Nov 18, 2013

Two Outstanding Texans Honored by AMA

WASHINGTON, DC - Two stalwart members of the Texas family of medicine were honored at the AMA House of Delegates meeting.

AMA President Ardis Hoven, MD,
and Dr. Mattox

Houston trauma surgeon Ken Mattox, MD, received the 2013 AMA Benjamin Rush Award for Citizenship and Community Service. The award is given “for outstanding contributions to the community for citizenship and public service above and beyond the call of duty as a practicing physician.”

Dr. Mattox was recognized for his service in Houston’s medical response to several natural disasters, including Hurricanes Katrina and Rita in 2005 and Tropical Storm Allison in 2001. As part of the Katrina Joint Unified Command, Dr. Mattox helped form an “evacuation city” to house, treat, cloth, and feed 27,000 evacuees from New Orleans in only 18 hours.

The award is named for Benjamin Rush, an American Revolutionary from Pennsylvania, the only physician to sign the Declaration of Independence, and the surgeon general of the Continental Army. Dr. Rush is known as the “founder of American psychiatry.”

Marshall Cothran, CEO of the Travis County Medical Society and the Blood and Tissue Center of Central Texas, received the Medical Executive Meritorious Achievement Award. The AMA gives this award to a medical society executive who has provided exemplary and exceptional service that benefits and supports physicians in caring for their patients. This contribution “is exemplary beyond the normal scope of their duties or responsibilities.”

The AMA cited Marshall for “the financial turnaround of the Blood and Tissue Center of Central Texas [that] has benefitted patient care in Travis County and preserved the Center's independence as a local physician-governed asset to the community.”


Nov 17, 2013

What Doctors Can Learn From Each Other (TEDMED Video)

Different hospitals produce different results on different procedures. Only, patients don’t know that data, making choosing a surgeon a high-stakes guessing game. Stefan Larsson looks at what happens when doctors measure and share their outcomes on hip replacement surgery, for example, to see which techniques are proving the most effective. Could health care get better -- and cheaper -- if doctors learn from each other in a continuous feedback loop? (Filmed at TED@BCG.)

Nov 16, 2013

Two Texas Students Win AMA Spots

WASHINGTON, DC - Congratulations to a pair of medical students who won election as new Region 3 representatives to the American Medical Association Medical Student Section today. Raghuveer Puttagunta from the Baylor College of Medicine is a new Region 3 delegate, and Ben Karfunkle from the University of Texas-Houston Medical School is an alternate delegate.

Oct 23, 2013

Choosing Wisely: It's Good Medicine


Texas Medical Association Council on Health Care Quality chair Frank Villamaria, MD, and member Lisa Ehrlich, MD, answer questions from TMA communications vice president Steve Levine, about the new "Choosing Wisely" initiative. They explain why Choosing Wisely is good medicine and a wise course for physicians and their patients.

Oct 22, 2013

Uncertainty in Marketplace Health Plans Concerns Doctors

As consumers weigh coverage options available in the newly launched federal health insurance marketplace, three of the largest medical associations in Texas have raised concerns about the uncertainty of provider networks offered by health plans in the marketplace.

The Affordable Care Act requires most people to carry health insurance beginning in 2014. While some states received federal financing to set up a state-run health insurance marketplace, Texas chose to participate in the federal marketplace, which offers dozens of health plans and sliding-scale tax credits to help poor individuals and families in Texas purchase coverage. Since the marketplace launched on Oct. 1, technical glitches have plagued the federal website and made it difficult for consumers to create accounts and compare health plans.

The Texas Medical Association, Texas Hospital Association and Texas Academy of Family Physicians said many physicians and hospitals have also been unable to determinewhich health plans offered in the marketplace include them in their provider networks.

“Physicians, they just want to know who's walking through their door and what kind of coverage they’re going to have,” said Lee Spangler, vice president of medical economics at the Texas Medical Association. “They’d like that uncertainty to be settled.”

Many insurance companies participating in the marketplace have created health plans with provider networks based on existing contracts with physicians and hospitals, and did not contact those providers to sign new contracts or ask if they were willing to participate in the new health plans, according to the associations. As a result, many providers do not know which of the health plans offered in the marketplace will pay them for services.

Spangler explained that many physicians sign contracts that allow insurance companies to include the physician in the provider network for any of their health plans. Often, the insurer is not required to notify the physician which of the health plan networks include the physician.

Physicians may not be able to offer alternatives that would be less costly for the patient, if they are unfamiliar with the patient's health plan network, said Spangler. Furthermore, health plans from the marketplace could present financial obstacles for physicians, because those health plans are required to have a 90-day grace period for policyholders that do not pay their monthly premiums on time. While other health plans would cut off coverage if a patient did not pay their bill on time, the health plans offered in the marketplace would still indicate the patient was covered during that grace period, and retroactively revoke payments to the physician for treatment provided during that time. In those situations, the doctor would be forced to seek payment from the patient for services already provided.

Lance Lunsford, a spokesman for the Texas Hospital Association, said the association has also received inquiries, mostly from small and rural hospitals, on why some hospitals haven’t been contacted to participate in the health plans offered in the federal marketplace and how those hospitals can determine whether they’re already participating through their existing contracts with insurers. The hospitals have the same concerns as doctors, said Lunsford, adding that the hospitals want to be included in the plans. 

Texas Oncology, one of the largest cancer treatment groups in the state, has chosen not to participate in any health plans offered in the marketplace because “there are many unknowns related to how the Health Insurance Market Place will cover cancer treatment,” according to a statement by the organization. “These details will impact our ability to provide patients with the latest and most effective treatments, so it is imperative that we are fully informed before a decision is made,” the organization further stated, while also indicating that it would re-evaluate its decision not to participate once more information was available.

Not all of the health plans in the marketplace are based on existing contracts between providers and insurers. For example, some insurance companies participating in the federal marketplace have signed new contracts with specific providers to create HMOs with "skinny networks." Those plans have fewer participating providers but lower monthly premium costs. 

All of the health plans in the marketplace are required to maintain provider networks that have sufficient numbers and types of providers to ensure all health services are available in a reasonable time period, according to federal officials at the Health and Human Services Department.

The uncertainty of the provider networks also creates a hardship for consumers, many of whom consider whether their current doctor is covered before purchasing a health plan. On average, Texans have 54 health plans in the marketplace to choose from, all of which have varying monthly premiums, deductibles and provider networks.

Before a consumer can view specific information on the provider networks of health plans offered in the federal marketplace, consumers must create an account on healthcare.gov and apply for coverage. The website does not have a tool to search for specific providers to determine which health plans they’re participating in. Federal officials said that consumers could click a link associated with each health plan to review the provider network, but the Tribune was unable to access that feature because of glitches on the federal website that made it difficult to create an account.

This story was produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

Texas Tribune donors or members may be quoted or mentioned in our stories, or may be the subject of them. For a complete list of contributors, click here.

This article originally appeared in The Texas Tribune at http://www.texastribune.org/2013/10/18/uncertainty-federal-marketplace-creates-hardships/.

Sep 27, 2013

ZDoggMD to Keynote TexMed 2014

Zubin Damania, MD, the rapper-hospitalist-comedian-health care reformer from Las Vegas, has signed as the keynote speaker for TexMed 2014 in Fort Worth. We're excited, and he's excited. And we're excited that he's excited!

Sep 10, 2013

Texas' Two Largest Papers Back Medicare Payment Reform

First The Dallas Morning News then the Houston Chronicle published editorials supporting major changes in how Medicare pays physicians. The Morning News piece, “Rep. Burgess’ plan to better pay Medicare physicians,” lauds Congressman Michael Burgess, MD (R-Lewisville), for his leadership in trying to solve the decade-long disaster caused by the Sustainable Growth Rate (SGR) formula. The Chronicle printed “Medicare needs repair” just two days after the Texas Medical Association and the Harris County Medical Society (HCMS) arranged a meeting among U.S. Rep. Kevin Brady (R-The Woodlands), TMA and HCMS leaders, and the Chronicle editorial board.

Of note, the Morning News pointed out “Several medical groups say they see this proposal as a work in progress. Undoubtedly, there are ways to tweak it.” True. The bill is not perfect. We are concerned that payment increases won’t keep up with the cost of running a practice. We are concerned with the potential for a new set of bureaucratic hassles to spring up. But we are pleased with the bill’s growing support.

Aug 16, 2013

Not Doing #PQRS? Quick Action Will Avoid a Penalty

For practices that don't currently participate in the Medicare Physician Quality Reporting System (PQRS), and that don’t want to use a qualified registry or electronic health record PQRS reporting mechanism, another Medicare penalty is looming. Take action now to sign up for a temporary mechanism to prevent it.

Practices not participating in PQRS in 2013 will pay a 1.5-percent penalty on their Medicare claims in 2015. The Centers for Medicare & Medicaid Services (CMS) has created an option — for 2013 only and if you sign up by Oct. 15, 2013 — that allows practices to participate in PQRS and avoid the penalty just by signing up — no quality reporting required (and no eligibility for PRQS incentives, either).

But don’t delay. Signing up is a multi-step process, and practices are already reporting significant delays in getting their sign-up approved and completed through the Medicare system.

Here’s an outline from TMA of what you need to do.

Aug 15, 2013

Texas Company Recalls Sterile Use Products

Sterile Compounding of Cedar Park has voluntarily recalled all products it produced and distributed for sterile use because of reports of bacterial bloodstream infections possibly related to the company's calcium gluconate infusions.

Learn more about the products recalled and the possible infections associated with them.

Aug 12, 2013

Brochure Answers Health System Reform Questions

Are your patients asking you questions about the Patient Protection and Affordable Care Act and how it affects them?

To help you answer their questions, TMA created a free brochure for patients, "Because Your Doctor Cares: What You Need to Know About Health Care Reform."

TMA members may order free copies of this brochure to hand out or place in waiting rooms. Call the TMA Knowledge Center at (800) 880-7955 or email knowledge@texemd.org with the number of brochures you need and your mailing address.

Jul 30, 2013

When Will I Have to Use an EHR?

We get asked this question all the time: "When, by law, do I have to switch from paper records to an electronic health record (EHR)?"

The answer is delightfully simple and maddeningly complex. No law says you have to switch to an EHR. But Medicare will hit you with a nasty payment hammer if you don't.

Read all the details.

Jul 29, 2013

Help on the Way

From health care problem, to TMA solution, here's the story behind the birth of TMA's Physician Services Organization for Patient Care. It's designed to deliver doctors the survival tools they need to provide demonstrably better and more efficient patient care and compete in today's health care marketplace.


“I am confident the Physician Services Organization for Patient Care will save local practices,” said TMA President Stephen L. Brotherton, MD. “Texas doctors are determined to make health care better and more affordable for Texans.

“To do that, we need to shift the balance of power away from the government, the health insurance companies, and the large hospital systems and back to the patients and their physicians.”

TMA’s Physician Services Organization for Patient Care is a physician-led organization that will offer services to bolster physicians’ clinical and financial autonomy. In addition to TMA, the Dallas County Medical Society (DCMS) and Harris County Medical Society (HCMS) are key members of the organization. The center will bring in new and existing physician groups, health plans, and technology vendors as needed to test and develop effective new care models.

Read more at www.texmed.org/tmapso.

Will the ICD-10 Switch Cost Me Money?

Moving from ICD-9 to ICD-10 will result in lost revenue. It is unavoidable. Practices can expect a 20-percent to 40-percent loss of productivity in the first three to six months after ICD-10 takes effect on Oct. 1, 2014, says Denny Flint of Complete Practice Resources in this video interview with TMA Practice Management Consultant Heather Bettridge.

Practices that prepare well in advance for the change will fare best, Mr. Flint noted. TMA can help you prepare. Visit our ICD-10 Video Vault for more quick Q&As covering a variety of ICD-10 topics. Be sure to bookmark TMA’s ICD-10 resource page for news, tools, education, and updates.

Jul 27, 2013

Stuck in the Medicare-Won't-Pay-for-an-Incarcerated-Patient Runaround? It Just Got Worse

Did you get a payment demand letter from Medicare because it paid a claim for a patient who was incarcerated on the date of service? Please note: Your instructions have changed!

Find out what this is all about and how tangled up it has become. We just don't know why it's gotten this bad, yet. But, as always, TMA is on it.

Jul 17, 2013

ICD-10: 442 Days and Counting

The remaining time before the ICD-10 transition date is short, especially given the amount of preparation that must be completed. This transition to a new coding system is primed to be the most challenging initiative since the inception of medical coding.

Find out how TMA can help.

Jul 15, 2013

Working With Vendors Toward ICD-10

Vendors are key partners who can help you prepare for ICD-10. Assess a vendor’s capabilities by answering these questions:

Well, where are the questions? Check it out here.

Jul 13, 2013

What Employer Mandate Delay Means for Your Practice

Physicians who have 50 or more employees have another year to comply with the "employer mandate" of the Patient Protection and Affordable Care Act (PPACA). The law requires employers with 50 or more employees to offer health insurance coverage or pay a penalty.

Read more.

Jul 12, 2013

Three Newly Common Medicare Claims Errors You Can Avoid

Novitas identified the top Medicare claim submission errors for Texas the first quarter of 2013. These three on the list are new compared with those reported in December 2012.

  1. Patient/insured health identification number and name do not match.
  2. Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement.
  3. The benefit for this service is included in the payment/allowance for another service or procedure that has already been adjudicated.

Learn more about these errors and pick up some tips on how to avoid them.

Jul 11, 2013

Texas Medical Records Law Provisions Eased

The 2013 regular session of the Texas Legislature brought relief from some burdensome provisions of Texas’ medical record privacy law. Senate bills 1609 and 1610 alter the privacy training requirements and breach notification requirements, respectively. TMA supported these changes to reduce red tape hassles for physician practices. The new provisions of the law are now in effect.

Find out more.

Jul 9, 2013

TMA PSO Seeks Health Care Service, Software Providers

Texas Medical Association’s Physician Services Organization for Patient Care today issued a Request for Information (RFI) for service and software vendors that wish to help the new organization develop and deliver to doctors the survival tools they need to compete in today’s health care marketplace.

“We are looking for the very best vendors, the ones who can help us build the support organization Texas physicians need,” said TMA President Stephen L. Brotherton, MD. “We are looking for firms whose skills and expertise can complement TMA’s outstanding brand image and credibility among Texas doctors.”

Find out more.

Jul 3, 2013

Go Team! Help Grandma!



From the people who brought you "Grandma and the Big, Bad SGR."

Our landmark scope bill that sets up a more collaborative, delegated practice among physicians and advanced practice nurses or physician assistants is now law. Texas Gov. Rick Perry has signed Senate Bill 406 by Sen. Jane Nelson (R-Flower Mound) and Representative Lois Kolkhorst (R-Brenham). The law firmly establishes the physician-led medical team, allows all involved to practice at their level of education and training, and places more authority and responsibility on the physician to supervise. TMA never deviated from the core principle that diagnosing and prescribing remain the practice of medicine. Now we have a process and a model for future scope-of-practice discussions.

This amusing little video demonstrates how Texas physicians and allied health practitioners turned a non-stop legislative battle into a joint bid for common goals.

And in case you forgot how much fun it was, here's the link to the original "Grandma" video.

Jul 2, 2013

4 complaints of physician employees and 1 solution to fix them

by Dike Drummond, MD

Originally published KevinMD.com, June 30, 2013. Reprinted with permission of publisher and author.

Medscape published an article titled, 4 Top Complaints of Employed Doctors, and it was a very interesting read. Turns out the things employed physicians complain about are basically that they are employees.

Let me lay out these employed physicians gripes for you with a little detail so you will see what I mean. I will finish this article with a solid way to address all of them. These gripes are basically a cry for effective physician leadership.

Although the numbers are not exact, these days about half of doctors are employed physicians, either by a hospital, a medical group or a larger healthcare system. That number is rising pretty rapidly as the industry consolidates to grab the bonus pools soon available to groups large enough to qualify as ACOs.

This move to become employed physicians is so popular, I have even seen articles lamenting the death of private practice and killing Marcus Welby.

Here is what Medscape identified as the four things employed doctors dislike the most and my suggestion of the best way to avoid these in your organization.

1. Being bossed around by less educated administrators.  As an employee, you no longer have the final say in the decisions affecting the logistics of your practice. The person actually in charge is often not a physician. They work for the institution, not you. They report to the heads of the administration, not you. They can literally tell you what will and will not be done. You are treated just like any other employee.

The article uses the term “loss of autonomy” over and over again.

You do retain most of your autonomy over clinical decisions in the exam room (notice I said “most”) and lose the decision making power over the way the office/hospital is run.

2. Not being able to make decisions about staff and personnel. That is because you are no longer their boss. You are not the leader/manager/person responsible for any of these decisions in the org chart.  If you had an office manager in your private practice, you probably lost them in the transition. Your medical assistant and receptionists are hired and fired by a middle manager, sometimes without your input, consent or awareness.

3. Having less authority over billing and charge coding. In many cases your employer has a remote and centralized billing office that takes over billing on day one. They may not have much experience with your specialty or outpatient medicine in general. They will require documentation in enough detail to survive an audit. You may not have been as thorough in your private practice as you are required to be now. It can sometimes feel like you have to learn documentation and coding all over again.

4. Being forced to use new equipment and technology. Your employer has their own equipment, EMR, supply chains and procedures. You will now comply with their systems, just like any other employee – systems you did not choose, request or approve along the way.

If a copier breaks down in your office you will have to go through the bureaucracy and policies and procedures to get a new one. That is much more difficult than handing your office manager the credit card and sending them down to the local office supply store to pick up a new one.

In some cases there are reports of groups “telling employed surgeons which kinds of joint implants to use, and according to a New York Times article, even whether to implant defibrillators in Medicaid patients.”

What don’t employed doctors complain about?

Turns out Medscape’s answer is practice guidelines. The reason is simple. Most groups don’t enforce them, yet. Many organizations have established guidelines, they can even be built into the meat of the EMR, however few are strictly enforcing them at this time. As ACOs grow and shoot for quality bonuses, you can certainly expect that to change.

Physician leadership is the answer to these concerns

Leaders have influence and power, Employees do not. So how can physicians get these features of autonomy back as employees? The key is a strong physician leadership structure on the clinical side of the business.

Doctors must step up and play a leadership role within the organization. Don’t fight and object and resist. Dive in and lead. Without strong physician leadership in your organization, you have little or no influence on the administration and in the board room.

It is equally important that you allow your physician leaders to lead. You must allow them to represent you and provide solid input from our clinical side of the house to all the decision making committees in the organization.

Without physician leadership, the gripes will continue and the feeling of powerlessness will not change.

There is a famous quote, “Lead, follow or get out of the way.” My encouragement is that these gripes be addressed by a wave of effective physician leadership that accompanies your move to become an employee. Just because you are not in private practice, does not mean leadership stops. It is perhaps even more important when you are inside MegaHealthCorp than when  you were in private practice.

The two biggest challenges to employed physicians taking this leadership role are:

1. Bandwidth. Where do you find the time for the committee work to represent the doctor’s interests in your busy practice?  Does your organization respect these leadership activities enough to compensate you fairly for them?

2. Learning how to lead inside a large and established bureaucracy. The rules of influence here are very different than in your smaller, physician lead private practice.  It is a whole different ballgame.

The bottom line is some group of physicians in the organization must step powerfully into this new style of leadership. It is the only way the doctors as a group can hope to maintain any influence or autonomy as members of a large group of employed physicians in a much larger organization.

There is an alternative that might become viable in the near future. I will only mention it here. That option is for physicians to unionize.

Dike Drummond is a family physician and provides burnout prevention and treatment services for healthcare professionals at his site, The Happy MD.

Jul 1, 2013

TMA Questions Newest Cigna Red Tape Hassle

TMA believes a Cigna referral policy imposes a red tape hassle on physicians and patients and will ask the Texas Department of Insurance (TDI) to determine if the company has violated the agency's network adequacy rules.

Read more.

Jun 29, 2013

Act Now to Get Medicaid Fee Increase

Later this year, Texas will increase Medicaid payments to Medicare parity for two years — retroactive to Jan. 1, 2013 — for select primary care services provided by primary care physicians and related subspecialists. However, to benefit from the fee increase, you must submit a signed self-attestation form to the state's Medicaid claims payer, the Texas Medicaid and Healthcare Partnership.

The state has not set a deadline for returning attestation forms but will do so in the coming months. (Physicians who return the attestation form after the deadline will not be eligible for increases retroactive to Jan. 1, 2013, though they will be eligible for higher payments through the end of 2014.) If you are eligible, attest early to ensure the state receives your paperwork.

See who's eligible and how to attest.

Jun 25, 2013

TMA Challenges Dentists' Sleep Apnea Rule

Dentists should not independently diagnose and treat sleep apnea because they are not trained to do so, TMA told officials of the Texas State Board of Dental Examiners. "It is beyond the scope of practice of dentistry in Texas to diagnose a medical disease or disorder, including a sleep disorder, or to independently treat such disorder once diagnosed," TMA President Stephen L. Brotherton, MD, said in a letter to the board's executive director.

Read more.

Jun 24, 2013

TMA Helps You Meet New Meaningful Use Rules

Physicians participating in the Medicare or Medicaid meaningful use incentive programs will have to meet increasingly more difficult criteria in 2014 when stage 2 begins. The new requirements will apply to physicians who started the meaningful use program in either 2011 or 2012. Those who began in 2013 won't move to stage 2 until 2015. There are some significant changes for stage 2 meaningful use, thus TMA offers a two-page snapshot of the criteria physicians should review as they prepare.

Read more.

Jun 19, 2013

"We Got Results"

The 2013 regular session of the Texas Legislative delivered some amazing results for Texas patients and their physicians.

This TMA Legislative News Hotline for June 19, 2013, summarizes the action. Legislators passed quite a few key health care-related bills that are good for Texas patients and physicians, as described by TMA's Darren Whitehurst and the TMA lobby team.

Read more in this special issue of TMA's Action newsletter.

Jun 16, 2013

Regina, Sue, Joe, and More ...

 ... Images from the opening two days of the 2013 Annual Session of the American Medical Association House of Delegates in Chicago. At least the Texas perspective.


U.S. Surgeon General Regina Benjamin, MD, visits with Dallas
pediatrician Carolyn Evans, MD
We're excited, too!
Susan Rudd Bailey, MD, of Fort Worth is unanimously
reelected vice speaker of the AMA House of Delegates
Austin anesthesiologist Joe Annis, MD (right) squares off against
Maryland's Robert Wah, MD, in the debate between the two
candidates for AMA president-elect.
Will Bradley, MD, of Mansfield chairs the Reference Committee on AMA Constitution and Bylaws Les Secrest, MD, of Dallas serves
on the Reference Committee
on Legislation
David Lichtman, MD, of Fort Worth
serves on the Reference Committee
on Medical Education

Gary Floyd, MD, of Fort Worth testifies for a Texas resolution
calling on AMA to identify the pros, cons, and costs of the
Patient Protection and Accountable Care Act.

Jun 14, 2013

Texas Students Win AMA Posts

Left to right: Janning, Coffee, Chhabra

(CHICAGO) Congratulations to three Texas medical students who won positions on the Region 3 Board for the American Medical Association Medical Student Section.

Kaitlin Janning, the new Region 3 secretary, and Elizabeth Coffee, the membership chair, are both students at the Texas A&M College of Medicine. Divya Chhabra, the new community service chair, attends the University of Texas Southwestern Medical School.

All three are rising second-year students.

May 29, 2013

TMA Scores Long-sought Wins for Physicians and Patients

The Texas Medical Association has long beat the drum for bolstering graduate medical education, cutting red tape that hinders patient care, promoting transparent insurance markets, and preventing unqualified health professionals from delivering care outside their expertise. This was the year those and other messages got through to lawmakers and paid off in long-sought, even precedent-setting victories at the conclusion of the 2013 Texas Legislature.

As this article was prepared, all of TMA's priority bills either became law or were on their way to Gov. Rick Perry's desk for signature following House and Senate approval. He has 20 days to act, whether signing it into law, vetoing it, or allowing the legislation to become law without signature.

Key milestones include:

  • First regulation of so-called "silent PPOs" that share physician-contracted discounts without doctors' knowledge or consent; 
  • A new model for physician-led, team-based care, and for future legislative scope of practice discussions;
  • Wide-ranging reductions in practice red tape, including development of uniform prior-authorization forms for medications and health care services;
  • Due process protections in Medicaid fraud investigations;
  • Increased access to immunizations;
  • More money for GME, mental health, and women's health; and
  • Preservation of tort reforms and a strong Texas Medical Board.

Medicine's success this session was due on large part to seeds TMA planted early on, said Darren Whitehurst, vice president for advocacy.

"We took a very good preventive approach," he said. "We did a good job educating legislators back in their districts before the session. We had a good game plan in the political cycle in getting elected people who look to their doctors to understand medicine's issues. And that paid dividends in the legislature."

Even though not all of TMA's bills made it to the finish line, medicine did not lose any ground, TMA leaders add.

Additional money to boost Medicaid physician payment rates never materialized, but neither were rates reduced. Reforms to the Texas Medical Board and medical liability laws stayed intact. Heated debates halted compromise end-of-life legislation put forth by prominent pro-life and religious groups in Texas in collaboration with TMA, hospitals, and disability groups. But physicians still have access to existing safe harbors under the Texas Advance Directives Act for resolving conflicts out of court, without being forced to violate their moral beliefs and professional ethics.

Read all the details.

May 24, 2013

TMA Launches Physician Services Organization for Patient Care

Texas Medical Association, Dallas and Harris County Medical Societies Team Up

Texas’ premier physician associations today announced the establishment of an organization to deliver doctors the survival tools they need to provide demonstrably better and more efficient patient care and compete in today’s health care marketplace.

“I am confident the Physician Services Organization for Patient Care will save local practices,” said Stephen L. Brotherton, MD, president of the Texas Medical Association (TMA). “Texas doctors are determined to make health care better and more affordable for Texans.

“To do that, we need to shift the balance of power away from the government and the large hospital systems, and back to the patients and their physicians.”

Read more about the Physician Services Organization for Patient Care.

May 22, 2013

TMA Reaffirms Medicaid Reform Stance

The Texas Medical Association House of Delegates adopted the Board of Trustees' position statement on expanded health care coverage and Medicaid reform, and added a provision calling for equality in Medicaid and Medicare fees during its May 17-18 meeting in San Antonio.

Earlier this year, trustees said political leaders in Washington and Austin must immediately develop a bipartisan solution to reform the state's Medicaid program and expand coverage for low-income adults.

TMA leaders called on state leaders and lawmakers to "look beyond the federal government expansion solution and design a solution that works for Texas and for Texans."

TMA officials emphasized that the association is seeking expansion of coverage for poor adults that is nottraditional Medicaid. The state, they say, has the ability to work with the Centers for Medicare & Medicaid Services on a proposal that:

  • Has patient copays and deductibles,
  • Allows the state to develop a benefit package that makes sense for this patient population, and
  • Allows the state to drop out of the program if conditions change.

TMA calls on Texans to use their ingenuity to "devise a comprehensive solution that:

  1. Draws down all available federal dollars to expand access to health care for poor Texans;
  2. Gives Texas the flexibility to change the plan as our needs and circumstances change;
  3. Clears away Medicaid's financial, administrative, and regulatory hurdles that are driving up costs and driving Texas physicians away from the program; and
  4. Relieves local Texas taxpayers from the unfair and unnecessary burden of paying the entire cost of caring for their uninsured neighbors."

During their debate, delegates voted to add additional points to TMA's position. They call for a system that "provides Medicaid payments directly to physicians for patient care equal to at least those of Medicare payments" and that continues to "uphold and improve due process of law for physicians in the State of Texas as it relates to the Office of Inspector General."

The house also voted against a resolution urging TMA to oppose Medicaid expansion, and against another resolution asking TMA to support repeal of the Patient Protection and Affordable Care Act.

May 3, 2013

Will EHR Vendors Charge Doctors for Building "Crosswalks" Between ICD-9 and ICD-10?



Since the adoption of the new ICD-10 medical coding system is mandatory, will physicians' electronic health record vendors charge medical practices to help with the transition to the new system? Steve Arter, CEO of Complete Practice Resources (CPR), and Denny Flint, CPR's president, have answers and suggestions for doctors in this interview with Heather Bettridge, a TMA practice management consultant.

Apr 30, 2013

Senators Want Meaningful Use Law Reviewed

Six Republican senators voiced "significant concerns" with the government's implementation of the HITECH Act and meaningful use program in a letter to U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius. The letter says their concerns include "the lack of data to support the Administration's assertions that this taxpayer investment is being appropriately spent and actually achieving the goal of interoperable health IT."

Read more about "REBOOT: Re-examining the Strategies Needed to Successfully Adopt Health IT," which the senators sent to Secretary Sebelius.

Apr 29, 2013

TMA Calls for Medicaid Payment Hike

“Like a rundown house in need of repair, you’ve got to pick up a hammer and start somewhere. Increasing Medicaid payment rates to Medicare parity is the nail that needs to be hit first.” That was the take-home line of a letter TMA President Michael Speer, MD, sent to the five state senators and five representatives who are hammering out the details of the 2014-15 state budget.

“Over the past several months, there has been considerable attention paid to Texas’ ‘broken’ Medicaid system, with particular interest in the plummeting physician Medicaid participation rate and the impact that exodus is having on patients’ ability to obtain timely, medically necessary care,” Dr. Speer wrote. He pointed out that “grossly inadequate payment” is the single largest reason our members gave to TMA’s Physicians Medicaid Congress for not participating in the program.

Check out some excellent news stories on this issue from over the weekend:

CMS Delays Plan to Deny Non-Enrollees' Medicare Claims

Now you see it, now you don't.

Technical issues have delayed plans by the Centers for Medicare & Medicaid Services (CMS) to begin denying claims for services ordered or referred by a physician who is not enrolled in Medicare. The denials were scheduled for May 1. CMS did not elaborate on the technical issues, or set a new deadline.

Once CMS solves its technical issues, physicians who receive claim denials will need to contact the ordering or referring physician to verify that he or she has enrolled in Medicare to prevent future denials. See TMA's free tool to check your Medicare ordering and referring status.

Apr 25, 2013

VIDEO: What’s the Main Difference Between ICD-9 and ICD-10?

There’s been much buzz about the new ICD-10 medical coding system — and you’ll be hearing a lot more about it between now and the Oct. 1, 2014, implementation date.

So what are the real differences between it and ICD-9? In an interview with TMA’s Associate Vice President for Practice Management Services Peggy Pringle, Denny Flint, president of Complete Practice Resources, explains that structurally the two codes sets are not all that different. ICD-9 codes have three to five numeric digits, while ICD-10 has three to seven alphanumeric digits. The switch last year to HIPAA 5010 transaction standards for electronic claims paved the way for practices and payers to be able to accommodate the extra digits.


See how TMA can help you prepare for the transition. You better begin now.

Apr 18, 2013

Don't Get Mad, Get Politically Active

Reprinted with permission from Texas Family Doc - "Don’t Get Mad, Get Even: Political Advocacy"
Posted on April 18, 2013 by tfiesinger

Last December, after months of “planning to,” I finally got around to calling to my state senator to set up a meeting before the legislature convened.

“Hello, my name is Dr. Y, I am a constituent and I would like to set up a meeting with Senator X in the district.”

“You know the session starts in 3 weeks.”

“Yes, I do”

“You know Christmas is in 2 weeks.”

“Yes, I do.”

“You know she’s very busy.”

Yes, I do. I will be at the Capitol on the first day of the Legislature. Is her legislative aide for health affairs available instead?”

“Yes. I will ask her to contact you to set up a time to meet.”

When I met with the legislative aide several weeks later, we had a productive conversation. She had worked on health affairs for another state senator before. I pitched our bill to restore funding to family medicine graduate medical education and the physician loan repayment program to help place doctors in underserved areas. We had been instructed to ask our senators to support the bill and cosponsor it if possible. I thought, ‘What the heck, nothing to lose by asking.’ I was told that the Senator was interested in health care issues and she would get back to me with the senator’s answer. I also forwarded a map of the senate district with all the medically underserved areas and primary care physician to population ratios labeled.

A few weeks later, she emailed me to say that the Senator had decided to support the bill. Ok, I thought, she’ll vote for it when it is heard in committee. A few days later I saw that she was listed as a cosponsor! With 2 of the committee members listed as cosponsors, our chances of getting the bill out of committee looked much better.

Politics can be frustrating, but persistence pays off. And you have nothing to lose by asking.

Apr 10, 2013

No to Chiros Conducting School Bus Driver Mental and Physical Exams

The Texas Medical Association today asked the House Committee on Public Health to send House Bill 3183 back to the bus barn.

The bill would allow a chiropractor to conduct the required mental and physical examination of a school bus driver, but such examination is beyond the scope of practice of chiropractic in Texas.

The Texas Legislature must protect Texas schoolchildren by ensuring that the men and women behind the wheel of their bus have the mental and physical ability to drive them safely. The heart, lungs, vision, reflexes, hearing, and mental health should all be evaluated for a prospective school bus driver. Chiropractors have neither the statutory scope of practice nor the training to analyze, examine, or evaluate such important components of one’s health.

The Texas Chiropractic Act defines the practice of chiropractic as using “objective or subjective means to analyze, examine, or evaluate the biomechanical condition of the spine and musculoskeletal system of the human body,” or performing “nonsurgical, nonincisive procedures, including adjustment and manipulation, to improve the subluxation complex or the biomechanics of the musculoskeletal system.” 

Mental health is not part of the “biomechanical condition of the spine and musculoskeletal system.” Thus it is not something that can be analyzed, examined, or evaluated by a chiropractor.

Likewise, many components of a physical examination exceed the biomechanical condition of the spine and musculoskeletal system. For example, cardiac, neurological, and pulmonary health are all important components to determine whether one is healthy enough to transport our youngest and most vulnerable citizens.  The heart, lungs, and central nervous system are not part of the “biomechanical condition of the spine and musculoskeletal system.” Thus they cannot be analyzed, examined, or evaluated by a chiropractor.

Vote "No" on HB 3183.

Antikickback Vs. Stark - Know the Difference

Do you understand the difference between the antikickback statute and the Stark law? The Centers for Medicare & Medicaid Services has begun ratcheting up enforcement in regard to billing and financial relationships.

Here’s a quick comparison between these two laws that aim to prevent fraud and abuse.

TMA Strongly Opposes SB 1193 - A Medical Bully Bill

Experience TEDMED 2013 Free – Courtesy of TMA

TEDMED LIVE 2013

The Texas Medical Association is proud to host a live simulcast, April 17, of the TEDMED lectures direct from the John F. Kennedy Center for the Performing Arts in Washington, DC.

What’s TEDMED? It’s an annual meeting of the minds where multi-disciplinary innovators discuss hot topics and new developments in health and medicine. Past TEDMED speakers include Temple Grandin, President Bill Clinton, and TMA’s 2013 General Session speaker, Abraham Verghese, MD, to name a few. This year’s speaker line-up includes 50+ global leaders from medicine, science, research, technology, academia, business, government, and the arts. Don’t miss out!

Though much of the focus of the event is on stage, it is important to remember that TEDMED is a fast-paced, all-encompassing and immersive event that provides stimulation and exciting discourse from start to finish…onstage and off.

Come prepared to think; come prepared to interact -- but most of all, come prepared to have fun! You're sure to find TEDMED an unforgettable experience.
ATTENDANCE IS FREE FOR TMA MEMBERS! Register now. 

Two ways to attend: 

  1. Join us live April 17, 1:30-6:30 pm
    Doubletree Suites by Hilton Hotel, Bluebonnet Room
    303 W. 15 St.
    Austin, TX 78701
    FREE parking is available in the TMA Building.

    Beverages and light refreshments will be available courtesy of the Texas Medical Association.

    Event is limited to 100 guests. Register now. You may register for 2 tickets per session.

     
  2. Mobile access to all four days and all speakers!

Go beyond passively watching. Use the TEDMEDConnect mobile app to connect “live” to the TEDMED stage and participate in live polls and activities, ask and answer questions, and share comments with the speakers. Be part of the conversation about the future of health and medicine!

Download the TEDMEDConnect Mobile in your app store. The App will:  

  • Allow all of our 1,200+ Kennedy Center Delegates and tens of thousands of TEDMEDLive participants to connect "live" to the speakers on the TEDMED stage and ask them questions or transmit comments.
  • Contain the up-to-the-minute TEDMED schedule, including a handy "What's On Now" feature.
  • Provide users the ability to view photos from TEDMED and upload photos from TEDMEDLive viewing locations.
  • Allow users to participate in live polls and games.
  • Give users the opportunity to request a follow-up "Science-Kit" from speakers.
  • Allow users to download the conference program.
  • Connect users to Facebook and Twitter.

    Texas Medical Association Location ID: L82830

    When prompted by the app, input the TEXAS MEDICAL ASSOCIATION location ID and your personal email address so each user can identified and communicate with the Kennedy Center stage or speakers.

You can read about TEDMED 2013 here

If you have any questions about the event, please contact TMA's Knowledge Center at (800) 880-7955.


 

Apr 9, 2013

TMA Helps Improve Quality, Avoid Penalties

PQRS is switching from the carrot to the stick.

Learn how TMA can help you keep from getting hit.

Apr 3, 2013

TMA Wins Choosing Wisely Grant

TMA, partnering with the TMA Foundation, is among 21 state and specialty medical societies and regional health collaboratives that won grants from the ABIM Foundation to advance the Choosing Wisely campaign. Support for the grant program comes from the Robert Wood Johnson Foundation.

Learn more about Choosing Wisely.

Apr 2, 2013

Medicare Starts Denying Non-enrollees' Claims May 1

Starting May 1, Medicare will deny claims for services ordered or referred by a physician who is not enrolled in Medicare. Physicians who receive claim denials will need to contact the ordering or referring physician to verify that he or she has enrolled in Medicare to prevent future denials.

Use TMA's exclusive free tool to check your Medicare ordering and referring status.

Apr 1, 2013

Doom No More

TMA's "Calendar of Doom" is now "Deadlines for Doctors: Do This Now."


It is still loaded with the key dates you need to know to stay abreast of all the upcoming state and federal regulations and key health policy issues that impact you and your practice. It is still filled with the outstanding TMA information resources, tools, and educational programs you need stay in compliance. It is still a great way for you to plan ahead for those insurance company demands and health information technology carrots and sticks.

Check out the new "Deadlines for Doctors."

Mar 28, 2013

IRS Owes Some of You Money

TMA has learned that if you were in residency or fellowship training between Jan. 1, 1995, and March 31, 2005, you may qualify for a refund of Federal Insurance Contributions Act (FICA) taxes collected on your stipend during that time.

Find out how you can get your money back.

Mar 21, 2013

TMA Calculates Impact of Medicare Fee Cut

Medicare payments to physicians will drop 2 percent on April 1 because of the federal budget sequester. TMA's Payment Advocacy Department analyzed the impact of the fee reduction and compiled a list of answers to questions you may have.

Here is an example of how the fee cut would affect payment for a service with a Medicare fee schedule amount of $100:

Mar 20, 2013

Take the "Silent" Out of Silent PPOs


Physicians Call for End to Sneaky “Silent PPOs”

A North Texas doctor was shocked last year to discover a health plan was using a discounted rate he had agreed to 20 years ago, in spite of the fact that he had canceled all of his insurance contracts since then.

Dawn C. Buckingham, MD, a member of the Texas Medical Association (TMA) Council on Legislation, shared the physician’s story before the Texas House Insurance Committee. The committee is examining silent Preferred Provider Organizations (silent PPOs), which many doctors and others in health care consider a sly practice. A company listed the doctor as a member of a health plan’s network and offered a discounted rate for the care he provided, without the physician’s permission or knowledge.

Silent PPO activity is evident when an insurer or third-party payer accesses a physician’s contract rate using a secondary or “rental” network. Often such networks do not have a valid contractual relationship with the physician.

Most physicians accept lower rates from health plans to treat the patients enrolled in that particular plan in exchange for potential benefits including the possibility of seeing more patients, and direct, prompt payment. The problem occurs when silent PPOs apply that same lower rate to other contracts (or patient bills) without the doctor’s permission or knowledge.

House Bill 620 by Rep. Craig Eiland (D- Galveston) would regulate these companies or networks that sell, lease, or share physician discounts without the doctor’s knowledge or consent to ensure they obtain express agreement from the physician and provide prior notification of who may access the contract. It would take the “silent” out of silent PPOs.

“Silent PPOs are a huge problem because these networks apply rates physicians might have agreed to with one company, to other companies without the physician even knowing. It confuses patients because they believe they’re choosing a physician who contracted with their health plan and is ‘in network,’ but actually they’re choosing a physician with no contractual obligation to their insurance company,” Dr. Buckingham explained. “We’re looking forward to this regulation so physicians will stop being undersold, patients will stop being misled, and the networks will have transparency in what they’re doing.”

Dr. Buckingham showed the house committee a chart detailing the complex story of Philip Korenman, MD, a Plano psychiatrist, who, along with his patients, is a victim of a silent PPO.

TMA, the Texas Pediatric Society, the Texas Academy of Family Physicians, BlueCross BlueShield of Texas, and the Texas Hospital Association support HB 620. Sen. Charles Schwertner, MD (R-Georgetown), a TMA member physician, will carry the companion bill, Senate Bill 822.

“We see patients every day who get stuck in the middle [because of silent PPOs],” said Dr. Buckingham. “We hear all the time about big surprises you get when you seek medical care and you thought you were doing all the right things within your insurance company, and it turns out they misled you, gave you the wrong information, and now you end up with a tremendous bill.”

“We want to stop this and make sure there’s transparency in the process so patients can make the correct decisions based on accurate information.” She asked lawmakers, “Would this be acceptable behavior in any other type of business in this state?

Mar 19, 2013

Dueling End-of-Life Bills to Face Off in Committee

Dr. Weltge

The Senate Health and Human Services Committee is taking up two bills on end of life today.

One measure is an agreed-to bill supported by TMA, the Texas Hospital Association, the Texas Catholic Conference, and the Texas Alliance for Life. Senate Bill 303 by Sen. Bob Deuell, MD (R-Greenville), amends the Texas Advance Directives Act (TADA) to allow patients to make their care preferences known before they need care and to protect patients from discomfort, pain, and suffering due to excessive medical intervention in the dying process. This bill would maintain protection against forcing physicians to violate their religious beliefs, moral conscience, and professional ethics. Rep. Susan King (R-Abilene) is carrying the bill in the Texas House (House Bill 1444).

The other bill, Senate Bill 675 by Sen. Kelly Hancock (R-North Richland Hills), significantly changes TADA and interferes in the physician’s ability to exercise his or her medical judgment. It could subject terminally ill patients to unneeded pain and suffering, and expose physicians and caregivers to a very vague new cause of legal action. TMA opposes this bill.

"I have come to realize that this is an issue that requires the wisdome of Solomon and the patience of Job," Senator Deuell said at the outset of the hearing. "Lacking that, we must simply do our best to do right by patients and their families."

Houston emergency medicine physician Arlo Weltge, MD, is at the Texas Capitol today to testify for SB 303 and against SB 675 on behalf of TMA.

Here's what TMA's Healthy Vision 2020 says about this controversial and difficult issue:

Respect patients in their final days

Thanks to the advancements of medicine and science, Texans are living longer. However, these blessings bring the challenges of care and treatment decisions in life’s final stages. Advance directives allow patients to make their end-of-life treatment decisions known in the event they become incapable of communication or incompetent. Without advance directives, some of life’s most difficult decisions are being thrust upon unprepared adult children, parents, or other loved ones.

At each step, human beings are involved in both deciding on and providing treatment. We must respect the value of life and the moral conscience of those involved.

Texas physicians abide by the principle, “First, do no harm.” For this reason, TMA supports the Texas Advance Directives Act (TADA). Its aim is to allow patients to make their care preferences known before they need care, and to protect patients from discomfort, pain, and suffering due to excessive medical intervention in the dying process. The time may come when all that can be done for a patient is to alleviate pain and suffering, and preserve the patient’s dignity. For physicians, this is about medical ethics and providing medically appropriate care.

Then-Gov. George W. Bush signed TADA into law in 1997. It had unanimous support from physicians, nurses, hospitals, nursing homes, hospice care facilities, and pro-life organizations. The law provides a balanced approach to addressing one of life’s most difficult decisions.

TADA allows a patient to issue an out-of-hospital do-not-resuscitate (DNR) order, a medical power of attorney, or a directive for physicians and family members regarding the person’s wishes to administer or withhold life-sustaining treatment in the event the person is in a terminal or irreversible condition and unable to make his or her wishes known. Additionally, when an attending physician morally disagrees with a health care or treatment decision made by or on behalf of a patient, the act provides for a process whereby an ethics or medical committee reviews the physician’s refusal. The patient is given life-sustaining treatment during the process. If the ethics committee decides that discontinuing lifesaving treatment is in the best interest of the patient, and the family disagrees with that decision, the hospital must continue treatment for 10 days to allow the family some time to find a different facility for the dying patient.

Legislation has been introduced in the past two legislative sessions that would instead require indefinite treatment.

TMA has opposed the proposed legislation because it would prolong unnecessary — and often painful — care. It would require physicians, nurses, and other health care professionals to provide medically inappropriate care, even if that care violates medical ethics or the standard of care. It also sets a dangerous precedent for the legislature to mandate the provision of physician services and treatments that may be medically inappropriate, outside the standard of care, or unethical.

Mar 15, 2013

EHR Incentive Payments Are Taxable Income

Incentives paid under the Medicare electronic health record incentive program are taxable, the Internal Revenue Service ruled in February.

Find out why and what you need to know to stay out of IRS hot water.

Mar 14, 2013

U.S. Doctors Lead in Wellbeing

U.S. physicians don't have to heal themselves ... or maybe they already have.

Gallup's latest Well-Being Index report on 14 occupational groups puts physicians at the very top of the list that "measures physical, emotional, and fiscal wellbeing." (These findings are based on more than 170,000 interviews conducted from January through December 2012 with employed Americans at least 18 years of age as part of the Gallup-Healthways Well-Being Index.)

Physicians rank at or near the top in terms of getting regular exercise, eating enough fruits and vegetables, not being obese, and not smoking.

But the report also gives physicians credit for doing what they do best, and liking it:

One key factor that contributes to physicians' higher average wellbeing score is related to how they view their workplace. Physicians are the most likely to say they use their strengths to do what they do best every day, followed by nurses and teachers.

Here's the list by overall ranking:

Mar 13, 2013

RAC Audits: Alive and Well - Look out cardiologists

The top problem uncovered by the Medicare Recovery Audit Contractor (RAC) for Texas’ Region C involves showing medical necessity for cardiovascular procedures, according the Centers for Medicare & Medicaid Services.

That doesn't mean they're not medically necessary -- just that the documentation wasn't right.

Find out what you can do about it.

TMA, CMS, Justice Fight ID Theft

Learn how to protect your practice and patients by preventing fraud through identity theft at a two-hour seminar in Dallas April 17. TMA, the Centers for Medicare & Medicaid Services, the U.S. Department of Justice, and the Senior Medicare Patrol are sponsoring the seminar.

Read more.

Mar 11, 2013

Progress for Women’s Preventive Care


By Janet Realini, MD, MPH

Panels in both the Texas House and Senate have recommended $100 million additional funding for women’s preventive care, including family planning. The additional funding would flow through the Department of State Health Service (DSHS)’s Primary Health Care (PHC) program and be earmarked for health screenings, contraceptives, perinatal services, and dental services for women aged 18 to 64.

This development is enormously encouraging to the Texas Women's Healthcare Coalition, a coalition of organizations—including both TMA and the TMA Alliance—working to restore access to preventive care for low-income Texas women.

Women’s preventive care was severely cut in the 2011 Texas Legislature, when $73 million was diverted from the DSHS Family Planning program, leaving Texas’ women’s health “safety net” in tatters. Two-thirds of the 53 clinics that closed were not related to Planned Parenthood. An estimated 147,000 women lost access to preventive care and birth control. As a result, Texas taxpayers will pay an additional $136 million in Medicaid birth costs in 2013-2015.

While the proposed PHC funding is a good start, there is still much to do to ensure access to preventive care and birth control for the 1 million Texas women who need it. For example, Texas must also ensure continued funding and provider capacity for the Texas Women’s Health Program, which serves another 130,000 women.

Texas Medical Association and TMA Alliance members, patients, and friends are invited to participate in Women's Health Advocacy Day in Austin on Wednesday March 20. The event will begin at 10 AM at TMA’s Thompson Auditorium and will equip advocates to talk about the importance of women’s preventive care with their legislators.

With strong advocacy from physicians, patients, and other allies, the Texas Women’s Healthcare Coalition is hopeful that more Texas women will have access to the care they need to have healthy, planned pregnancies.

Mar 8, 2013

Medicaid Expansion in Texas -- By the Numbers

Kyle Janek, MD

As the Texas Legislature continues to search for a Texas-style solution to provide health insurance coverage to low-income adults, Texas Health and Human Services Commissioner Kyle Janek, MD, today shared the lay of the land with the House Appropriations Committee.


Based on Census Bureau estimates from March 2012, about 6 million of Texas' 25.5 million population -- or 24 percent -- lack health insurance. Texas continues to lead the nation in the percentage of uninsured. Here's how that 6 million breakdown:

  • 2.4 million (40 percent) would be eligible to buy subsidized health insurance under the Patient Protection and Affordable Care Act (PPACA) insurance exchanges.
  • 1.4 million (23 percent) earn less than 138 percent of the federal poverty level and would be covered by Medicaid if Texas chose to expand the program as described in the PPACA.
  • 851,000 (14 percent) are undocumented immigrants.
  • 790,000 (13 percent) are currently eligible for Medicaid but not enrolled in the program.
  • 608,000 (10 percent) are not eligible for any government health care assistance.

The combination of Medicaid expansion and the PPACA insurance exchanges, Commissioner Janek forecast, would cut the number of uninsured in Texas to 3.1 million, or about 12 percent of the population.


Here are some links to stories that put these numbers in context (political and otherwise);

Finally, we had a report from Gallup today that added some confusion to our numbers. According to the report, Texas' adult uninsurance rate is 28.8 percent, we're still the highest in the country, and the spread between Texas and "second-ranked" Louisiana is growing wider. The discrepancy between Gallup's 28.8 percent and the Janek/Census Bureau's 24 percent comes about because the Census Bureau numbers include children, whose uninsurance rate is lower due to Medicaid coverage that's not available to most adults, due to the Children's Health Insurance Program, and other factors.

Feb 25, 2013

Feds Reject Request to Delay ICD-10

Centers for Medicare & Medicaid Services (CMS) officials rejected organized medicine's request to delay implementation of the ICD-10 coding system. That means the new coding system will take effect Oct. 1, 2014.

Because of the CMS decision, you must begin preparing for ICD-10 now if you haven't already. TMA has a variety of ways to help physicians prepare.

Learn more -- and be prepared.

Feb 14, 2013

TMA Wants HIT Safety Czar

Federal officials should appoint a "highly visible HIT Safety Czar" to help protect patients from adverse events caused by electronic health record systems functioning improperly, TMA says in a letter to the director of the Office of the National Coordinator for Health Information Technology.

Read more.

Feb 11, 2013

Flu Vaccine Supplies Increase

Sanofi Pasteur has made additional influenza vaccine available for children and adults. This includes Fluzone in 0.25 mL prefilled syringes for children ages 6 through 35 months, as well as Fluzone in 0.5 mL vials for patients 3 and older.

Read more and find out all the various flu vaccines that are on the market now.

Feb 5, 2013

Undo Dual-Eligible Cut Harming Patient Access

Physicians: Stop Medical Emergency for Medicare/Medicaid Patients


TMA President-elect Stephen Brotherton, MD, joins the Border Health
Caucus and physicians from around Texas calling for reversal of
the dual-eligible cut.

Dozens of physicians from across Texas took time away from their medical practices to ask state leaders to reinstate cuts that harm access to care for thousands of Texas’ dual-eligible patients. Dual-eligible patients are old enough to qualify for Medicare and able to qualify for Medicaid assistance because of their income.

Texas Medicaid slashed program funds over a year ago at the direction of the 2011 Texas Legislature, creating a medical emergency for thousands of dual-eligible patients and the doctors who care for them.

“The increased regulation and low Medicaid payments are forcing doctors to leave the Valley or retire early,” said Victor Gonzalez, MD, Hidalgo-Starr County Medical Society president, and member of the Texas Medical Association (TMA) and Border Health Caucus (BHC). “It’s impossible to recruit young physicians.” The ophthalmologist lost six young physicians he trained and who received retina fellowships under his program. Dr. Gonzalez explains, “When the health care infrastructure collapses, it hurts all patients in the community and in neighboring cities. If patients can’t get care in a Harlingen emergency department (ED), they will end up in a San Antonio, Houston, or Dallas ED at a much greater expense.”

For nearly a year, TMA and BHC physicians organized rallies, met with state leaders, and lobbied to get the cuts reversed. BHC is a confederation of county medical societies that work together to improve patient care and public health throughout South Texas. Many of the BHC doctors take care of large percentages of elderly, low-income patients.

“Texas must fully reinstate the Medicaid cuts to ensure dual-eligible patients receive the health care they need to survive,” said Stephen L. Brotherton, MD, TMA’s president-elect. “We must take another step to stop Texas’ medical emergency that’s harming access to care for thousands of patients and their doctors.”


Background

Medicare and Medicaid pay dual-eligible patients’ medical bills, with Medicare paying a majority of the tab. In January 2012, Texas Medicaid stopped paying the patients’ Medicare deductible, which was $140 — this year its $147. Medicaid also stopped paying the patient’s coinsurance (due if Medicare’s payment to the physician exceeded what Medicaid pays for the same service, which is usually the case). The coinsurance had been an 80/20 split, with Medicare paying 80 percent of the patient’s doctor bill and in most cases, Medicaid paying the remaining 20 percent.

These cuts affected approximately 320,000 dual-eligible patients in Texas, who are the oldest, sickest and most frail, and who rely on regular physician care and prescription medications. Doctors kept seeing these patients even though Texas Medicaid was not paying the patients’ deductibles nor fully paying all of the 20-percent coinsurance. Many doctors were forced to tap savings, obtain loans, cut staff, retire early, or move away. Some patients lost their doctor altogether.

Other patients were more fortunate, like the 5,000 dual-eligible patients of Javier A. Saenz, MD, a family doctor in La Joya, Texas. “For months early last year he worked 12 hours every day, caring for his patients’ needs the best he could, while the State of Texas paid him basically nothing for providing all of that care,” said Dr. Gonzalez. “He exhausted his personal savings account of $50,000 and took out bank loans so he could keep his doors open and continue to care for the people of his community.”


Part of the Cut Restored

Finally last week, under the direction of the Texas Legislative Budget Board, the Texas Health and Human Services Commission restored coverage of the Medicare deductible for dual-eligible patients in 2013.

“That’s a start,” said Dr. Brotherton, pleased that some relief has arrived. But the 20-percent coinsurance cut remains.

“We’re asking state leaders and lawmakers to fully restore the funding for our Medicaid-Medicare dual-eligible patients,” said Luis M. Benavides, MD, the Border Health Caucus vice chair. “Our patients need us.”

Jan 31, 2013

State Finally Paying Dual-Eligibles’ Medicare Deductible

The Texas Health and Human Services Commission (HHSC) restored the Medicare Part B deductible payment on Jan. 25 for patients eligible for both Medicare and Medicaid, also known as "dual eligibles."

Learn how it works -- and what about all of January's claims?

Jan 29, 2013

Time to Decide About Medicare

Time is running out to decide if you will participate in Medicare this year. Feb.15 is the deadline to make a decision. TMA will help you decide with a new webinar discussing your three options.

Read on to learn about your three options and how to exercise them.

Jan 28, 2013

Texas Clinics Repay Medicare for Improper Claims

Several Texas dialysis clinics in El Paso and the Dallas-Fort Worth area have had to repay Medicare for treating people in the country illegally.

Read more.

Jan 24, 2013

How to "Deidentify" Personal Health Information

Q. I need to provide an insurance company a deidentified sampling of medical records from my practice for initial credentialing. What, precisely, defines a “deidentified” record?

A. Physicians may need to use deidentified records for various purposes, such as research, demographic and public health studies, or operational purposes like credentialing. Deidentified health information as defined by HIPAA is not protected health information (PHI) and thus is not covered by the HIPAA Privacy Rule.

To create a deidentified record according to HIPAA, you must remove all of the following information about a patient, as well as similar information about the patient’s relatives, employer, and household members:

Read the list and more tips.

Jan 23, 2013

“Other qualified health care professionals” and other 2013 CPT changes to note

The new year brings new and revised CPT codes. TMA’s Payment Advocacy staff highlighted the changes most likely to affect the most practices in 2013.

Eighty-two evaluation and management (E&M) codes were revised to include “other qualified health care professionals.” This phrase also was added to several non-E&M services in various sections of the guidelines.

Find out what that means and check out the other CPT coding changes we've flagged.

Jan 22, 2013

Medicare in 2013: Are You In or Out?

You have less than a month to decide if you will participate in Medicare this year. Feb. 15 is the deadline to make a decision. The Texas Medical Association will help you decide with a new webinar discussing your three options.

Learn more.

El Paso Physicians ... Join Us

Dr. Speer (left) administers the oath of office to Dr. Pazmino

On. Jan. 16, 2013, TMA President Michael E. Speer, MD, traveled to El Paso to swear in Patricio Pazmino, MD, as the new president of the El Paso County Medical Society. Dr. Pazmino took over after the year-long term of Richard M. Applebaum, MD. Below are Dr. Speer's comments to the assembled audience.



Thank you Dr. Applebaum … and let me be the first to congratulate Dr. Pazmino and wish him well. You are taking over the reins of a proud, 115-year-old organization of physicians.

Just as the Texas Medical Association does statewide, the El Paso County Medical Society stands tall for its physicians and your patients, advocating for better health care for the people of El Paso. We do this well not only because of the energy and commitment of leaders like Dr. Applebaum and Dr. Pazmino, but also because of the legions of superb physicians who stand with us.

Your Society represents your 1,090 members admirably.

I like to believe that TMA represents all 47,000 members equally as well.

But think how much more we could do if the El Paso County Medical Society counted 12 … or 13 … or 14 hundred members. Think how much more we could do if the TMA counted 48 … or 49 … or 50,000 members.

If each of you were to leave here and … tomorrow morning … try to recruit a non-member colleague, what would you say? What is your sales pitch to convince them to join TMA and the El Paso County Medical Society? I think it’s pretty obvious.

For example, thanks to the hard work of El Paso physicians like Manny Alvarez and Manny Acosta and your Executive Director Patsy Slaughter, you’ve built the Border Health Caucus into a powerful force in Austin and Washington, DC.

For example, you’ve made the Paul L. Foster School of Medicine a reality, right here on the border.

For example, we’ve reversed part of the disastrous cut in payments for dual-eligible patients. … And we are determined to overturn the rest of it in the Texas legislative session that began last week.

For example, we understand that Medicaid – which covers such a huge share of the population here in El Paso – is badly broken. El Paso doctors like Gil Handel and David Palafox and Jose Burgos and Maureen Francis served on TMA’s Physicians Medicaid Congress to help us find ways to make that broken system work again for you and your patients. The Congress’ long list of excellent recommendations will come before the TMA Board of Trustees in two weeks.

For example, TMA and the Border Caucus and the El Paso County Medical Society have already delivered a strong message to a legislature that needs to listen.

Physicians … we said … are critical to a cost-effective health care system in Texas. Otherwise, the state’s efforts to increase preventive care … to improve medically necessary treatment for the chronically ill … to reduce inappropriate emergency department visits … will fail.

We are attempting to impress on state leaders that cutting physicians’ Medicaid and CHIP payments is not an effective tool for controlling health care costs. That … quite the contrary … it exacerbates the cost of care.

We are asking them to ensure Texans of all income levels have access to preventive, routine, and emergent care.

We are asking them to ensure competitive Medicaid and CHIP payments for physicians.

We are asking them to increase funding for cost-effective, community-based mental health care and substance abuse.

And lastly, “Remember Tort Reform!” That great law you helped to create has resulted in every physician in this state paying one-third to one-half less every year in liability premiums compared to 2003.

That is just a small portion of what … together … we’ve done and we are doing. But I think it’s plenty to convince more El Paso physicians to join us.

And I urge you to try it out.

Thank you.

Jan 21, 2013

ICD-10: What Should I Do Now?

Although ICD-10 implementation doesn't kick in until Oct. 1, 2014, you can take steps now to help minimize your stress level in the months leading up to it. Time is on your side, but you must begin preparations to transition your practice soon.

In a recent video interview, TMA Practice Management Consultant Heather Bettridge sat down with Steve Arter, the chief executive officer of Complete Practice Resources (CPR), and CPR President Denny Flint to get their take on the necessary steps physicians should be taking now.

Read more.

Jan 16, 2013

Health Care in President's Gun Control Bull's-Eye

While his proposal for a new law to ban the sale of assault weapons is grabbing the early headlines, a number of pieces of President Obama's plan to reduce gun violence involve physicians and the health care system.

Already drawing controversy, for example, is the president's announcement that he will "clarify that the Affordable Care Act does not prohibit doctors asking their patients about guns in their homes."

In an article entitled "Obama: Doctors Should Ask About Guns in Homes," the conservative NewsMax publication says that provision "sounds like George Orwell’s 1984." From the other side, The Atlantic reported that "the order actually just preserves a legal expectation for doctors to report on their patients that has existed for 37 years."

All in all, a review of the president's 23 executive actions and nine legislative proposals reveals much that will -- or could -- impact physicians and patients and the health care system. (See below for the official White House press briefing on the pieces of the plan.)

One piece is already a formal executive order signed by the president:

The Secretary of Health and Human Services (Secretary), through the Director of the Centers for Disease Control and Prevention and other scientific agencies within the Department of Health and Human Services, shall conduct or sponsor research into the causes of gun violence and the ways to prevent it. The Secretary shall begin by identifying the most pressing research questions with the greatest potential public health impact, and by assessing existing public health interventions being implemented across the Nation to prevent gun violence.

"And while year after year, those who oppose even modest gun safety measures have threatened to defund scientific or medical research into the causes of gun violence," the president said at his news conference, "I will direct the Centers for Disease Control to go ahead and study the best ways to reduce it -- and Congress should fund research into the effects that violent video games have on young minds. We don't benefit from ignorance. We don't benefit from not knowing the science of this epidemic of violence."

The other six executive actions related to health care are:

  • Address unnecessary legal barriers, particularly relating to the Health Insurance Portability and Accountability Act, that may prevent states from making information available to the background check system. 
  • Release a letter to health care providers clarifying that no federal law prohibits them from reporting threats of violence to law enforcement authorities.
  • Release a letter to state health officials clarifying the scope of mental health services that Medicaid plans must cover.
  • Finalize regulations clarifying essential health benefits and parity requirements within ACA exchanges.
  • Commit to finalizing mental health parity regulations.
  • Launch a national dialogue led by Secretaries Sebelius and Duncan on mental health.

And the two pertinent pieces of President Obama's legislative agenda on gun violence are:

  • Help ensure that young people get the mental health treatment they need.
  • Ensure health insurance plans cover mental health benefits.

The first item, according to the White House press briefing, is aimed at training teachers, school counselors, social workers, and others who routinely work with students and young adults. We'll be curious to see more details on the second item.


White House Gun Proposals by Matt Sullivan