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Tuesday, May 26, 2015

Budget Accord Boosts GME Spending, Drops Medicaid Pay Bump

The 2016-17 state budget took another step forward late last week, and so did one of TMA’s legislative priorities. The House-Senate Conference Committee on the budget approved $53 million for graduate medical education (GME) expansion grants over the biennium, up from the current $14.3 million. This includes:
  • $3.5 million for GME planning and partnership grants;

  • $32.55 million for creating new first-year GME positions at $75,000 per resident per year. Of that amount, $12 million is specifically for new GME positions that prepare physicians for entry into primary care practices;

  • $9.75 million to maintain unfilled first-year GME positions; and

  • $7.2 million for continued grant support to residency positions that were created with state grants during this budget cycle.
The committee also appropriated $4 million in additional dollars for existing family medicine residency programs (a 31-percent increase over current funding) and $3 million to revitalize the Statewide Primary Care Preceptorship Program.

We are extremely disappointed that our push for Medicare parity for Medicaid payments for primary care services fell short. The House version of the budget had included $460 million in state funds to reinstate the parity payments. They had been established and paid for with federal funds for two years under the Affordable Care Act, but that funding ran out Jan. 1. The Senate’s draft state budget included no money for the reinstatement, and the conference committee voted 9-1 for the Senate version on that budget item. Rep. Sylvester Turner (D-Houston) was the only conferee to vote against that decision.

TMA PracticeEdge Signs Innovista to Power ACO Services for Physicians

TMA PracticeEdge announced a multiyear partnership with Innovista Health Solutions to provide a comprehensive suite of accountable care organization (ACO) services for physician practices. Unlike many other firms we considered, Innovista’s business model aligns its own success with its physician clients’. That has the potential for a win-win for everybody. The services Innovista can provide include population health management, network development, care management, financial management, and claims administration. To learn more about TMA PracticeEdge, visit www.TMAPracticeEdge.com, email info@TMAPracticeEdge.com, or call (888) 900-0334.

Dr. Bailey So Far Unopposed for Speaker of AMA House of Delegates

Right now, it looks like former TMA President Sue Bailey, MD, of Fort Worth will cruise to victory as the next speaker of the American Medical Association House of Delegates. No other candidates have announced for the post, which will be decided at AMA’s annual meeting, June 6-10 in Chicago. Dr. Bailey has spent the past four years as vice speaker of the AMA house. Dallas internist Lynne Kirk, MD, is one of three incumbents — and six candidates total — running for four seats on the AMA Council on Medical Education.

Texas Delegation Brings Four Resolutions to AMA Meeting

Following up on the actions of the TMA House of Delegates, Texas physicians are presenting four resolutions for consideration by the AMA house. They are:
  • A call for AMA to ask Congress to “act rapidly” to repeal all penalties for noncompliance with Medicare’s electronic health records incentive program and meaningful use requirements;

  • A call for AMA to work with Congress to require real-time notification to physicians when patients are within the 45- or 30-day COBRA grace periods;

  • A request for AMA to “evaluate and work to establish consensus regarding the appropriate value of resident and fellow services”; and

  • A directive for AMA to support legislation to “prevent and divert prostitution” rather than criminalize it.

Ask Governor Abbott to Sign These Bills

Give Gov. Greg Abbott’s office a call this week at (512) 463-2000 and urge the governor to put his signature on these bills: Senate Bill 97 — e-cigarette regulation; Senate Bill 359 — allowing a four-hour emergency department hold for mentally ill patients; House Bill 1945 — removing restrictions on direct contracting for primary care; and Senate Bill 66 — on unassigned epinephrine autoinjectors in public schools. These four TMA-backed bills have made it all the way through the Texas Legislature this session and deserve to be signed into law.

Dr. Morrow Named President of Blue Cross Blue and Shield Houston Region

Congratulations to Bob Morrow, MD, of Sugar Land, who was appointed president of the Houston and Southeast Texas region of Blue Cross and Blue Shield of Texas. A family physician, Dr. Morrow has a long history of service to TMA and organized medicine.

Call Today for Medicare-Parity for Medicaid Payments

2015 could go down as a banner year for improving Texas Medicaid. Some outstanding reforms to how the Medicaid fraud police operate are close to becoming law. A bill to make the state force Medicaid HMOs to actually build adequate physician networks has passed the Senate and is out of committee on the House side. The biggest obstacle to participating in Medicaid is the woefully inadequate rates the program pays Texas physicians. This is an issue that the House-Senate Conference Committee on the 2016-17 state budget is considering. If your representative and/or senator serves on that conference committee (see list here), please call them today with this simple message: Support the House proposal to allocate $460 million in the General Revenue Fund to restore primary care physicians’ Medicaid payments to Medicare parity. If your legislators are not on the committee, please deliver that same message to Lt. Gov. Dan Patrick’s office at (512) 463-0001 and to House Speaker Joe Straus’ office at (512) 463-1000.

Emergency Hold Bill Goes to the Governor

A priority of TMA’s Behavioral Health Task Force has completed its legislative journey. The Texas House gave final passage to Senate Bill 359 by Sen. Royce West (D-Dallas) and Rep. Paul Workman (R-Austin) and sent it to Gov. Greg Abbott to sign. The bill would let physicians 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. With just two weeks left in the session, we’re seeing lots of other progress on our legislative agenda:
  • Our bill to require issuers of Affordable Care Act exchange plans (known as qualified health plans) in Texas to display the acronym “QHP” on the plan ID card won House approval Monday then received a Senate committee hearing on Thursday. Sara Austin, MD, an Austin neurologist and member of the TMA Council on Legislation, testified for House Bill 1514 by Rep. J.D. Sheffield, DO (R-Gatesville), before the Senate Business and Commerce Committee.

  • Thanks to all the physicians who called the House Calendars Committee members, the bill that would have allowed direct access to physical therapists without a referral from a physician was never scheduled for debate on the House floor.

  • The bill to prevent minors from buying e-cigarettes won final approval in the Texas House, 119-24. Senate Bill 97 by Sen. Juan “Chuy” Hinojosa (D-McAllen) and Rep. Carol Alvarado (D-Houston) is now back in the Senate for consideration of changes the House made to it.

  • The House Public Health Committee passed the bill that would eliminate the state’s Controlled Substance Registration permit program. Senate Bill 195 by Sen. Charles Schwertner, MD (R-Georgetown), also would move the Prescription Drug Monitoring Program from the Texas Department of Public Safety to the Texas State Board of Pharmacy.

  • The Texas Senate overwhelmingly passed Senate Bill 1229 by Sen. Kel Seliger (R-Amarillo). It outlaws health insurance plans’ use of virtual credit card (VCC) payments to settle claims for health care services — a practice that makes you pay to get paid.

TMA PracticeEdge Gets the Word Out

It was a double bill Thursday night at the Jefferson County Medical Society. New TMA President Tom Garcia, MD, made the first of what will be many county society visits, briefing physicians in Beaumont on the status of our 2015 legislative agenda, and reminding them, “We are not ‘providers’. We are healers. We are physicians.” Also on the agenda that night was Dave Spalding, chief operating officer of TMA PracticeEdge, who explained how our new services company can help practices grow and remain independent. The TMA PracticeEdge team also made presentations to the Smith and Denton county societies last week. Want to learn more about TMA PracticeEdge? Visit www.TMAPracticeEdge.com, email info@TMAPracticeEdge.com, or call (888) 900-0334.

Goldsmith Asks, “What if the Crowd Is Wrong About the Future?”

What if everything the experts predict for the future of health care doesn’t happen at all? What if we don’t move from volume to value? Don’t shift from treatment to prevention? Don’t put all our eggs in the Integrated Delivery Network basket? Those scenarios are not altogether unlikely, and physicians should prepare for the day we find out “The Crowd Is Wrong,” says health care strategist (and former TexMed keynote speaker) Jeff Goldsmith, PhD. We gathered TMA’s Austin-area leaders plus the heads of some of the city’s most vibrant physician networks to discuss with Jeff his provocative ideas. We concluded that independent practice is indeed viable, and physicians need to work together (as practices and as professional societies) to help each other survive. Thanks to TMA Secretary-Treasurer Michelle Berger, MD; Trustee David Fleeger, MD; former TMA President Bruce Malone, MD; Austin Regional Clinic CEO Norm Chenven, MD; and Kevin Spencer, MD, president of Premier Family Physicians, for joining us.

May Magazine Gives You Legislative Insight: GME, Scope, Balance Billing

Want details on some of the more complex issues medicine is fighting for — and against — in the 2015 Texas Legislature? Check out May’s issue of Texas Medicine for the big picture on graduate medical education funding, scope-of-practice fights, and the battle to save balance billing.

Monday, May 11, 2015

Contact Your Lawmakers on Medicine’s State Budget Priorities

Close to 100 physicians, residents, medical students, and TMA Alliance members came to Austin to participate in TMA’s First Tuesdays at the Capitol. The 2016-17 state budget was the big topic of conversation. Now it’s your turn to weigh in on medicine’s funding priorities. Look for a TMA action alert today asking you to call your representative and senator. Tell them you want better Medicaid payments for primary care, more graduate medical education slots for Texas residents, a stronger public health defense system, better wellness services for low-income women, and better mental health care. We expect budget negotiators to finish up their work in the coming week. Here’s an update on the status of some of our other legislative priorities:
  • We expect the Senate Finance Committee today to make some important tax decisions, including whether to back repeal of the $200 annual occupation tax on some 400,000 professionals, including physicians. If your senator is on the committee, please call and urge the panel to include the occupation tax repeal in its version of House Bill 7.
  • The House of Representatives Friday gave preliminary approval to House Bill 1514 by Rep. J.D. Sheffield, DO (R-Gatesville). It would help physicians’ offices easily identify patients who are eligible for the Affordable Care Act’s 90-day grace period.
  • Two TMA-backed vaccination bills won final approval in the House last week despite the full-court press antivaccine groups put on to spread misinformation about them.
  • The Senate State Affairs Committee heard testimony from TMA and others on House Bill 80, which would impose a statewide ban on texting or talking on handheld phones while driving.

Congressman Poe Files Bill to Kill ICD-10

It looks like another case of the big guys versus the little guys in health care. Recent reports show that big insurance, big hospitals, and big health care systems believe they’re ready for the Oct. 1 conversion to the ICD-10 coding system. Many private physicians’ offices are not. U.S. Rep. Ted Poe (R-Houston) seemed to be listening when the TMA House of Delegates voted to urge Congress to “permanently abandon” implementation of ICD-10. He filed HR 2126, the Cutting Costly Codes Act of 2015, to prohibit the federal government from requiring the medical community to comply with ICD-10. “The new ICD-10 codes will not make one patient healthier,” Representative Poe said. “What it will do is put an unnecessary strain on the medical community who should be focused on treating patients, not implementing a whole new bureaucratic language.” TMA obviously supports the bill.

“The Personal Political Nature Of Medical Care” — My Latest in Forbes.com

It’s not just ICD-10 that’s overwhelming private physician practices. The avalanche of federal regulations — like meaningful use, PQRS, and the thousands of pages of federal rules — gets in the way of doctors caring for patients. Large organizations, Physicians Foundation CEO Tim Norbeck and I write in our latest post on Forbes.com, are much more able to find resources they can waste on compliance with these onerous federal requirements. “Just as overzealous government regulations are forcing community banking out of business by creating even more ‘too big to fail’ banking systems, private practice is being forced out of business, thus creating even larger, cost-ineffective health care giants,” we wrote. On a related note, I want to let you know that I am stepping down from my post as president of The Physicians Foundation after nine years at the helm. Walker Ray, MD, of Georgia — a man I have grown to trust and admire — is the new president. I will continue my work on the board of the foundation, working to direct research and funding toward projects that can benefit practicing physicians and their patients.

TMA Foundation Elects New Officers

Congratulations to Deborah Fuller, MD, an obstetrician-gynecologist from Dallas, who was elected the new president of the TMA Foundation (TMAF), succeeding Sealy Massingill, MD, of Fort Worth. Other new TMAF officers are Carl Trusler, MD, of Abilene, vice president; Mary Love (Bitsy) Henderson of Austin, secretary; James A. Prentice, MD, of Austin, treasurer; and former TMA Alliance President D’Anna Wick of Tyler, executive committee member-at-large.

TMA Hosts School of Public Health Graduation

TMA invited The University of Texas School of Public Health, Austin Regional Campus to conduct its commencement exercises in the Thompson Auditorium at the TMA building. We have a very good relationship with the school, whose research focuses on child and adolescent health and tobacco regulation. Regional Dean Cheryl Perry, PhD, is a former member of the TMAF Board of Trustees.

Lawmakers Honor the Father of Hard Hats for Little Heads

The Texas House of Representatives officially recognized Houston anesthesiologist Larry Driver, MD, whose brainchild is a TMA program that has given away 200,000 bicycle helmets over 20 years. Representative Sheffield, a TMA member who has sponsored several helmet giveaway events, made the presentation, which declared April 30 as Hard Hats for Little Heads Day.

Hail Dr. Tom Garcia, Our New Leader

Alfredo Tomas Garcia III, MD, took the oath of office as TMA’s 150th president, pledging to defend the patient-physician relationship. “We are not ‘providers,’ ” the Houston cardiologist told the House of Delegates. “We are healers. We are physicians.” Patty Loose of Austin became the 98th president of the TMA Alliance. “The alliance is an army of volunteers who are dedicated to helping the family of medicine,” she said. “We married it. In one form or another we committed ourselves to you and to the practice of medicine.” The house gave rousing rounds of farewell applause to outgoing TMA President Austin King, MD, and departing Alliance President Angela Donahue.

Dr. Read Chosen President-Elect

The TMA House voted for Don Read, MD — a colon and rectal surgeon from Dallas — to be TMA president-elect in the only contested election at TexMed 2015. He will take office as TMA’s 151st president at TexMed 2016 in Dallas. In other election results:
  • With the retirement of House Speaker Cliff Moy, MD, the house elevated Vice Speaker Susan Strate, MD, to the top spot at the podium. Delegates chose Houston emergency medicine physician Arlo Weltge, MD, as the new vice speaker.
  • The House reelected David Henkes, MD, to the Board of Trustees. New trustees are Dallas cardiologist Rick Snyder, MD, and Houston ophthalmologist Keith Bourgeois, MD. Board members chose Doug Curran, MD, as the new board chair; Dr. Henkes as vice chair; Dr. Snyder as secretary; and Drs. David Fleeger and Linda Villarreal as at-large members of the executive committee. The new resident physician member of the board is Laura Faye Gephart, MD, an obstetrician-gynecologist in Temple, and the new medical student member is Justin Bishop from the Texas Tech University Health Sciences Center School of Medicine in Lubbock.
  • Three new members won election to the Texas Delegation to the American Medical Association: John Carlo, MD, a public health physician from Dallas; Denton internist John Flores, MD; and Bret Beavers, MD, an orthopedic surgeon from Fort Worth.

Congressman Burgess Takes SGR Victory Lap at TMA House

A physician-leader who got his start in politics in the TMA House of Delegates railing against Medicare payment cuts returned home the conquering hero. U.S. Rep. Michael Burgess, MD (R-Lewisville), the primary author of the bill that repealed Medicare’s Sustainable Growth Rate (SGR) formula, earned a rousing, standing ovation from the House of Medicine. “I am grateful for you giving me the confidence to keep after this,” Dr. Burgess said of the 13-year battle to do away with the SGR. Following his presentation, new TMA Council on Legislation Chair Ray Callas, MD, gave him a special award on behalf of TMA, the Texas Medical Liability Trust (TMLT), and the Texas Alliance for Patient Access.

Passionate Professor Wins Distinguished Service Award

A real giant of American medicine received TMA’s Distinguished Service Award, a well-deserved crown for a lifetime of leadership. “I regard this award not only as a tribute to my own contributions, but also a recognition of the achievements and performance of my students, house-staff, and fellows,” said Donald W. Seldin, MD, who built The University of Texas Southwestern Medical School from a ramshackle cluster of buildings to an institution that has spawned six Nobel Prize winners. In testimony to the long reach of his 60-year teaching career, more than half the members of the TMA House of Delegates stood to indicate that Dr. Seldin had been an influence in their medical education. Other awards presented at TexMed included these:
  • Jose Manuel de la Rosa, MD, MSc, of El Paso received the Platinum Award, the top honor in the TMA Award for Excellence in Academic Medicine.
  • The Young Physician Section presented its Young at Heart Award to Dr. Weltge.
  • The Resident and Fellow Section presented its J.T. “Lamar” McNew, MD, Award for outstanding mentoring and service to young physicians to San Antonio neurosurgeon David Jimenez, MD.
  • The Medical Student Section gave its Chapter of the Year Award to The University of Texas Medical School at Houston (UTHealth Medical School) chapter; its Student of the Year award to Kayla Riggs, a UTHealth Medical School student; and the C. Frank Webber, MD, Award to Russ Kridel, MD, Houston, for his commitment to mentoring medical students.

House of Delegates Targets Compulsory Electronic Health Records

The TMA House of Delegates voted for TMA to lead the fight to throw off the yoke of servitude from government mandates for physicians to use electronic health records (EHRs). “I took the Hippocratic Oath, not the HIPAA Oath, when I graduated from medical school,” said James Hays, MD, the delegate from the Central Texas County Medical Society, which brought the resolution to Austin. The adopted resolution says TMA should recommend that Congress repeal compulsory EHR requirements. The house waded through dozens of other reports and resolutions at this meeting. Notably, delegates:
  • Urged Congress to “permanently abandon” implementation of the ICD-10 coding system,
  • Adopted policy to spur continued growth in new graduate medical education slots,
  • Enacted new policy on improving network adequacy in health insurance plans,
  • Adopted a series of policies to combat prescription drug abuse and drug overdoses,
  • Adopted a strong new position statement on medical marijuana,
  • Said TMA should advocate for undocumented children to be able to receive nonemergency and preventive care,
  • Updated TMA’s vision and mission statement and strategic goals and objectives,
  • Voted to encourage medical schools and residency and fellowship training programs to reconsider policies that strictly limit or prohibit moonlighting by residents, and
  • Voted for TMA to ask AMA to develop “appropriate adjustments to resident and fellow compensation and benefits.”

Lawmakers Pass Pair of TMA Priority Immunization Bills

The Texas House of Representatives gave initial approval to two of TMA’s priority immunization bills Friday, both authored by Rep. J.D. Sheffield, DO (R-Gatesville). House Bill 2171 prevents the automatic deletion of an 18-year-old’s immunization records from the ImmTrac state registry, preserving them instead until the person turns age 26. House Bill 2474 would require the state to provide vaccine exemption counts down to the school campus level. Thanks to all the physicians and alliance members who attended our special Last Thursday at the Capitol white-coat lobby day. These physician-witnesses testified last week: 
  • Austin ophthalmologist Jack Pierce, MD, testified before the Senate Health and Human Services Committee in favor of Senate Bill 1718 by Sen. Donna Campbell, MD (R-New Braunfels), which would direct the Texas Medical Board to maintain a registry of physicians and therapeutic optometrists who comanage glaucoma patients. He also spoke against Senate Bill 577 by Sen. Charles Perry (R-Lubbock), which would allow optometrists to perform certain surgeries.
  • Austin neurologist Sara Austin, MD, testified before the House Public Health Committee, expressing our concern with three medical marijuana bills.
  • Ryan Van Ramshorst, MD, a San Antonio pediatrician, testified against two bills by Rep. Allen Fletcher (R-Tomball) that would expand the scope of practice of chiropractors.
  • Louis P. Appel, MD, an Austin pediatrician, testified on House Bill 2304 by Rep. Four Price (R-Amarillo), the Health and Human Services Commission (HHSC) sunset bill. He asked the House Human Services Committee to delay merging the Texas Department of State Health Services and Texas Department of Family and Protective Services into HHSC until 2019, to streamline Medicaid credentialing, and to cut Medicaid red tape.
  • Houston neurologist Kim Monday, MD, testified before the House Public Health Committee Tuesday in support of House Bill 2978 by Rep. Greg Bonnen, MD (R-Friendswood), about the role of neurodiagnostic technicians as part of the medical care team. 

Did You Miss Our TexMed General Session Speakers? Catch the Replay on TMA TV

Our opening and closing speakers at TexMed 2015 shared some outstanding, inspirational stories and ideas. If you couldn’t be there, we’re replaying them tonight and tomorrow online:
  • Ira Byock, MD — Opening General Session speaker, the future of end-of-life care. Watch the replay on TMA TV at 7 pm, May 4.
  • Trisha Shands, MD — Closing General Session speaker, journey through health care on the Alaskan tundra. Replay on TMA TV at 7 pm, May 5.