Dec 23, 2012

Commissioner Janek Talks Medicaid, etc. with TMA


New Texas Health Commissioner Kyle Janek, MD, has concerns about Medicaid - about having enough physicians to care for patients, about how to improve the health insurer, and other thoughts he shares with Texas Medical Association's Texas Medicine magazine. See excerpts of his thoughts below.

Then watch for the entire entire interview 1/1/13 in Texas Medicine magazine and TMA's YouTube channel.

Dec 18, 2012

State Delays Medicaid Fee Increase

The Texas Health and Human Services Commission postponed the Medicaid primary care physician payment increase authorized under the Patient Protection and Affordable Care Act. The law requires states to increase Medicaid payments to Medicare parity for primary care services provided by pediatricians, family physicians, and general internists from Jan. 1, 2013, to Dec. 31, 2014. The federal government will pay the higher costs.

So when will you start to get paid the higher fees? Read on.

Learn more about the Medicaid primary care pay hike.

Dec 17, 2012

Dual-Eligibles Cut Partially Restored

After months of TMA-organized rallies, lobbying, and meetings, the Legislative Budget Board directed the Texas Health and Human Services Commission (HHSC) to restore part of the cut in payments for patients covered by both Medicare and Medicaid.

Read more about this critical breakthrough and the work that's still left to do, and check out the video below that brought the issue to the public's attention nearly a year ago.


Medicaid Expansion Update

From the Health Care Reform Memo, Dec. 17, 2012, Deloitte Center for Health Solutions publication

As of Friday (12-14-12), 10 states reported they will not expand their program; 14 states and the District of Columbia will expand, and 27 plus states are undecided/undeclared.

Participating in Medicaid expansion Not participating Medicaid expansion
Undecided/ Undeclared
AR, CA, CT, DE, DC, HI, IL, MD, MA, MN, MO, OR, RI, VT, WA AL, GA, LA, ME, MS, OK, SC, SD, TX, VA AK, AZ, CO, ID, IN, IA, KS, KY, MI, MT, OH, PA, NC, NE, ND, NH, NJ, NM, NV, NY, TN, UT, WI, WV, WY, FL

Note: states do not have a deadline to make a decision on Medicaid expansion and may opt in or out of participation at any time.

Dec 11, 2012

Your Online Reputation: Shifting Negative Reviews to Positive

Maintaining a healthy online reputation is pivotal to success as a physician in the Internet Age. In 2011, a report by the Pew Research Center’s Susannah Fox found that 44 percent of Internet users consulted the Web to evaluate potential physicians and healthcare professionals. If you look just at the 34-45 years old age group, that number jumps to 51 percent.

Software Advice’s David Fried recently spoke with two experts in reputation management to learn how physicians can manage their online reputation effectively. Fried discovered that it’s important to focus on what you absolutely can’t do (such as electronically communicate with patients without their permission), what you shouldn’t do (point fingers--you’ll only validate negative reviews this way), and what you must do (ask websites to remove libelous comments).

Read Fried's findings on the Profitable Practice blog: Ionizing Your Online Reputation: Shifting Negative Reviews to Positive.

Dec 6, 2012

2013 Medicare Enrollment Deadline Dec. 31

Are you going to stay in Medicare next year?

Physicians have until Dec. 31 to enroll in the Medicare program for 2013. You have three options. Make sure you understand what they mean and how to use them.

Dec 5, 2012

Practice Tied Up in Red Tape?

TMA wants to hear from you as part of its red-tape reduction effort in the 2013 session of the Texas Legislature. What administrative hassles do you face? Where does the red tape need to be cut and how?

Read more ... or submit your entry to our Red Tape Hassle Log.

Dec 4, 2012

Tell Congress to Kill the SGR Zombie

We need your help to convince Congress to stop the "zombie Medicare financing" it uses to pay physicians. Every year for the past 12, cuts driven by the defective Sustainable Growth Rate (SGR) formula have come back from the dead … but in even worse shape. The SGR crisis is not dead nor does it lie dormant. It's very much alive.

Physician calls to your representative and senators can make a real difference in the fiscal cliff negotiations. Make your voice heard.

Find out how you can kill this zombie ... for good.

Dec 3, 2012

HIPAA Privacy Training: Why Now Is a Good Time

Here’s a New Year’s resolution for you: Train your staff about HIPAA privacy rules. Here are three good reasons for doing this:

  1. It’s required by state and federal law.
  2. It’s good defense in the case of an audit.
  3. It’s good insurance against privacy violation complaints, or against stiff sanctions if a slip-up in your practice occurs.

TMA can help you get rolling on New Year’s training resolution. Our new suite of three live lunch-hour training webinars with Q&A can give you a firm underpinning for training your whole staff. We’ll offer the series in December and again next spring.

Nov 30, 2012

Free Tips to Help Your Practice Run Right

TMA publishes TMA Practice E-Tips , a popular free e-newsletter twice a month to offer four brief, practical tips for managing a medical practice in Texas. Each issue gives you hands-on, use-it-now advice on coding, billing, payment, HIPAA compliance, office policies and procedures, practice marketing, and much more, along with useful links for more information.

Subscribe, for free, today.

Nov 29, 2012

How Can You Stop ODs?

Prescriptive drug abuse is at epidemic levels in the United States, and opioids are the drug patients use most often in unintentional deadly overdoses. How can physicians help stop these preventable deaths?

Learn what you can do and earn CME credit from TMA.

Nov 20, 2012

AMA gears up for lame duck session and fiscal cliff negotiations

The American Medical Association began laying the groundwork for negotiations in the lame duck session to deal with the “fiscal cliff” in 2010 by urging the Simpson-Bowles Commission to include a permanent repeal of the Medicare sustainable growth rate (SGR) formula in its budget deficit proposal. Last month, the AMA led an effort to outline principles for transition to a new Medicare payment system that was endorsed by 48 states and over 60 national specialty societies. Congress has heard repeatedly from the AMA and other physician groups on the need for action to avert the 27 percent SGR cut on Jan. 1 and the additional 2-percent sequestration cut that will occur as a result of a previous failure to reach agreement on a deficit reduction package.

While there is a great of deal of uncertainty regarding how Congress and President Obama will address the “fiscal cliff,” the AMA is poised to deal with a range of scenarios. Many observers anticipate a two-step process in which an initial deficit reduction package is enacted during the lame duck session that prevents SGR and sequestration cuts. This would include or be accompanied by a framework for a larger deficit reduction package to be finalized next year.

At the onset of the process, the AMA’s objectives are:

  • Avert looming SGR and sequestration cuts
  • Permanent repeal of the SGR and transition to new Medicare payment system that rewards physicians for high-quality care and savings across the delivery system
  • Medical liability reforms to reduce the cost of defense medicine
  • Preserve investments in graduate medical education, research, public health and prevention

The AMA will engage state and national medical societies, as well as individual patients and physicians, throughout the negotiations through grassroots alerts, various AMA communications channels and Federation conference calls.

Nov 19, 2012

TMA Opposes New Chiropractic Board Rules

The Texas Board of Chiropractic Examiners (TBCE) is at it again. The board has lost numerous court battles with physicians over its attempts to expand chiropractors' scope of practice by passing a rule. This time, TBCE proposed a new definition of biomechanics, one of the keys to that profession’s statutorily prescribed scope.

Read all about it.

Nov 18, 2012

Soon, there will be more little Texans riding bicycles because some not-for-profits organizations give bikes to underprivileged children as a holiday gift. Help ensure they have a safe experience when riding their new bike by giving the gift of health: a helmet.

Find out how you can help make this happen.

Nov 17, 2012

Submit Immunization Data Electronically

Physicians can now use their electronic health record (EHR) to submit adult and pediatric immunization data to ImmTrac, Texas' immunization registry operated by the Texas Department of State Health Services.

Learn how

.

Nov 16, 2012

Change Coming to Your Medicare Claims Monday

Novitas Solutions takes over administration of physicians' Medicare claims in Texas and several surrounding states from TrailBlazer Health Enterprises on Nov. 19. It began handling Medicare claims for hospitals and skilled nursing facilities on Oct. 29.

Are you ready? Read more.

A Call-to-Action: Young Physicians, Join Your County and State Medical Society


By Tracey Haas, DO, MPH

Well, the election is over – and whether you’re red, blue or green, there’s a lot of work to do, and we physicians need to collaborate on the road ahead. This is true in the medical world now more than ever.

The upcoming interim meeting of the American Medical Association will certainly address some of these concerns – but whose voices are the delegates listening to?

There is no doubt that membership has been down over the past few years. It is unclear whether or not this is just a trend or due to a split in philosophies around health care reform and other hot issues. Regardless of the political climate and differing views, physicians must be at the table to be heard. Yes, many young physicians are joining large groups or choosing to be employed rather than own their practice, but this should not mean their choices default to those of their employers. Progressive change in medicine cannot come at the expense of passivity in our new doctors. More than ever our medical societies must step up to embrace this gradual shift in healthcare delivery models, while empowering the physician to speak up about the practice of medicine.

The future of medicine relies on participation. If physicians want to be heard, they must join and must speak. Medical societies have been around for over a century to bring the medical community together to do just that. With new membership from recent grads and the seasoned practitioners – medical societies must stay strong – and continue to help doctors stay focused on the issues and become inspired to speak up, stand up and get fired up! The change hasn’t happened – it is coming.

Let’s continue to be the voices of change for our profession, for our patients and for the reform we hope to see by participating at local, state and national levels.

Dr. Haas is a family physician in Austin and medical director of DocbookMd.

Nov 13, 2012

AMA House: Save Medicare, Help Employed Physicians, Stop ICD-10

HONOLULU -- The American Medical Association House of Delegates wrapped up its 2012 interim meeting this morning after taking significant action to address some of medicine's most pressing problems.

Dr. Lockhart

Delegates completed a multi-year plan by adopting a framework to transition Medicare to a defined contribution program that would allow beneficiaries to either buy coverage of their choice from a wide variety of plans or stay in the traditional Medicare system. Tyler anesthesiologist Asa Lockhart, MD, said change is needed because the current system is not working and not sustainable.

"We have coverage without access, which I view to be the most cruel situation of all," Dr. Lockhart said. "Defined contribution would allow of multitude of options and expand choice, but it would do it under the current federal Medicare funding levels."

Jason Sharp, MD, a newly hired interventional radiologist in Dallas, said he expects the new AMA Principles for Physician Employment to be very helpful for young doctors who, like him, are coming out of residency and fellowship with no training on the business side of medicine. "It will help us know what the game is, what the rules are ... how do I compare and contrast the offers I get, Dr. Sharp said.

Dr. Sharp

AMA Board of Trustees member Joe Annis, MD, an Austin anesthesiologist, said the principles cover such aspects of the employee-employer relationship as conflicts of interest, advocacy, contracting, hospital-medical staff relations, peer review and performance evaluations, and payment agreement. "The guidelines reinforce that patients’ welfare must take priority in any situation where the interests of physicians and employers conflict," Dr. Annis said.

After winning a one-year delay in the mandatory implementation of the ICD-10 coding system, AMA delegates voted to "vigorously advocate" with the Centers for Medicare & Medicaid Services to make the change permanent. Austin colon and rectal surgeon David Fleeger, MD, past chair of the TMA Council on Practice Management Services, said he is concerned about the time, cost, and "an inefficiency that goes on forever" if physicians are forced to use ICD-10 for coding and billing.

Dr. Fleeger

"It's the private practice doctor in small groups that's going to have the biggest problem implementing ICD-10," he said.

Dr. Fleeger said medicine will find itself up against hospitals, health plans, and technology vendors that have invested much time and money into ICD-10. "Those are opponents, and they are people with deep pockets," he said.

Nov 10, 2012

Quite Distinguished Indeed

HONOLULU -- Congratulations to former TMA President Mark J. Kubala, MD, winner of the 2012 American Medical Association Distinguished Service Award.

AMA President Jeremy Lazarus, MD,
(l) presents the Distinguished Service
Award to Mark Kubala, MD

Dr. Kubala, a neurosurgeon from Beaumont, has been active in organized medicine since his days as a medical student in 1968. He has been a member of the AMA House of Delegates, where he received the award Saturday, since 1994.

The Distinguished Service Award, established in 1938, is presented for "meritorious service in the science and art of medicine."

Dr. Kubala is not only a great member of organized medicine, an excellent surgeon, and a devoted husband, father, and grandfather, he is also a very fine individual. He is well-known for mentoring young physicians, and countless Texans speak of his kindness and generosity. This award is very well deserved.

Nov 5, 2012

Follow Tuesday's Election Returns here

Thanks to our friends at The Texas Tribune, we're tracking results from all the races with TEXPAC-endorsed candidates here. Check back throughout the night Tuesday for the latest numbers.

Nov 2, 2012

Healthy Vision 2020 - The Videos



Healthy Vision 2020, is the Texas Medical Association's strategic roadmap for state and federal advocacy initiatives for the remainder of the decade.

Says TMA President Michael E. Speer, MD, "As this report explains, we desperately need an unobstructed, clear view of the future of health care in Texas. Our growing population, beset by expensive acute and chronic diseases, doesn't have enough physicians to care for them now, let alone in the future. The legislature's view of the massive state Medicaid budget rarely extends beyond what it takes to balance this year's budget, let alone the next. Many physicians wish they could just shut their eyes to the deluge of new laws, rules, and regulations that keeps coming between them and their patients. But we cannot, even though the only thing certain is the coming uncertainty."

These short videos feature physicians' personal stories that illustrate the challenges they face ... and the solutions they face ... in caring for Texans.

For details, see the TMA website.

Nov 1, 2012

Medicare Payments Upon Transition to Novitas

Q. What will happen to any outstanding balances TrailBlazer owes physician — and vice versa — at the time of the cutover (Nov. 19, 2012) from TrailBlazer Health Enterprises to Novitas Solutions as the Medicare payment contractor for Texas?

A. Novitas will assume responsibility for these balances at the time of cutover and predicts no disruptions in payments.

Find out all the details.

Oct 31, 2012

Ranking Letters Coming From United

In late October, United Healthcare began sending letters to physicians in its network outlining their rankings in the insurer's Premium Designation program for 2013. The specialties involved in the program range from family practice to rheumatology.

Nov. 26 is the deadline to appeal your ranking before United posts it on its website.

Read more, including TMA's Basic Steps for Reviewing and Disputing Physician Rankings & Tierings.

Oct 30, 2012

TMA Membership Passes 46,000

Thank you so much! TMA membership recently passed the milestone of 46,000 and the year isn’t over yet. We are projecting ending 2012 near 46,500 members on our way to TMA President Michael E. Speer, MD’s, goal of 50,000. That means TMA remains the largest (and the best) state medical association in the country. The more members we represent, the stronger our collective voice, and the more we can accomplish for every Texas physician and the patients you serve.

Join or renew your membership today.

A Night to Remember


A ruined first-anniversary dinner for a husband-wife physician team led to the creation of DocBookMD, an exclusive HIPAA-compliant application for smartphone and tablet devices. Use DocbookMD to send HIPAA-compliant text messages bundled with photos of X-rays, EKGs, wounds and more.

Docbook co-founders Tim Gueramy, MD, and Tracey Haas, DO, tell their touching story. Find out more at www.texmed.org/docbookmd.

Sep 29, 2012

Novitas Posts E&M Score Sheets

E&M coding for Medicare exams can be quite confusing. But the Nov. 19 administrator transition from TrailBlazer Health Enterprises to Novitas Solutions is an opportunity to hit the ground running with new tools from your new Medicare Administrative Contractor – provided you familiarize yourself with them beforehand.

Find out how.

Sep 23, 2012

Physician Practice Quality Improvement Award Nominations Due Sept. 30

You have just about one week to nominate your practice for the 2012 Texas Physician Practice Quality Improvement Award.

2012 Texas Physician Practice Quality Improvement Award banner.

TMF Health Quality Institute has partnered with Texas Medical Association and Texas Osteopathic Medical Association to recognize physician practices statewide that are focused on providing exceptional preventive services and using health information technology in every day practice.

The Texas Physician Practice Quality Improvement Award program is available to any practice in Texas with one or more Texas-licensed physicians providing care for Medicare fee-for-service patients.

The 2012 Texas Physician Practice Quality Improvement Award criteria consist of four major components:

  • Adoption of health information technology
  • Regular use of population care management methods
  • Participation in data reporting quality initiatives
  • Top performance on nationally recognized clinical outcomes measures

Nominate your practice today.

Sep 17, 2012

Medicare E&M Audits Coming

The Centers for Medicare & Medicaid Services (CMS) gave Region C recovery auditor contractor (RAC) Connolly, Inc. the green light to begin auditing Medicare coding for CPT 99215 (evaluation and management [E&M]of an established patient) in physician offices in Texas and several other states.

Read more for the details we have so far on the audits and all the resources TMA offers to keep you out of coding hot water.

Aug 31, 2012

DocbookMD Enhances Care

A new mobile app, DocbookMD, addresses the many issues surrounding the convenience, speed, and legality of physician-to-physician communication. It's your latest membership benefit from TMA.

Read more and find out how to download the app on your smartphone.

Aug 30, 2012

Don't Leave $5,000 on the Table!

Physicians planning to participate in the Medicare Electronic Health Record (EHR) Incentive Program must begin their 90-days of meaningful use by Oct. 1 or they will forfeit $5,000 of the maximum $44,000 bonus. Physicians who begin the program in 2013 will be eligible only for $39,000 over the next four years.

Read more about the Medicare and Medicaid EHR incentive programs and what you need to do to qualify.

Aug 29, 2012

Can You Give Prompt Payment Discounts?

Giving patients “cash” discounts patients can be problematic. However, a carefully developed, written prompt payment discount policy could work for your practice.

Read more.

Aug 28, 2012

Identify Your Own Fraud and Abuse Red Flags

One way to help keep your practice operations squeaky clean and in compliance with fraud and abuse laws is to develop an internal set of warning indicators.

These might include:

  • Significant changes in the number and/or types of claim rejections and/or reductions,
  • Correspondence from carriers and insurers challenging the medical necessity or validity of claims, Illogical patterns or unusual changes in coding patterns or usage, and
  • High volumes of unusual charge or payment adjustment transactions.

Find out what you can do about it.

Aug 27, 2012

It's Official; It's Bad: ICD-10 Starts in 2014

Federal officials' decision to go ahead with the ICD-10 coding system does not improve patient care and only helps bureaucrats, Texas Medical Association President Michael E. Speer, MD, said after the Centers for Medicare & Medicaid Services (CMS) announced the new system would take effect Oct. 1, 2014. The ICD-10 announcement was contained in a news release about a CMS rule establishing a unique health plan identifier system officials say will save physicians time and money.

Read more of TMA's reaction.

Aug 21, 2012

Medicaid Infographic

JAMA has just published a Kaiser Family Foundation infographic entitled "Medicaid: Its Role Today and Under the Affordable Care Act." We reprint a low-resolution version below.You can download the high-resolution PDF from the JAMA website.


Aug 18, 2012

Doctor-Patient Battles West Nile Virus in Dallas

At the urging of area physicians, Dallas County declared a state of emergency and began aerial spraying yesterday to combat West Nile virus. Learn more about the dangers of the virus, its origins, how it is transmitted, and more by watching this informative video by DocDano. Dan McCoy, MD, interviews West Nile virus survivor and Dallas physician Don Read, MD.

Watch Dr. Read's compelling story and learn how he's using his personal experience to protect Dallasites from reliving his odessey.

Aug 17, 2012

You CAN Negotiate a Health Plan Contract

Many physicians assume that attempting to negotiate a health plan contract is hopeless — but that is a myth. New survey data from TMA shows that practices’ negotiation attempts are successful more often than not. Members report winning both payment and term changes in their contracts.

Read TMA's step-by-step advice.

Aug 16, 2012

Feds Begin Meaningful Use Audits

You’ve achieved meaningful use and received a federal electronic health record (EHR) system incentive payment. Next, you might get audited.

The Centers for Medicare & Medicaid Services (CMS) has begun auditing physicians who have received Medicare EHR incentive payments. The Garden City, N.Y., accounting firm of Figliozzi & Company is conducting the audits. Physicians being audited will receive a letter from Figliozzi on CMS letterhead.

Find out more.

Aug 15, 2012

TMLT Lowers Rates Again

The Texas Medical Liability Trust (TMLT) is reducing liability premiums an average of 4 percent for policyholders who renew in 2013. It is TMLT's 10th rate cut since 2004, following passage of the liability reforms TMA pushed through the legislature in 2003.

Read the details.

Aug 14, 2012

Medicare Fees Reward Some, Punish Others

Total Medicare payments to family physicians could increase 7 percent and fees for other physicians providing primary care could rise 3 to 5 percent, due mostly to a proposal to create new payment codes for outpatient discharge care management. Payments to some specialists would decrease in the Centers for Medicare & Medicaid Services' (CMS') proposed 2013 Medicare Physician Fee Schedule. However, unless Congress intervenes again, CMS will slash overall Medicare payments 27 percent next year because of the Sustainable Growth Rate formula.

Read more.

Aug 13, 2012

DPS Tracks Drug Shoppers

Physicians can check patients' controlled substance prescription history through the Texas Department of Public Safety's (DPS) new secure online Prescription Access in Texas (PAT) database. The program -- designed to reduce patients' prescription drug abuse -- allows physicians and police to go online to see what controlled substances a patient has been prescribed in the past year.

Read more.

Aug 7, 2012

TMLT Makes First Trust Rewards Payout

Arthur Brock, MD, and his wife Myrna enjoying retirement in Cape Coral, Florida. Dr. Brock retired in May 2012 and was one of the first physicians to receive a Trust Rewards payout from Texas Medical Liability Trust (TMLT).

Trust Rewards is TMLT’s nest egg program for enrolled policyholders. To learn more about the program, go to www.tmlt.org/trustrewards.

Aug 6, 2012

West Nile Webinar Today

An outbreak of the West Nile virus across Texas -- and especially in the Dallas-Fort Worth area -- prompted the Department of State Health Services (DSHS) to hold a free webinar, Nile Virus: An Update for Clinicians, from 5:30 to 6:30 pm CDT today, Aug. 6.

Read more and find out how to register.

Aug 1, 2012

TMLT Declares Dividend Again

Physicians who hold policies from the Texas Medical Liability Trust (TMLT) will save about $20 million in premiums in 2013, thanks to the TMLT Board of Governors' approval of a 15-percent dividend for policyholders who renew in 2013. TMLT says this is the eighth time it has declared a dividend, saving policyholders approximately $226 million since 2005.

See all the details.

Prepare for New Medicare Payer

Novitas will become the new Medicare carrier for Texas on Nov. 19, taking over from TrailBlazer Health Enterprises to administer Medicare claims for Texas and the six other states in Medicare Jurisdiction H (JH).

Here are some things you ought to do now to ease into the switch.

Jul 31, 2012

TMA: No Chiropractic Neurology

A state chiropractic board proposal to recognize a specialty it calls "chiropractic neurology" could deceive and harm patients, TMA warns in a formal letter to the board.

Read more.

Jul 17, 2012

Governor Perry Rejects PPACA Mandates

Railing against "brazen intrusions into the sovereignty of our state," Gov. Rick Perry told federal officials he opposes expanding Medicaid in Texas or creating health insurance exchanges, two key provisions of the Patient Protection and Affordable Care Act.

TMA President Michael E. Speer, MD, said the association is already at work developing an alternative approach to present to Governor Perry and the Texas Legislature. "I do not know what that system looks like … yet. But I do know we need to fix the system so poor patients can receive care. We need to win realistic payment rates, we need to reduce the stifling state bureaucracy, and we need to eliminate the fraud-and-abuse witch hunts."

Read more.

Texas Tops in EHR Incentive Payments

The Centers for Medicare & Medicaid Services says Texas leads the country in combined Medicare and Medicaid payments for adopting, implementing, upgrading, or demonstrating meaningful use of electronic health records. At the end of May, 7,119 physicians and other health care professionals and 321 hospitals had received more than $505 million.

Read more.

Jun 29, 2012

Patient Testimonials in Advertising OK?

Q. Is it permissible for physicians to use testimonials from satisfied patients to promote their practice?

A. While Texas Medical Board rules do not forbid their use outright, practices should be very, very careful when considering the use of a testimonial in an ad. Testimonials regarding a physician’s skill or the quality of the physician’s professional services may be misleading or deceptive and therefore unethical.

Read more -- and don't forget to check the Texas Medical Board website for current updates on its rules and policies with respect to this issue.

E-Prescribing Exemption Deadline Extended

Physicians now have until 10:59 pm on July 2 to apply for the e-prescribing hardship exemption to prevent a penalty in 2013 on Medicare allowable charges. The original deadline was June 30, but the Centers for Medicare & Medicaid Services extended it because of scheduled maintenance on the webpage where physicians must apply for the exemption.

Read more...

Jun 28, 2012

TMA: Reduce Health Law Red Tape

Now that the U.S. Supreme Court has upheld the Patient Protection and Affordable Care Act, Congress and the Obama administration must find a way to reduce the law's overbearing bureaucracy, said Texas Medical Association President Michael E. Speer, MD.

But, he added, "One thing today's ruling has not, and cannot, change is Texas physicians' deep commitment to care for our patients. The well-being of our patients comes first."

Read more.

Don’t Skimp on EHR Training

Some 60 percent of Texas physicians now use an electronic health record (EHR), according to TMA's latest survey data. However, dissatisfaction and discontent persist among some physician users of EHRs.

A recent report from AmericanEHR Partners indicates a direct correlation between physician satisfaction with EHRs and the amount of training they received. The report concludes it takes at least three to five days of EHR training for physicians to achieve the highest level of overall satisfaction. Nearly half of survey respondents indicated they received three or fewer days of training.

Read more.

Jun 27, 2012

Comptroller Offers Franchise Tax Amnesty

Haven't paid your 2012 state franchise tax yet? You have until Aug. 17 to do so and avoid penalty and interest under the State Comptroller's limited amnesty program.

Log on to the comptroller's Project Fresh Start website to find out what you need to do.

Jun 18, 2012

Another Texan Takes the Helm of AMA Alliance

Mrs. Red

CHICAGO -- Ninety years ago, Mrs. Samuel Clark Red -- wife of an influential and well-known Houston surgeon -- helped convince the American Medical Association to establish the Women's Auxiliary. Mrs. Red became the first president of the auxiliary.

Now known as the AMA Alliance, the organization celebrated its 90th anniversary with the installation of yet another great Texas woman -- Pat Hyer of Fort Worth -- as its 89th president. She becomes the third Texan, in fact the third from Fort Worth, to hold that office in less than a decade.

TMA President Michael Speer, MD, heaped praise on Pat at the anniversary party, as she recounted some of the early days of the organization.



By the way, here's the text of the resolution the AMA House of Delegates approved in St. Louis in 1922 creating the Women's Auxialiary to the American Medical Association:

"The object of this auxiliary shall be to extend the aims of the medical profession through the wives of doctors to the various women's organizations, which look to the advancement in health and education; also to assist in entertainment at all medical conventions and to promote acquaintanceship among doctors' families that closer professional fellowship may exist."

What About a "Soda Tax"?

CHICAGO -- For two years now, the AMA Council on Science and Public Health has proposed that the American Medical Association adopt a "soda tax" or "sugar tax" as one of its primary weapons against America's obesity epidemic. For two years in a row, the AMA House of Delegates rejected the proposal.

This year, the council decided to take a more moderate approach, saying "taxes on beverages with added sweetners are one means by which consumer education campaigns ... could be financed."

Council member Russ Kridel, MD, of Houston, explains the idea and why every little bit helps in the battle against the bulge.




Here's the full text of the Council on Science and Public Health recommendation:

Our American Medical Association (AMA) recognizes the complexity of factors contributing to the obesity epidemic and the need for a multifaceted approach to reduce the prevalence of obesity and improve public health. A key component of such a multifaceted approach is improved consumer education on the adverse health effects of excessive consumption of beverages containing added sweeteners. Taxes on beverages with added sweeteners are one means by which consumer education campaigns and other obesity- related programs could be financed in a stepwise approach to addressing the obesity epidemic.

Where taxes on beverages with added sweeteners are implemented, the revenue should be used primarily for programs to prevent and/or treat obesity and related conditions, such as educational ad campaigns and improved access to potable drinking water, particularly in schools and communities disproportionately effected by obesity and related conditions, as well as on research into population health outcomes that may be affected by such taxes.

Texans Take Charge at AMA House

David Teuscher, MD

CHICAGO -- The Texans, it seemed, were everywhere at the AMA House of Delegates meeting Sunday. From Sue Bailey, MD, on the dais as vice speaker to Texas physicians serving on -- and running -- reference committees to Texans offering testimony and introducing resolutions to the traditional chili reception for Texas candidates for AMA office, the Lone Star twang was thick in the Windy City.

Beaumont orthopedic surgeon David Teuscher, MD, launched the Texas show as he laid out a resolution that would combine AMA's three yearly meetings into two, with the House of Delegates meeting once a year in Washington to advance the association's lobby agenda. "I want to see a sea of white coats at the Capitol," Dr. Teuscher said. The resolution calls on the AMA Board of Trustees to report in six months "on the logistics of inviting all American physicians, spouses, patients, and leaders, and members of state and specialty societies to particiapted in the newly reformatted annual advocacy meeting in Washington."

Drs. Gary Floyd of Fort Worth and Bob Morrow of Sugar Land presented TMA's three other resolutions.




Three Texas physicians served on House of Delegates reference committees, which take testimony on all reports and resolutions and then make recommendations for the full house to consider later in the week.

Lyle Thorstenson, MD, an ophthalmologist from Nacogdoches and chair of the Texas Delegation to the AMA, continued his two-year service as chair of the Reference Committee on AMA Finance and Governance. Needville family physician Art Klawitter, MD, and John Gill, an orthopedic surgeon from Dallas, both sat on the Reference Committee on Legislation.


The Texas chili reception proved to be quite the hot event, as hundreds of delegates and their families stopped by for a bowl of the red or a Frito pie and to meet the Texas candidates. Dallas pediatrician Carolyn Evans, MD is running for the AMA Board of Trustees. Asa Lockhart, MD, an anesthesiologist from Tyler, is seeking a seat on the AMA Council on Medical Service. Elections are Tuesday morning.



Dr. Carolyn Evans and family

Chili Chef Ray Callas, MD

Dr. Asa and Joy Lockhart greet a guest

Jun 17, 2012

Texans Bring Agenda to AMA Meeting

CHICAGO -- Health system reform, errors caused by entering orders on computers, electronic health records (EHRs), and change in the American Medical Association meeting schedule are the subjects of four resolutions the Texas Delegation to the AMA brought to the AMA Annual Meeting June 16-20 in Chicago. The TMA House of Delegates approved the resolutions at TexMed 2012 last month.

The resolutions ask AMA to:

  • Be ready to work for new health system reforms if the Supreme Court throws out the Patient Protection and Affordable Care Act (Resolution 239);
  • Study the potential increase in errors caused by hospitals and clinics adopting computerized physician order entry systems and suggest possible alternatives (Resolution 721);
  • Analyze the current cost and/or benefit of implementing an EHR system to determine if it produces a financial return and improves quality of care, and advocate that those who benefit the most financially share fairly in the implementation costs (Resolution 722); and
  • Revise AMA meetings to make them more efficient (Resolution 612).

Reference committee hearings on these and more than 100 other reports and resolutions begin today in Chicago. The full house will vote on them June 18-20.

Bailey Wins; Evans and Lockhart Aim for AMA Posts

CHICAGO -- One familiar Texas face earned a rousing -- and unopposed -- reelection at the 2012 Annual Meeting of the American Medical Association House of Delegates Saturday as two other Texas physicians launched their campaigns for AMA leadership positions.

Former TMA President Sue Rudd Bailey, MD, was unanimously re-elected vice speaker of the American Medical Association House of Delegates. David Savage, a medical student from Houston, nominated Dr. Bailey.




Meanwhile on Saturday, Dallas pediatrician Carolyn Evans, MD, announces her candidacy for the AMA Association Board of Trustees. Four candidates, including one incumbent, are seeking two open spots on the board. And Asa Lockhart, MD, an anesthesiologist from Tyler, is one of five candidates, including one incumbent, running for two open seats on the AMA Council on Medical Service. Election Day is Tuesday, June 19, 2012.

Jun 16, 2012

Savage Wins AMA Student Post

CHICAGO -- Congratulations to David Savage, a third-year MD/PhD student at the University of Texas Houston Medical School. David was elected speaker of the American Medical Association Medical Student Section Assembly.

Jun 15, 2012

Humana Drops Medicare Advantage Physicians

Humana notified about 200 Texas physicians it is removing them from its Medicare Advantage network on Jan. 1. Humana began sending letters to physicians on June 1 telling them that claims data indicate their practices do not meet its cost and/or quality measures.

Read more.

Jun 14, 2012

Be Sure to Use G Code for E-Prescribing

TMA has heard from practices who expected to reap a Medicare incentive payment — or avoid a penalty — by e-prescribing. But because they failed to report the electronic prescriptions using G-code G8553, Medicare did not recognize their e-prescribing claims.

Read more.

HIPAA 5010 Takes Effect July 1

The HIPAA 5010 grace period ends June 30. Starting July 1, if you do not file your electronic claims under the Health Insurance Portability and Accountability (HIPAA) 5010 transaction standards, Medicare, Medicaid, and other health plans will reject the claims.

Read more.

Jun 4, 2012

TMA, TPS Back Woman in Lactation Dispute

A Houston federal judge was wrong when he ruled against a woman who says her employer fired her because she wanted to pump breast milk, TMA and the Texas Pediatric Society (TPS) contend in a brief filed with the Fifth Circuit U.S. Court of Appeals. They urge the appeals court to overturn an opinion by U.S. District Judge Lynn Hughes that childbirth ends pregnancy-related medical conditions and that Title VII of federal law does not protect women from being discriminated against or fired for lactation and breast pumping.

Read more.

May 31, 2012

TMA to Congress: No Sneak Torts

TMA, the Texas Medical Liability Trust, and other liability insurers are asking Congress to make sure the Patient Protection and Affordable Care Act (PPACA) does not create new theories of liability or alter the rules governing medical professional liability lawsuits. They wrote the chair and ranking minority member of the House Energy and Commerce Committee that they support HR 816, The Provider Shield Act, sponsored by U.S. Reps. Phil Gingrey (R-GA) and Henry Cuellar (D-Laredo).

Read more ...

May 25, 2012

Medicare Enrollment Now Has 60-Day Lead Time

Good news: Physicians now can submit Medicare enrollment applications 30 days sooner than before. You may submit CMS-855 enrollment applications and Internet-based Provider Enrollment, Chain and Ownership System (PECOS) applications 60 days prior to the effective date (previously, it was 30 days prior).

More details ...

TMA Staff Averts Medicaid Claims Nightmare

When the claims clearinghouse Availity inadvertently cut its connection to the Texas Medicaid & Healthcare Partnership (TMHP) last month, more than 30,000 claims totaling $23 million filed by physicians and other healthcare professionals in just four days were in danger of disappearing. And the number of claims was increasing by the hour.

But Availity knew who to call -- Genevieve Davis, director of TMA's Payment Advocacy Department. She notified TMA Director of Government Affairs Helen Kent Davis, who immediately found someone at TMHP who could help resolve the issue.

Read more ...

May 24, 2012

U.S. Physician Compensation Among Lowest

The United States may have a reputation for having one of the most expensive health care systems in the world, but it apparently is not because of physician payments. According to a study released in May by Jackson Healthcare, physician compensation in the United States is among the lowest of the major western nations.

May 21, 2012

What Happens in Dallas ... Affects All of Texas

In case you missed, forgot, or just want to catch up on the highlights of TexMed 2012 in Dallas last week, here's a short recap. (We''ll have full coverage in the July 2012 issue of Texas Medicine. For photos, quips, and comments, check out the #TMAmtg Twitter stream.)

Incoming TMA President Michael E. Speer, MD, delivers
his installation address.
(Image courtesy of Susan Rudd Bailey, MD)

Houston Pair Take Reins as New Leaders of TMA and Alliance

Neonatologist Michael Speer, MD, and longtime political activist Linda Adkins – both of Houston – are the new presidents of TMA and the TMA Alliance. Dr. Speer was installed as TMA’s 147th president and Mrs. Adkins as the 95th TMA Alliance president at TexMed 2012 in Dallas. Dr. Speer told the TMA House of Delegates that his goal is to increase TMA membership from nearly 46,000 to 50,000 by the end of his one-year term. “Because the more physician boots on the ground and the more physician voices in the air when discussing medical issues with mothers, fathers, grandfathers, grandmothers, aunts, cousins and … by the way … legislators, the more we are heard, and respected,” he said. “Go out and multiply.”

Delegates Establish Legislative Priorities for 2013

Wading through a lengthy handbook of reports and resolutions, the House of Delegates set Smoke-Free Texas, more residency slots, and restored funding for the Texas Physician Education Loan Repayment Program and the Statewide Preceptorship Program as priorities for the 2013 legislative session. Among the other highlights, the house:

  • Asked for restoration of funding for the state family planning program and Texas Women’s Health Program;
  • After extensive debate, voted to study whether general hospitals in urban counties should have a physician on-site to respond to emergencies 24 hours per day, seven days per week;
  • Said only licensed physicians or their appropriately supervised physician assistants or advanced practice nurses should conduct athletics-participation physicals for Texas school children;
  • Set policy to make Medicare’s Value-Based Purchasing program fair and financially sound;
  • Adopted a new plan to help physicians who belong to inactive county medical societies;
  • Supported efforts to prevent elective deliveries prior to 39 weeks of gestation;
  • Said TMA should work to require allied health professionals to clearly display proper identification;
  • Called for new regulations against, and education about, the dangers of distracted driving;
  • Said the state should use only scientifically accurate information in the brochure physicians must give to all patients requesting an abortion, and lawmakers should reduce the loss-of-license penalty for physicians who do not comply with the new abortion-sonogram law; and
  • Adopted strong new policy to protect clinical training opportunities for Texas medical students.
Medical students from the Paul L. Foster School of Medicine
in El Paso with Gilberto Handal, MD, at TMA Border Health
Caucus meeting. (Photo courtesy David Palafox, MD)

Dr. Brotherton Leads Pack of Newly Elected TMA Leaders

In one of the day’s few uncontested elections, the House of Delegates unanimously chose Fort Worth orthopedic surgeon Steve Brotherton, MD, as TMA president-elect. Dr. Brotherton, who has served as speaker and vice speaker of the house for seven years, will be installed as TMA president at TexMed 2013 in San Antonio. In other election results, delegates:

Abilene’s Virginia Boyd Connally, MD, Earns for Distinguished Service Award

At age 99, Virginia Connally, MD, has certainly kept her sense of humor. Taking the stage to receive TMA’s 2012 Distinguished Service Award after Abilene ophthalmologist Paul Thames, MD, read a lengthy history of her accomplishment, Dr. Connally said, “If I could hear what he said, I’d be blushing.” The trailblazer was the first female physician in Abilene, practicing as an eye, ear, nose, and throat doctor for 42 years. Other awards bestowed at TexMed 2012 include:

  • Former TMA President Josie Williams, MD, won the Young Physician Section’s Young at Heart award;
  • Waco family physician Jackson Griggs, MD, received the J. T. “Lamar” McNew, MD, award from the Resident and Fellow Section;
  • The Medical Student Section (MSS) gave its C. Frank Webber, MD, award to Steve Robinson, MD, a family physician from Lubbock;
  • Texas Tech University Health Sciences Center won the MSS Chapter of the Year Award; and
  • MSS Student of the Year was Alexandra Iacob, from the University of Texas Medical School at Houston.

Is Our Vision Clear Enough for You?

We distributed the first draft of TMA’s Healthy Vision 2020, the strategic roadmap for our state and federal advocacy initiatives for the remainder of the decade, at TexMed 2012. But this is the first draft, and we are already at work making it better. We want your ideas, suggestions, and improvements. A blog has been established at www.texmed.org/vision to allow members of the TMA official family to add comments and suggestions, which will be incorporated into later versions of the document. Please read Healthy Vision 2020 and give us your feedback.

Six Science Teachers Win Butler Awards for Excellence

Teachers who inspire students’ love of science got some love of their own at TexMed 2012. Six of them received TMA Ernest and Sarah Butler Awards for Excellence in Science Teaching, which include cash prizes for them and their schools. “These dedicated educators help create the physicians of tomorrow by inspiring students of today with the possibilities available in the field of science,” Dr. Speer said as he presented the awards. First-place winners are Paula Bagwell of Belmar Elementary School in Amarillo, Elizabeth Klammer of St. John’s Episcopal School in Dallas, and Matthew Wells of Cypress Lakes High School in Katy. Second-place winners are Jo Williams of Spicewood Elementary in Austin, Elizabeth Freeman of Westwood Junior High in Dallas, and Kimberly Beck of Seymour High School in Seymour.

Nine Minority Medical Students Receive Scholarships

Now in its 13th year, the TMA the Minority Scholarship Program has awarded 74 scholarships totaling $370,000 since 1999. That includes the nine most-recent winners, announced at TexMed 2012. The scholarship encourages minority students to enter medicine by lightening the financial burden of medical school.
As proud as we are of the winners, I want to use this space to thank the individuals and organizations who underwrote this year’s scholarships: Wendell Daniels, MD, of Longview; Betty and Mark Kubala, MD, of Beaumont; Alan and Sarah Losinger of Dallas; Cecilia and Tim Norwood, MD, of Dallas; Susan M. Pike, MD, and Harry T. Papaconstantinou, MD, of Georgetown; Irvin Robinson, MD, of Fort Worth; Charli and Jim Rohack, MD, of Bryan; Dana and Jamie Ronderos, MD, of Frisco; Cathy Scholl, MD, of Austin; the Bell, Dallas, El Paso, Hidalgo-Starr, McLennan, Midland, Nueces, Tarrant, and Travis county medical societies; Harris County Medical Society/Houston Academy of Medicine; Blue Cross and Blue Shield of Texas; HEB; and the Khushalani Foundation of Humble. Thank you all very much.

May 14, 2012

TMA Wants ICD-10 Canned

TMA is glad the federal government postponed adoption of the ICD-10 coding system until 2014 but believes it should skip ICD-10 for a more up to date coding system. If officials don't do that, then they should delay ICD-10 even longer. That was the message TMA delivered in a letter to U.S. Health and Human Services Secretary Kathleen Sebelius on May 11.

May 3, 2012

Medical Emergency Continues for Dual Eligibles



A state budget cut to patients who rely on Medicare and Medicaid for their care is devastating physician practices and putting patient care in jeopardy. Texas Medical Association (TMA) President C. Bruce Malone, MD, on Wednesday told Rio Grande Valley physicians that TMA continues to work on the problem.

“We hear your urgent stories and feel your and your patients’ pain,” said Dr. Malone during his second meeting with Valley area physicians about the medical emergency the cut is creating. He added that the cut is harming access to care across Texas.

Cameron-Willacy County
Medical Society members
meet to discuss the
dual-eligibles policy

Physicians are reeling from a 20-percent state budget cut for “dual-eligible” patients, which went into effect Jan. 1. Dual-eligible patients qualify for Medicare and are eligible for Medicaid assistance.

In a the video above, Alvin family physician Dale L. Messer, MD, says the cut is “squeezing” his medical practice of more than 40 years. He estimates about half of the people he sees are dual-eligible patients. More than 300 of his patients reside in nursing homes.

With so many dual-eligible patients, he worries that eventually the cut will leave them without health care.

“I haven’t been paid for six months. We’ve taken my personal savings out because we were short [to pay his staff and office overhead],” said Dr. Messer. “I’m not saying it’s all due to that Medicaid cut, but it’s true.” He also has taken out loans to make payroll.

“I feel sorry for the older people,” he adds. “It isn’t just me that’s being affected, it’s all these older people — my patients.”

Javier Saenz, MD, from La Joya is struggling to keep his practice open to patients as well. In addition to the 20-percent budget cut, his and other doctors’ payments have been delayed because the state and federal government experienced computer glitches the first three months of the year. Dr. Saenz had to borrow money twice this year to keep his office open. TMA has heard similar stories from physicians from Lubbock to Nacogdoches, El Paso to Brownsville, and in Houston.

“We hope lawmakers take action to mitigate the cut so physicians can continue to care for Texas’ elderly — and often sickest — patients,” said Dr. Malone. Earlier this week, Texas Health and Human Services Executive Commissioner Tom Suehs told lawmakers that “unintended consequences” have arisen from the cuts. He plans to propose a solution to state budget officials by the end of May.

Dr. Malone hopes so. “Relief for these physicians and patients cannot happen too soon,” he said.


Apr 24, 2012

Report: Texas Medical Residency Slots Not Keeping Up

NOTE: The Texas Tribune reports on a new study from the Texas Higher Education Coordinating Board that our state continues to slip in terms of having enough residency slots to keep pace with our intentional effort to increase medical school class size. This is a critical issue for Texans. The lack of enough physicians to keep up with growing demand (from our growing population, or aging population, and the requirements of the Affordable Care Act) is a huge concern for TMA and Texas physicians.


by Emily Ramshaw, The Texas Tribune

Responding to calls to meet the state’s physician shortage, Texas medical schools have increased their enrollment by roughly 30 percent in the last decade. But the slots available for students to complete their medical residencies in Texas are not keeping pace, according to a new report from the Texas Higher Education Coordinating Board.

The report — commissioned by lawmakers in the last legislative session, and going before the coordinating board for approval tomorrow — found that without an increase in the number of first-year residency positions, at least 63 graduates of Texas medical schools will not be able to enter a Texas residency program in 2014. By 2016, the shortfall will nearly triple to 180. Research shows that if Texas medical students leave the state for their residency, they’re far less likely to return, meaning the state’s investment in their first four years of medical education — a total of $168,000 per student —  “will not benefit the state.”

According to the report, in 2011, Texas had more than 550 residency programs, offering a combined 6,788 residency slots. By 2014, Texas will need 220 more residency positions in order to have one for every Texas medical school graduate.

Despite some federal funding and limited state financing, the bulk of the cost for training these students — estimated at $150,000 per student per year — falls to the residency programs, many of which are cash-strapped themselves.

The report recommends that the Legislature provide an additional $11.7 million in funding in the 2014-15 biennium to support “10 percent of the cost for new first-year entering residency training positions” — but only if funding is available. Considering Gov. Rick Perry’s vow to further curb state spending, finding money for residency slots isn’t likely to be a priority. 


This article originally appeared in The Texas Tribune at http://www.texastribune.org/texas-education/higher-ed-coordinating-board/report-texas-medical-residency-slots-not-keeping/.

Apr 13, 2012

TMLT Enhances Medefense Coverage

Texas Medical Liability Trust (TMLT) policies covering individual physicians include the Medefense Endorsement, which provides reimbursement for legal and tax audit expenses for disciplinary proceedings.


The endorsement covers:

  • Review actions by the Texas Medical Board (TMB);
  • Hospital actions regarding clinical privileges;
  • Actions by the Texas Department of State Health Services or the U.S. Department of Health and Human Services;
  • Non-compliance with Medicare/Medicaid regulations, including the Recovery Audit Contractor Program;
  • Proceedings alleging violations of EMTALA, HIPAA, or Stark Laws; and
  • Federal tax audits.

Apr 12, 2012

Appeals Court Backs TMA in Chiro Lawsuit

Texas chiropractors may not perform needle electromyography (EMG) or manipulation under anesthesia (MUA), the Third Court of Appeals ruled earlier this month. The 58-page appellate court decision supports arguments from TMA and the Texas Medical Board that the Texas Board of Chiropractic Examiners exceeded its legal authority when it adopted rules allowing chiropractors to perform needle EMGs and MUA.

Apr 2, 2012

Aetna Deselecting 130 Texas Physicians

Aetna has notified 130 Texas physicians it will terminate them from its networks on July 1, TMA's Payment Advocacy Department has learned. Aetna says it told the physicians a year ago it was concerned about their billing patterns. Evaluation and management (E&M) codes were the only ones Aetna examined, and its concern involves primarily levels 4 and 5 E&M codes.

Mar 29, 2012

Medicine Warns of Brewing Regulatory Storm

Physicians face an "imminent storm" of mass confusion caused by overlapping regulatory mandates and reporting requirements from multiple federal programs unless federal officials do something to prevent it, TMA and other state and national medical societies warn in a letter to Centers or Medicare & Medicaid Services (CMS) Acting Director Marilyn Tavenner.

The groups are concerned about regulations and penalties associated with the value-based modifier, about penalties under the electronic prescribing program, Physician Quality Reporting System and electronic health record incentive program, and about the transition to the ICD-10 coding system.

Mar 28, 2012

McAllen Crowd Rallies to Stop Medical Emergency



Hundreds of patients and their doctors joined forces Tuesday in McAllen, Texas, urging state legislators to rescind budget cuts that are harming access to care for thousands of dual-eligible patients —  those who qualify for both Medicare and Medicaid.

Texas’ new payment policy on services doctors provide to these patients has created a medical emergency across the state. The problem has been particularly acute in the Rio Grande Valley, where severe poverty makes many Medicare patients eligible for Medicaid as well.

As a result of the new policy, many doctors face financial ruin, and their most vulnerable patients may lose their doctor. TMA President Bruce Malone, MD; Hidalgo-Starr County Medical Society President Victor Gonzalez, MD; and TMA Board Vice Chair Carlos Cardenas, MD, discussed the severity of the crisis at the huge rally and news conference. The physicians encourage everyone to sign the Medical Emergency petition urging the state to reverse its decision.



Mar 21, 2012

Live from McAllen: TMA House Call on Dual Eligibles

The state's new payment policy on services physicians provide to patients who are eligible for both Medicare and Medicaid coverage has prompted outrage from doctors all across the state. The problem has been particularly severe in the Rio Grande Valley, where severe poverty makes a lot of Medicare patients eligible for Medicaid as well.


On Tuesday, March 27, 2012, from 7 to 9 pm (CT), TMA and the Hidalgo-Starr County Medical Society are hosting a House Call for physicians to express their concerns on this issue. This is a meeting between physicians and the Texas Health and Human Services Commission and Texas legislators. Watch a live streaming broadcast of the House Call here or go to our UStream page.






Live video for mobile from Ustream

NOTE: This works a whole lot better on Firefox or Chrome browsers than it does on Internet Explorer.

NOTE 2: You have to come back Tuesday night between 7 and 9 pm to watch the live stream. Otherwise, you can see the video of our 2009 McAllen House Call on health system reform.

Mar 14, 2012

TMA Urges IPAB Repeal

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.

Sign the Petition to Stop the Dual-Eligible Disaster



Medical Emergency Threatens Most Vulnerable Texas

Mar 13, 2012

ERS to Switch to United

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.

Mar 12, 2012

5010 Enforcement Grace Period About to End

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.

Mar 9, 2012

Dual-Eligible Glitches Fixed; Misguided Policy Remains

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.

State Cuts Squeezing the Elderly Poor and Their Doctors

From today's New York Times:

Texas has cut its share of co-payments for such patients, and Dr. Javier Saenz's practice is suffering.

Mar 8, 2012

TMA Cancer Conference April 27

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.

Medical Emergency Threatens Most Vulnerable Texas Elderly and Physicians Who Care for Them

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."

Mar 7, 2012

HIEs Active in Texas

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.

Mar 6, 2012

AMA Joins TMA in Hospital Lawsuit

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.

Mar 5, 2012

Medical Board Will Consider Drug Shortages

Drug shortages and drug storage are mitigating factors in Texas Medical Board (TMB) investigations of physicians who use expired drugs, the board says.


TMB spokesperson Leigh Hopper said the board recently heard from a physician about a case in which doctors had to use expired emergency drugs to resuscitate a patient, thus raising the question of whether the board would consider the use of expired drugs a violation of the standard of care.

Mar 1, 2012

Rejected Medicare Claims May Have a Linkage Problem

With the implementation of the HIPAA 5010 standard for submitting electronic claims, some practices are running into a “linkage problem” with Medicare claims, which results in rejected claims.

This error will appear on your 277 Claims Acknowledgement as a 496 edit (submitter not approved for electronic claim submissions on behalf of this entity) in the message “A8:496:85.” TrailBlazer Health Enterprises says this edit can result from one of two types of errors, which you can correct on your end.

Feb 29, 2012

Bills Would Repeal IPAB

With Medicare's Sustainable Growth Rate still in effect, the U.S. House of Representatives is considering legislation to repeal another federal mechanism to drive down Medicare payments to physicians – 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 fees to physicians if federal spending on health care reaches certain levels.

Feb 25, 2012

Get CME Easier From TMA Education Center

Something good is now even better. TMA's practice management, cancer, and physician health courses are now easier than ever for you to find online. The new TMA Education Center offers convenient, one-stop access to the continuing medical education (CME) Texas physicians need. Log in using your TMA website user name and password to automatically receive member pricing.

"We are especially excited about the center's mobile-friendly capability," said Carl O. Trusler, MD, chair of the TMA Council on Practice Management Services. "You can start an online course on your office computer, and finish it at home on your iPad or smart phone. You can take up where you left off.

Feb 24, 2012

Making Meaningful Use Meaningful

Don't lose out on your Medicare or Medicaid incentive payment for meaningful use of an electronic health record (EHR). For physicians who qualify, reaching meaningful use can mean up to $63,750 in incentives from Medicaid or $44,000 from Medicare.

Turn to TMA's Meaningful Use Achievement Toolkit for detailed instructions about what you must do, specific to your EHR product, to meet any one of the 25 meaningful-use criteria defined by the Centers for Medicare & Medicaid Services.

Feb 23, 2012

Penalized for Not E-Prescribing in 2011?

To prevent a 2012 penalty, physicians should have successfully e-prescribed 10 times and reported G8553 on the claim form before June 30, 2011. Physicians also could have filed for an exemption with the Centers for Medicare & Medicaid Services (CMS) before Nov. 7, 2011.


Some physicians did take the required action but CMS penalized them anyway. If you are one of them, here are two possible reasons.

Feb 16, 2012

United UCR Lawsuit Payments Coming

Physicians who filed claims against UnitedHealthcare in the lawsuit over its usual, customary, and reasonable (UCR) claims payment system will soon receive payments. A federal judge has approved the release of payments from the 2009 settlement of the case. Physicians are expected to receive $200 million of the $250 million settlement fund.

Feb 14, 2012

Exhibit Honors Pioneer Texas Black Physicians

The struggles of early African-American physicians in Texas are on display on the TMA website in the exhibit "Courage and Determination — A Portrait of Pioneering African-American Physicians in Texas."

Tell Congress to Fix the SGR

It's SGR crunch time again. In about two weeks, the Sustainable Growth Rate (SGR) formula will drive a 27.4-percent cut in physicians' Medicare payments unless Congress steps in first. Hopes that Washington would finally repeal the SGR seem to wax and wane daily, as the issue is tied up with the partisan debate over extending Social Security tax cuts and extending unemployment benefits.

One thing we know for sure is that members of Congress react to real stories from their constituents far more than to form letters or emails. You have an excellent story to tell. You know what the constant threat of the Medicare Meltdown has meant to your patients and your practice. Please pick up the phone today and share your story with Sens. John Cornyn (202) 224-2934 and Kay Bailey Hutchison (202) 224-5922, and your representative. See the TMA Grassroots Action Center for the number.

Feb 13, 2012

TMA Teaches ICD-10 Essentials

The ICD-10 code sets will soon be medicine's new coding language. Is your practice ready to take on the challenge?

Preparing for ICD-10 is more than learning a new code set and upgrading office technology. Start your smooth and successful transition to ICD-10 by attending TMA's half-day seminar "ICD-10 Essentials."

TrailBlazer Review Causes Claims Denials

The Centers Medicare & Medicaid Services has ordered all of its contracting administrators to review Medicare Part A/B claims for completeness and documentation related issues. Trailblazer, the administrator for Texas, announced late last year it would review knee and hip joint replacement surgery, among other procedures. Trailblazer says its review showed cases where the necessary information is missing or the documentation is otherwise insufficient. This means TrailBlazer will deny payment for both Part A and B services and ask physicians subject to the review to return any amount already paid for the service.

Feb 10, 2012

Sonogram Law Enforcement Begins

State health officials began enforcing the state's sonogram law Feb. 6 after a federal judge in Austin reluctantly dismissed a lawsuit challenging it. Texas Health Commissioner David Lakey, MD, notified physicians that the Department of State Health Services (DSHS) will review physicians' documentation to make sure they comply with the law.

Feb 9, 2012

Chiropractic Board Withdraws Scope Rules

Ongoing opposition from TMA and others to the Texas Board of Chiropractic Examiners' (TBCE) attempts to expand chiropractors' scope of practice caused the board to shelve those plans. The board's executive director said the board intends to stay within its statutory authority in the future. The proposed rules, that would have permitted chiropractors to perform some procedures that state law only allows physicians to perform, were withdrawn.

Feb 8, 2012

Texas Suffers in GME Redistribution

Texas was one of the biggest losers in the federal government's August 2011 redistribution of unused Graduate Medical Education (GME) positions eligible for Medicare GME funding, a TMA analysis found. The state lost 50.08 Direct Graduate Medical Education slots and 39.8 Indirect Medical Education positions from 21 hospitals.

The TMA Council on Legislation and Council on Medical Education are working to identify opportunities for educating state legislators before the 2013 legislative session about the need to grow GME and the important role of state government in facilitating this process. TMA is planning a legislative forum this year to educate legislators about the critical role of GME in meeting the state’s physician workforce needs.

Feb 2, 2012

New Patient Visit Not “Incident-to”

If a new Medicare patient comes into the office and sees the physician assistant (PA) only, can we bill Medicare for the PA’s services as “incident to” the physician?


Get the answer to this and many other coding questions from TMA Practice E-Tips.

Feb 1, 2012

One Month Left to Claim 2011 Medicare Incentive Payment

Physicians have until Feb. 29, 2012, to register and attest to meeting meaningful use requirements to receive payments for 2011 through the Medicare & Medicaid EHR Incentive Program Registration and Attestation System.

Feb. 29 also is thedeadline to submit any pending Medicare Part B claims from 2011.

Jan 31, 2012

Use War Money for Medicare

Texas Medical Association joined the American Medical Association and dozens of other state and national medical organizations in urging Congress to permanently stop the fiscally irresponsible cycle of scheduled cuts and short-term patches to Medicare physician payments.

In a letter to U.S. Rep. Dave Camp (R-Michigan), chair of the House Ways and Means Committee, physician groups called for an end to the failed Sustainable Growth Rate (SGR) formula that threatens access to care for seniors and military families in the Medicare and TRICARE programs. They asked Congress to use projected spending that will not be needed as the wars in Iraq and Afghanistan wind down to help pay for ensuring access to health care for military and seniors.

Jan 30, 2012

Physicians Need to Lead Innovation in Health Care

Nancy Nielsen, MD, PhD, discussed the latest in care and payment innovation at the TMA 2012 Winter Conference.


"We're seeking ideas that make sure we do coordinated care better," Dr. Nielsen said. She referred interested physicians to http://innovations.cms.gov/.


Dr. Nielsen is the senior adviser to the Center for Medicare and Medicaid Innovation and past president of the American Medical Association.

TMA, ACS Join Cancer Study

TMA and the American Cancer Society teamed up in a landmark study aimed at reducing the impact of cancer. The goal of the Cancer Prevention Study-3 (CPS-3) study is to enroll men and women from various racial/ethnic backgrounds from across the U.S. to help researchers better understand the lifestyle, environmental, and genetic factors that cause or prevent cancer, and to save lives.

Jan 29, 2012

Texans Tops in Meaningful Use

More Texas physicians are meeting federal meaningful use criteria in adopting electronic health records than in any other state, according to an analysis of Centers for Medicare & Medicaid Services data by the Institute for Health Technology Transformation.