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Monday, October 26, 2015

Physicians Tell Congress: Get Government Off of Our Backs

Leaders from TMA and the medical associations from California, Florida, and New York stormed Capitol Hill last week with our plan to take the regulatory burden off physicians’ practices. Former TMA Board of Trustees Chair Carlos Cardenas, MD, joined TMA lobbyist Dan Finch and me in D.C. The group visited with 25 lawmakers or their offices, including Texas Reps. Michael Burgess, MD (R-Lewisville), and Gene Green (D-Houston), and House Budget Committee Chair Tom Price, MD, of Georgia. The Coalition of State Medical Societies’ priorities included calls for Congress to:
  • Eliminate federal mandates, like the poorly named “meaningful use” program, that compel physicians to do unnecessary make-work and wade through convoluted reporting systems;

  • Stop the bounty-hunting Medicare Recovery Audit Program contractors (RACs);

  • Maintain the state-based system of licensing physicians;

  • Be prepared to act quickly to protect physicians’ practices from financial problems caused by the new ICD-10 coding system;

  • Clarify that maintenance of certification is not and never will be a nationwide condition for physicians to receive or keep a state license or to participate in Medicare or Medicaid;

  • Allow physicians and patients on Medicare to contract for services directly; and

  • Bolster funding for graduate medical education.

TMA Submits 16 Recommendations to Improve Texas Medicaid

As last week’s Texas Medicaid Congress illustrated, Medicaid’s cumbersome regulations make it that much more unlikely that physicians will participate in a program that pays so poorly. Boosting physicians’ Medicaid pay remains one of TMA’s top priorities, but that requires action by the legislature, which doesn’t meet again until 2017. Meanwhile, TMA and the Texas Pediatric Society submitted a list of 16 recommendations to Health and Human Services Commissioner Chris Traylor to make Medicaid and Medicaid HMOs work better for physicians. Among our ideas:
  • Require Medicaid HMOs to process physician credentialing applications at the same time the state is processing Medicaid enrollment. Physicians tell us it can take six months or more to enroll in Medicaid, become credentialed by the HMOs, and begin seeing HMO patients.

  • Simplify and streamline the Medicaid Vendor Drug program. The drug benefit is too complicated, frustrating, and time-consuming for physicians. No other payer has such a byzantine pharmacy benefit, thus fueling physicians’ reluctance to participate in Medicaid.

  • Make the various insurance companies and HMOs handle coordination of benefits. Stop recouping payments from physicians and forcing them to find the right insurer to bill.

  • Promote adoption of innovative Medicaid delivery models, such as physician-led accountable care organizations or patient-centered medical homes.

Wanted: New State Health Commissioner

Texas needs an outstanding physician to head the state health department. We’ve had a caretaker commissioner in place since David Lakey, MD, left the Department of State Health Services (DSHS) in January. This week, the Texas Health and Human Services Commission posted the position. In addition to running DSHS, the commissioner is frequently the face of public health policy in Texas. I encourage physicians who want to make a real difference in the health of our state to apply.

Dr. Garcia Leads Exclusive Briefing for 100-Percent Groups

One benefit of 100-percent membership in TMA for large groups is an annual give-and-take session with TMA leaders. The groups share problems they want TMA to address, and senior TMA staff provide exclusive briefings on hot issues. TMA President Tom Garcia, MD, moderated our meeting last week with groups from Travis County. Participating were Austin Area OB/GYN and Fertility, Austin Diagnostic Clinic, Austin Gastroenterology, Austin Regional Clinic, Capital Medical Clinic, Capitol Anesthesiology, Premier Family Practice, and The University of Texas at Austin Dell Medical School Residency Program.

Dr. Secrest Honored for Mental Health Work

Congratulations to Dallas psychiatrist and former TMA Council on Legislation Chair Les Secrest, MD, who received a Prism Award from Mental Health America of Greater Dallas. Dr. Secrest received the Ruth Sharp Altshuler Award, which recognizes “outstanding community service meeting the needs of persons with mental illness.” The award is named for, and was presented by, long-time Dallas volunteer and philanthropist Ruth Sharp Altshuler.

Physicians Foundation Aims for a Better Future for U.S. Physicians

The board of the Physicians Foundation met in Austin and formulated plans to continue our extensive work in support of physicians and your practices. In addition to renewing our biennial, nationwide physician and patient surveys, the foundation agreed to conduct a new study of telemedicine. In recognition of the nine years I served as president of the foundation, the board awarded an annual grant in my name to support the Association of American Medical Society Executives’ Leadership Academy. I am humbly grateful and hope the grant will help raise a new generation of executives to serve America’s physicians.

Monday, October 19, 2015

Medicaid Congress Tackles Physicians’ Ire

Capturing the frustration of all the physicians in the room, San Antonio radiologist Adam Ratner, MD, asked a simple question with a very complicated answer at Friday’s Texas Medicaid Congress meeting. “Why can’t we just make this all simpler?” Dr. Ratner asked Texas Health and Human Services Executive Commissioner Chris Traylor. “It’s like unraveling a bowl of spaghetti,” responded Traylor, whose administration of the $30 billion-a-year program is bound by federal and state laws and dozens of contracts with Medicaid HMOs. Despite the glutinous nature of the problems, members of the congress vowed to find ways to cut through the payment hassles, enrollment and credentialing morass, vexing drug formularies, and other obstructions that dissuade Texas physicians from participating in Medicaid. TMA Board of Trustees Chair Doug Curran, MD, and John Holcomb, MD, chair of TMA’s Select Committee on Medicaid, CHIP, and the Uninsured, led the meeting. The group will explore potential solutions in January at the 2016 TMA Winter Conference meeting of the Select Committee on Medicaid, CHIP, and the Uninsured.

Primary Care Preceptorship Program Is Back

Attention physicians in family practice, internal medicine, and pediatrics: Love what you do and want to show medical students why your primary care specialty is so, well, special? Thanks to medicine’s hard work during this year’s legislative session, lawmakers reinstated funding for Texas’ Statewide Primary Care Preceptorship program since all appropriations for the program were eliminated in 2011. The $3 million, two-year appropriation brings back a program that introduces students to real-life primary care — and hopefully encourages them to choose those specialties. Students typically participate during the summer between their first and second year of medical school. By working in practicing physicians' offices, they experience the daily life and work of primary care physicians. Watch for word from your specialty society on how you can participate.

UTHealth Med School’s First Female Dean Begins Work

Barbara Stoll, MD, is the new dean of UTHealth Medical School in Houston and the first woman to hold that post. The Yale-educated pediatrician comes to Texas from Emory University School of Medicine in Atlanta, where she chaired the Department of Pediatrics and served as CEO of Emory-Children’s Center. “One of the reasons I took this job is because I think women need to step forward when offered senior leadership roles,” Dr. Stoll told the Houston Chronicle. “I love the Chinese expression, ‘Women hold up half the sky.’

Confused About Value-Based Modifier? Look to TMF

Hot on the heels of PQRS and meaningful use comes yet another federal program that will bring bonuses or cuts to your Medicare payments. The value-based modifier combines your PQRS quality scores and cost measures to come up with a “payment adjustment.” Free help is available for Texas physicians from TMF Health Quality Institute. “TMF now works with physicians and physician practices to provide free assistance to help them meet the requirements of the value modifier program,” said Cliff Moy, MD, TMF’s medical director for behavioral health. “Part of that assistance is to help physicians and physician offices understand how the value modifier is calculated.” See TMF’s Value-Based Improvement and Outcomes Network for details. TMF also has launched educational networks to help physicians meet Medicare patients’ behavioral health needs and boost adult immunization rates to help prevent influenza, pneumonia, and shingles.

Make Waves in DC on Twitter — Learn How for Free from TMA

A headline on the website of KIAH-TV in Houston caught our eye: “Want something done in Washington? Report says ‘Tweet it!’ ” The report in question is the Congressional Management Foundation’s annual study of how best to capture the attention of our senators and representatives and their staffers. Social media, like Twitter, it says, are particularly effective because they are public. Considering medicine’s need for some serious action from Congress — on issues like PQRS, meaningful use, RAC audits, graduate medical education, and public health funding — I’m inviting TMA leaders like you to get tweeting. Don’t know how? Check out our free TMA Twitter Academy. Four easy video lessons will help you set up your account, earn some followers, and grab politicians’ attention. For starters, here’s a list of the Twitter handles for all 36 U.S. House members from Texas. Our senators? They’re @JohnCornyn and @SenTedCruz.

Monday, October 12, 2015

New Mexico Court Urged to Heed Texas Tort Reforms

A medical liability case involving a Texas physician who provided care to a New Mexico resident in Texas should not be governed by New Mexico’s far weaker tort laws, TMA, the Texas Alliance for Patient Access (TAPA), the New Mexico Medical Society, and dozens of other physician groups in both states wrote in a brief to the New Mexico Supreme Court. Access to health care is already challenging enough for New Mexico patients seeking care. New Mexico doctors and hospitals have long relied on referring or transferring sick and injured patients to Texas for specialized care. The willingness of Texas physicians and hospitals to receive those patients may be shaken if the New Mexico Supreme Court upholds a recent state appellate court ruling. That ruling is causing a significant liability risk for Texas doctors, forcing physicians here to consider what patients they will see and under what circumstances they will see them. Unless overturned, this decision will diminish access to care for thousands of Eastern New Mexicans.

TMA Calls Out Insurance Companies Over Balance Billing

The national health insurance lobby and their cronies in the Texas Association of Health Plans released their annual “report” citing physicians for what they called “exorbitant” bills for out-of-network services. We challenged the allegations publicly and earned some positive news media coverage. “This so-called report is nothing more than a desperate smoke screen to divert attention from the real problem,” said TMA President Tom Garcia, MD. He not only pointed out the absurdity of using Medicare payments as a benchmark for “reasonable” charges. He also directed reporters to a recent University of Pennsylvania study that found Texas home to some of the narrowest physician networks in the country. “The health insurance industry games the system to keep more of patients’ premium dollars by forcing patients to seek care out of network,” Dr. Garcia said. “Then they have the gall to criticize what some doctors’ bill for that care.”

Medicine Fights Federal Mandates on Physicians

Since our last visit to Capitol Hill, Congress has repealed the Medicare Sustainable Growth Rate (SGR) formula, and House Speaker John Boehner’s announced retirement has created a free-for-all battle for House leadership positions. But TMA and the Coalition of State Medical Societies are still fighting to pry some of the regulatory burdens off of physicians’ backs. When we return to Washington in a few weeks, our agenda will sound familiar to senators and representatives:
  • Eliminate federal mandates, like the poorly named “meaningful use” program, that compel physicians to engage in unnecessary activities and reporting;
  • Stop the bounty-hunting Medicare Recovery Audit Program contractors (RACs);
  • Maintain the state-based system of licensing physicians;
  • Be prepared to act quickly to protect physicians’ practices decimated by the new ICD-10 coding system; and
  • Clarify that there are not now and never will be a requirement for Maintenance of Certification (MOC) to be a condition for state licensure or for participation in Medicare or Medicaid.

Dr. Garcia’s Travels Heat Up As Weather Cools

Fall finds Dr. Garcia spending more time on the road, spreading the word about TMA’s legislative successes, and helping to recruit new members. He recently spoke to the Wichita County Medical Society and the Southwest Branch of Harris County Medical Society. Coming up is a visit to the Webb-Zapata-Jim Hogg County Medical Society in Laredo. Then Dr. Garcia will be a featured speaker at the National Association of Latino Elected and Appointed Officials on what health reform means to physician practices. Let us know if you want Dr. Garcia to speak to your county society or physician group.

TMA Raises Serious Concerns About Aetna-Humana Merger

If Aetna is allowed to complete its deal to buy Humana, our state’s already highly concentrated health insurance market would be even less competitive. And that would be bad for physicians and patients. That’s what TMA wrote in a formal comment letter to the Department of Justice. Texas’ many one- to three-physician groups “may have very little negotiating leverage to allow them to secure favorable pricing terms,” we wrote. “Health plans that can wield unchecked pricing power can force physician practices out of business.” That would create access problems for patients in addition to the problems associated with trying to buy insurance in noncompetitive markets. The letter cited data showing the purchase would give the new company “enhanced market power” in San Antonio, Houston, Austin, El Paso, Corpus Christi, and many other Texas markets.

High Court to Hear Tobacco Tax Case

The Texas Supreme Court has accepted an appeal of a lower court ruling that invalidated a tax the legislature applied to so-called “small tobacco.” Back in 1998, the nation’s five largest tobacco companies settled a case with Texas and 45 other states over the health care costs of cigarette smoking. They agreed to pay $10 billion a year indefinitely to the states. In 2013, state lawmakers enacted the “small tobacco” tax to “recover health care costs” from the tobacco companies that were not part of the settlement. TMA urged the high court to take the case. “Whether produced and sold by Small Tobacco or by Big Tobacco, tobacco products cause the same health problems and inflict the same physical and financial burdens upon Texas citizens and the State budget,” we wrote in our amicus brief to the court. “Both should, therefore, have to pay their fair share of tobacco-related health costs whether that be through a judgment, settlement, tax or otherwise.”

Monday, October 5, 2015

Submit ICD-10 Problems to TMA’s Hassle Factor Log

Thursday, Oct. 1, was the mandatory date to switch to the ICD-10 coding system in the United States. The government’s paltry “grace period” notwithstanding, all claims to Medicare, Medicaid, commercial insurers, and other payers with a date of service on or after Oct. 1 must use ICD-10. If you run into problems submitting claims, email PaymentAdvocacy@texmed.org or send a report to TMA’s Hassle Factor Log. TMA staff will monitor the reports and contact health plans, Medicare, or Medicaid. If your practice is behind in its ICD-10 preparation, or if you’re just looking for some tips and tools to make the new system work more smoothly, see TMA’s ICD-10 Resource Center.

TEXPAC Backs Supreme Court Challenger

The TEXPAC Board of Directors voted to endorse Justice Michael Massengale for Texas Supreme Court Place 3. Justice Massengale has served on the First Court of Appeals since 2009, when then-Gov. Rick Perry appointed him, and he won reelection in 2012. “After completion of a very thorough vetting process, Texas physicians believe the decision is clear: Justice Massengale will be the best choice to serve on the Texas Supreme Court,” said TEXPAC Chair Brad Holland, MD. “We further believe he will be an unwavering protector of tort reform, he will help both patients and physicians, and he will interpret the law in a fair and objective manner.” After interviewing both candidates in the race extensively, TEXPAC board members said Justice Massengale clearly articulated his belief that the law is the law and judges should not legislate from the bench.

Sign Up Now for Our Medicare 2016 Seminar

Once again, big changes are coming to Medicare. Although the Sustainable Growth Rate (SGR) formula is now history, the bill that repealed the SGR is likely to accelerate the movement towards value-based payment systems — for all physicians. Sooner rather than later, you will have to prepare to participate in a Merit-Based Incentive Payment System (MIPS) or an alternative payment model system. Doing nothing may cost you. TMA can help you do it and do it right. Our day-long Medicare Now and Tomorrow seminar will help you develop short-term and long-term strategies to adjust. Registration is open now for the seven-city tour.

Governor Abbott Appoints Falcon to University Research Initiative Advisory Board

Rio Grande City family physician Tony Falcon, MD, is among nine Texans whom Gov. Greg Abbott appointed to the University Research Initiative Advisory Board. The program will provide matching funds to help public colleges and universities recruit prestigious, nationally recognized researchers to their faculty. The advisory board will review grant applications and recommend approval or disapproval to the governor’s office. Dr. Falcon, a long-time, active TMA and TEXPAC member, joins a group of business and philanthropy leaders on the advisory board.

Don’t Miss TMA’s 2015 Advocacy Retreat

While Texas politics is a year-round sport, the season really heats up in odd-numbered years just about the time mall elves and holiday music are making their crescendos. That’s why we hold our biennial political retreat the first week of December. Register today for TMA’s 2015 Advocacy Retreat, Dec. 4-5 at the Omni Barton Creek Resort in Austin. Join other physician leaders from around the state as we gather to recap the 84th Texas Legislature and discuss what the 2016 elections will mean for Texas medicine.