Stories written by Joey Berlin

Out in the Cold: Health Plan Blamed For Major Prompt-Pay Mess - 05/01/2019

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.


Medicine to CMS: Medicare Report Inflates Success of Quality Program - 05/01/2019

If you read the recent Centers for Medicare & Medicaid Services (CMS) report on the first-year of the Quality Payment Program, you’d likely come away with the perception that the program’s launch was an overwhelming success. But a closer look by the Texas Medical Association raises serious doubts about CMS’ numbers, transparency, and cheerleading – so much so that TMA and seven other state medical associations are asking the agency to take back the report.


TDI Fines Molina Healthcare $500,000 in Prompt-Pay Order - 04/30/2019

The Texas Department of Insurance (TDI) has fined an insurer whose inability to pay claims on time kept physicians waiting on millions of dollars. TDI dealt Molina Healthcare of Texas an administrative penalty of $500,000 – on top of almost $8 million combined that the insurer paid in penalties and interest to TDI, and to affected physicians and other health care providers.


Battling Burnout - 04/25/2019

The state most susceptible to burnout is Texas, which registered the lowest morale rate in the Physicians Foundation’s “2016 Survey of America’s Physicians.” Pockets of organized medicine are stepping up to address burnout, to give physicians a place to talk about their problems and grievances, and to rekindle their professional fire.


Federal Bill Would Limit Opioid Scrips for Acute Pain - 04/22/2019

The proposed three-day limit on opioid prescriptions for acute pain would be one of the more impactful provisions for pain doctors and their patients. Exceptions would include prescriptions for chronic pain, cancer care, hospice or end-of-life care, and pain treatment that’s part of palliative care.


Closing a Loophole: Medicine Works to Clarify MOC Law - 04/17/2019

It was an important law that gave physicians new life, greatly restricting the discrimination they can face based on their maintenance of certification (MOC) status. And yet, opponents may have found a way to circumvent the 2017 legislature’s Senate Bill 1148.


Taking Medicine's Temperature: TMA's 2018 Survey of Texas Physicians - 04/17/2019

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 - 04/17/2019

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


TMA Pushes for Prior Authorization Limits, Clarity - 04/17/2019

After hearing story after story of delays and denials, the Texas Medical Association is pushing the Texas Legislature to sign off on measures that would significantly curb insurers’ ability to require prior authorization on needed care, as well as clarify for both physicians and patients what it means when prior authorization is required.


TMA Pushing To Delay PMP Mandate, Buy Time for Integration With EHRs - 04/09/2019

Starting Sept. 1, physicians will be required to check the PMP before issuing any prescription for opioids, barbiturates, benzodiazepines, or carisoprodol, a mandate the Texas Legislature passed during the 2017 session. As this year’s session of the legislature enters its back stretch, TMA is hoping to persuade lawmakers to delay that mandate until March 2020 to allow for a widespread rollout of PMP-EHR integration.


Alert: Scammers Demanding Bogus Fines For Drug Purchases - 04/01/2019

The Texas Medical Association and the Texas Medical Liability Trust (TMLT) are warning physicians about scammers posing as a U.S. Drug Enforcement Administration agent trying to defraud doctors into paying a nonexistent federal fine for allegedly intercepting illegal prescription drugs the doctor had sent through the mail.


Medicine’s Monthly Bullhorn: First Tuesdays at the Capitol - 03/28/2019

First Tuesdays are important not only for getting medicine’s message across in the moment, but also for building and maintaining relationships that pay dividends in the future. The Vijjeswarapus experience it all as Texas Medicine follows them on the morning of this year’s first First Tuesdays.


Respecting the Roles: TMA Battles Another Round of Scope of Practice Bills - 03/28/2019

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.


Evening Out the Scale: TMA Gears Up for Another Legislative Battle Over Surprise Bills - 03/20/2019

TMA gears up for another legislative battle over surprise bills.


TMA Leery of Proposed Balance Billing Law - 03/20/2019

The Texas Medical Association is deeply skeptical of a state senator’s freshly filed effort to prevent physicians from balance billing patients for the services they provide. On Thursday, Sen. Kelly Hancock (R-North Richland Hills) filed Senate Bill 1264, a measure to address surprise out-of-network medical bills. The legislation emerged with no input from the House of Medicine


Pharmacy Board Nixes Proposal That Could’ve Broadened Pharmacists’ Scope - 03/14/2019

Medicine’s objections were strong, and the state’s draft rules allowing pharmacists to perform medication therapy management services aren’t going to make it after all.


Breaking Up Is Hard to Do: Physicians Can Get Subpoenaed in Divorce Cases - 03/11/2019

Physicians subpoenaed to participate in a divorce case, whether to testify or simply to supply medical records to the court, could find themselves at the center of an acrimonious split. There are certain things they should know.


Medicine to Feds: Back Off Prior Authorization Requirements - 03/07/2019

The Texas Medical Association, American Medical Association, and a host of other medical societies are trying to stop onerous, care-impeding prior authorization requirements from overrunning Medicare Advantage plans.


The Right to Fight: Attorney-Client Protections for Physicians and Other Professionals Under Threat - 03/05/2019

The Texas Medical Association is asking the Texas Supreme Court to make sure physicians can maintain the right to keep attorney-client communications private when doctors testify as experts in their own cases.


On Call at the Capitol: TMA's 2019 Legislative Agenda - 02/27/2019

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.


Getting Personal - 02/26/2019

Incoming TMA president will stress stronger patient relationships, access to care.


Friends and Leaders - 02/26/2019

Outgoing TMA, TDA presidents complete latest step on “mirrored” journey.


Running off the Enemy - 02/26/2019

Following primary success, TEXPAC works to give more medicine-friendly candidates final nudge to November.


“Look to your past to know where you’re going” - 02/26/2019

Ailment-plagued childhood helped set medical student’s path.


High Court Decision Brings Favorable Wind for Physician Experts - 02/22/2019

The Texas Supreme Court has sided with the Texas Windstorm Insurance Association – and by extension, with medicine – in a case that impacts physicians who testify as expert witnesses in their own defense.