Why We Join
By Robert T. Gunby Jr., MD
2005-06 TMA President
Do you write a dues check each year without giving a lot of
thought to what you're getting for your money? If so, I encourage
you to read this Texas Medical Association 2005 Annual Report to
see what our association did for us and our patients last year.
As I look back at 2005, I'm struck by the power we were able to
exercise throughout the year. And when I say power, I mean it in a
good way. Power to defend medicine in the halls of the state
Capitol against those who sought changes that were bad for us and
worse for our patients. Power to influence lawmakers, policymakers,
and regulators to keep medicine the premier profession in Texas.
Power to make sure insurance companies treat us fairly and raise a
ruckus when they don't. Power to develop a plan to keep our
patients safe. Power - and the vision - to
enhance our efforts to keep Texas and Texans healthy in the future.
And, the power to take a hard look at our association and make sure
it remains the successful organization that still deserves the
reputation as America's best medical society.
Perhaps the greatest display of our power came in what may well
have been our finest hour, when Hurricane Katrina sent hundreds of
thousands of devastated people streaming across our borders. The
power of our organizational capabilities were instantly on display
as we worked with our county medical society partners to mount a
relief effort unequaled in Texas history. Thousands of us across
this state volunteered to help people we had never seen before and
likely would never see again. Why? Because they needed us, and
that's what we do. And then we turned around and helped our own,
digging into our pockets to help colleagues rebuild their practices
after Hurricane Rita paid a nasty visit to the southeast Texas
So, read the report and take pride in what we accomplished last
year. After you're finished, show it to your colleagues who are not
TMA members. Tell them this is why you write that dues check every
year. Encourage them to join us. It's the best deal
For Texas physicians, 2005 was a year of triumph, testing, and
tragedy. Triumph early in the year as the Texas Medical
Association's army of physicians and alliance members defended
patients and the medical profession in a legislative session filled
with potential landmines; testing as Hurricane Katrina added
225,000 evacuees to already-overloaded medical systems in Houston,
Dallas, San Antonio, and Austin; and tragedy as Hurricane Rita tore
apart physicians' homes and practices in Southeast Texas.
TMA's accomplishments in 2005 were many, but five stand out:
- TMA protected physicians and patients from an onerous tax on
physician practices that would have impeded patients' access to
- Along with several other state medical societies, TMA
generated more than $1 billion in relief for physicians by making
some of the nation's largest insurers accountable for their
actions in not paying doctors what they were owed.
- TMA protected patients by joining a national patient safety
campaign and offering solid, evidence-based protocols to improve
- TMA prevented health care professionals who don't have a
medical license from expanding their scope of practice.
- TMA mounted an unprecedented humanitarian effort to mobilize
physicians across the state to care for the victims of Hurricane
Katrina who sought refuge in Texas and raised $225,000 to help
Texas physicians rebuild their Rita-ravaged medical
All of this was done with an eye to the future. Responding
to the priorities set by the TMA Board of Trustees, the association
tailored its efforts on behalf of physicians and patients by
following the goals of TMA 2010, our roadmap to the future. TMA
2010 is the trustees' strategic plan to allow TMA to remain
successful, stick to our core values, and address issues affecting
physicians' ability to care for patients. Its goals are Practice
Viability, Healthy Environment, Trusted Leader, and One Voice.
With that clear vision of the future, TMA remains America's
largest and strongest state medical society, effectively
representing member physicians in nearly all venues and providing
members with quality education, information, and tools they can
find nowhere else. The Lone Star family of medicine - TMA
and our 120 component county medical societies - is a
153-year-old institution that no Texas physician or medical student
should do without.
TMA has earned $1.5 billion in retrospective and prospective
relief for physicians through its class action federal
antiracketeering lawsuits against Aetna, CIGNA, Humana, WellPoint,
Prudential, and Health Net. The association and several other
medical societies won significant settlements against those health
plans. Throughout 2005, TMA's legal and practice management experts
monitored the companies' compliance with the settlements and told
physicians how to file complaints when the insurers strayed from
And, TMA secured a $1 million grant from the Physicians'
Foundation for Health Systems Excellence - one of two
foundations created by the settlement - to help Texas
physicians learn about, adopt, and maximize use of health
You cannot maintain a viable medical practice unless you are
treated fairly by insurance companies and other payers. Thanks to
advocacy initiatives by the TMA Council on Socioeconomics with the
Texas Department of Insurance in 2005, UnitedHealthcare was fined
$4 million in early 2006 for violating the state's prompt payment
In addition, TMA in 2005:
- Helped 20,000 physician practices resolve payment disputes
with health plans and recover lost reimbursement through the TMA
Hassle Factor Log™.
- Provided 6,324 physicians and office staff the tools to make
their practices better through comprehensive seminars,
conferences, and home studies on topics such as Medicare,
workers' compensation, health information technology, practice
management, medical records, consumer-directed care, coding, cost
analysis, patient-physician communications, and risk
- Provided cutting-edge, personalized consulting services at a
members-only price to more than 200 physicians in 60 practices
with a focus on operational challenges, reimbursement, optimal
coding and documentation skills, and setting up new medical
- Answered 4,000 practice management and 3,000 legal questions
that members and their staffs sent to the TMA Knowledge Center
via telephone calls and e-mails.
TMA's theme for the 2005 Texas Legislature was "In Defense of
Medicine." The session was unlike most sessions before it. Instead
of focusing primarily on trying to get legislation passed, TMA
defended physicians against hundreds of proposed bills that were
bad for doctors and patients.
By the end of the session, thanks to TMA's strong legislative
Physicians did not have to pay a new
tax on their practices. TMA let lawmakers know that physician
practices are not traditional businesses and should not be
subject to a business activity tax and that taxing patient care
is neither good public policy nor in the best interests of
The landmark 2003 tort reforms
remained intact, and liability carriers across Texas followed
the lead of the Texas Medical Liability Trust and reduced their
rates. In the first nine months of 2005 alone, all five of
Texas' largest physician insurers announced rate cuts.
Lawmakers passed legislation
establishing a new workers' compensation system that ensures
injured workers' access to quality health care and guarantees
physicians prompt payment and the right to negotiate
None of eight proposed bills to
prohibit out-of-network physicians from balance billing
patients when their HMO or PPO fails to pay the physicians'
full fee or to place a cap on out-of-network physician fees
An attempt to pass a state
moratorium on physicians referring patients to physician-owned
specialty hospitals and other facilities in which they hold
financial interests and stop new construction of
physician-owned facilities was blocked. TMA is still pursuing
this issue at the federal level.
The state improved funding for
Medicaid and the Children's Health Insurance Program and put on
hold the STAR+PLUS Medicaid HMOs rollout.
The Texas Legislature created the
first state formula for funding graduate medical education and
restored $51 million in funding.
As the legislative session began in January 2005, TMA released
Healthy Vision 2010
. TMA published a second, stronger edition of the
document in November, timed to generate maximum impact on the 2006
elections and the 2007 legislature.
articulates the voice of medicine and allows TMA to assume the lead
in preparing Texas for the health care challenges of the
Healthy Vision 2010
offers a five-point prescription for change:
- Health care must be accessible and affordable for all
- Prevention and personal accountability must be
- Health information technology should be used effectively and
- Patient safety must be protected.
- End-of-life care must be humane and cost-effective.
The entire report is on the TMA Web site (
Meanwhile, in Washington, TMA worked with the American
Medical Association and other state and specialty societies to stop
what would have been a disastrous 4.4-percent cut in physicians'
Medicare reimbursements. The lobby campaign extended up
to - and beyond - Congress' 2005 Christmas
holiday, as the Medicare cuts actually took effect on Jan. 1, 2006.
Medicine's hard work throughout 2005, however, paved the way for
Congress to reverse the reduction shortly after convening in the
When Hurricane Katrina devastated our neighbors to the east, TMA
acted immediately. It drew on the compassion of our members and
their local county medical societies to enlist physicians across
the state to provide medical care for the victims who sought refuge
in Texas. TMA compiled a database of more than 1,500 Texas and
out-of-state physicians willing to volunteer to care for hurricane
victims in some 2,000 shelters and coordinated volunteer activities
in concert with county societies and state health and emergency
The most sacred element of the patient-physician relationship is
patients' trust in their doctor to keep them safe. Acting on Robert
T. Gunby Jr., MD's, call to make patient safety the cornerstone of
his year as president, TMA launched the Select Committee on Patient
Safety in July to develop programming, services, and strategies to
help keep patients safe.
TMA backed up that effort by joining the Institute for
Healthcare Improvement's 100,000 Lives Campaign to save 100,000
patient lives across the country over 18 months by implementing six
interventions. TMA also adopted three of those goals to help
improve Texas patient outcomes:
- Prevent surgical site infection and related deaths by not
using razors to shave surgical patients ("Clip, Don't
- Deliver evidence-based care for patients with acute
myocardial infarction by prescribing aspirin when they arrive at
the hospital and beta blockers when they leave ("Keep a Healthy
- Prevent adverse drug events through medication reconciliation
("What Are You On?").
In addition, a Patient Safety Resource Center was established on
the TMA Web site. It will be updated continuously with news,
research findings, and links to tools physicians can use in their
practice. To reach the resource center, browse to
During the legislative session earlier in the year, TMA created
the PatientsFIRST coalition to protect patient safety and blocked
legislation that would have expanded the scope of practice of
optometrists, podiatrists, and other allied health
Thanks to association members, TMA's commitment to enhancing
physicians' roles as trusted leaders in public health was evident
Texas' new disaster response and
pandemic influenza plan includes communication strategies and
the role of private physicians in responding to events.
The National Newborn Screening and
Genetic Resource Center comprehensive report on screening in
the state included physicians' recommendations for areas
needing attention or improvement.
At the Obesity Summit at TexMed
2005, 303 physicians increased their awareness of Texas'
The power of TMA's voice to serve physicians and patients grew
louder in 2005 as TMA membership reached a record 41,000.
Recruiting newly licensed physicians added 775 names to the
association's membership rolls.
Not only did TMA add new members in 2005, but the value you get
for your dues dollars increased as TMA secured new benefits and
services for physicians.
The TMA Web site was redesigned to provide information that's
easier to find. The site's navigation structure was redone. The
search feature was enhanced to make it Google-like, and key words
for every major topic on the site were created. More color and
graphics were added to the site.
Communication with members also was enhanced with new e-mail
newsletters to target audiences - medical students,
academic physicians, and international medical
graduates - as well as a newsletter on continuing medical
education. They complement existing newsletters for young
TMA also improved its communications with members by launching
the TMA Folio, a new communication e-tool that delivers, stores,
and organizes TMA's best information on your desktop in an
easy-to-use electronic portfolio (log on to
and click on TMA Folio on the left side of the home page).
2005 by the Numbers
|TMA members at end of 2005
|Physician practices helped in resolving
payment disputes with health plans and recovering lost
|Texas primary care physicians,
nurses, and other allied health care professionals who
attended 18 Physician Oncology Education Program cancer
prevention, screening, and early detection programs
|Physicians who attended CME programs offering
695 credits in 206 courses
|Physicians and alliance members who signed up
to receive a daily e-mail newsletter updating them on the
2005 legislative session.
|Do-not-resuscitate bracelets and advance
directive forms distributed to physicians and
|Physicians educated in forums on health
literacy, pay for performance, children's environmental
health, children's mental, and the TMA Obesity Summit
2005 Income and Expenses
TMA ended 2005 with revenue of $18,977,920 and expenses of
$19,224,920. The loss resulted from expenses associated with
representing the interests of physicians and patients in two
special sessions of the Texas Legislature. The association's
primary source of income was membership dues. TMA members received
$2 worth of service for every $1 of dues money.