Some years we make history just by doing the same things over
and over, only we do them better and better -- and we do more of
them -- with each passing year.
Thus, 2000 was another history-making year for the Texas Medical
Association. Once again, we could count on TMA to watch our
practices so we could keep a better eye on our patients. As always,
our association chalked up triumphs in advocacy, practice
management, public health, politics, education, and technology. Yet
again, TMA found new venues in which to fight for patients and
Take a moment to read about the hassle-busting common
credentialing form, about Project WATCH's success and its expansion
into WATCH for Kids, about the dramatic conclusion to the Zamora
case, and about our online evaluation and management tool. Check
out TEXPAC's stellar performance at the polls or TMA's never-ending
work on prompt payment. See what our association has accomplished
in 12 months. You'll know why physicians around the United States
envy our membership in the country's most proactive, most effective
state medical society. You'll take pride in what you've
As you read this, TMA is again leading the charge for Texas
physicians and our patients in the 77th legislative session.
Medicaid reform, tobacco funds, physical education, lawsuit abuse,
and scope of practice are just the most prominent of the issues on
medicine's plate. Based on our record, we can predict victory on
many of those fronts -- even in a highly politicized session.
We must look to the past to know the present and influence the
future. That's been my motto as a physician, educator, and leader.
TMA's glorious 148-year history explains much of our current
success and positions us well to continue to improve the health of
Jim Rohack, MD
TMA Speaks Out on Payment Problems, Patients' Rights
TMA is not just watching out for Texas physicians, it's speaking
out as well. Advocacy on a wide range of economic and policy issues
affecting physicians and their patients is an important part of
With physicians struggling under the burden of delayed payments
despite two legislative fixes, TMA geared up in 2000 to push for
new legislation to close a glaring loophole that allows managed
care organizations to use their contracts to redefine "
." TMA and local medical societies also sought to change statutory
requirements that place the administrative burden on physicians to
document whether patients have other insurance coverage. And, the
association urged the Texas Department of Insurance to better
enforce existing rules on clean claims.
The association also reported needed reforms in the Medicaid
managed care system to Health and Human Services Commissioner Don
Gilbert and Texas legislators. TMA backed efforts to gain
substantial fee increases, administrative simplification, and a
continued moratorium on further rollouts in Texas. TMA favors
keeping the primary care case management system intact as a
competitive alternative to Medicaid managed care and supports
efforts to create alternative models to the current systems.
TMA conducted 17 meetings with insurers in 2000 to address
physicians' problems with insurance companies that were identified
through 5,000 individual
Hassle Factor Logs
compiled during the year. The logs showed downcoding, prompt
payment, and denials to be major issues for physicians. Those
meetings settled many disputes over payment and insurance company
procedures in physicians' favor.
TMA also partnered with county medical societies to stage 27
visits during the year. These consults covered topics such as
Medicare, Medicaid, managed care, and general payment-related
coding and billing issues.
To help Texas physicians tune up their practices,
TMA Physician Services
provided hands-on practice management consulting expertise to
hundreds of TMA members. The most frequently requested services
were practice set-ups, operational assessments, and coding and
Physician Services provided members with information on the
newest technology for medical practices, including electronic
medical records, Web-based software, and prescription writers. The
group developed physician practice policy and procedure manuals
available for sale in written and electronic form and published a
How to Hire a Practice Administrator
. Physician Services also created a monthly newsletter and regular
e-tips on the TMA Web site at
to provide practice management information. The e-tips link
to more detailed information within the site.
Advocacy in the Courts
Legal battles were an important part of TMA advocacy efforts in
2000. The association's general counsel helped to develop a new
legal remedy for physicians advocating for patients, as well as for
patients with chronic and severe, disabling conditions. Along with
the American Medical Association's Litigation Center, TMA worked
with lawyers for eight patients, a widow of a patient, and
rheumatologist Jorge Zamora-Quezada, MD, in challenging managed
care practices that discourage proper treatment. The Zamora case
ended in a settlement, but not before TMA advocacy resulted in a
federal district court decision recognizing that the Americans With
Disabilities Act and the Rehabilitation Act protect patients with
disabilities and their treating physicians. As a result, the
plaintiffs received significant compensation for discriminatory
treatment by four health maintenance organizations (HMOs) and a
nonprofit, hospital-owned clinic and its for-profit management
TMA attorneys also helped to block an HMO's effort to seal
testimony and documents in a case that resulted in a $20 million
jury verdict for John Paul Schulze, MD, of Corpus Christi, who
alleged Humana retaliated against him for speaking out against its
managed care policies. Because the files remain open, this
information about Humana's attempts to silence Dr. Schulze may aid
other physicians who are challenging HMOs.
When a panel of the U.S. 5th Circuit Court of Appeals ruled in
June that the Employee Retirement Income Security Act pre-empted
the use of the independent review process in Texas, TMA and AMA
filed an amicus curiae brief in support of the state's appeal to
the U.S. Supreme Court.
TMA and AMA advocates worked closely with Texas Attorney General
John Cornyn to strictly enforce his settlement with Aetna so that
the insurer no longer could use financial incentives to induce
physicians to withhold necessary care.
TMA and AMA also worked together to lobby Congress to pass the
bipartisan Patients' Bill of Rights.
TMA's legal staff built a strong relationship with a number of
attorneys across the nation who have filed class-action lawsuits
challenging common wrongful managed care practices. Although TMA is
not yet party to any of the suits, its attorneys are seeking new
ways for physicians to hold HMOs accountable for their
decision-making and business practices.
Project WATCH Focuses on Children
Attacking the state's No. 1 killer -- cardiovascular disease --
is the objective of the multitiered Project WATCH campaign.
TMA, the TMA Alliance, county medical societies, the Texas
affiliate of the American Heart Association, the Texas Department
of Health (TDH), and other organizations have collaborated to
improve professional and public awareness of the five leading
preventable risk factors for heart disease and stroke -- Weight,
Activity, Tobacco, Cholesterol, and High blood pressure. Project
WATCH is underwritten by the TMA Foundation.
Aimed at increasing awareness and accountability by both
physicians and patients, the three-year grassroots program has
developed and distributed thousands of patient-physician encounter
forms, patient brochures, wallet cards, and stickers at special
events and exhibits throughout the state. The program has been
promoted through multimedia efforts, including magazine articles
and radio and television public service announcements that have
gained statewide air play.
began focusing on physical inactivity in elementary
schoolchildren. TMA produced bookmarks featuring "Wags the
Watchdog," with a message on the importance of physical activity.
The bookmarks, printed in English and Spanish, were distributed in
collaboration with the TMA Alliance, the Texas PTA Association, the
Texas School Nurses Association, and others.
Education Tops TMA Priorities
Throughout the year, TMA made strides in all its medical
education service areas.
Medical Education Policy
The Council on Medical Education established the Medical Education
Financing Task Force in January. This group provided testimony to
the Texas Senate Finance Committee's Interim Subcommittee on GME in
support of adequate state graduate medical education (GME) funding
and reiterated the TMA policy of supporting GME funding through an
Recognizing that fewer medical students are selecting primary
care residencies, TMA conducted surveys and a focus group meeting
to assess changing market demand and to identify reasons for this
shift. Initiatives and legislative proposals were developed for
improving physician distribution in rural areas.
TMA Minority Scholarship
awarded a $5,000 scholarship to incoming Baylor College of
Medicine student Stephanie C. Jones, of Houston.
Continuing Medical Education
The Accreditation Council for Continuing Medical Education awarded
TMA four years' accreditation, with commendations, to continue to
accredit Texas organizations as providers of continuing medical
education (CME). TMA also received the Rutledge W. Howard, MD Award
for maintenance of high standards in the intrastate accreditation
CME credit was offered for the October
symposium issue on quality in health care, making TMA
the only state medical society to provide such an opportunity. A
joint sponsorship program with state specialty societies and county
medical societies was expanded to offer additional, largely
TMA's Physician Health and Rehabilitation (PHR) Committee
developed two new ethics courses in 2000, "
Nicotine Dependence and Its
" and "
Boundaries and Treating Difficult Patients
." Of the 3,640 physicians who completed the seven ethics courses
developed by the PHR committee, 1,110 completed the courses
The association's annual meetings took on a new look in 2000 as
Fall Conference and Interim Session of the House of Delegates were
combined into TMA Summit 2000, with 669 physicians and medical
students attending. More than 2,100 physicians and students took
advantage of CME opportunities and other events at TexMed 2000,
while Winter Conference drew 599 physicians and students.
The association also endorsed Compliance Trak Inc., which
provides online staff and CME sources, plus a reporting and
tracking system to comply with regulations of the Occupational
Safety and Health Administration.
In 2000, TMA looked ahead to the new millennium and emphasized
positioning the TMA Library for the future, which includes
offering online resources such as the new ethics course "Medical
Ethics and Professionalism." By taking the ethics course in print
or online, 1,620 physicians earned AMA PRA Category 1 CME credit.
Of this number, 1,080 physicians took the course online.
Librarians taught a monthly three-hour CME course on "The Basics
of PubMed MEDLINE Searching" to members and staff. More than 3,600
online database searches were conducted to answer clinical,
socioeconomic, and public health research questions for TMA
members, and the library responded to more than 3,500 requests for
articles through the National Library of Medicine's online Loansome
Doc document delivery program.
Disease Management Drives Public Health Efforts
The association achieved firsts on a number of fronts in the
areas of public health, science, and quality.
Physician Oncology Education
(POEP) reached more than 25,000 health care and education
professionals in 2000. A $300,000 grant from the Texas Cancer
Council was used to establish CME programs for primary care
physicians in underserved areas and for those who treat underserved
populations. Among the program's educational accomplishments was
the development of a skin cancer education initiative for
POEP and TMA's Committee on Cancer spearheaded an effort to
improve the quality of the state's cancer data. The Cancer Data
Workgroup received $66,000 from the Centers for Disease Control and
Prevention to study the reporting system and recommend ways to
improve timeliness and accuracy of data collection and lessen the
burden of reporting cancer cases.
TMA conducted a statewide survey to examine physician attitudes
and behaviors regarding colorectal cancer screenings. Results will
guide the TMA Workgroup on Prevention and POEP in developing
programs and policy changes to increase screening for colorectal
cancer in Texans.
An electronic chart audit tool, the first of its kind in the
nation, was developed during the year for use by participants of
TMA's HeartCare Partnership, a program that emphasizes physician
and patient education and practical office strategies to improve
secondary risk factor management of patients with cardiovascular
The Council on Scientific Affairs held discussions with TDH
regarding effective disease management programs for the state,
including pilot programs for the treatment of asthma. The council
also participated in the TDH effort to implement a statewide asthma
Through the efforts of the Committee on Infectious Diseases, TMA
received a $60,000 grant from Schering-Plough to provide
educational programs on hepatitis C focusing on screening,
treatment, and patient management. The program has been approved
for up to one hour in AMA PRA Category 1 CME credit and will be
offered throughout the state in 2001.
TMA has been a long-standing, ardent supporter of the U.S.-Mexico
Border Health Commission, which opened its offices in El Paso in
November. This organization spearheads binational policy
development to address public health problems for all states along
the U.S.-Mexico border. TMA collaborated last year with the Texas
Pediatric Society, forming the Border Health Alliance to address
children's health issues in the border region.
In February, the Committee on Child and Adolescent Health began
researching and developing a position paper on children's mental
health to provide TMA members with tools and resources to address
this far-reaching problem.
Common Credentialing Form
TMA actively promoted the use of a
common credentialing form
developed by the Dallas-Fort Worth Business Group on Health.
Association staff organized statewide meetings with physicians,
health plans, hospitals, and employers and held regional meetings
with county medical societies to advocate use of the form.
TMA created the Ad Hoc Committee on Medical Errors early in 2000 to
study the controversial Institute of Medicine report and consider
policy development and physician education on patient safety. The
committee developed policy principles for patient safety reporting
systems and conducted survey research on a number of issues
relating to medical errors. Of interest, TMA physicians do not
support mandatory reporting of errors without adequate peer review
and liability protections because it has not been proven to reduce
TMA Technology Delivers the E-Goods
From the launch of a new Web site design to the purchase of a
powerful new membership database to the development of a host of
e-tools for members, technological innovation was a hallmark of TMA
in the year 2000.
The revamped TMA Web site allows members to create a personal
page that provides easy access to information relevant to their
specialties or areas of interest. It also provides the latest news
that affects members' practices and patients, links to credible
health information, online CME opportunities and medical research,
and more. By year's end, the Web site's new features included an
online tool that allows members to compare their evaluation and
management coding patterns with those of their peers in Texas and
around the nation. The new TMA Knowledge Base gives members
access to answers to the most commonly asked questions -- on
practice management, legal and legislative issues, TMA membership
and member services, continuing medical education, and public
health and science.
Work has been under way on a new membership database with plans
for completion in mid-2001. The system will significantly enhance
TMA's abilities to track members' preferences, offer e-commerce
services, provide customized member communications, and maintain
accurate membership information. Several of the state's largest
county medical societies are implementing complementary
For the first time, the TMA House of Delegates ratified a
comprehensive technology plank as part of the association's
2000-2001 Strategic Plan. The four priority goals in the technology
section of the plan direct TMA to educate physicians on the growing
e-health industry and how it can affect their practices. The plan
also calls on the association to promote the sound regulation of
telemedicine, protect the confidentiality of patient information
that might travel online, and provide access to performance
measurement tools that enhance clinical decision making.
TEXPAC Scores Big in November State Elections
Association Political Action Committee
(TEXPAC) again led the way for medicine, positioning doctors
and patients for more legislative success in the future.
The political arm of TMA supported the winners in more than 98
percent of the November state races in which it was involved.
TEXPAC-endorsed candidates won in all but four races.
In key Texas Senate races, Rep. Todd Staples (R-Palestine)
defeated Democratic attorney David Fisher in the race for Senate
District 3, and Sen. David Cain (D-Dallas) survived a hard-fought
and well-financed campaign by Republican Bob Deuell, MD, of
Greenville. TEXPAC was on the winning side of both races and played
a significant role in both campaigns. TEXPAC-endorsed candidates
for the Texas House suffered only one loss, that being Rep. David
Lengefeld (D-Hamilton), who was the lone House incumbent defeated.
As a result of the November elections, Republicans maintained their
16-15 majority in the Senate, and Democrats held onto their 78-72
edge in the House of Representatives.
On the judicial front, TEXPAC continued to lead the charge to
change the face of the Texas judicial system. In the 3rd Court of
Appeals, Republican challenger David Puryear upset incumbent
pro-plaintiff Justice Woodie Jones. TEXPAC was one of the few
groups to oppose Justice Jones.
In another key judicial race, Republican David Gaultney won the
election over Gerald Bourque in an open seat for the 9th Court of
Appeals. TEXPAC worked with the Texas Association of Business and
Chambers of Commerce and other tort reform-minded groups to support
Association Boasts Organizational Strength
The year 2000 saw a growing membership and new delegate
Membership increased from 36,398 in 1999 to 37,049 in 2000. The
latter figure represents 32,806 physicians and 4,243 medical
students. TMA continued its recruitment work with county medical
societies, resulting in increased membership for both TMA and the
TMA did not run any candidates for election at the annual AMA
meeting in 2000, but the Texas delegation announced that TMA
President Jim Rohack, MD, will be a candidate for the AMA Board of
Trustees in 2001. Brad Butler, a student at Texas A&M
University System College of Medicine, became speaker of the AMA
Medical Student Section (MSS). Angela Siler-Fisher, a student at
Texas Tech University Health Sciences Center School of Medicine,
became one of two MSS delegates to the AMA house.
TMA Expenditures Reflect Physician Priorities
TMA ended a highly successful programmatic year with income of
$15,855,000 and expenses of $16,097,000.
The association's primary source of operating income was dues
(55 percent). Additional income was derived from nondues,
income-producing programs approved by the Board of Trustees, such
as educational workshops, advertising, and member services. An
average of $650 per active member was expended on TMA programs and
activities in 2000.
2000 Expense by Focus Area
2000 Operating Income
March 2001 Contents