Blogged Arteries

TMA and 41 other medical organizations have written Congressional leaders and urged them to support legislation repealing the Independent Payment Advisory Board (IPAB). Created by the Affordable Care Act, IPAB is a 15-member panel appointed by the president that would recommend cuts in Medicare fees to physicians if federal spending on health care reaches certain levels.

More than 400,000 state employees, retirees, and their dependents will get a new health insurance company. The Employees Retirement System (ERS) is negotiating a new contract with UnitedHealthcare Services, replacing Blue Cross and Blue Shield of Texas as the party administrator for theself-funded HealthSelect of Texas health plan.

March 31 is the final day of the government's 90-day grace period for enforcement of the Health Insurance Portability and Accountability Act version 5010 transaction standards. If you are not already using the 5010 standards, you must start or Medicare, Medicaid, and private insurers will reject your claims.

A combination of poorly informed government decisions and bureaucratic bungling is creating a medical emergency for thousands of dual-eligible Texans and the physicians who care for them. "Dual-eligibles" are people old enough to qualify for Medicare as their health insurer and poor enough to qualify for Medicaid assistance. Hundreds of thousands of them live across Texas. But budget cuts and bureaucratic bungling threaten their care – and more.

Learn about intimacy during and after cancer, genetic risk assessment for hereditary cancers, the Texas Cancer Registry, how to use online tools, and exercise for cancer survivors at TMA's Physician Oncology Education Program annual cancer symposium. This year’s event is at the Central Texas Medical Center, 1301 Wonder World Drive in San Marcos, on Friday, April 27, from 9 am to 1:30 pm.

A combination of poorly informed government decisions and bureaucratic bungling is creating a medical emergency for Texas’ thousands of dual-eligible Texans and the physicians who care for them. "Dual-eligibles" are people old enough to qualify for Medicare as their health insurer, and poor enough to qualify for Medicaid assistance. Hundreds of thousands of these seniors live across Texas. But budget cuts and bureaucratic bungling are threatening their care -- and more.

Javier Saenz, MD, is a Rio Grande Valley family physician who cares for many of these patients. They make up about half of his practice. Since January, he’s treated these patients as always but has received no Medicare payments and very little in payments from Texas through Medicaid. As a result he is exhausting personal savings and turning to bank loans to make payroll and keep his medical practice open to serve his patients. He doesn't know how long he can hold out.

“If all I see are my most needy patients, I can’t stay in business,” Dr. Saenz told the Texas Medical Association. “If I can’t stay in business then I can’t help anybody.”

Dr. Saenz is not alone. Physicians who care for dual-eligible patients in poor communities from rural Texas to inner cities are caught in this vise.

The jaws of this vise are coming from several directions. As part of a cost-saving move the Texas Legislature ordered, and the Texas Health and Human Services Commission (HHSC) adopted, a new policy of not paying coinsurance and deductible payments for Medicare Part B services for patients eligible for both Medicare and Medicaid.

Several serious Medicare and Medicaid computer errors have compounded the situation.

A trio of computer glitches were identified that resulted in claims paying $0 during the patients’ annual Medicare deductible period, even though physicians should have been paid up to the amount Medicaid would have paid for the service if the patient weren’t covered by both Medicare and Medicaid. One of the problems stemmed from a processing error in the state’s Medicaid claims payment system. In another, state and federal computers were not talking to each other properly because of problems tied to the new national rule requiring physicians, providers, and public and private insurers to use a new billing standard known as HIPAA 5010.

With TMA demanding action, state and federal officials say they corrected the computer problems and the claims Dr. Saenz and other filed for taking care of these patients will be reprocessed. But those officials have not yet announced when that will happen.

TMA is calling on state leaders to take emergency action to help these patients, and the doctors who care for them.

TMA argued against the change from the start. TMA spoke against the Texas Legislature’s decision to direct HHSC to make the cut as part of broader efforts to close the state’s $27 billion budget deficit.

Late last year, association President C. Bruce Malone, MD, presciently warned HHSC that the changes were about to "penalize the physicians who care for the sickest and frailest Medicare patients. They hit particularly hard practices in rural, inner-city, and border Texas, as those practices serve a disproportionate number of dually eligible Medicare patients. In addition to compromising the financial viability of these practices, we fear that the rules could result in fewer physicians willing to set up a practice in the communities that most need them."

Health information exchanges (HIE) in Texas are being established with $28 million in federal funds Texas received as a result of the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009. The Texas Health Services Authority (THSA), a public-private partnership whose board includes physicians, oversees distribution of the money.

The American Medical Association Litigation Center is joining TMA to support a group of South Texas physicians in their ongoing legal battle with Knapp Medical Center in Weslaco. TMA and AMA are preparing to file an amicus curiae ("friend of the court") brief urging an appeals court to uphold a lower court ruling in the physicians' favor.

Thanks in part to TMA's legal arguments, State District Judge Israel Ramon Jr., ordered Knapp to release balance sheets; cash flow statements; management letters from the external auditor; compensation documentation for all employees; documentation of deferred executive compensation; Internal Revenue Service (IRS) Forms 990 for the years 2008-10; and other financial records.