Stories written by Amy Lynn Sorrel

Physician-Legislator Rep. John Zerwas, MD, Steps Down, Joins UT System - 08/02/2019

One of medicine’s long-time and most influential state legislative champions, Rep. John Zerwas, MD (R-Richmond), has been named The University of Texas System’s new executive vice chancellor for health affairs. On Wednesday Representative Zerwas announced that he will step down from elected office as of Sept. 30. He will start his new position Oct. 1.

Q&A: SeattleMamaDoc Wendy Sue Swanson, MD, Headlines TexMed 2019 - 08/02/2019

Digital innovator, Seattle pediatrician Wendy Sue Swanson, MD, will share her expertise at the May 17 opening general session at TexMed 2019 in Dallas. The title of Dr. Swanson’s talk: “How Technology is Transforming Health Care and the Physician-Patient Relationship.” Her answer to that question: “Rapidly and at a pace that’s hard for us to keep up.”

Profile: Beekeeper John Haley, MD - 08/02/2019

When Garland ophthalmologist John Haley, MD, is not wearing a white coat taking care of patients, you might find him in a beekeeper’s suit tending to his six beehives.

Revved-up Reporting - 05/03/2018

As federal quality reporting mandates and noncompliance penalties add up, experts say registries can help take the sting out of the process and rev up quality improvement for physician practices. The online reporting tool is also taking a front seat over claims-based reporting as Medicare signals its plans to eventually phase out that less efficient and less clinically accurate option.

Capitol Decisions Ahead - 04/27/2018

Jan. 13 marks the start of the 2015 legislative session. TMA has an ambitious agenda to ensure that the patient-physician relationship is a priority and that legislators consider it as bills work through the legislative process.

Balance-Billing Ban Back in 2015 Legislature - 04/27/2018

Renewed attention in the 2015 Texas Legislative over balance billing stems in part from interim charges that tasked the Senate State Affairs and House Insurance committees to look at whether existing laws dating back to 2007 are working to inform patients ahead of time when out-of-network physicians might balance-bill them for services their health plans don't fully cover. The issue is in the national spotlight, too, with the proliferation of high-deductible and narrow-network plans sold in the Accountable Care Act insurance marketplace. New federal rules take aim at ACA plans' inadequate networks and inaccurate physician and hospital directories. The Texas Medical Association is pushing for similar health plan accountability measures at the state level, with a careful eye on legislation that could restrict out-of-network physicians' ability to balance-bill for services they legitimately provide.

Capitol Success - 04/26/2018

This legislative session, medicine resolved to ensure physicians can give their patients the best care possible. The hard work paid off in significant victories that largely build on the Texas Medical Association's 2013 legislative successes.

ACOs, Texas-Style - 04/24/2018

Burdensome federal regulations and antitrust rules and hefty overhead costs are oft-cited stumbling blocks to physician involvement in accountable care organizations (ACOs). So perhaps it came as little surprise when the Texas Legislature, less than enamored with the federal health reform legislation that authorized the coordinated care models, came up with its own rendition. In 2011, state lawmakers passed Senate Bill 7, which created a Texas-style ACO, known as a health care collaborative, to encourage physicians, hospitals, and payers to collaborate on more coordinated, cost-effective health care delivery. Now that the Texas Department of Insurance has adopted rules laying out a path to licensure as a collaborative, Texas physicians have a more flexible option that overcomes many of the barriers preventing them from stepping into integrated care models.

Texas First - 04/24/2018

The 2013 Texas Legislature passed legislation barring foreign medical schools from buying up core clinical training spots at Texas teaching hospitals and institutions. Those clerkships are reserved for third- and fourth-year medical students to begin their clinical training. With most of them at or nearing capacity, however — and a queue of new students as Texas medical schools expand enrollments — there's little room to spare for foreign medical schools to scoop them up.

Using Social Media to Curb HPV on Campus - 04/20/2018

With funding help from the TMA Foundation, the association’s philanthropic arm, more than 100 students at Angelo State University in San Angelo and Tyler Junior College in Tyler received free HPV shots at their schools’ health fairs March 5 and 7.

Survey Says … - 04/19/2018

Texas Medical Association leaders say physicians should take the time now to understand the impact of patient satisfaction and evaluate themselves before payers or others do it for them. Already Medicare ties a portion of hospital pay to patient satisfaction measures, and similar mandates are beginning to hit physicians.

Hard Evidence - 04/19/2018

The Texas Medical Association is collaborating with the Agency for Healthcare Research and Quality's Effective Health Care Program to put free, evidence-based resources directly into physicians' and patients' hands. TMA is a member of the program's National Partnership Network, and the tools are the latest in a suite of quality improvement resources the association's Council on Health Care Quality has developed or collaborated on with other organizations.

Saving 1 Million Lives - 04/19/2018

The Million Hearts initiative aims to get physicians, health systems, patients, and public and private partners on board to prevent 1 million heart attacks and strokes by 2017.

Partner in Quality - 04/19/2018

The TMF Health Quality Institute (TMF) remains the statewide quality improvement organization for Texas after winning another multiyear contract with the Centers for Medicare & Medicaid Services. One of TMF's top jobs is to help physicians, hospitals, and other entities improve quality right at home with hands-on technical assistance to bolster clinical processes and health care outcomes and to home in on federal quality reporting obligations that will affect all physician payments by 2017. 

Driving Quality - 04/19/2018

Private payers aren't the only ones eyeing quality-based payment reform to control costs while improving patients' health. Now that Texas Medicaid has moved into managed care almost completely, the state is intent on similar strategies. The Texas Health and Human Services Commission won a $3 million federal grant to design innovative delivery and payment systems. It hopes to win as much as $50 million to later test the models under the Centers for Medicare & Medicaid Services State Innovation Models initiative. From accountable care organizations and medical homes to health information technology and bundled payments, the state is looking to physicians, health plans, and others to figure out what it takes to successfully implement such models for Medicaid patients across the multiple payers and providers that manage them.

Investing in Prevention - 04/19/2018

The Patient Protection and Affordable Care Act requires most private health insurance plans and Medicare to cover certain U.S. Preventive Services Task Force (USPSTF) services without patients sharing costs. The services are in four categories: evidence-based screenings, counseling, routine immunizations, and preventive services for women and children. Some physicians may already perform those services for their patients but miss out on additional payment; others may not realize the range of preventive services that would benefit patients. Still others may be unsure of the fiscal sustainability of providing the services. To help physicians make those assessments, the Texas Medical Association Council on Health Care Quality has developed 36 interactive "prevention calculators" encompassing all of the billing codes associated with each USPSTF guideline.

Penalties Add Up - 04/19/2018

Putting off Medicare's quality reporting initiatives could take a financial toll on physicians as many of the current incentives shift to penalties over the next couple of years. Those programs include the Physician Quality Reporting System (PQRS), e-prescribing, meaningful use of electronic health records, and, eventually, a value-based modifier that will automatically adjust physicians' Medicare payments based in part on PQRS performance.

Recognition and Reward - 04/19/2018

Physicians are dedicated to improving the health of their patients, but they want to be compensated for it. Health plans and employers want to see costs come down alongside quality improvements. The TMA House of Delegates voted to support best-practice models like the Bridges to Excellence (BTE) program to help physicians prepare for a value-based care system that will start paying them based on quality measures. BTE measures the quality of care delivered by physicians and other clinicians. Many payers have adopted the program to financially reward those who earn BTE recognition. The program emphasizes managing patients with chronic conditions and offers recognition in more than a dozen different areas, including diabetes, cardiac care, depression, and medical home readiness. 

Hand in Hand - 04/19/2018

Fifteen years after the Institute of Medicine issued its 1999 sentinel patient safety report, To Err is Human: Building a Safer Health System, physicians agree there's more work ahead. But they also say heightened awareness of the issue has sparked progress thanks to collaborative quality improvement efforts among systems, physicians, and patients, and a number of patient safety tools that have emerged as a result.

Untested Waters - 04/17/2018

It got off to a really rough start, but the federal government launched the insurance marketplace under the Affordable Care Act (ACA) on Oct. 1. And physicians could encounter their own challenges if they are not vigilant in their business practices with the health plans in the marketplace that take effect Jan. 1, Texas Medical Association officials say. Topping the list is widespread physician uncertainty about whether having existing contracts with insurers means they're already included in an exchange network. Right after that is a federal rule that jeopardizes physician payments if patients with subsidized marketplace coverage don't pay their premiums. Exchange regulations give those patients three months to pay their premiums and allow health plans to deny or later recoup payments from doctors for services provided to patients who end up delinquent.

Medicare Meltdown: Another Lost Opportunity - 04/17/2018

Congress once again let physicians down by failing to fix the flawed Medicare Sustainable Growth Rate formula and defaulting to a temporary patch for the 17th time. Because Congress came closer than ever to solving the problem with bipartisan legislation, medicine is eager to get back to the negotiating table and capitalize on the progress made this session.

R.I.P. SGR - 04/17/2018

Medicine's united voice was instrumental in successfully repealing the flawed Medicare Sustainable Growth Rate (SGR) formula — a payment design enacted in 1997 to sustain Medicare with lower costs but that instead threatened physicians with unsustainable payment cuts every year since 2003. Doctors say the elimination of SGR frees medicine to advocate for other lingering issues affecting Medicare. 

SGR Is Gone. Now What? - 04/17/2018

Physicians will have to prepare to participate in one of the new payment systems that will replace Medicare's Sustainable Growth Rate formula, which Congress eliminated in April via the Medicare and CHIP Reauthorization Act. Come 2019, physicians can participate in one of two major payment tracks: the fee-for-service Merit-Based Incentive Payment System, which boosts or docks physician pay based on their quality and cost performance; or one or more alternative payment models, such as accountable care organizations, medical homes, bundled payments, or other initiatives.

Transparency: Disruptive Innovation - 03/01/2018

Get to know the two prestigious speakers TMA has secured to headline the TexMed 2016 General Session: Marty A. Makary, MD, and Mark G. Dotzour, PhD.

Extra Fee, Extra Hassle - 07/27/2017

As physician practices struggle to stay viable, some have resorted to charging additional patient fees to make up for declining payments, rising costs, and scarce time that stack the odds against many doctors. The fee may come in different brands and sizes, labeled as an annual medical home fee, administrative charge, or direct payment for a membership of sorts for insured patients to stay in the practice. But the idea is the same: Physicians are looking for a way to continue to give their patients high-quality, personalized care, while filling in the economic gaps created by the many things doctors say today's health care system expects them to do but tends not to compensate.