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 Volume 17, No 32                        

 Oct. 12, 2015                    


New Mexico Court Urged to Heed Texas Tort Reforms

A medical liability case involving a Texas physician who provided care to a New Mexico resident in Texas should not be governed by New Mexico’s far weaker tort laws, TMA, the Texas Alliance for Patient Access (TAPA), the New Mexico Medical Society, and dozens of other physician groups in both states wrote in a brief to the New Mexico Supreme Court. Access to health care is already challenging enough for New Mexico patients seeking care. New Mexico doctors and hospitals have long relied on referring or transferring sick and injured patients to Texas for specialized care. The willingness of Texas physicians and hospitals to receive those patients may be shaken if the New Mexico Supreme Court upholds a recent state appellate court ruling. That ruling is causing a significant liability risk for Texas doctors, forcing physicians here to consider what patients they will see and under what circumstances they will see them. Unless overturned, this decision will diminish access to care for thousands of Eastern New Mexicans. 

TMA Calls Out Insurance Companies Over Balance Billing

The national health insurance lobby and their cronies in the Texas Association of Health Plans released their annual “report” citing physicians for what they called “exorbitant” bills for out-of-network services. We challenged the allegations publicly and earned some positive news media coverage. “This so-called report is nothing more than a desperate smoke screen to divert attention from the real problem,” said TMA President Tom Garcia, MD. He not only pointed out the absurdity of using Medicare payments as a benchmark for “reasonable” charges. He also directed reporters to a recent University of Pennsylvania study that found Texas home to some of the narrowest physician networks in the country. “The health insurance industry games the system to keep more of patients’ premium dollars by forcing patients to seek care out of network,” Dr. Garcia said. “Then they have the gall to criticize what some doctors’ bill for that care.”

Medicine Fights Federal Mandates on Physicians

Since our last visit to Capitol Hill, Congress has repealed the Medicare Sustainable Growth Rate (SGR) formula, and House Speaker John Boehner’s announced retirement has created a free-for-all battle for House leadership positions. But TMA and the Coalition of State Medical Societies are still fighting to pry some of the regulatory burdens off of physicians’ backs. When we return to Washington in a few weeks, our agenda will sound familiar to senators and representatives: 

  • Eliminate federal mandates, like the poorly named “meaningful use” program, that compel physicians to engage in unnecessary activities and reporting;
  • Stop the bounty-hunting Medicare Recovery Audit Program contractors (RACs);
  • Maintain the state-based system of licensing physicians;
  • Be prepared to act quickly to protect physicians’ practices decimated by the new ICD-10 coding system; and 
  • Clarify that there are not now and never will be a requirement for Maintenance of Certification (MOC) to be a condition for state licensure or for participation in Medicare or Medicaid.

Dr. Garcia’s Travels Heat Up As Weather Cools

Fall finds Dr. Garcia spending more time on the road, spreading the word about TMA’s legislative successes, and helping to recruit new members. He recently spoke to the Wichita County Medical Society and the Southwest Branch of Harris County Medical Society. Coming up is a visit to the Webb-Zapata-Jim Hogg County Medical Society in Laredo. Then Dr. Garcia will be a featured speaker at the National Association of Latino Elected and Appointed Officials on what health reform means to physician practices. Let us know if you want Dr. Garcia to speak to your county society or physician group.

TMA Raises Serious Concerns About Aetna-Humana Merger

If Aetna is allowed to complete its deal to buy Humana, our state’s already highly concentrated health insurance market would be even less competitive. And that would be bad for physicians and patients. That’s what TMA wrote in a formal comment letter to the Department of Justice. Texas’ many one- to three-physician groups “may have very little negotiating leverage to allow them to secure favorable pricing terms,” we wrote. “Health plans that can wield unchecked pricing power can force physician practices out of business.” That would create access problems for patients in addition to the problems associated with trying to buy insurance in noncompetitive markets. The letter cited data showing the purchase would give the new company “enhanced market power” in San Antonio, Houston, Austin, El Paso, Corpus Christi, and many other Texas markets.

High Court to Hear Tobacco Tax Case

The Texas Supreme Court has accepted an appeal of a lower court ruling that invalidated a tax the legislature applied to so-called “small tobacco.” Back in 1998, the nation’s five largest tobacco companies settled a case with Texas and 45 other states over the health care costs of cigarette smoking. They agreed to pay $10 billion a year indefinitely to the states. In 2013, state lawmakers enacted the “small tobacco” tax to “recover health care costs” from the tobacco companies that were not part of the settlement. TMA urged the high court to take the case. “Whether produced and sold by Small Tobacco or by Big Tobacco, tobacco products cause the same health problems and inflict the same physical and financial burdens upon Texas citizens and the State budget,” we wrote in our amicus brief to the court. “Both should, therefore, have to pay their fair share of tobacco-related health costs whether that be through a judgment, settlement, tax or otherwise.”


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