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.