Stories written by Joey Berlin

Have Your Say on Texas’ New Surprise Billing Law - 10/16/2019

The Texas Department of Insurance (TDI) is holding a public hearing next week on rulemaking for the state’s new “baseball-style arbitration” law to address surprise medical bills. If you wish to speak at the meeting, TDI requests you submit written comments or a summary of your testimony by noon Friday, Oct. 18 “to facilitate a meaningful discussion.”


Easing the Pain? Opioid Settlement Brings Valuable Funding to Fight Crisis - 10/15/2019

September 2019 brought what could become a major victory for the state’s handling of opioid addiction. Drug-maker Purdue Pharma – which faced thousands of lawsuits from cities and states, including Texas, for its role in the national opioid crisis – announced it had agreed to a settlement with 24 state attorneys general and other plaintiffs. The maker of OxyContin and other pain drugs says the agreement will provide more than $10 billion to address the epidemic.


Big Noises Big Issues: Health Care Takes Center Stage One Year Out From 2020 Election - 10/15/2019

One year from now, Texas voters will hit the polls. They’ll be voting for president, for Congress, and for seats in the Texas Legislature. At the state and national levels, health coverage, Medicaid access, and prescription drug costs have gotten plenty of attention already, and they’ll get plenty more between now and the closing of the polls on Nov. 3, 2020. Here’s a look at some of the major health care debates taking center stage during the 2020 election cycle, what voters are and will be hearing about, and what Texas Medical Association policy says on those particular issues.


Charting Medicine’s Statehouse Progress: A Successful Legislative Session for Physicians - 10/08/2019

Legislation is just one piece of a healthy Texas. But it’s a big piece, and when the Texas Medical Association told the lawmakers of 2019 how it should fit, those legislators largely shaped it to what physicians and patients need. The house of medicine convinced lawmakers that raising the age to purchase tobacco to 21 was the right thing for the state’s present and future. Medicine also successfully persuaded the legislature and Gov. Greg Abbott to improve insurance network adequacy and directories, which will help with surprise medical bills.


Warning: Watch Your Referrals - 10/01/2019

Federal anti-kickback law has changed, and it’s gotten broader. As a result, you may need to re-examine your practice’s compensation arrangements. That includes payments for laboratory referrals.  


More Pain for Small Shops? 2020 Quality Program Rule Could Mean More Penalties - 10/01/2019

Small and solo practices already take the worst of the administrative and financial pounding the Quality Payment Program (QPP) dishes out each year. In the Texas Medical Association’s analysis, the government’s plans for the QPP in 2020 would make the situation even harder on those smaller shops. Since QPP’s birth in 2017, small practices have struggled with the demands and synapse-straining complexities of the program’s Merit-Based Incentive Payment System (MIPS). And TMA analysis shows the payment penalties those “have-not” practices incur fund the bonus payments earned by MIPS “haves” – often, larger practices with the resources to make the program work. Under the 2020 changes that the Centers for Medicare & Medicaid Services (CMS) has proposed, the maximum penalties for practices who don’t hit their MIPS targets will be larger than ever. But TMA’s review shows that MIPS – despite CMS’ claims to the contrary – isn’t getting any simpler.


No Docs of All Trades: Ruling Reinforces Expert Witness Reforms - 09/26/2019

Before Texas’ landmark liability reforms passed in 2003, gray areas in the law often led to serious green for people who sued physicians.


System Failure: Houston Practices Fight WellCare for Payment - 09/26/2019

Several Houston-area practices say a botched technology conversion by insurer WellCare after it acquired a Medicare Advantage plan led to prior authorization and network confusion, undue denials, and unpaid claims by the barrelful.


We Need to Come in Force: Physician-Lawmakers Look Ahead to 2021 - 09/18/2019

A panel of medicine’s representatives in the Texas Legislature said Saturday that 2019 was a good year for medicine in Austin, but unfinished business remains for the next session in 2021.


Telemedicine: Valuable, But Not a Panacea - 09/18/2019

Telemedicine can provide patients with considerable convenience and satisfaction, but challenges still exist with insurance payments and bottom-line value for individual physicians. That’s what physicians who have successfully integrated telemedicine into their practices told fellow doctors during Saturday’s Dawn Duster presentation at the 2019 Texas Medical Association Fall Conference.


Doctors Drive New Opioid Laws - 09/18/2019

Several new laws will affect how physicians practice and how they prescribe controlled substances, including a delay on required checks of the state’s prescription monitoring program (PMP); a limit on opioid prescriptions for acute pain; and a new electronic prescribing requirement coming in 2021.


Opioids and Pharmacy: PMP Extension Granted - 09/16/2019

When it came to opioids and pharmacy matters, some of the major pieces of medicine’s 2019 agenda came down to something everyone wishes they had more of: time. Physicians need it to get comfortable with a mandate to check the state’s prescription monitoring program (PMP). Patients need it to make sure the pain medications they’re prescribed do what the drugs are supposed to do. The legislature listened, and TMA achieved wins on both counts, as well as on increased transparency from pharmacy benefit managers (PBMs).


CRNAs Can’t Administer Anesthesia Unless Physician Delegates It, AG Rules - 09/12/2019

The state attorney general has agreed with the Texas Medical Association in an official opinion that keeps certified registered nurse anesthetists (CRNAs) from administering anesthesia without physician delegation.


United Healthcare Cuts Consults - 09/04/2019

United Healthcare is eliminating payment for consults in two phases – one that took effect June 1 for certain services, and their complete elimination starting in October. The change is an effort to align with the Centers for Medicare & Medicaid Services policy that eliminated payment for most consults in 2010, but it’s going to make it more difficult for many specialists to get compensated for the extra time and work those services require.


Anybody There? Physicians Unfairly Penalized for AWOL Medicare Advantage Patients - 09/04/2019

You’ve tried and tried and tried. Phone calls, emails – nothing. A Medicare Advantage plan assigned you a patient who didn’t choose you, and the patient is driving that point home – by ignoring you. Or maybe the contact information the plan gave you is out of date, and the patient’s latest phone number or email is unknown. Either way, your as-yet-unseen patient is AWOL – and you can be penalized for it on health plans’ quality ratings, which ultimately can affect payments. New Texas Medical Association policy takes aim at the unfairness this lack of patient response can present for physicians, while opening up an opportunity for medicine to work with health plans to solve the problem.


Fighting Back: Practice Wins Court Battle Over Defamatory Online Reviews - 09/03/2019

One practice’s recent legal battle epitomizes physicians’ worst nightmares when it comes to online reviews. Here’s an extreme but glaring real world example, straight from the documents in a lawsuit that Austin Eye first filed in October 2017 over


TMB Clarifies New 10-Day Limit on Opioids - 08/30/2019

The Texas Medical Board is trying to head off confusion about the state’s new 10-day opioid prescribing limit for acute pain, which takes effect on Sunday. TMB’s statement, released Friday, appears to address concerns that the new law means acute pain patients must be completely cut off from opioids beyond the 10-day mark. That’s not the case, according to the statement.


Court Rejects Hospital Challenge to Defamation Lawsuit - Again - 08/21/2019

Once again, Houston cardiothoracic surgeon Miguel Gomez, MD, has won in court in his battle to collect more than $6 million from Memorial Hermann Health System in a defamation lawsuit.


“The future” of pain treatment? - 08/15/2019

Some physicians, depending on the situation, are avoiding opioids to every reasonable degree, doing their part to keep patients off the drugs that killed more than 42,000 people in the United States in 2016. Fort Worth anesthesiologist Aaron Shiraz, MD, and his group, Trinity Medical Associates, are taking it to a rarely seen extreme.


Changes Coming to Certain Informed Consent Forms - 08/02/2019

The Texas Medical Disclosure Panel has adopted changes to two informed consent forms, which will take effect at the beginning of 2020. The panel made amendments to its Disclosure and Consent for Medical Care and Surgical Procedures form and its Disclosure and Consent for Hysterectomy form.


On Call at the Capitol: TMA's 2019 Legislative Agenda - 08/02/2019

When the 86th Texas Legislature convenes on Jan. 8, TMA will build on its major successes of 2017, renew some of the biggest battles that stalled two years ago, and tackle relatively new ones. Physicians will make their case to a somewhat new makeup of lawmakers as they pursue better Medicaid coverage for postpartum women, insurer accountability for narrow networks, more funding for community mental health, and many other aims.


Out in the Cold: Health Plan Blamed For Major Prompt-Pay Mess - 08/02/2019

Molina Healthcare of Texas isn’t the only insurer to give physicians prompt-pay problems, and it won’t be the last. Some of the practices trying to recover payments blame not just the health plan, but also the extended response time from the state regulator overseeing insurance products and conduct: the Texas Department of Insurance, which says it’s hiring staff and making other changes to improve that response.


Respecting the Roles: TMA Battles Another Round of Scope of Practice Bills - 08/02/2019

When nonmedical professionals ask the Texas Legislature for the authority to practice medicine, TMA mounts a full-court press, letting lawmakers know why there are some roles only physicians can fill.


Taking Medicine's Temperature: TMA's 2018 Survey of Texas Physicians - 08/02/2019

TMA’s 2018 Survey of Texas Physicians asked members about their legislative priorities, payer relationships, and practice environment, scope of practice concerns, and much, much more. TMA conducted the email survey in monthly installments between January and August 2018. Here are some highlights.


A Focused Leader: Incoming TMA President David Fleeger, MD - 08/02/2019

Incoming TMA President David Fleeger, MD, sets his sights on protecting the patient-physician relationship and equipping physicians for sea changes affecting medicine.