Apr 15, 2017

Mandate? Hardly.

As in a bad Freddy Krueger movie, rumors of a binding, incestuous relationship between the Interstate Medical License Compact and Maintenance of Certification (MOC) just will not die.

Let’s set the record straight.

The Interstate Medical License Compact is a multistate agreement that allows physicians to obtain a license in a new state faster and with fewer hassles. Here are some basic facts to remember:

1.      The Compact does not replace, override, or reduce the need for the physician to meet the licensing requirements of the new state.

2.      Physicians who, for any reason, do not want to use the Compact still may apply for a license in the new state using the traditional route.

3.      Physicians who want to use the Compact must have an active board certification at the time of the license application through the compact. The Compact does not require MOC before, during, or after that procedure.

Mandate? Hardly.

Now, as to the position of the Texas Medical Association (TMA):

TMA opposes mandatory MOC requirements for licensing, credentialing, hospital privileges, health plan contracts, or payment. This position was adopted by votes of the TMA House of Delegates in 2013 and in 2016 in adopting these policies:

·         Maintenance of Certification Requirement: TMA supports the American Medical Association’s Principles of Maintenance of Certification (MOC) H-275.924 to ensure physician’s choice of lifelong learning, and will pursue legislation that eliminates discrimination by the State of Texas, employers, hospitals, and payers based on the American Board of Medical Specialties’ proprietary MOC program as a requirement for licensure, employment, hospital staff membership, and payments for medical care in Texas. (2016)

·         Opposition to Maintenance of Licensure: TMA opposes any efforts by the Texas Medical Board (1) that require the Federation of State Medical Boards’ Maintenance of Licensure (MOL) program as a condition of licensure, and (2) that unilaterally implement different Maintenance of Licensure requirements other than those currently in place for physicians in Texas. (2013)

In the current (2017) session of the Texas Legislature, TMA is strongly supporting Senate Bill 1148 by Sen. Dawn Buckingham, MD (R- Lake Travis). That would prohibit the sole use of MOC status to credential, license, or pay physicians. Kim Monday, MD, a neurologist from Houston and former president of the Harris County Medical Society testified for the bill in committee on behalf of TMA. Dr. Monday called the requirement “burdensome, expensive, and filled with irrelevant curriculum.” She noted the combined cost including materials, fees, and time away from patients and the medical practice to undergo the process can be as high as $10,000. Dr. Monday referred to MOC as a “moneymaking scheme” with “little applicability to day-to-day practice.”

The Interstate Medical License Compact provides a route for Texas to recruit and quickly deploy physicians currently licensed in other states. Given the desirability of practicing medicine in Texas and the state’s severe physician shortage, adopting the Compact by the Texas Legislature would have a positive outcome.

In 2015, the TMA House of Delegates considered but did not adopt a resolution calling on the association to “oppose the Federation of State Medical Board’s (FSMB) Interstate Medical Licensure Compact as currently written.”

Apr 6, 2017

Speak Up and Be Heard

By Sara G. Austin, MD
2017 Travis County Medical Society President

This article was originally published in the March/April edition of the Travis County Medical Society Journal.

Gosh, it's time to write this article again! So I was thinking—no worries, I'll just wait until after the first First Tuesday at the Capitol and write about what the House of Medicine is advocating for in this legislative session. There, done, simple. I’ve done that lots of times; it takes about 10 minutes and it's important stuff, stuff you guys need to know something about. Plus the rattlesnake wranglers were at the Capitol and they are fun to watch and make a great picture, and I could talk about that too.

But this First Tuesday seemed different to me. For one, I work at Seton now, and I'm staffing Brackenridge this week. I saw a nice lady with Medicaid (who couldn't have afforded to see me in my private practice) complaining of hand numbness and weakness. Initially I thought it was just carpal tunnel. But after an exam and some testing, it turned out to be ALS. It made me grateful that I was in a place where I can see people who don't always have good insurance. And staffing Brackenridge makes me aware of how much need is out there. So I go down to First Tuesdays and we are fighting some of the same battles we’ve fought for years and we need to continue to fight—fair policies from insurance companies, patient safety and scope of practice, public health (smoking in public places, vaccinations) and funding for Graduate Medical Education. Medicaid is always mentioned but feels like such a losing battle that sometimes it only gets one sentence, like "Please do something with Medicaid."

The Capitol was packed on this First Tuesday! I mean it was difficult to walk through the rotunda and up and down the stairs because the sanctuary cities issue was being debated in both chambers. There was a palpable tension in the Capitol that I've not run across before. I hear the same tension in the news when they are talking about D.C.—people trying to figure out how to get their head around this new administration and wondering what's going on, and perhaps, what's going to change?

I found myself thinking how much easier things were to handle when it was the same old, same old. This conflict, this possibility of doing things differently, this . . . change . . . is now making me nervous. I realize change does that because it brings up the chance of loss, but it has the chance of gain as well. And really, nowhere is change more important to our lives and wellbeing than in health care.

I am still hoping that something breaks lose for the better. That it somehow gets easier to see and care for patients than it is now. That we don't let people suffer for lack of access to health care. It needs to change. And yes, we have got to keep pushing for Medicaid to improve.

I think now is the time to speak up—to be heard—especially for the House of Medicine. When else will we ever have a better chance to actually make a difference for our patients? So work to understand the issues, and tell your stories and your patients' stories. Believe me, there are lots of other folks out there telling theirs. Don't forget that the next First Tuesday is April 4. We had a great turn out this last time and really would love to see even more white coats in the Capitol this next time. Think about it.

Meanwhile, it is comforting that there are still people out there who can mess with a rattlesnake and not (or very rarely) get bit. They may be in the safest place of all this year.

Nov 14, 2016

Texas Doctors See Post-Election Opportunity to Reshape Health Care

(ORLANDO) -- The 2016 elections brought physicians an excellent opportunity to rebuild America’s health care systems, Texas Medical Association officials say.

“Everything is on the table — the Affordable Care Act (ACA), Medicare, and Medicaid,” said David Henkes, MD, chair of the Texas Delegation to the American Medical Association. “Today, we are crafting plans to remake the system so it truly serves our physician members and our patients.”

Drs. Kridel (l) and Henkes prepare to lead discussion on health care reform
at meeting of Texas Delegation to the AMA.
Fortuitously, the interim meeting of the AMA House of Delegates brought dozens of TMA leaders together just four days after the Nov. 8 elections. They laid out key strategic directions that TMA staff will use to devise a detailed plan.

“We need one document for all physicians, all specialties, to take to Congress and the administration and say, ‘This is what medicine believes in,’ ” Houston facial plastic surgeon Russ Kridel, MD, a member of the AMA Board of Trustees, said at an hour-long health care reform conversation among members of the Texas Delegation to the AMA, who are in Orlando, Fla., for the interim meeting of the AMA House of Delegates. “We need to act now, and we need to do those things that will put us at the table.”

“The ACA was a first step, now we need to take another step,” said former AMA and TMA President Jim Rohack, MD.

The Texas physicians said they are looking for an approach that simplifies the health care system for physicians and patients, reduces the huge regulatory burden on physicians, and reduces the cost of U.S. health care.

“This whole system is just too complicated for most people to handle,” said Dallas psychiatrist Clifford Moy, MD.

Many of the ideas in President-Elect Donald Trump’s “Great Again” health care platform and the health care agenda in House Speaker Paul Ryan’s “Better Way” plan are consistent with TMA policy.

TMA actively opposed passage of the ACA in 2010 but has since adopted an approach to “Keep what’s good, fix what’s broken, and find what’s missing.” Speaker Ryan echoed that approach during a Nov. 13 television interview, when he said, “We can fix what is broken in health care without breaking what is working in health care."

Six years of near absolute gridlock in Washington, DC, prevented even the tiniest ACA reforms from passing. One very significant achievement – from TMA’s “Find what’s missing” category – was the repeal of Medicare’s Sustainable Growth Rate (SGR) formula via the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

“Texas Solution” Gets New Life

It’s important to remember that what happens in Washington not only affects Medicare, commercial health insurance, and coverage for uninsured patients, but also plays a big role in how states implement the Medicaid program.

“We are entering into a new time,” U.S. Rep. Michael Burgess, MD (R-Lewisville), said at a fundraising reception TMA hosted for him in Orlando. “I would love it if the governors came to Washington and said, ‘OK, guys, you deliver the mail and secure the border, we’ll take care of our sick folks.’ That would be a far, far more reasonable way to approach it.”

Representative Burgess (l) discusses opportunities for major health system
changes with Drs. Robert Gunby (c) and John Carlo (r) of Dallas.
Dr. Burgess likely will be a key player in the health care debate in the next Congress.

Both the Trump and Ryan plans call for Medicaid changes that mirror the “Texas Solution” for expanded coverage that TMA has promoted since 2013. The Texas Solution calls for a comprehensive plan that:
  • Improves patient care;
  • Draws down all available federal dollars to expand access to health care for poor Texans;
  • Gives Texas the flexibility to change the plan as our needs and circumstances change;
  • Clears away Medicaid’s financial, administrative, and regulatory hurdles that are driving up costs and driving Texas physicians away from the program;
  • Relieves local Texas taxpayers and Texans with insurance from the unfair and unnecessary burden of paying the entire cost of caring for their uninsured neighbors; and
  • Pays physicians for Medicaid services at a rate at least equal to Medicare payments.

TMA staff are preparing a white paper on “Post-Election Strategies for Health System Reform” for discussion at the TMA Advocacy Retreat, Dec. 2-3 in Austin.

Nov 9, 2016

TEXPAC and Texas Physicians Enjoy Strong Election Results

This unique presidential election brought on many predictions and projections for who would win, but even as the polls closed last night, most voters were unsure of the likely outcome and how it would affect the races across the state.

As expected, voters flocked to the polls to vote for the next president. But while Texas set a record for early voter turnout, our Election Day turnout struggled — most Texans had cast their ballot early. TEXPAC’s concern was that the high volume of voters overall would affect our friends running for reelection in swing districts in counties such as Bexar, Dallas, Harris, and Travis. However, hard work and Donald Trump’s 54-percent win in Texas helped most of our friends claim victory last night.

Wins for Medicine

The election resulted in two HUGE wins for medicine. We have two new TMA/TEXPAC physicians elected to the Texas Legislature! Sen.-Elect Dawn Buckingham, MD, won Senate District 24 with 72.4 percent of the vote, and Rep.-Elect Tom Oliverson, MD, is the newest physician in the Texas House. He won House District 130 in the primary election last March and ran unopposed in the general election. TEXPAC endorsed both candidates in the primary and general elections, and we are thrilled to work with them in the upcoming legislative session.

TEXPAC had an extremely successful night. In total, 119 endorsed candidates for the Texas House, 16 for the Texas Senate, and four endorsed judicial candidates were victorious. Despite these successes, we did lose three friendly incumbents to their challengers:
  • In House District 117, Rick Galindo (R) was defeated by former State Rep. Philip Cortez (D). A Democrat usually holds the seat, and we expected this outcome, but we are sad to lose Rick Galindo. Fortunately, Philip Cortez is also a friend of medicine. He was a champion of our issues during the 83rd legislative session, and we are excited to work with him again.
  • In Harris County, we saw a similar scenario. In House District 144, another swing district, former State Rep. Mary Ann Perez reclaimed her seat from TEXPAC-endorsed Gilbert Pena (R).
  • The most disappointing loss for medicine last night, however, was in House District 107. Our good friend Kenneth Sheets (R) was defeated by his opponent Victoria Neave (D). This is a big loss for TEXPAC; Kenneth Sheets was a wonderful state representative, as well as a champion for medicine. He had a great relationship with the TMA Advocacy team and even better relations with his local physicians. He played a big role on the House Insurance Committee, and we are sad to lose him. His race was considered to be one of the toughest this cycle, and we worked hard to help him get reelected. I know he is grateful for the support we provided him as an organization.
Fortunately, most of our friends will be back to represent medicine in the 85th legislative session. We are extremely excited for our friendly incumbents to return, and we also are looking forward to working with the new members we supported. Below are the results for our priority races.


State Senate
SD 19 
Carlos Uresti (D) 
SD 20
Juan “Chuy” Hinojosa (D)
SD 24
Dawn Buckingham, MD (R)
72.4% (new member)

State House
HD 23 
Wayne Faircloth (R)
HD 33
Justin Holland (R)
67.8% (new member)
HD 41
Bobby Guerra (D)
HD 43
J.M. Lozano (R)
HD 47
Paul Workman (R)
HD 54
Scott Cosper (R)
54.8% (new member)
HD 64
Lynn Stucky (R)
61.6% (new member)
HD 65
Ron Simmons (R)
HD 102
Linda Koop (R)
HD 105
Rodney Anderson (R)
HD 107
Victoria Neave (D)
50.8% (new member)
HD 112
Angie Chen Button (R)
HD 113
Cindy Burkett (R)
HD 114
Jason Villalba (R)
HD 117
Philip Cortez (D)
51.4% (new member)
HD 118
Tomas Uresti (D)
55.2% (new member)
HD 134
Sarah Davis (R)
HD 136
Tony Dale (R)
HD 144
Mary Ann Perez (D)
60.2% (new member)
HD 149
Hubert Vo (D)

Texas Supreme Court 
Place 5
Paul Green (R)
Place 9
Eva Guzman (R)

Texas Medical Association Political Action Committee (TEXPAC) is a bi-partisan political action committee of TMA and affiliated with the American Medical Association Political Action Committee (AMPAC) for congressional contribution purposes only. Its goal is to support and elect pro-medicine candidates on both the federal and state level. Voluntary contributions by individuals to TEXPAC should be written on personal checks. Funds attributed to individuals or professional association (PAs) that would exceed federal contribution limits will be placed in the TEXPAC statewide account to support non-federal political candidates. Contributions are not limited to the suggested amounts. TEXPAC will not favor or disadvantage anyone based on the amounts or failure to make contributions. Contributions used for federal purposes are subject to the prohibitions and limitations of the Federal Election Campaign Act.
Contributions or gifts to TEXPAC or any CMS PAC are not deductible as charitable contributions or business expenses for Federal income tax purposes.
Federal law requires us to use our best efforts to collect and report the name, mailing address, occupation, and name of employer of individuals whose contributions exceed $200 in a calendar year. To satisfy this regulation, please include your occupation and employer information in the space provided. Contributions from a practice business account must disclose the name of the practice and the allocation of contributions for each contributing owner. Should you have any questions, please call TEXPAC at (512) 370-1361.
Paid for by the Texas Medical Association Political Action Committee
401 W. 15th St. Austin, TX 78701

Oct 14, 2016

Ready for MACRA? TMA Can Help

Earlier today, the Centers for Medicare & Medicaid Services (CMS) released its final rule implementing the Medicare Access and CHIP Reauthorization Act (MACRA). Physician practices across the country now have a busy two and a half months trying to get ready to begin collecting and reporting data on Jan. 1.

TMA will continue to work with CMS and the Texas congressional delegation to rewrite and reform many of the problems we identified in CMS’ draft regulations. Although CMS granted physicians a reprieve from 2019 Medicare payment penalties if they attempt to report some data next year, practices still face a host of decisions about what path they will take to try to comply with the biggest change in Medicare payment policies in more than a generation.

TMA is here to provide guidance:

For all the latest, visit TMA's online MACRA Resource Center regularly.

Sep 15, 2016

Does the government know what it’s doing to physicians?

By Don R. Read, MD
President, Texas Medical Association

(This article first appeared in the KevinMD.com blog. Reprinted with permission.)

Physicians spend almost twice as much time each day typing on computers and filling out paperwork as they do seeing patients. That astonishing conclusion comes from research published this week in the Annals of Internal Medicine.

Just think about that. How would you feel if you spent two hours documenting every hour of work that you do? How would your boss feel about it? You’d be depressed and frustrated; your boss would probably be angry as hell.

Patients should be up in arms over this report. Taxpayers should be up in arms. Physicians already are up in arms because we already knew this was true — and we know it’s just going to get worse.

We know it’s going to get worse because we know what’s causing it in the first place.

And that’s what’s missing in this study. Why? Why do physicians spend just 27 percent of their time “on direct clinical face time with patients” and 49.2 percent on electronic health records (EHRs) and “desk work”? From my nearly 50 years in medicine and thousands of conversations I’ve had with my colleagues, I can guarantee you it’s not a willing choice.

But again, the question is “why.” Why is this happening? Part of it has to do with EHR systems that appear to have been designed by someone who never set foot in a physician’s exam room. They’re clunky, not intuitive, and don’t fit the flow of how we examine, diagnose, and interact with our patients.

But the bigger issue is why we have to enter all of this data into a computer system in the first place. It comes back to an alphabet soup of government regulations that definitely were written by someone who’s never been in the exam room with a patient. The Physician Quality Reporting System (PQRS), Meaningful Use (MU), and the Value-Based Payment Modifier (VBM) program all aim to “capture” the quality of care we’re providing and score us on the cost of that care. MU — the worst-named government program ever — actually cuts our Medicare payments if we don’t use an EHR.

A study published in Health Affairs earlier this year estimates the cost in physician time to comply with just one of those programs, PQRS, exceeds $50,000 per primary care physician per year. That’s a lot of money; but it’s also a lot of our time. That’s time the government has stolen from our patients.

And — as I mentioned earlier — it’s only going to get worse. The Merit-Based Incentive Payment System (MIPS), part of the Medicare Access and CHIP Reauthorization Act (MACRA), begins in January. MIPS is supposed to replace PQRS, MU, and VBM. But, as I wrote in this space in June, the new program looks to be far more costly, complex, and confusing than the costly, complex, and confusing programs it is replacing.

The Centers for Medicare & Medicaid Services (CMS) estimates MACRA will add $128 million a year in compliance costs above the costs of complying with the programs it is replacing. Texas Medical Association analysis finds that “official” number woefully low.

And all of that brings us to one more, even bigger question: Does the government know what it’s doing to physicians?

We went to medical school and dedicated our lives to helping people heal and stay healthy, not to become data entry operators. But that’s what we have become, and that’s taking a toll on physicians, our patients, and the entire health care system. Physicians are burned out and unhappy, patients have less time with their doctors, and everyone has to pay more to get less care.

I’ve been a patient — a seriously ill patient — and I owe my life to the physicians who helped me recover from West Nile virus encephalitis. Like every patient, I don’t want a burned-out, unhappy doctor who’s enslaved by his computer. I want a bright-eyed, engaged, and satisfied physician who has the time and energy to put me — and my health — first.

Jul 12, 2016

"We have deliberately set the game so that you cannot win"

Shortly before a senior Medicare official came to visit his Dallas office in late June, Texas Medical Association President Don R. Read, MD, shared with Texas Medicine his thoughts on the agency's draft rules implementing the Medicare Access and CHIP Reauthorization Act (MACRA). Dr. Read compared changing complexity of Medicare rules to a progression from a simple game of checkers to a new game no one understands, whose rules are written in Mayan hieroglyph, and which "you cannot win."

Listen to the short audio clip, or read the full transcript below.



“This is how MACRA comes across to me. With original Medicare, we were playing checkers. There were some rules we didn’t agree with, some that were truly stupid, like you couldn’t pay for a TPN outside the hospital, which was much cheaper so we had to keep them in the hospital which was much more expensive, but you pretty much understand the rules. Then with PQRS and MU, we started playing chess. Kind of easy chess, but we were starting to play chess.

“And now you say, well we’re going to change the game. It’s not checkers; it’s not chess; it’s something new. The board’s got two more columns and two more rows. Some of the chess pieces are the same, but we’ve put new ones out there. And we’ve written rules. We started to write them in Mandarin Chinese, but we figured you’d be able to get an interpreter and interpret them, so we’ve written them in Mayan hieroglyphs to make sure you don’t understand.

“But you have to start playing right away, and don’t worry about the fact that you don’t understand the rules because we have deliberately set the game so that you cannot win.

“And by the way, two years from now you’re going to get penalized because you did not win.”