2012 a Success, But We're Not Done
By Michael E. Speer, MD, 2012-13 TMA president
As you can see by reading this annual report, 2012 was another very successful year for the Texas Medical Association. We accomplished a great deal for physicians and our patients.
We crossed the 47,000-member mark in 2012, but there still are physicians who simply don't understand the value of membership in TMA. When I became president last May in Dallas, I said I wanted TMA to achieve 50,000 members this year. We're close, but there is still work ahead.
There's disagreement over who first said "Decisions are made by those who show up," but whoever said it was right. We can sit back and complain about what government and insurance companies do to us and our patients, or we can show up. We can show up and vote. We can show up and work for candidates who support our positions. We can show up and talk to our local lawmakers when they are in their home districts. But first we must show up and join TMA.
If you’re already a member, thank you. I hope you will continue your membership for years to come. And please talk to your colleagues who are not members. Tell them why you joined TMA, explain to them what we do for you and your patients, and urge them to join us.
Some of the issues we faced in 2012 are still with us. Preserving Medicare fees, fixing the broken Medicaid system, maintaining tort reform, and fending off encroachment on our scope of practice are just a few.
We've already seen what sequestration did to physicians' Medicare payments, down 2 percent. Later this year, as they have for more than a decade, Congress and the Centers for Medicare & Medicaid Services likely will put physicians and patients through another gut-wrenching experience by again threatening us with drastic cuts in Medicare payments for 2014 via the Sustainable Growth Rate (SGR) formula.
Before this occurs, we must redouble our efforts to convince Congress to do what it should have done years ago, lo, more than a decade ago – repeal the SGR formula and establish a fair Medicare payment system.
While we're at it, we must convince Congress to repeal the Independent Payment Advisory Board, an unelected board created by the Patient Protection and Affordable Care Act. The board’s only option, by law, is to cut Medicare payments to physicians.
None of these challenges will be easy. They never are. But I'm confident that with the same hard work it took for us to become physicians, we can overcome them.
It was an honor for me to serve as your president during the past year. I know that with our new president, Dr. Steve Brotherton, at the helm, it will be another impressive year for our association.
Protecting the Profession: TMA Works for Physicians, Patients in 2012
National Football League (NFL) Commissioner Roger Goodell says his main job is to "protect the shield," a reference to the NFL's shield logo. By that, he means it's his job to safeguard the league's integrity. Likewise, the Texas Medical Association's primary job is to protect the profession of medicine and the safety of patients who depend on physicians for their very lives.
TMA did just that in 2012. Whether it was protecting the financial viability of medical practices and patients' access to care, or protecting patients from inadequately trained nonphysicians who want to practice medicine, TMA and its physician leaders and staff worked tirelessly to live up to the association's mission.
Physicians faced numerous challenges in 2012, and TMA was always there, working on their behalf.
- TMA and member physicians in the Rio Grande Valley convinced the Texas Health and Human Services Commission to restore the Medicare Part B deductible payment for patients eligible for both Medicare and Medicaid, also known as "dual eligibles." The state cut payments to physicians treating those patients to save money, financially devastating their practices and placing some of our state's most vulnerable citizens at risk.
- TMA helped state officials resolve computer issues threatening payment of more than 30,000 physicians' claims worth $23 million when the claims clearinghouse Availity inadvertently cut its connection to the Texas Medicaid & Healthcare Partnership.
- The Hassle Factor Log program, which allows physicians to bring payment issues to TMA's attention, recovered $26.2 million, including money recovered from incorrectly processed claims, lost or delayed Medicare enrollment applications, and other payment issue claims.
- A special TMA team conducted a tele-town hall meeting, plus webinars and seminars and other educational efforts, to help physicians make the transition from TrailBlazer Health Enterprises to Novitas Solutions for processing Medicare claims with as little disruption as possible.
- After the U.S. Supreme Court upheld the Patient Protect and Affordable Care Act in June, TMA doubled down on its efforts to improve the broken Medicaid system in Texas. TMA convened the Physician Medicaid Congress to examine Medicaid. After a lengthy study, the group made several recommendations for lawmakers to consider in their 2013 session to strengthen the ailing program, improve patients' access to care, and attract physicians back to it.
- TMA lobbied the federal government to delay implementation of the ICD-10 coding system in 2014, but at the same time developed a webinar, video series, and other tools to help physicians prepare for the profound change in how they code their claims. That proved to be a wise decision when the government decided to go ahead with the switch.
- Working with other state and national medical societies, TMA reached a settlement with Aetna in a lawsuit over out-of-network claims that will earn physicians $120 million.
- TMA won a court ruling protecting patients' safety in a lawsuit over nonphysicians' encroachment into physicians' scope of practice. The Texas Court of Appeals upheld a trial court verdict against the Texas State Board of Chiropractic Examiners that needle electromyography and manipulation under anesthesia are not within the scope of chiropractic practice.
- TMA improved physicians' access to TMA's practice management, cancer, and physician health continuing medical education (CME) courses by establishing the TMA Education Center on the TMA website offering convenient, one-stop access to the courses.
- TMA offered a free member service, DocbookMD, a mobile app that allows physicians to send and receive vital patient information instantly via smartphones or tablets and to be HIPAA-compliant in the process. DocbookMD helps enhance patient care, make your practice more efficient, gain and give referrals, and avoid mistakes.
In 2012, TMA also:
- Continued its effort to convince Congress to repeal the Sustainable Growth Rate formula that annually threatens to cut Medicare payments to physicians and to scrap the even-worse Independent Payment Advisory Board set up under the Patient Protection and Affordable Care Act;
- Promoted pro-consumer insurance rules on preferred and exclusive provider organizations that foster network adequacy and protect physicians' ability to freely contract;
- Filed court briefs supporting physicians in two lawsuits against hospitals over unfair practices, efforts that resulted in an $8 million settlement for physicians in one case and a court ruling for physicians in the other;
- Collaborated with the Texas Department of State Health Services on public health priorities, including women's health, the West Nile virus, and tuberculosis control;
- Launched an online Meaningful Use Achievement Toolkit and continued support of the Texas regional extension centers to help physicians meet health information technology meaningful use requirements and earn Medicare and Medicaid incentives;
- Drew on the expertise of the TMA Council on Health Quality to develop policies on quality improvement;
- Sponsored its first influenza vaccination clinic at the TMA Winter Conference under the direction of the Council on Science and Public Health;
- Expanded TMA Foundation philanthropic contributions to fund a record 15 community health grants;
- Created the TMA Academic Achievement Award to recognize the efforts of academic physicians; and
- Established a video studio to produce videos and increase the association's presence on social media platforms such as Twitter and Facebook that enhance TMA's ability to get its message to members, policymakers, the news media, and the public.
Looking to 2013
The Texas Legislature was not in session in 2012, but TMA worked throughout the year to build on the success it achieved in 2011 and prepare for the 2013 session.
In July, TMA outlined its strategic roadmap for state and federal advocacy initiatives for the remainder of the decade in Healthy Vision 2020, a comprehensive plan for improving health care and maintaining the viability of physicians' practices in Texas. The plan makes eight key recommendations:
- Ensure an adequate health care workforce;
- Protect physicians' independent medical judgment;
- Promote efficient and effective new models of care;
- Repeal harmful and onerous state and federal regulations;
- Invest in prevention;
- Protect and promote a fair civil justice system;
- Provide appropriate state and federal funding for physician services; and
- Establish fair and transparent insurance markets for patients, employers, taxpayers, and physicians.
You also may order a copy of Healthy Vision 2020 from the TMA Knowledge Center by calling (800) 880-7955 or emailing TMA Knowledge Center.
Medicine's priorities for the 2013 session include expanding coverage and reforming Medicaid; reversing the funding cuts to dual-eligibles, graduate medical education, and public health programs; supporting delegation and team care; protecting the 2003 health care tort reforms; cutting red tape and hassles for physician practices; and stopping the theft of physicians' services by silent PPOs.
TMA also prepared for the 2013 legislative session by joining the Texas Public Health Coalition to hold four University of Health forums to brief legislators and their staffs on medicine's public health priorities. And, TMA physician leaders and staff met with officials at all of the state's medical schools to discuss strategies for graduate medical education funding this year.
To ensure lawmakers and bureaucrats in Austin and Washington hear physicians' voices, the TMA Political Action Committee (TEXPAC), TMA's political arm, endorsed an impressive list of candidates in both parties running for state and federal office. As a result, the Texas House and Senate each gained two new doctors, complementing the physicians and one TMA Alliance member serving in the legislature and in Congress.
Texas physicians responded to TMA's efforts on their behalf. The association membership continues to increase; TMA now represents more than 47,000 physicians and medical students, making TMA a powerful advocate for physicians and patients.