Stories written by Joey Berlin

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.


Charting Medicine’s Statehouse Progress: A Successful Legislative Session for Physicians - 08/06/2019

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.


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.


Medicare Muzzle? New Rules May Make Physicians Reluctant to Speak Up - 08/02/2019

New Medicare rules on local coverage determinations may make physicians reluctant to speak their minds.


False Impression: Medicine Says Medicare Report Inflates Success of Quality Program - 08/02/2019

High participation, “significant strides,” overwhelming success. That was the picture the Centers for Medicare & Medicaid Services painted in a March report on the first year of the Quality Payment Program. 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 rescind the report.


Medical Futility Law Sustained - 08/02/2019

Court tosses out challenge to ethics committee review of end-of-life care.


Final Verdict? Case Tests Court's Ability to Overturn a Jury Verdict - 08/02/2019

It was an overwhelming, 12-0 verdict – a jury’s unanimous rejection of a negligence case against a Laredo physician. Then, a judge took that decision away and ordered a new trial – not because of jury misconduct, or any procedural stumble that usually negates a court decision. It was taken away, essentially, because the judge said so.


United Healthcare Cuts Consults - 08/02/2019

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.


The Meaning of Monthly: Court Ruling Offers Hope on Pain Clinic Registrations - 08/02/2019

Physicians can encounter a web of confusion and unfairness when it comes to navigating the Texas Medical Board (TMB). A Travis County district court has given Texas physicians clarity and hope when it comes to certain medical board investigations. The court’s decision, if it holds up, establishes an important precedent for when physicians are required to register their facility as a pain management clinic.


Anybody There? Physicians Unfairly Penalized for AWOL Medicare Advantage Patients - 08/02/2019

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.


Setting the Record Straight: Supreme Court Curtails TMB for Over-Sanctioning Physician - 08/02/2019

Eight years ago, when he experienced a rare patient death, McAllen family physician Ruben Aleman, MD, signed the death certificate the way Texas physicians had been doing it for years, and the only way he knew how: using pen and paper. That resulted in the Texas Medical Board (TMB) not only coming after him, but accusing him of “unprofessional or dishonorable conduct that is likely to deceive or defraud the public” – words found in the state Medical Practice Act. The Texas Supreme Court recently decided that was an overreach for a physician who simply hadn’t signed up on the state’s electronic death registration system, which at the time was relatively new.


Swinging For Fairness: Law Creates New Ballgame for Surprise Billing - 08/02/2019

When Senate Bill 1264 was first introduced in February, insurers had the bases loaded, threatening to score a lopsided surprise-billing victory on one swing. With some deft pitching in the Texas Legislature, medicine worked its way out of the jam. The “baseball-style arbitration” measure by Sen. Kelly Hancock (R-North Richland Hills) isn’t perfect, and like a hitter who’s getting busted inside, physicians will have adjustments to make. But the improved SB 1264 passed with a framework that’s fairer to everyone involved.   


TMB: Back on Track - 08/02/2019

Two years ago during the 2017 regular session, the Texas Legislature put the practice of medicine in the state in serious danger, failing to renew the Texas Medical Board (TMB) and the state’s Medical Practice Act. In 2019 House Bill 1504 by Rep. Chris Paddie (R-Marshall) put TMB back on the standard 12-year sunset cycle, renewing the board through 2031.


Scope of Practice: Shot Down - 08/02/2019

When it comes to shooting down dangerous attempts to expand non-medical practitioners’ scope of practice, TMA’s advocacy army once again proved to be expert marksmen in 2019. Medicine trained its scope on bills that would have allowed nurse practitioners, chiropractors, and optometrists, among others, to wade into the practice of medicine.


Medicaid: Reforms, But No Raise - 08/02/2019

Medicine didn’t get everything it needed from lawmakers for Medicaid, including TMA’s biggest and boldest ask of the 2019 session. Still, progress TMA achieved on managed care reform and other facets of Medicaid will advance physicians’ efforts to care for the most vulnerable Texans.


Opioids and Pharmacy: PMP Extension Granted - 08/02/2019

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).


Insurance: Network Solutions - 08/02/2019

Charting Medicine’s Statehouse Progress TMA went into this session looking to attack insurer network inadequacy and health plans’ use of care impeding prior authorization demands. On both fronts, medicine scored solid legislative wins that will make it


TMA President: Rulemaking on Surprise Billing Must Be Fair to Docs - 07/31/2019

Now that the Texas Legislature has passed a measure to counteract surprise billing involving many state-regulated plans, it’s time for rulemaking. The Texas Medical Association is working to make sure the Texas Department of Insurance’s eventual rules borne out of Senate Bill 1264 will give physicians a fair shake.


Beware of Phony TMB or DEA Agents - 07/03/2019

The Texas Medical Board (TMB) is warning physicians and pharmacies of a scam involving criminals who sometimes pose as TMB officials. TMB passed along a report from the U.S. Drug Enforcement Administration (DEA) that says physicians registered with the DEA are receiving calls and emails from criminals who identify themselves as DEA personnel or other law enforcement agents.