Jun 30, 2011

Medicine Wins; CMS Drops Lab Signing Rule

Admitting it did not fully understand the impact of what it was requiring, the Centers for Medicare & Medicaid Services now says it will drop a proposed rule that the ordering physician or nonphysician practitioner must sign requisitions for all clinical diagnostic laboratory tests paid under the clinical laboratory fee schedule.

Jun 29, 2011

Finally, They're Gone!

TMA Legislative News Hotline

Wednesday, June 29, 2011


SINE DIE
Today is the last day of the special session. The Texas Senate headed home a day early yesterday after taking action on bills critical for the special session. However, the Texas House is still at work. House members returned today to take up legislation that would stop invasive pat-downs by Transportation Security Administration and an omnibus bill to fund courts.

Yesterday, the House almost caused lawmakers to come back for a second special session when it initially voted down Senate Bill 1. After a quick emergency caucus, budget negotiators were able to put the bill back on track. House members passed the bill on the second attempt. SB 1 is critical to helping balance the 2012-13 budget. It creates more than $3.5 billion in additional nontax revenue. It also cuts public education by $4 billion statewide.

Look for TMA’s complete legislative summary in Friday’s TMA Legislative Hotline.

Jun 27, 2011

House to Take Up Special Session Health Bill Today

TMA Legislative News Hotline

Monday, June 27, 2011



UNDER THE ROTUNDA
UPDATE: The House passed SB 7 today 96-48. Shortly afterward, the Senate approved it 22-8, sending the bill to Gov. Rick Perry for his signature.
With only three days left in this special session, lawmakers still need to finalize three budget bills to balance the 2012-13 budget and carry out the spending cuts lawmakers made during the regular session. All three bills are close to completion providing they don’t hit a snag. The Texas House will take up conference committee reports for two of the three budget bills — Senate bills 2 and 7— today. Negotiations are still underway for SB 1, which is in conference committee. SB 1 would create around $3.5 billion in nontax revenue for the next two-year budget.

SB 2 would amend current law to appropriate $37 billion to the Foundation School Program for the 2012-13 budget. Money cannot be allocated to certain parts of government without the passage of this bill. At issue is a provision the House added that would draw money from the Rainy Day Fund for the Foundation School Fund if the balance of the Rainy Day Fund exceeds the amount included in the comptroller’s certification. Check out the conference committee report.

SB 7 is the omnibus health care bill. Among the provisions included in the conference committee report, the bill would:
  • Establish a statewide plan to improve quality and increase efficiency by forming and regulating health care collaboratives;
  • Ensure physicians would have an equal say and vote in a collaborative’s governing board, and due process protections and the ability to participate in more than one collaborative arrangement in their community;
  • Create a new Medicaid and Children’s Health Insurance Program Quality-Based Payment Advisory Committee and program that would tie a portion of Medicaid HMO premiums to improved health outcomes and quality, and implement copayments in Medicaid to reduce unnecessary emergency department use;
  • Create more than $460 million for Medicaid by placing a premium tax on Medicaid managed care companies that are expanding to the Rio Grande Valley;
  • Protect patients from vaccine-preventable diseases in health care facilities, such as hospitals, by requiring them to implement vaccination policies to immunize their employees;
  • Establish the Texas Emergency and Trauma Care Education Partnership Program to ensure support of the trauma infrastructure in Texas;
  • Allow Texas to participate in a multistate compact to help fund and administer Medicaid and Medicare; and
  • Deny state funding to public hospital districts that perform abortions except in the case of a medical emergency.
SMOKING BAN
SB 28 by Sen. Rodney Ellis (D-Houston) could come up in the Senate today. It would ban smoking in some public places and could save the state more than $30 million in Medicaid costs.

Magazine Honors Dr. Malone, Raises Funds for Hard Hats

TMA Photo by Brent Annear

Nside Austin magazine held a reception at Lambert’s in downtown Austin to honor TMA President Bruce Malone, MD. Around 70 physicians, alliance members, and Austin business people attended. Dr. Malone discussed the challenges and opportunities in today’s changing health care landscape. He also discussed why TMA started the Hard Hats for Little Heads program and our accomplishment of giving 100,000 Texas children new bicycle helmets since 1994. Most of the helmets have been giving away in the past six years. Part of the money raised at the event will help buy more helmets for little heads.

Jun 23, 2011

Special Session at Critical Point on Key Budget, Health Bills

TMA Legislative News Hotline

Thursday, June 23, 2011


BUDGET WATCH
The halls of the Texas capitol are quiet today because the House and Senate are not meeting again until Friday. With only four days left of the special session, lawmakers still have a lot of work to accomplish. First and foremost is to pass three bills to the balance the 2012-13 budget and carry out the spending cuts. Here is where the budget bills stand:

Senate Bill 1 generates about $3.5 billion for the next two-year budget. A few ways the bill creates additional nontax revenue for the 2012-13 budget are by:
  • Rewriting the school finance formulas to reduce entitlements to $4 billion;
  • Delaying part of the payment for state aid to schools to the next budget cycle;
  • Requiring one-time partial prepayment of sales, fuels, and alcohol taxes;
  • Extending the small business franchise tax exemption; and more.
The bill has been in conference committee this week. Conferees composed of five Senate and five House members debated which amendments that were added by the House to keep or not. At issue is whether the state should collect sales tax from online retailers who do business in Texas. Other amendments would:
  • Allow the state to guarantee charter school debt;
  • Authorize a superintendent to suspend the state testing for the 2011-12 and 2012-13 school years;
  • Provide for flexible school days; and
  • If a school district is owed more than is appropriated in the second year of a biennium, require the state to pay back the district the following year.
SB 2 also is in conference committee. The legislation would amend current law to appropriate $37 billion to the Foundation School Program for the 2012-13 budget. Money cannot be allocated to certain parts of government without the passage of this bill. At issue is a provision added by the House that would draw money from the Rainy Day Fund for the Foundation School Fund if the balance of the Rainy Day Fund exceeds the amount included in the comptroller’s certification.

The conference committee reports for SBs 1 and 2 are expected on Monday.

SB 7: The conference committee report for the omnibus health care bill was ready for approval by lawmakers earlier this week, but it hit a snag in the Texas House Tuesday over abortion-related provisions. House leaders are working to resolve the issue so they can approve the conference committee report and get it over to the Senate.

SB 7 is a key component of the budget puzzle. It would:
  • Establish a statewide plan to improve quality and increase efficiency by forming and regulating health care collaboratives;
  • Ensure physicians would have an equal say and vote in a collaborative’s governing board, and due process protections and the ability to participate in more than one collaborative arrangement in their community;
  • Create a new Medicaid and Children’s Health Insurance Program Quality-Based Payment Advisory Committee and program that would tie a portion of Medicaid HMO premiums to improved health outcomes and quality, and implement copayments in Medicaid to reduce unnecessary emergency department use;
  • Create more than $460 million for Medicaid by placing a premium tax on Medicaid managed care companies that are expanding to the Rio Grande Valley;
  • Protect patients from vaccine-preventable diseases in health care facilities, such as hospitals, by requiring them to implement vaccination policies to immunize their employees;
  • Establish the Texas Emergency and Trauma Care Education Partnership Program to ensure support of the trauma infrastructure in Texas; and
  • Allow Texas to participate in a multistate compact to help fund and administer Medicaid and Medicare.
IS ANOTHER SPECIAL SESSION PENDING?
Gov. Rick Perry threatened to call another special session yesterday if lawmakers don’t pass legislation to reform the Texas Windstorm Insurance Association (TWIA). In a statement sent out yesterday, the governor asked lawmakers to pass a bill that adequately compensates TWIA policyholders without enriching trial lawyers or further undermining TWIA’s financial stability. Lawmakers have struggled in the regular and special sessions to find a balanced approach for TWIA reform.

SMOKING BAN
SB 28 by Sen. Rodney Ellis (D-Houston) is on the Senate calendar but has yet to be taken up. It would ban smoking in some public places and could save the state more than $30 million in Medicaid costs. It could come up when senators return on Friday. Stay tuned.

Buckingham and Mattox Make Last Minute Runs at AMA



Responding to two last-minute openings on American Medical Association councils, Texas Drs. Dawn Buckingham and Ken Mattox willingly threw their hats into the ring. Although neither Dr. Mattox, a trauma surgeon from Houston, nor Dr. Buckingham, an Austin ophthalmologist, won their races, they ran well and displayed the TMA's "bench strength" in Chicago. We appreciate their willingness to step up to the plate.

Jun 22, 2011

Dr. Malone on the AMA Debate on Mandate for Insurance

(CHICAGO) -- Immediately after the American Medical Association House of Delegates voted on Monday to keep the AMA’s support for a mandate that nearly all Americans be required to have or buy health insurance, TMA arranged an interview with national CBS Radio for TMA President Bruce Malone, MD. The discussion ranged from the issue itself, to the tenor of the often-heated debate, to the impact the vote will have on AMA membership.
Below are some excerpts of Dr. Malone’s comments.
“The AMA house has struggled with the question of how do you provide insurance for more of our citizens without violating individual rights? The mandate to buy health insurance is offensive to some, but insurance pools do not work economically without broad participation. So Texas physicians wanted to leave these rules to the states instead of having it determined by the federal government. But many physicians in this country and as you can tell the 60% of the House of Delegates to the AMA feel that the only way access to insurance can be achieved is by mandating large pools that can have the advantage of the popular things of guarantee issue and no maximum limits.”

The debate “was very emotional and it was very heated. As you can tell by the vote there are large numbers on both sides. I can tell you that in the reference committee yesterday this one issue was debated for three hours. It’s something of terrific interest to people and they feel strongly about it one way or the other.”

“I was personally disappointed that it didn’t go along with the policy of our state medical association. But I understand the points on both sides.”

“Some people who strongly support the idea of no mandate may drop their membership with the AMA. It’s a chance you have to take when you’re a democratic membership organization. What I hope is the members who disagree with the policy will stay in the AMA and work hard to change it to what they think is better. What we will see of course in the next two years is health system reform is going to evolve and we will see things that work and don’t work so we’re going to have to make some changes and hopefully we can all work together to make the changes for the better. “

Jun 21, 2011

Governor Signs TMA-Backed Bills Into Law

TMA Legislative News Hotline

Tuesday, June 21, 2011


PERRY SIGNS TMA BILLS INTO LAW
Gov. Rick Perry signed more than 1,400 bills into law. Around 200 are health-related bills that TMA actively supported. In addition to winning key reforms to the Texas Medical Board (TMB), TMA also won important protections for physicians who seek employment in rural and urban county hospital districts and nonprofit health care 501(a) corporations, new vaccination requirements to protect Texans from meningitis and pertussis, a study by the Higher Education Coordinating Board to assess the number of graduate medical education slots to make sure the state is maximizing its investment in medical education, and much more. Check out the complete list of TMA’s bills the governor signed.

New TMB-Reform Laws: The package of bills to reform TMB include Senate Bill 227 by Sen. Jane Nelson (R-Flower Mound) and Rep. Susan King (R-Abilene), and House Bill 680 by Rep. Charles Schwertner, MD (R-Georgetown), and Sen. Joan Huffman (R-Southside Place). One of the most important things the bills do is prohibit the filing of anonymous complaints. They also:
  • Require the board to notify the physician when insurance companies, pharmaceutical companies, or third-party administrators file a complaint;  
  • Increase the time for a physician to respond to a complaint notice from 30 days to 45 days;
  • Allow physicians to tape the proceedings of a TMB informal settlement conference;
  • Allow TMB to require a remedial action plan rather than impose a fine for a minor administrative violation; and
  • Institute a seven-year statute of limitation on bringing a disciplinary action.
The governor only vetoed two key bills TMA supported: A measure by Senator Nelson and Representative King that would bind TMB to the ruling of an administrative law judge in a proceeding supervised by the State Office of Administrative Hearings and another bill that would ban Texans from texting or reading emails while driving.

SMOKING BAN STILL SMOKING
Yesterday, the Senate Health and Human Services Committee approved SB 28 by Sen. Rodney Ellis (D-Houston), which would ban smoking in some public places. The legislation would save the state more than $30 million in Medicaid costs because fewer people will get sick from smoking or secondhand smoke. The measure could be before the full Senate as early as tomorrow.

OMNIBUS HEALTH CARE BILL
The conference committee report for SB 7 by Senator Nelson will be taken up this afternoon in the House. The omnibus health care bill would:
  • Ensure physicians would have an equal say and vote in a collaborative’s governing board, and due process protections and the ability to participate in more than one collaborative arrangement in their community;
  • Establish a statewide plan to improve quality and increase efficiency by forming and regulating health care collaboratives;
  • Create a new Medicaid and Children’s Health Insurance Program Quality-Based Payment Advisory Committee and program that would tie a portion of Medicaid HMO premiums to improved health outcomes and quality, and implement copayments in Medicaid to reduce unnecessary emergency department use;
  • Create more than $460 million for Medicaid by placing a premium tax on Medicaid managed care companies that are expanding to the Rio Grande Valley;
  • Protect patients from vaccine-preventable diseases in health care facilities, such as hospitals, by requiring them to implement vaccination policies to immunize their employees;
  • Establish the Texas Emergency and Trauma Care Education Partnership Program to ensure support of the trauma infrastructure in Texas; and
  • Allow Texas to participate in a multistate compact to help fund and administer Medicaid and Medicare.

Sue Wins!

AMA Photo by Ted Grudzinski
(CHICAGO) -- Congratulations to Sue R. Bailey, MD, TMA's immediate past president, on winning the most high-profile race at this year's American Medical Association House of Delegates.

As the newly elected vice speaker of the AMA house, Dr. Bailey becomes a member of the AMA Board of Trustees and is now on what has historically been a track toward becoming AMA president.

"I am grateful for this honor and privilege to represent the views of the nation's physicians and help guide them in their policy-making decisions," said Dr. Bailey. "As the policy-making body of the AMA, the House of Delegates is in a unique position to blend the many views of the nation's physicians into one strong, unifiedand effective voice for physicians and the patients we serve."

Jun 20, 2011

Bailey Running Hard; Kridel Declares Victory

AMA Photo by Ted Grudzinski
(CHICAGO) -- It seems like it’s been all politics all the time here at the annual meeting of the AMA House of Delegates. Former TMA President Sue Bailey, MD, is campaigning hard in her race for vice speaker of the AMA house. Her support team includes Drs. Melissa Garretson, Dawn Buckingham, David Fleeger, and Dan McCoy, but the entire Texas Delegation to the AMA is making contacts on Dr. Bailey’s behalf. The election is tomorrow morning. Meanwhile, we’re proud to announce that Houston’s Russ Kridel, MD, has already won his race for reelection to the AMA Council on Science and Public Health.
On the policy side, the big debates continue to focus on AMA’s support for the health system reform law. Delegates in one reference committee spent several hours Sunday talking about whether AMA should continue to back the mandate for all Americans to buy health insurance. Another committee tackled a long list of improvements that need to be made in the law ― along the lines of TMA's Find It, Fix It, Keep It campaign.

Jun 19, 2011

Sue Bailey Runs Hard for AMA Vice Speaker



Sue Bailey, MD, was a busy lady on Saturday. She spent the morning and early afternoon shuttling among small groups of physicians in the AMA House of Delegates, asking for their vote to be the next vice speaker of the house. Later in the day, she made her formal presentation to the entire house.


The election is Tuesday, and the entire Texas Delegation to the AMA is working overtime to make sure Dr. Bailey comes out on top. Stay tuned to BloggedArteries and the TMA Twitter account for all the details -- and the outcome.

Jun 17, 2011

Three Texas Med Students Earn AMA Leadership Posts

(l to r) Abhinav Khanna, Rikki Baldwin, and Mary McFarland

(CHICAGO) -- The physician meetings haven't even begun up here where it's nice and cool (68 degrees felt great this evening), but our Texas medical students are already racking up the leadership positions in the AMA Medical Student Section.


Congratulations to:

  • The new AMA MSS Region III chair Abhinav Khanna, a second-year student at Baylor College of Medicine;
  • Mary McFarland, a second-year student at Texas A&M University Medical School, Region III Community Services Chair; and
  • Rikki Baldwin, a second-year student at the Texas College of Osteopathic Medicine, Region III Membership Chair.

Thanks to our intrepid reporter, TMA Membership Marketing Director Sylvia Salazar, for the news and the photo.

Saint Zerwas? TMA Member/State Rep Gets Kuddos For House Work


Rep. John Zerwas, MD
(R-Simonton)

The 2011 Texas Legislature's regular session is barely over -- and the sudden-death overtime special session is still running -- so it must be time for one of Austin's favorite biennial pasttimes: picking those lawmakers who stood out, for better or for worse.

Two of the first two lists that were published, Texas Monthly's "Best and Worst Legislators 2011" and Capitol Insider's "Top Ten Legislators," both heaped lots of credit on the lawmakers who ran their respective chambers' budget committees: State Sen. Steve Ogden (R-Bryan) and Rep. Jim Pitts (R-Waxahachie). But some of their brightest praise shone on one of the four physicians -- and TMA members -- in the 2011 legislature. Those of us who've watched Rep. John Zerwas, MD (R-Simonton) over the years aren't at all surprised at what the raters had to say about him.

Let's start with Texas Monthly:


July 2011
by Nate Blakeslee and Paul Burka

JOHN ZERWAS R–Richmond

As corny as it sounds, John Zerwas is the closest thing the Legislature has to a saint. His job this session, as chairman of the House Appropriations subcommittee on the health care section of the budget, was to listen, in meeting after meeting, to the testimony of people who depend on services facing deep cuts. A typical hearing found the room filled with supplicants in wheelchairs, clad in ponchos as a symbolic plea for lawmakers to use the Rainy Day Fund.

They had come to the right place. Zerwas was one of the few House Republicans who unequivocally supported using the fund to cover shortfalls in health care spending, despite criticism from self-anointed fiscal watchdog Michael Quinn Sullivan. “I think that most of my colleagues are hearing the same thing that I’m hearing from my constituents,” Zerwas told the Fort Bend Herald, “and this is, it’s raining out there and this is money we have specifically saved for this purpose. We expect the lawmakers up here to put it to the highest and best use that they can. And I don’t think the highest and best use is sitting in a savings account when we have the amount of needs out there that are not going to be met otherwise.”

Health care debates are particularly challenging because they tend to inflame the passions of the true believers on the far right, but here Zerwas’s training as a physician serves him well. He never engages in ideological battles, never panics. He just argues cause and effect, as a man of science is trained to do. If we don’t raise provider rates, Members, then doctors and nurses will not be able to afford to treat patients. What separates Zerwas from other members is that he uses his time on the House floor to speak from his medical experience. His purpose is to educate, and in a session as hellish as this one, that was grounds for beatification.



June 15, 2011
Mike Hailey

"Top Ten Legislators"

John Zerwas / Texas House / Houston Republican

You could search Texas history all day and it would be hard to find a state lawmaker who's not a committee chair with the kind of sparkling reviews that have been lavished on Dr. John Zerwas for his performance at the Capitol this year.
The third-term representative who represents three counties on the edge of the Houston area was tapped to lead the Appropriations subcommittee on health and human services at a time when those programs appeared to be on the verge of draconian devastation amid the worst state budget crisis in two dozen years. While there would be no elixir for the budget-cutting fever, Zerwas helped his colleagues understand the potential consequences and repercussions that an unbridled chopping block approach could bring to the areas of the budget that fell into his jurisdiction and expertise. That had a mitigating effect on the budget ax on Article II in the short term. But Zerwas tackled his job with one eye on immediate concerns and one on the future with a proactive mentality that he hopes will save the state money down the road without adversely effecting the health care delivery system in the state. It was a bold approach that didn't come without risks in a Legislature that's preferred the instant gratification of band-aids over cures that come with no guarantees.
Zerwas' biggest single splash arguably came last week as the sponsor of legislation that the House approved in special session in a move that's designed to have almost $500 million by privatizing Medicaid managed care in South Texas. The measure that was authored by State Senator Jane Nelson would create a Texas Institute of Health Care Quality and Efficiency that would link reimbursements for medical professions to the outcomes of the care and treatment they provide. Democrats fought the measure on the grounds that it would reduce state spending on children's health insurance, boost co-payments for Medicaid patients and run the risk of cutting payments to doctors who'd be inclined to refuse to take Medicaid patients as a result. Critics contended that the Medicaid privatization plan would compound the pain from a reduction in hospital reimbursements that the Legislature had already endorsed this year. But Zerwas, a relatively low-key lawmaker who reasons with his colleagues instead of pressing, browbeating or trying to scare them, persuaded the House to embrace the novel approach in a vote that approved it along party lines.
Zerwas, an anesthesiologist, wasn't distracted this time around by the need to save lives like he'd done two years ago when a House colleague suffered a near fatal heart attack on an elevator during a late night meeting in the lower chamber. But Zerwas had one of the most successful sessions in recent memory largely as a result of his ability to gain the trust of fellow lawmakers whose political futures could live or die on the votes they cast in the most extreme budget conditions that the Legislature has faced since 1987. He accomplished that with relative ease on the strength of his expertise, his commitment and the courage and will that it took to lead the fight in an arena where an increasing number of lives are on the line each day.

Jun 16, 2011

Chicago Tribune Article: AMA to reconsider support of health insurance requirement

From today's Chicago Tribune:
AMA to reconsider support of health insurance requirement Faction contends key tenet of overhaul legislation is 'a matter of individual responsibility to be encouraged by the use of tax incentives and other noncompulsory measures." A divided American Medical Association will consider withdrawing its support of a key tenet of the health overhaul law that requires Americans to purchase an insurance plan.

The vehicle for this debate will be the Council on Medical Services Report #9:

The CMS Report strongly recommends that AMA keep its current policy:

Accordingly, in to order to maximize the expansion of health insurance coverage to the uninsured in both the public and private sectors, and to retain the critical components underlying the AMA proposal for expanding health insurance coverage and choice as established by the House of Delegates, the Council on Medical Service recommends the reaffirmation of policies in support of individual responsibility to obtain health insurance; individually selected and owned health insurance; principles for health insurance tax credits and other subsidies; principles for health insurance market regulation; health savings accounts; and direct subsidies for the coverage of high risk patients. The Council firmly believes that the strength of this policy foundation is contingent on all of its parts; without each complementary component, the foundation begins to crumble and, as the literature suggests, the number of uninsured Americans will continue to grow.

Stay tuned. Blogged Arteries will keep you up to date on this and all other debates and elections at the House of Delegates meeting, which begins on Saturday.

Health Care Compact Bill #2 Up for House Vote Today

TMA Legislative News Hotline

Thursday, June 16, 2011


UNDER THE ROTUNDA
Interstate compact: The Texas House gave tentative approval to House Bill 5 by Rep. Lois Kolkhorst (R-Brenham) yesterday. The legislation would allow Texas to participate in a multistate compact to help fund and administer Medicaid and Medicare. HB 5 is slated for a final House vote today. Earlier this week the House approved HB 13 also by Representative Kolkhorst that would allow the state to apply for a federal waiver to help fund Medicaid.

Medicaid cost savings: House conferees for Senate Bill 7 by Sen. Jane Nelson (R-Flower Mound) were named yesterday. They are Reps. John Zerwas, MD (R-Simonton), chair; Jim Pitts (R-Waxahachie); John Davis (R-Houston); Veronica Gonzales (D-McAllen); and Kolkhorst. The House conferees join Senator Nelson and Sens. Robert Deuell, MD (R-Greenville); Juan “Chuy” Hinojosa (D-McAllen); Florence Shapiro (R-Plano); and John Carona (R-Dallas). These 10 lawmakers will decide which amendments stay on SB 7 and which ones don’t.

The omnibus health care bill is a combination of three bills heard during the regular session ― SBs 7 and 23 regarding Medicaid organization and cost containment, and SB 8, which establishes health care collaboratives in Texas. Taken together this huge bill would:
  • Ensure physicians would have an equal say and vote in a collaborative’s governing board, and due process protections and the ability to participate in more than one collaborative arrangement in their community;
  • Establish a statewide plan to improve quality and increase efficiency by forming and regulating health care collaboratives;
  • Create a new Medicaid and Children’s Health Insurance Program Quality-Based Payment Advisory Committee and program that would tie a portion of Medicaid HMO premiums to improved health outcomes and quality, and implement copayments in Medicaid to reduce unnecessary emergency department use;
  • Create more than $460 million for Medicaid by placing a premium tax on Medicaid managed care companies that are expanding to the Rio Grande Valley;
  • Protect patients from vaccine-preventable diseases in health care facilities by requiring health care workers to be properly immunized;
  • Establish the Texas Emergency and Trauma Care Education Partnership Program to ensure support of the trauma infrastructure in Texas;
  • Require the disclosure of physician discounts by any company that applies them to a patient claim;
  • Establish criminal penalties for physicians who fail to fill out appropriate paperwork for women who have received services related to an abortion; and
  • Allow Texas to participate in a multistate compact to help fund and administer Medicaid and Medicare.
CONGRESSIONAL NEWS
Medicare payments: Physician’s Medicare payments could be cut almost 30 percent Jan. 1, 2012, if Congress does not address the flawed Sustainable Growth Rate (SGR) funding formula. Congress currently is exploring different ways to fix the formula, but each has a hefty price tag. The Congressional Budget Office estimated the 10-year cost of different solutions range from $21.5 billion, which includes a 35-percent payment cut in 2013, to $388.5 billion, which includes an annual 2-percent increase through 2021 after resetting the SGR or forgiving all over-target spending that accrued cumulatively up to Dec. 31, 2010. Another option would use the same resetting formula and link updates to the Medicare Economic Index. That option has been projected to cost $358.1 billion from 2012 through 2021.

Obesity prevention: U.S. Reps. Michael C. Burgess, MD (R-Texas), and Eliot Engel (D-New York) reintroduced legislation yesterday designed to lower gestational diabetes and prevent affected women and their children from later developing Type 2 diabetes. If passed the legislation would:
  • Develop a multisite gestational diabetes research project within the Centers for Disease Control and Prevention diabetes program to enhance surveillance and public health research on gestational diabetes;
  • Provide demonstration grants to focus on reducing the incidence of gestational diabetes; and
  • Expand basic, clinical, and public health research investigating gestational diabetes and current treatments and therapies available.
WHAT YOU CAN DO
TMA’s Tele-2011 Legislative Update
In case you missed the Tele-2011 Legislative Update by TMA President C. Bruce Malone, MD, and physician leaders from TMA’s Council on Legislation — Gary Floyd, MD, and Dan McCoy, MD —you still can hear and see what they discussed. An audio recording and video are available on the TMA website.

Jun 15, 2011

House Passes Medicaid Waiver Bill; Waiting for the Conferees

TMA Legislative News Hotline

Wednesday, June 15, 2011


UNDER THE ROTUNDA
The Texas House gave final approval to House Bill 13 by Rep. Lois Kolkhorst (R-Brenham). The legislation would allow Texas to seek a federal waiver to fund Texas Medicaid. The House will take up the other piece of this proposal today, which is HB 5 by Representative Kolkhorst. The measure would allow the state to participate in a multistate compact to help fund and administer Medicaid and Medicare.

The House has not yet named conferees for the three budget bills whose House amendments were rejected by the Senate. On Monday, the Senate chose not accept the changes made to the bills by the House. All three bills now are headed to conference committee, where five Senate and five House members will decide which amendments stick and which ones don’t. House conferees should be selected today. These are the three bills and Senate conferee members:
  • Senate Bill 1 would generate about $3.7 billion for the next two-year budget. Senate conferees for SB 1 are Sens. Robert Duncan (R-Lubbock); Robert Deuell, MD (R-Greenville); Juan “Chuy” Hinojosa (D-McAllen); Florence Shapiro (R-Plano); and Tommy Williams (R-The Woodlands).
  • SB 2 would amend current law relating to appropriating money for the support of state government for the 2012-13 budget. Money cannot be allocated to certain parts of government without the passage of this bill. Senate conferees are Sens. Steve Ogden (R-Bryan), Duncan, Hinojosa, Jane Nelson (R-Flower Mound), and Williams.
  • SB 7 is the omnibus health care bill by Senator Nelson. Conferees are Senators Nelson, Deuell, Hinojosa, Shapiro, and John Carona (R-Dallas).
WHAT YOU CAN DO
TMA’s Tele-2011 Legislative Update
In case you missed the Tele-2011 Legislative Update by TMA President C. Bruce Malone, MD, and physician leaders from TMA’s Council on Legislation — Gary Floyd, MD, and Dan McCoy, MD —you still can hear and see what they discussed. An audio recording and video are available on the TMA website.

Jun 14, 2011

Senate Names Negotiators for Budget, Health Bills

TMA Legislative News Hotline

Tuesday, June 14, 2011



Sen. Juan "Chuy" Hinojosa
D-McAllen

UNDER THE ROTUNDA
Last week, the Texas House gave final approval to three key budget bills. It made changes to each, especially the bill aimed at generating more money for 2012-13 budget and the omnibus health care bill. The Senate decided not to accept the House’s changes and sent all three bills to conference committee yesterday. Here are the bills and Senate members selected to be on each conference committee:
  • Senate Bill 1 would generate about $3.7 billion for the next two-year budget. Senate conferees for SB 1 are Sens. Robert Duncan (R-Lubbock); Robert Deuell, MD (R-Greenville); Juan “Chuy” Hinojosa (D-McAllen); Florence Shapiro (R-Plano); and Tommy Williams (R-The Woodlands).
  • SB 2 would amend current law relating to appropriating money for the support of state government for the 2012-13 budget. Money cannot be allocated to certain parts of government without the passage of this bill. Senate conferees are Sens. Steve Ogden (R-Bryan), Duncan, Hinojosa, Jane Nelson (R-Flower Mound), and Williams.
  • SB 7 is the omnibus health care bill by Senator Nelson. Conferees are Senators Nelson, Deuell, Hinojosa, Shapiro, and John Carona (R-Dallas).
The House conference committee members have not been selected yet.

House Bill 13 by Rep. Lois Kolkhorst (R-Brenham) is before the House today for a final vote. The House tentatively approved the measure last Friday. The legislation would allow Texas to seek a federal waiver to fund Texas Medicaid. It’s before the House today for a final vote.

WHAT YOU CAN DO
Please take a few minutes to call the capitol on two key issues today.
  • Legislation to ban smoking in certain public places is still burning. If passed, the bill would save Medicaid more than $30 million because fewer people will get sick. The Senate may make take up its version of the bill — SB 28 by Sen. Rodney Ellis (D-Houston) — early this week. Please call your senator — if you’re from Houston, call Sen. Mike Jackson (R-Houston) — in support of SB 28.
  • Also, please take a moment today to call Gov. Rick Perry’s office at (512) 463-2000. Ask the governor to support the silent PPO amendment (No. 20) on Senator Nelson’s SB 7. The amendment promotes transparency of who is using physician and hospital contracted discounts. Governor Perry’s support is critical to keeping regulation of silent PPOs alive.
TMA’s Tele-2011 Legislative Update
In case you missed the Tele-2011 Legislative Update by TMA President C. Bruce Malone, MD, and physician leaders from TMA’s Council on Legislation — Gary Floyd, MD, and Dan McCoy, MD —you still can hear and see what they discussed. An audio recording and video are available on the TMA website.

WHAT WE'RE READING
Pro-Choice Group Files Suit over Sonogram Law
(Houston Chronicle)
Medicaid pay cut fight finds Justice Dept. at odds with doctors (American Medical News)
Why ObamaCare Is Losing in the Courts
(Wall Street Journal

Jun 13, 2011

Last Call to Avoid Medicare Penalty

Join the Chat

Physicians who have not e-prescribed at least 10 times by June 30 may be penalized (1 percent Medicare Part B) for the 2012 calendar year.

The Centers for Medicare & Medicaid Services (CMS) estimates 209,000 physicians and other providers will be penalized. The penalty increases to 1.5 percent in 2013 for physicians who do not submit 25 e-prescriptions by Dec 31. Submitting 25 e-prescriptions by Dec 31 may qualify you for a 1-percent bonus. (See TMA's 2011 E-Prescribing White Paper.)

TMA Asks AMA Help on Physician Compare Website

The Texas Delegation to the American Medical Association is taking Resolution 718 – passed last month by the TMA House of Delegates – to the 2011 Annual Meeting of the AMA House of Delegates. The AMA House convenes Saturday in Chicago.


This resolution asks AMA to push the Centers for Medicare & Medicaid Services (CMS) to develop fair and accurate ranking measures to use on the CMS Physician Compare Website. It also asks AMA to advocate that CMS develop an appeals process for physicians to use before any information is posted to the site.


A study by the RAND Corp. published in the New England Journal of Medicine >indicated that up to two-thirds of physician ratings by carriers are incorrect and that current methods for profiling physicians with respect to costs produce misleading results.

Jun 9, 2011

The Death of "Private" in Private Practice

A comprehensive report from The Physicians Foundation offers private practice physicians a new tool for understanding how federal health system reform may impact their practice of medicine. The report examines the provisions of the Patient Protection and Affordable Care Act (ACA) and how they will directly impact private practice physicians, both immediately and over the coming months.

CMS to Sell Medicare Data

Organizations that meet certain qualifications would have access to Medicare data to generate public reports on physicians, hospitals, and other health care professionals under the 'Availability of Medicare Data for Performance Measurement' rule the Centers for Medicare & Medicaid Services (CMS) proposed in early June. It is required by the 2010 health system reform bill.

House Gives First OK to Major Health Care Bill

TMA Legislative News Hotline

Thursday, June 9, 2011



UNDER THE ROTUNDA
The Texas House is set today to take up two major budget bills. House members prefiled more than 150 amendments for consideration to Senate Bill 1 by Sen. Robert Duncan (R-Lubbock). The goal of the legislation is to generate additional revenue to help cover spending in the 2012-13 state budget. During the regular session, the measure attracted more than 400 amendments. SB 2 by Sen. Steve Ogden (R-Bryan) also has a few dozen amendments waiting on the sidelines. SB 2 amends current law to appropriate money to support state government. While most of the state budget has passed and is awaiting action by the comptroller and governor, the appropriation for schools was contingent on the passage of school finance legislation, which failed in the regular session. This bill makes the needed appropriation.

SB 7, sponsored by Rep. John Zerwas, MD (R-Simonton), is a combination of three bills heard during the regular session ― SBs 7 and 23 regarding Medicaid organization and cost containment, and SB 8, which establishes health care collaboratives in Texas. Taken together this huge bill would:
Sen. Jane Nelson
(R-Flower Mound)
Yesterday, the House gave tentative approval to SB 7 by Sen. Jane Nelson (R-Flower Mound) after adding 29 amendments. Amendments ranged from denying state funding to hospital districts that provide abortions or abortion-related services except in cases of a medical emergency, to allowing Texas to enter into an interstate health care compact with neighboring states to take control of Medicaid and Medicare and seeking a federal waiver to fund Texas Medicaid. The omnibus health care bill is scheduled for final approval in the House today. The bill will then be sent back to the Senate, where the options are to concur with the changes or send the bill to conference to work out the differences.
  • Ensure physicians would have an equal say and vote in a collaborative’s governing board, and due process protections and the ability to participate in more than one collaborative arrangement in their community;
  • Establish a statewide plan to improve quality and increase efficiency by forming and regulating health care collaboratives;
  • Create a new Medicaid and CHIP Quality-Based Payment Advisory Committee and program that would tie a portion of Medicaid HMO premiums to improved health outcomes and quality, and implement copayments in Medicaid to reduce unnecessary emergency department use;
  • Create more than $460 million for Medicaid by placing a premium tax on Medicaid managed care companies that are expanding to the Rio Grande Valley;
  • Protect patients from vaccine-preventable diseases in health care facilities by requiring health care workers to be properly immunized; and
  • Establish the Texas Emergency and Trauma Care Education Partnership Program to ensure support of the trauma infrastructure in Texas.
TMA President Bruce Malone, MD
TMA’s Tele-2011 Legislative Update
Last night more than 1,400 physicians participated in TMA’s 2011 Tele-Legislative Update. TMA President C. Bruce Malone, MD, along with Gary Floyd, MD, chair of TMA’s Council on Legislation, and Dan McCoy, MD, immediate past chair of TMA’s Council on Legislation, walked physicians through what happened during the regular session that affects physicians and their patients, and what is still in play during the special session. TMA’s lobby team was available to answer questions. Next week, TMA will post the answers to the questions asked, along with a video of the event, on the TMA website. If you were on the call last night, remember to fill out your CME form. You can find it on the TMA website as well. Thanks to everyone who participated in the call.

WHAT WE'RE READING
Second Life: Bill Becomes Health Care Christmas Tree (Texas Tribune)
Texas House approves Medicaid changes
(Houston Chronicle)
Judges said to be skeptical of mandate in healthcare law
(The Hill Healthwatch)


Jun 8, 2011

Texas House to Tackle BIG Health Bill Today

TMA Legislative News Hotline

Wednesday, June 8, 2011


UNDER THE ROTUNDA
The omnibus health care bill, Senate Bill 7 by Sen. Jane Nelson (R-Flower Mound) is before the Texas House today. Rep. John Zerwas, MD (R-Simonton), is sponsoring the bill and will roll out the bill with only a few of his recommended amendments. House members may line up to offer dozens of other amendments, generally, bills that failed at some point in the regular session.

SB 7 is a combination of three bills heard during the regular session ― SBs 7 and 23 regarding Medicaid organization and cost containment, and SB 8, which establishes health care collaboratives in Texas. Taken together this huge bill would:
  • Ensure physicians would have an equal say and vote in a collaborative’s governing board, and due process protections and the ability to participate in more than one collaborative arrangement in their community;
  • Establish a statewide plan to improve quality and increase efficiency by forming and regulating health care collaboratives;
  • Create a new Medicaid and CHIP Quality-Based Payment Advisory Committee and program that would tie a portion of Medicaid HMO premiums to improved health outcomes and quality, and implement copayments in Medicaid to reduce unnecessary emergency department use;
  • Create more than $460 million for Medicaid by placing a premium tax on Medicaid managed care companies that are expanding to the Rio Grande Valley;
  • Protect patients from vaccine-preventable diseases in health care facilities by requiring health care workers to be properly immunized; and
  • Establish the Texas Emergency and Trauma Care Education Partnership Program to ensure support of the trauma infrastructure in Texas.
Tomorrow, the Texas House will take up two budget bills and one calling for the state to have more power to manage Texas Medicaid and Medicare:
  • SB 1 by Sen. Robert Duncan (R-Lubbock). It generates additional nontax revenue to cover spending in the budget.
  • SB 2 by Sen. Steve Ogden (R-Bryan). It amends current law to appropriate money to support state government. While most of the state budget has passed and is awaiting action by the comptroller and governor, the appropriation for schools was contingent on the passage of school finance legislation, which failed in the regular session. This bill makes the needed appropriation.
  • HB 13 by Rep. Lois Kolkhorst (R-Brenham). The bill calls for developing a Section 1115 federal waiver (block grant) to give Texas greater flexibility in the design and operation of the Medicaid program. TMA raised several concerns about the bill, specifically whether Texas could secure enough funding to cover not only annual medical inflation but also caseload growth.
WHAT YOU CAN DO
2011 Legislative Update: TONIGHT at 8 pm (CDT)
Remember tonight at 8 pm (CDT), TMA President C. Bruce Malone, MD, will call you at your home telephone number, and invite you to stay on the line for TMA’s Tele-2011 Legislative Update. For 45 minutes, Dr. Malone and members of TMA’s Council on Legislation and TMA’s lobby team will discuss what happened during the 2011 legislative session that affects you and your patients. They also will discuss what issues are still on the table. You may ask questions after each topic. And, the best part: You will earn 1 AMA PRA Category 1 Credit™ for your time (providing you stay on the line for the entire program).

You also can listen to a live audio webcast tonight or a recording at a later date. TMA is filming the event and will have a video on the TMA website next week. 

WHAT WE'RE READING
Feds May Block Effort to Force Out Planned Parenthood (Texas Tribune)
No, You Can't Keep Your Health Insurance
(Wall Street Journal)
The man who would remake Medicaid in Texas: Health chief Thomas Suehs has a reform plan, wants state waiver from Obamacare to implement it
(Texas Watchdog)

Jun 7, 2011

TMA to House: Follow Rep. Zerwas on Key Health Bill

TMA Legislative News Hotline

Tuesday, June 7, 2011


Rep. John Zerwas, MD
(R-Simonton)
UNDER THE ROTUNDA
The Texas House will take up the omnibus health care bill, Senate Bill 7 by Sen. Jane Nelson (R-Flower Mound), tomorrow. Rep. John Zerwas, MD (R-Simonton), is sponsoring the bill and has the power to decide, initially, which amendments stay and which don’t. However, House members can offer additional amendments. If an amendment is ruled germane to the bill, it can be added to the bill on an affirmative vote. Because this could be the last chance a lawmaker has to pass his or her health care-related bill this special session, SB 7 could get loaded down with many good and bad amendments. TMA is asking House members to accept only the amendments recommended by Representative Zerwas — and no more.

SB 7 is an important bill. It’s one of three bills key to balancing the state budget. It contains many provisions important to physicians and their patients. TMA supports items that will:
  • Create a new Medicaid and CHIP Quality-Based Payment Advisory Committee and program that would tie a portion of Medicaid HMO premiums to improved health outcomes and quality, and implement copayments in Medicaid to reduce unnecessary emergency department use;
  • Establish a statewide plan to improve quality and increase efficiency by forming and regulating health care collaboratives;
  • Ensure physicians would have an equal say and vote in a collaborative’s governing board, and due process protections and the ability to participate in more than one collaborative arrangement in their community;
  • Protect Texas’ ban on the corporate practice of medicine;
  • Create more than $460 million for Medicaid by placing a premium tax on Medicaid managed care companies that are expanding to the Rio Grande Valley;
  • Protect patients from vaccine-preventable diseases in health care facilities by requiring health care workers to be properly immunized; and
  • Establish the Texas Emergency and Trauma Care Education Partnership Program to ensure support of the trauma infrastructure in Texas.
The Texas House will take up these bills on Thursday:
  • SB 1 by Sen. Robert Duncan (R-Lubbock). It generates additional nontax revenue to cover spending in the budget.
  • SB 2 by Sen. Steve Ogden (R-Bryan). It amends current law to appropriate money to support state government. While most of the state budget has passed and is awaiting action by the comptroller and governor, the appropriation for schools was contingent on the passage of school finance legislation, which failed in the regular session. This bill makes the needed appropriation.
  • HB 13 by Rep. Lois Kolkhorst (R-Brenham). The bill calls for developing a Section 1115 federal waiver (block grant) to give Texas greater flexibility in the design and operation of the Medicaid program. TMA raised several concerns about the bill, specifically whether Texas could secure enough funding to cover not only annual medical inflation but also caseload growth.
BILL UPDATE
Interstate compact: The House Select Committee on State Sovereignty passed HB 5 by Representative Kolkhorst yesterday. The bill would establish the Interstate Health Care Compact to petition the federal government to block-grant all federal funding to the states for health care services.  TMA is concerned that Texas could be short-changed under a block grant proposal and wants to make sure that any proposal includes both state population growth and demographic changes.

MARK YOUR CALENDAR. SET YOUR WATCH.
Remember on Wednesday, June 8, at 8 pm (CDT), TMA President C. Bruce Malone, MD, will call you at your home telephone number and invite you to stay on the line for TMA’s Tele-2011 Legislative Update. For the next 45 minutes, Dr. Malone and members of TMA’s Council on Legislation and TMA’s lobby team will discuss what happened during the 2011 legislative session that affects you and your patients. They also will talk about what issues are still in discussion. You may ask questions after each topic. And the best part: You will earn 1 AMA PRA Category 1 Credit™ for your time (providing you stay on the line for the entire program).

WHAT WE'RE READING
Texas House panel approves health care compact (Houston Chronicle)
Senate Dems take hard stance on Medicare
(The Hill Healthwatc

Jun 1, 2011

Special Session Gets Off to a Health-Heavy Start

TMA Legislative News Hotline

Wednesday, June 1, 2011


UNDER THE ROTUNDA
Yesterday, House and Senate leaders spent the day getting organized for the special session. In addition to deciding upon what rules they will use in each chamber, they filed bills to take up over the coming days. Lawmakers need to finalize the next two-year budget, which entails coming up with a new school finance plan and nontax revenue to cover spending.

The Senate Finance Committee will start tackling the critical budget pieces tomorrow. Here are the four bills they will take up:

Senate Bill 1
by Sen. Robert Duncan (R-Lubbock). SB 1 basically is SB 1811 — the nontax revenue measure containing hybrid school finance allocation methods that was filibustered during the end of regular session. It is essential to pass some version of SB 1 to balance the state budget.

SB 2
by Sen. Steve Ogden (R-Bryan). It amends current law relating to appropriating money for the support of state government for the 2012-13 budget. Money cannot be allocated to certain parts of government without the passage of SB 1.

SB 5
by Sens. Joan Huffman (R-Southside Place) and Jane Nelson (R-Flower Mound). It would establish the Interstate Health Care Compact to petition the federal government to block-grant all federal funding to the states for health care services. TMA is concerned about Texas getting its fair share of the funding and wants to ensure that both population growth and demographic changes are accounted for in any proposal. During the regular session, this measure was House Bill 5 by Rep. Lois Kolkhorst (R-Brenham).

SB 7
by Senator Nelson, the health and human services efficiencies bill aimed at creating new health care collaboratives in the health care system and achieving cost savings in Medicaid and the Children’s Health Insurance Program (CHIP). This omnibus health care bill contains elements from the following five bills considered during the regular session:
  • SB 7 that would establish a new Medicaid and CHIP Quality-Based Payment Advisory Committee and program;
  • SB 8 that would establish a statewide plan for improving quality and increasing efficiency through formation and regulation of health care collaboratives;
  • SB 23 that would create Medicaid-cost savings; it includes the managed care expansion in the Rio Grande Valley;
  • Rep. Brandon Creighton’s (R-Conroe) language that prohibits mandating a person to purchase health care insurance through an insurance collaborative;
  • SB 1177 that would require health care facilities such as hospitals to develop and implement vaccination policies for health care workers to protect patients from vaccine-preventable diseases; and
  • HB 2546 that would establish the Texas Emergency and Trauma Care Education Partnership Program to ensure support of the trauma infrastructure in Texas.
Asa Lockhart, MD, chair of TMA’s Ad Hoc Committee on Accountable Care Organizations, will take the witness stand tomorrow to testify on SBs 5 and 7 on behalf of medicine.
The Senate Education Committee will take up these two bills tomorrow as well:
  • SB 6 by Sen. Florence Shapiro (R-Plano) on curriculum, the instructional materials allotment, and textbooks, much of which was included in HB 6 from the regular session; and
  • SB 8 by Senator Shapiro that would give school districts more management flexibility to save money. It was known as the SB 12 in the regular session.
Other Items Added to the Call by the Governor
Gov. Rick Perry added SB 4 by Sen. Kel Selinger (R-Amarillo) — the congressional redistricting measure — to the special session schedule yesterday. It is anticipated that more issues will be added for consideration during the special session.

WHAT YOU CAN DO
Remember Eight, at Eight, on the Eighth: Want to learn how the 2011 legislative session affects you and your patients? Then remember these three numbers: 8, 8, and 8. On June 8 at 8 pm, you can learn what actions legislators took on medicine’s top eight issues.

TMA President C. Bruce Malone, MD, will call you at your home telephone number and invite you to stay on the line for TMA’s Tele-2011 Legislative Update. For the next 45 minutes, Dr. Malone and members of TMA’s Council on Legislation and TMA’s lobby team will discuss these eight issues:

1.    2012-13 state budget,
2.    Employment protections,
3.    Texas Medical Board reform,
4.    Scope of practice expansions,
5.    Health system reform,
6.    Workforce,
7.    Public health, and
8.    Health insurance reform.

You may ask questions after each topic and use your phone to participate in a survey. And, the best part: You will earn 1 AMA PRA Category 1 Credit™ for your time (providing you stay on the line for the entire program).

If you prefer that we call you on your cell or office telephone, please contact the TMA Knowledge Center by telephone at (800) 880-7955 or by email by Monday, June 5, and let us know. We hope to talk to you on June 8.

WHAT WE'RE READING
A Third of Special Session Bills Relate to Health Care (Texas Tribune)
New health coverage takes effect in July
(San Antonio Express-News)
Managed care explained: Why a Medicaid innovation is spreading
(Stateline)
Is someone snooping your health records? New rule will tell you who
(MSNBC News)