President's Message: Build on Our Victories
By Josie R. Williams, MD, 2008-09 TMA President
As you can see by reading the annual report, 2008 was a very successful year for the Texas Medical Association. That means we made some important strides for you and your patients at a time when we all need it the most.
Our accomplishments were considerable, yet there is still significant work that needs to be done. We cannot and will not rest on our laurels.
As the new president and the new Congress take another serious run at health system reform, we are ready to claim our rightful place at the table as our patients' advocates. We are engaged and on the job. We have a plan of action that will bring your voices - your hopes and your fears - to the nation's capital.
We must continue our fight for fair Medicare payments to physicians. We headed off another devastating cut in 2008, but this annual game of brinksmanship we play with Congress and the Centers for Medicare & Medicaid Services must stop.
We have to convince Congress this year to adopt a system as outlined in our Texas Medicare Manifesto.
We need a rational Medicare physician payment system that automatically keeps up with the cost of running a practice and that is backed by a fair, stable funding formula, not the Sustainable Growth Rate formula that plagues us now. If they don't act, we're looking at a payment cut of 20 percent or more next year. The cut is not tenable for any of us or our patients.
We must remain vigilant against insurance companies that seek to rate us on the black boxes based on claims data rather than on good medicine. We must insist, as we are doing in the current session of the Texas Legislature, that insurance companies adopt a code of conduct that allows patients and their insurers to make smart coverage decisions and know that their money is spent on health care, not elsewhere.
We must stand fast against those who seek to weaken the tort reforms that have improved patients' access to care, lowered our liability premiums, and caused physicians across the country to flock to Texas.
We must demand that only those who are properly trained in medical school be allowed to make the final decisions and determine who performs the procedures that affect our patients' very lives. We must never allow nonphysician health care professionals to endanger our patients or usurp our authority and privileges as physicians when a physician's depth of knowledge makes the difference between life and death. We have earned the right to call ourselves physicians.
Finally, we must look at ourselves. As you know, the centerpiece of my presidency - in fact of my practice as a physician - has been to work to improve the quality of care we give our patients. We must be at the forefront of quality and patient safety and adopt new methods and strategies to achieve the highest level of quality possible.
We must study how we practice for better understanding of what works best. We will not allow ourselves to let others make health care reform be just about the money. If we don't, someone else - insurance companies and the federal government - will make it just about the money, and the essence of being a physician who cares for their patients will be gone.
As my term ends and Dr. William Fleming assumes the leadership of TMA, I want you to know that I have served with great pride in the men and women who make up our association. Your dedication to your patients and to TMA made 2008 the great year it was.
2008: TMA Brings the Heat
When a baseball pitcher needs a strikeout and reaches back for his best 90-plus-mile-per-hour fastball, it's called "bringing the heat." In 2008, your Texas Medical Association brought the heat on a number of issues. When it did, Congress, the state's largest insurance carrier, and podiatrists were brushed back.
Once again, TMA went to bat to make sure physicians are treated fairly and that patients have access to the best medical care in the world. And as in past years, we followed the TMA 2015 goals established by the TMA Board of Trustees as our roadmap to the future. TMA 2015 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.
Texas physicians responded to TMA's advocacy on their behalf. The association membership increased by 2 percent in 2008, and TMA now represents nearly 44,000 Texas physicians and medical students.
TMA scored many victories in 2008. Here are some of the association's major successes.
TMA physicians spoke loudly in one voice in 2008 when they let Congress know by e-mail, fax, letters, telephone calls, and personal contact that they would not stand for the 10.6-percent cut in Medicare payments scheduled to take effect in July.
Thanks to those efforts, Congress passed legislation stopping the cuts and instead raising payments by 1.1 percent. The fight wasn't over, however. President Bush vetoed the bill because it included cuts in the Medicare Advantage program. Physicians went back to work and persuaded Congress to override the veto and stop the fee reductions.
Weary of the annual fight over Medicare payments, TMA developed the Texas Medicare Manifesto in 2008 to outline the association's plan to drive a stake through the heart of the federal government's fatally flawed Sustainable Growth Rate formula that drives down physician Medicare payments. The twin goals: Make the payments fair to physicians, and preserve patients' access to care.
Log on to www.texmed.org/manifesto to read the plan.
In 2008, the association kept Texas a healthy place for physicians to practice medicine.
TMA's chief accomplishment in this area was persuading Blue Cross and Blue Shield of Texas to eliminate the risk-adjusted cost index (RACI) economic credentialing tool it used to rate physician performance in its BlueChoice Solutions program.
A TMA ad hoc committee of physician experts examined the system. It concluded that the Blue Cross physician-rating system "does not use an accurate or independently validated method to determine a physician's risk-adjusted cost" and that, combined with other problems with the program, "renders the method deceptive and invalid for credentialing and related performance assessment purposes at both individual and group physician performance levels as well."
TMA physician leaders and Blue Cross officials worked throughout 2008 to modify the physician-rating system to make it fair.
TMA subsequently expanded on its success in eliminating the RACI by creating the Performance and Quality Improvement Resource Center on the TMA Web site. The center features extensive practice tools, clinical guidelines, and education for physicians on performance measurement.
Also in 2008, TMA expanded membership in the Texas Public Health Coalition and developed a consensus on public health priorities for more than 20 statewide health advocates. It also developed a plan for TMA's 2009 legislative strategy on physician loan repayment to encourage physicians to address growing workforce shortages in primary care in underserved areas, and supplied extensive data forecasts of physician workforce to the Governor's Health Policy Council and shared the data with medical school presidents and deans.
A medical practice that is not economically viable cannot survive and care for patients. Thus, TMA used its expertise in several areas to keep practices viable. Among its accomplishments, TMA:
- Prevailed upon the Texas Department of Insurance Workers' Compensation Division to adopt a new physician fee schedule that includes an automatic annual update based on the Medicare Economic Index. Previously, such updates required a long rule-making process by the agency and were considered only every two to four years.
- Saved physicians thousands of dollars through reduced liability under the state franchise tax. TMA persuaded the state comptroller to adopt rules that allow physicians to deduct copayments and deductibles paid by Medicare, Medicaid, and other patients from taxable revenues.
- Provided its expertise to the Texas Health and Human Services Commission in implementing historic new Medicaid fee increases for physicians - 25 percent for children's services and 10 percent for adults - authorized by the legislature in 2007.
TMA worked hard to keep physicians the trusted leaders of the health care team by taking on several groups of health care professionals who wanted to expand their scope of practice beyond their training.
For example, TMA:
- Explained the definition of a "foot" to the Texas State Board of Podiatric Medical Examiners and won a court ruling that the board exceeded its authority by adopting a rule that expanded the definition of the foot to include the bones in the ankle. "Although there was extensive testimony and evidence presented during trial showing that treating the ankle was within the scope of podiatry, no evidence was introduced showing that treating structures found within the leg were within the scope of podiatry," the appeals court said in its March 14 decision in favor of TMA. The court added that the podiatric board exceeded "the limited exemption given to podiatrists and would constitute the unauthorized practice of medicine." The podiatrists are appealing the case.
- Filed a brief with the U.S. Supreme Court in a lawsuit against pharmaceutical giant Wyeth that the federal Food, Drug, and Cosmetic Act does not preempt state tort actions against drug manufacturers. The court agreed in a 2009 ruling. Had TMA not made its point to the court, patient care could have suffered and physicians could have faced increased liability.
- Protected patient safety rights by persuading the Texas Licensed Chemical Dependency Counselor Program not to allow counselors to diagnose substance disorders and by filing lawsuits to challenge rules adopted by the Texas Board of Chiropractic Examiners and the Texas State Board of Examiners of Marriage and Family Therapists that would expand chiropractors' and therapists' scope of practice. TMA also secured a Texas Court of Appeals decision that TMA has legal standing to file the lawsuits.
The association maintains that it is important for the safety of patients that any individual making a mental or medical diagnosis is appropriately educated, trained, and licensed to provide such services.
Also in 2008, TMA:
- Helped delay implementation of the ICD-10 codes for two years to give physicians more time to prepare to use them.
- Came to the rescue of physicians whose practices were blown away by Hurricane Ike by establishing the $1 million Hurricane Ike Disaster Relief Program to help them rebuild, and creating the UTMB Medical Student Recovery Program to help students at The University of Texas Medical Branch recover and continue their studies.
- Saved thousands of Texas children from serious head injuries through the Hard Hats for Little Heads program. A record 17,084 bicycle helmets were distributed at 105 events throughout Texas.
- Began the "Me and My Doctor" public awareness campaign to urge patients to join their physicians to take back control of the health care system.
- Armed physicians with information to answer their patients' questions before Myriad Genetics began a direct-to-consumer marketing campaign in Texas for its BRCA1 and BRCA2 gene tests. Similar marketing in other states substantially increased demand for this type of genetic testing.
- Led discussions to remove barriers to electronic prescribing of medications and hosted an e-Prescribing Stakeholder Summit with 74 attendees representing physicians, hospital systems, pharmacists, state government, and health care payment plans.
- Launched two new member services related to patient safety and quality of care. One gave physicians access to the Health Care Notification Network to allow physicians to receive U.S. Food and Drug Administration alerts immediately when they are issued, and the other established the Get Connected Campaign to encourage e-prescribing.
- Accredited and advised 68 local entities that offered 17,500 hours of continuing medical education (CME) credit. Some 70,000 physicians took advantage of those programs. TMA's own CME program offered 900 hours of CME. About 11,000 physicians accessed those hours.
- Created four volumes of e-Tips , online publications with practical information to help members with issues related to practice operations, medical records and privacy, and Medicare. Each volume included a segment of Podcast TMA to explore the issues in depth with TMA staff experts.
As it has been since its founding in 1853, TMA stood with physicians and the patients who depend on them in 2008 and lived up to its mission to improve the health of all Texans.