients. Dr. Kim, a member of TMA’s Council on Health Service Organizations, also asked the committee to oppose House Bill 2172 by Representative Smithee, which says that a patient-physician relationship may be established via “telemedicine medical services.”
  • Sara Austin, MD, an Austin neurologist, asked Insurance Committee members to support House Bill 1514 by Rep. J.D. Sheffield, DO (R-Gatesville), which requires labeling on identification cards issued for patients covered under the Affordable Care Act insurance exchange. Dr. Austin also testified against House Bill 3102, which would require any health care practitioner or facility to disclose in writing to the patient the price that will be accepted as payment in full for any health care service at least three business days before providing that service (other than emergency care) or forfeit any amount for unanticipated additional services provided.
  • Heather Aguirre, DO, a family medicine resident from Corpus Christi, testified in the House Public Health Committee against House Bill 1263, which would allow physical therapists to treat patients without a physician’s referral.

Texas Medical Board Enacts New Telemedicne Rules


The Texas Medical Board (TMB) adopted strong new patient-protection rules regulating the practice of telemedicine and clarifying the board’s disciplinary guidelines. While expanding the locations where telemedicine services may be used and carving out certain exceptions for mental health care services, the new rules clarify that a face-to-face visit — either in person or via telemedicine — is required to establish a patient-physician relationship. Despite claims to the contrary from critics, the changes do not and are not intended to interfere with traditional on-call coverage arrangements, based on the board’s discussion during its meeting Friday. In our letter to TMB commenting on the proposed rules, we said, “TMA supports the use of telemedicine that can provide safe, high-quality, timely care to patients, particularly in areas of the state that have critical physician shortages. However, TMA believes that Texas must maintain appropriate safeguards to protect patients and ensure telemedicine complements the efforts of local health care providers.” Barring a court challenge and subject to any changes during the legislative session, the rules take effect June 3.

TexMed Speaker Takes on Physician-Assisted Suicide Laws


“I think we’re better people than that.” That’s palliative care expert Ira Byock, MD’s, response to so-called “death with dignity” laws that would legalize physician-assisted suicide. The Los Angeles Times published an outstanding overview of Dr. Byock’s career and the battle for ethical end-of-life care. You can hear him in person in Austin. Dr. Byock is the Opening General Session speaker on May 1 at TexMed 2015 at the Austin Convention Center. Registration is still open

Dr. King Says Veterans Choice Program Not Working

“I am terribly disturbed by the VA’s inability to fix this problem,” Dr. King said in a statement to the news media in response to an Associated Press report of continued lengthy delays for Texans seeking care from Veterans Affairs health clinics. “The Veterans Choice Program, which is supposed to allow our veterans to seek care from community physicians, is not working. Our veterans are confused and don’t know how to use that program. … We have many, many private-sector physicians in Texas who would gladly provide care for veterans. The physicians of Texas respectfully ask Secretary McDonald to demonstrate his vaunted problem-solving abilities by cutting through the VA’s bureaucratic red tape so this can happen.”

Monday, April 6, 2015

Texas House Passes Solid Health Care Budget


It took state representatives nearly 17 hours of debate and more than 300 proposed amendments before they approved a $209.8 billion state budget for 2016-17 in the wee hours of the morning Wednesday. The proposed budget includes $460 million in general revenue funds to restore Medicaid payments to Medicare levels for certain primary care physicians and providers. The House proposal would increase funding for tobacco cessation, women’s health, mental health, and undergraduate and graduate medical education. The plan now moves to the Senate, which is expected to vote this week on its version of the budget. So far, the draft Senate plan doesn’t include the enhanced Medicaid payments, but it does have more money for graduate medical education, women’s preventive health care, and substance abuse and local mental health crisis services. The two chambers will resolve their differences in a conference committee.
In other legislative news:
  • The Senate passed Senate Bill 538 by Sen. Charles Schwertner, MD (R-Georgetown), which would increase the state’s preparedness for responding to infectious disease threats.
  • The House Committee on Licensing and Administrative Procedures took testimony on the occupation tax repeal bill, Committee Substitute House Bill 7 by Rep. Drew Darby (R-San Angelo).

Call Senator Cruz for SGR Repeal


From the time the U.S. Senate convenes at 2 pm (ET) a week from today, senators will have just 34 hours to take up and pass HR 2, the Medicare Access and CHIP Reauthorization Act, before the 21-percent Medicare cuts kick in for real. At the end of those 34 hours, the Centers for Medicare & Medicaid Services will no longer hold claims for services provided after April 1, and physicians will begin to see the cut mandated by the Sustainable Growth Rate (SGR) formula in their Medicare payments. We’re grateful for the House of Representatives’ overwhelming approval of the bill — authored by Rep. Michael Burgess, MD (R-Lewisville) — and for the support we’ve seen from Senate Majority Whip John Cornyn of Texas. But we need to make sure our other senator, Sen. Ted Cruz, hears from Texas physicians why the SGR must go and go now. Please call Senator Cruz’ district offices today to deliver that message. Use these talking points.
Austin: (512) 916-5834

Dallas: (214) 599-8749

Houston: (713) 718-3057       

McAllen: (956) 686-7339

San Antonio: (210) 340-2885

Tyler: (903) 593-5130 

Tomorrow Is First Tuesdays — And It Kicks Off a Busy Week

Hundreds of medical students and residents will join their older colleagues and TMA Alliance members tomorrow for the third First Tuesdays at the Capitol of 2015. (It’s not too late to register.) In addition to visiting with their representatives and senators, the lobbyists for a day can expect a long agenda in the House Public Health Committee and possible Senate floor action on some of our key bills. TMA leaders and lobbyists are prepping for extensive committee hearings this week on insurance, telemedicine, scope of practice, public health, and end-of-life bills.

Texans Rule National Orthopedic Association


Led by its new president and board chair — David Teuscher, MD, of Beaumont — the American Association of Orthopaedic Surgeons’ (AAOS’) leadership is packed with Texans. David Mansfield, MD, of El Paso is chair of the Board of Councilors; Howard Epps, MD, of Houston is an at-large member of the Board of Directors; retired Dallas businessman Ken Sowards (father of a third-year Texas medical student) is a lay member of the Board of Directors; Kevin Bozic, MD, who is moving from San Francisco to be the inaugural chair of the Department of Surgery and Perioperative Care, and a professor of orthopedic surgery at the Dell Medical School in Austin, is chair of the AAOS Council on Research and Quality; and John Gill, MD, of Dallas will chair the Orthopaedic PAC.

TMA and Ophthalmologists: PROKERA Not for Optometrists


In a strongly worded letter to the Texas Optometry Board, TMA and the Texas Ophthalmological Association reject a proposal to allow optometrists to use PROKERA® to treat corneal conditions. “It is our position that Texas statutes do not authorize optometrists to use the PROKERA® ophthalmic device or similar devices from other manufacturers in their practice,” we wrote. “PROKERA® is a medical device intended for use in the closure of human tissue, which is specifically prohibited by Texas statute.” Safe and appropriate use of these ocular devices requires the training, skills, and experience provided by medical school and postgraduate training.

In Memory of Alan Jay Goodman

The officers, board, and staff of the Texas Medical Association extend our deepest sympathies to TMA EVP Lou Goodman and his family on the passing of his brother, Alan Jay Goodman. Services will be 1 pm tomorrow at the Jewish Memorial Chapel, 841 Allwood Rd., Clifton, N.J., followed by burial at the Hillside Cemetery, 742 Rutherford Ave., Lyndhurst, N.J. In lieu of flowers, memorial contributions may be made to The American Cancer Society or Temple Beth El in Rutherford, N.J.