By Bohn D. Allen, MD
Inertia and momentum. As scientists, we learned those concepts
in our earliest studies. An object in motion tends to stay in
motion until acted upon by an outside force. The faster the object
is moving and the larger it is, the greater the force needed to
deflect it off course.
Coming off our outstanding tort reform and managed care
victories of 2003, the Texas Medical Association began 2004 with a
tremendous momentum and forward inertia. Thanks to our great speed
and mass -- America's largest state medical society passed the
40,000-member mark in December -- we closed the year in even better
Our profession and our patients already are reaping the benefits
of another milestone year for TMA. You can thank the volunteer
physician leaders who serve on TMA boards, councils, and committees
and the TEXPAC Board of Directors for doing their homework last
year. As a result, we were very well prepared, with solid policy
and solid politics, when the 2005 Texas Legislature began debating
taxes, scope of practice, and workers' compensation and
Your TMA Board of Trustees and our outstanding staff spent much
of 2004 looking even further into the future. You'll soon hear much
more about the TMA 2010 planning process and our new mission
statement: "TMA aggressively supports Texas physicians by providing
distinctive solutions to the challenges they encounter in the
practice of medicine." Isn't that what we expect?
I encourage you to read this 2004 Annual Report. Only when it's
all printed in one place can you appreciate what we've
accomplished. From fighting Medicaid HMOs to launching the Be Wise
project to getting the most from the Aetna and CIGNA settlements in
our nationwide lawsuit against for-profit managed care, TMA was
there -- aggressively supporting us with distinctive solutions to
the challenges we encounter.
Remember the noble roots and traditional virtues that brought us
into medicine: dignity, honesty, sincerity, and simplicity.
It has been a humbling pleasure to be your president in such an
exciting and invigorating time for Texas medicine.
A lesser medical association might have taken a break in 2004
and rested on its laurels. In the 2003 legislative session, the
Texas Medical Association reformed the state's professional
liability system, passed a prompt pay bill to make sure insurers
pay you on time, averted drastic cuts in physician reimbursement
and other Medicaid funding, and improved the availability of
childhood vaccinations. But that's not how we earned our reputation
as America's best medical society.
TMA and your physician leaders worked even harder last year to
build on the 2003 triumphs and prepare for 2005. Physicians and TMA
staff spent much of 2004 on projects to improve the state of
Texans' health, while at the same time gearing up for the important
issues legislators are debating this spring. TMA honed medicine's
position to fend off possible taxation of doctors' practices and to
preserve physicians' rights during the sunset review of the Texas
State Board of Medical Examiners and the Texas Workers'
Compensation Commission; readied the defense against the expected
assault on liability reform by trial lawyers; and prepared to
defeat any attempt by non-medical school graduates to expand their
scope of practice.
If the issue was important to physicians and their patients, TMA
was there, advocating for fair treatment for both. Just a few
examples: We convinced Blue Cross and Blue Shield of Texas to
modify its Blue Choice Solutions health plan to address physician
concerns about economic credentialing. We provided technical
assistance to help the Texas Department of Insurance (TDI) make
prompt pay rules effective and true to the legislature's intent for
physicians to be paid on time for their services. We mobilized
grassroots efforts to fight replacement of the popular Medicaid
Primary Care Case Management model with an HMO-only model, and
organized a delegation of Texas-Mexico border physicians to go to
Washington, D.C., to educate the Texas congressional delegation on
the unique public health, workforce, and health care access
challenges facing border physicians and patients.
TMA also worked on behalf of the physicians of the future in
We assumed the lead role in recommending that the Texas
Legislature increase funding for graduate medical education (GME).
We provided testimony at all related interim legislative hearings
and submitted a briefing document for legislators and staff on the
critical need for increased funding. We supported increased state
funding for undergraduate education.
In light of anticipated physician shortages, TMA recommended
expanding medical schools and residency slots in Texas and
collaborated with the American Medical Association to push for
equitable Medicare GME funding for Texas teaching hospitals and
removal of Medicare GME funding caps.
While doing all this, we helped you maintain healthy practices
with continuing medical education (CME) programs and practice
management workshops throughout the state.
Meanwhile, our membership topped 40,000 in 2004, thus increasing
physicians' influence at the state Capitol. TMA remains a
member-driven organization that represents all physician
specialties and groups, and provides services that benefit you at
every stage of your career.
Preserving Texans' Health
Although immunization is one of the most effective weapons
against disease, Texas ranks well below the national average of
immunized citizens. In 2004, TMA set out to change that by
launching the immunization awareness program Be Wise - Immunize,
one of our most ambitious public health programs.
A joint initiative of TMA and the TMA Alliance, and funded
through a grant from the TMA Foundation, the program promotes
immunization to the public as important, effective, and safe
through education, communication, and action.
The first stage of Be Wise - Immunize focuses on children, while
the second targets adolescents, and the third stresses adult
The ever-worsening obesity problem in Texas also drew attention
from TMA in 2004. Association physicians and Division of Public
Health, Quality, and Medical Education staff:
- Worked closely with state officials to develop and promote
better school nutrition policies.
- Joined the Texas State Strategic Health Partnership to
promote obesity prevention through education, partnerships, and
coalitions to make physicians and the public more aware of
nutrition and physical activity issues.
- Organized physician testimony before the legislature's Joint
Interim Committee on Health and Nutrition in Schools and helped
the committee draft recommendations to fight childhood
- Took an active role in the Texas Action for Healthy Kids
Alliance to address childhood obesity in Texas through
legislative, policy, and community efforts.
- Developed obesity legislation guidelines adopted by the
American Cancer Society, American Heart Association, and other
- Participated in Gov. Rick Perry's Texas Round-Up health fair
in Austin in April to promote physical fitness by offering
information on nutrition.
- Advised Austin PBS television station KLRU in developing
community antiobesity initiatives for "The American Family" and
"Sesame Street" programs, and worked with the station on a public
obesity awareness campaign.
Besides obesity and immunizations, TMA and its team of public
health and science experts also:
- Developed a policy on stem cell research that supports
research on embryonic and adult stem cells and therapeutic
cloning in biomedical research, but opposes cloning to produce a
- Endorsed a physician's right to discuss any and all treatment
options, including medical marijuana, with a patient without fear
of regulatory, disciplinary, or criminal sanctions.
- Coordinated physician participation in the XLHealth disease
management demonstration project to improve care for chronically
ill Medicare patients in Texas.
- Helped develop and distribute clinical office tools and a
physician recognition program for the Texas Cardiovascular
Disease Patient Safety and Quality Initiative.
- Conducted two symposia on major cancers and pain, helped
update the Texas Cancer Plan, and helped the American Cancer
Society update its C-Tools handheld software for physicians.
Guaranteeing Your Rights
CIGNA and Aetna settled their portions of organized medicine's
federal antiracketeering lawsuit against some of the nation's
largest for-profit HMOs. That means physicians finally will be paid
millions of dollars for claims the companies failed to pay for
years. But because the claims-filing process is complicated, TMA's
Office of the General Counsel educated physicians on how to make
sure they are paid what they are owed. It also arranged a
members-only discount with the Managed Care Advisory Group to help
physicians file their claims.
TMA attorneys participated in monthly enforcement meetings and
biweekly conference calls that resulted in substantial improvements
in making the two settlements meaningful for physicians.
Also in 2004, TMA's legal team:
- Joined the Texas State Board of Medical Examiners and Baylor
College of Medicine in their court battle to reverse a Texas
attorney general's opinion that would make physicians' licensing
files subject to open records disclosure.
- Successfully argued in a brief filed with the attorney
general that a state law against injuring an unborn child does
not force physicians to turn in pregnant women who have used
illegal drugs or alcohol.
- Prevailed in an appeals court decision that TMA and the Texas
Orthopaedic Association do have the right to sue the Texas Board
of Podiatric Examiners over its definition of the foot and
delineation of hospital privileges for podiatrists. The case is
set for trial in August.
- Joined the California and Georgia medical societies in filing
a brief supporting AMA in its appeal of a court ruling that
restricts medical associations' ability tocommunicate on proposed
settlements of pending and future lawsuits against HMOs.
- Filed a brief supporting two physicians who appealed a court
decision that overturned sanctions against an attorney who sued
them even though there was no evidence they prescribed an
allegedly unsafe medication.
- Developed policy on the state's prompt pay law and
standardized managed care contracts.
- Upgraded existing physician drug screening programs through
expanded testing panels, increased technical services, and
enhanced randomization of the drug screen process so that
computer-generated test dates are based on an entire year, as
opposed to a monthly basis.
Protecting the Bottom Line
You can't treat patients if you can't stay in business. Our
Division of Medical Economics and the Council on Socioeconomics
worked throughout 2004 to maintain the fiscal health of your
- Held 16 meetings with insurance carriers toresolve
claims-payment problems and resolve other disputes created by
health plan practices.
- Conductedmore than 700 mini-consults across Texas to educate
physicians and staff on Medicare, Medicaid, managed care,
payment-related coding and billing issues, and other topics; and
distributedmore than 1,200 consultation handbooks statewide.
- Answered 2,028Hassle Factor Log complaints about
reimbursement problems from physicians throughout Texas.
- Represented your interests in addressing Medicaid, Medicare,
workers' compensation, and TDI regulatory problems.
- Served as faculty for successful seminars on practice
management, coding, and Texas prompt payment requirements.
Planning for the Future
Recognizing that the Texas today is not what it will be
tomorrow, TMA's Board of Trustees under the leadership of Chair
Dennis Factor, MD, launched the TMA 2010 program in 2004 to make
sure the association meets members' needs in the future.
The process began with an environmental scan that included an
examination of demographers' predictions of an "older, poorer,
sicker, and less educated" population; physician demographics and
supply and demand; the changing health care team; trends in health
care financing and delivery; information technology; and
association and membership trends.
Among the questions asked during the process were how predicted
changes will affect physicians and their practices in 2010, what
kind of help physicians will expect from TMA in 2010, and what kind
of physician leadership will best suit TMA in fulfilling that
The process identified four major goals:
- Protect, improve, and strengthen the viability of medical
practices in Texas.
- Ensure continued success in legislative, regulatory, and
legal interventions to enhance the statewide environment in which
Texas physicians practice medicine.
- Strengthen physicians' trusted leadership role within their
communities and the health care team.
- Enhance the powerful, effective, and unified voice of Texas
In 2005, trustees and staff will prioritize strategies to meet
the goals, allocate resources, define measurements, and evaluate
the governance structure to implement the TMA 2010 plan.
2004 by the Numbers
|Medical student members
|Resident physician members
students, and other health professionals educated on cancer
prevention, early detection, and control by TMA's Physician
Oncology Education Program
|Free copies of
TSBME: The Devil's in the Details
home study course mailed to members
|Physicians and staff attending 120 TMA
practice management seminars
|Physicians who took advantage of free CME
courses at TexMed 2004
|Physicians and staff members who benefited
from TMA publications, including home studies on ethics,
documentation, and billing compliance
|CME credit hours offered in 201 courses on
issues such as HIPAA security, obesity, and diabetes
|Record number of CME professionals at TMA's
Texas CME Conference
|Physicians at children's mental health
workshop at TexMed 2004
|New services endorsed by TMA: medical
collections, equipment leasing, physician recruitment,
credentialing services, and an online career center
Maintaining Financial Health
TMA ended 2004 with income of $19,085,890 and expenses of
$18,554,620. The association's primary source of operating income
was membership dues. Additional income came from programs approved
by the Board of Trustees, such as educational seminars,
publications, consulting services, advertising, and member
services. An average of $720 per active member was expended on TMA
programs and activities in 2004.