Action: Jan. 14, 2011


TMA Action Jan. 14, 2011
News and Insights from Texas Medical Association

INSIDE: Physicians Protest Medicaid, CHIP Cuts

Save Medicine on Tuesdays
Physicians Protest Medicaid, CHIP Cuts
Governors: Medicaid Flexibility Vital
Legislative Hotline Keeps You Informed
Medicare Advantage and EHR Incentives
TrailBlazer Posts Medicare Fees
TMA Membership Exceeds 45,000
TMA Will Train You to Use ICD-10
HHSC to Expand Medicaid HMOs

Workers' Comp's Quality Review Process
TMB Names New Medical Director
Meet KevinMD at Winter Conference
Save the Date!
TMF Hosts CKD Webinar
This Month in Texas Medicine
Do You Twitter? Follow TMA

Save Medicine on Tuesdays

With the state facing a $30 billion budget deficit, the 2011 Texas Legislature could be disastrous for medicine in Texas. Lawmakers will look for ways to save money, and health care could face potentially devastating funding cuts. Trial lawyers will try to erode the historic tort reforms physicians fought so hard for in 2003, hospitals will try once again to crack the state's ban on the corporate practice of medicine, and advance practice nurses and other nonphysician practitioners will battle for the right to practice independently.

This is where you come in. You can work to save health care funding by lobbying lawmakers and explaining to them how vital it is to preserve and enhance health care funding in Texas. Your patients depend on you.

How can you help? The easiest way is to come to Austin and make your voice heard during First Tuesdays at the Capitol Feb. 1, March 1, April 5, and May 3. Lobbying tips, legislative briefings and debriefings, and personal visits to legislators' offices are all part of First Tuesdays at the Capitol.

First Tuesdays have been incredibly successful since they began in 2003. Lawmakers say seeing all those white lab coats in their offices and in the Capitol galleries and hallways make a difference. They listen when their hometown doctors show up in their offices.

"Caring for Patients in a Time of Change" is TMA's theme for this session. TMA President Susan Rudd Bailey, MD, says "this message reminds each of us – as well as our patients and state officials and candidates for office and the general public – that caring for patients is what we do. It's what we do regardless of the environment. It's what cements that bond with our patients and their families. And it's what makes our profession so special."

It is absolutely essential for medicine to engage the representatives and senators early and often. TMA and the TMAAlliance are calling on you. Be a medical lobbyist for a day. You will make a difference.   


Physicians Protest Medicaid, CHIP Cuts

Leaders of organized medicine in Texas warned state officials that further cuts in payments to physicians for treating patients in Medicaid and in the Children's Health Insurance Program (CHIP) will only make it harder for patients to find the medical care they need. And that, they say, will increase, not decrease, costs. 

Even small cuts in Medicaid and CHIP payments "will result in more physicians restricting their Medicaid participation, thus exacerbating the challenges patients face in finding a participating physician," they said in a Jan. 7 letter to the Texas Health and Human Service Commission (HHSC). That letter expressed their "deepest concern about the proposed 1-percent budget reduction for Medicaid and CHIP physician services." They added that "as more physicians leave Medicaid, the rate cuts undoubtedly will contribute to higher Medicaid and CHIP costs because more patients will have no choice but to rely on costly hospital emergency rooms (ERs) for care."

Texas Medical Association President Susan Rudd Bailey, MD, and the presidents of the specialty societies representing anesthesiologists, cardiologists, emergency physicians, family physicians, pathologists, pediatricians, gastroenterologists, internists, neurologists, obstetricians and gynecologists, ophthalmologists, orthopedists, otolaryngologists, pathologists, psychiatrists, radiologists, and urologists, as well as the president of the Texas Medical Group Management Association, signed the Jan. 7 letter.

They sent the letter after state officials announced in December that fees paid to physicians, hospitals, dentists, and other acute care providers for treating patients in Medicaid and CHIP would drop another 1 percent Feb. 1 as the state makes more spending cuts to deal with a $30 billion budget shortfall. Nursing homes will see a 2-percent reduction. The fee cuts are in addition to reductions that may occur as a result of periodic updates to the relative value units (RVUs) associated with Medicaid payable CPT codes.  






Medicaid acute care and CHIP fees were cut 1 percent last Sept. 1 after leaders directed state agencies to cut their budgets by 5 percent. Then on Dec. 6, Gov. Rick Perry, Lt. Gov. David Dewhurst, and House Speaker Joe Straus sent a letter [PDF] to state agency heads directing them to identify another 2.5-percent reduction in spending for the remainder of the 2011 fiscal year.

In the Jan. 7 letter, the physician leaders said they understand the seriousness of the state's budget problems, but recommended officials use a "scalpel vs. a cleaver to close the budget gap." They said one of the best ways to limit Medicaid and CHIP growth "is to broaden physician participation in these programs," noting that a 2007 HHSC analysis "found that the state could have saved $26 million by redirecting patients with minor illnesses to a physician from an emergency room. On average, the state pays about $36 for a physician office visit vs. $144 for an ER visit, excluding the costs of drugs, lab, and x-ray."

The physicians say in their letter that they "understand why a nominal Medicaid payment cut for physicians might appear reasonable. However, current Medicaid rates do not cover physicians' practice costs. As with any small business, those costs increase each year. Medicaid rates lag woefully behind all other payers, making the program less and less competitive. On average, Medicaid pays about 80 percent of Medicare and about 50 percent of commercial insurance payments. For busy practices already juggling more demand than they can handle from privately insured patients, it just does not make economic sense to add more patients from a low-paying program like Medicaid or CHIP. Further, physicians, unlike hospitals, have no ability to partially recover some of the losses through federal funding programs.

The letter concludes by saying Texas physicians "stand ready to work closely with you to evaluate cost-containment alternatives that will continue to ensure our Medicaid and CHIP patients can obtain timely medical care."  


Governors: Medicaid Flexibility Vital

States need more flexibility in managing Medicaid, Gov. Rick Perry and 12 other governors say in a letter [PDF] to President Obama and congressional leaders. The new health system law prohibits states from reducing Medicaid and Children’s Health Insurance Program enrollment. The governors called on the president and Congress to immediately remove the restriction so states can better control their Medicaid costs and make necessary budget decisions.

 "Texas is looking at a $9.1 billion increase to retain current service levels," the letter says. "Because of the lack of flexibility in the Medicaid program, one of the few places states maintain the ability to make adjustments is in provider rate cuts. To fund for the full $9.1 billion, Texas would have to consider a 48-percent provider rate cut – an untenable option that would likely cause providers to leave the system altogether, resulting in severe shortages in access to care." 

It adds that states "must have flexibility … to best serve those with the highest needs, as well as continue to fund other budgetary priorities like education and public safety."

In December, the Texas Health and Human Services Commission and the Texas Department of Insurance issued a report to the legislature [PDF] that said opting out of the federal Medicaid program would mean a huge reduction in the state program, unless state officials found replacement funds elsewhere in the state budget. The legislature directed the agencies to examine the implications of leaving Medicaid and ways to reverse the program's growing cost. Some state officials have suggested opting out of federal Medicaid as one way to deal with the state's estimated $30 billion budget deficit.

The report says that if Texas opted out of the federal program, "Texas Medicaid, which funds about 15 percent of personal health care spending in the state, would face the equivalent of a 60-percent budget cut, unless state policymakers replaced the lost federal dollars with state funds." 

Instead, the report recommends several options to create "a sustainable future" for Medicaid. They include giving states additional flexibility to design Medicaid benefit packages that encourage individual decision-making and improve health outcomes, revising the formula used to allocate federal Medicaid dollars, and giving states more flexibility to use cost-sharing as a way to promote individual responsibility for personal health and wellness decisions.   


Legislative Hotline Keeps You Informed

While you are going about your day, the Texas Legislature is in Austin making decisions that affect your practice. You can stay informed about what lawmakers are doing by signing up for TMA's Legislative Hotline.

The Hotline is a daily newsletter for TMA members only. Delivered to your e-mail inbox, the newsletter tracks issues affecting medicine and reports on the latest actions of the legislature. The Hotline is delivered each legislative day before noon during the 140-day session. A weekly recap, delivered each Friday, also is available.  

e-MDs Ad  


Medicare Advantage and EHR Incentives

Medicare Advantage (MA) plans are treated differently in the Health Information Technology for Economic and Clinical Health (HITECH) Act, the law that includes provisions for the electronic health record (EHR) meaningful use incentives 

If a physician participates in a Medicare Advantage organization, he or she should contact that organization to see if participation in the EHR incentive program is affected by that MA plan. If the MA plan indicates the practice is not eligible for the meaningful use incentives because of a complex Centers for Medicare & Medicaid Services rule, please contact TMA at (800) 880-5720.

Regional extension centers (RECs) have been established to help physicians work through the details of EHR selection, adoption, and achievement of meaningful use. Primary care physicians and specialists who can attest to providing primary care are eligible for on-site consulting services at a subsidized rate of only $300 per year.    






For more information on RECs and stimulus incentives, visit the TMA website or contact the TMA Health Information Technology Department by telephone at (800) 880-5720 or by e-mail at


TrailBlazer Posts Medicare Fees

TrailBlazer Health Enterprises, the Texas Medicare carrier, has posted the 2011 Medicare fee schedule on its website. Fees are available either by searching a specific procedure code or by downloading the entire locality in PDF or CSV format. 

The fee schedule was set after Congress in December blocked the 25-percent reduction in payments that was scheduled to take effect Jan. 1.

The Medicare and Medicaid Extenders Act of 2010 stabilizes Medicare physician payments at current rates through the end of 2011 and extends several other payment policies that were set to expire at the end of this year. It extends through 2011:  

  • The "floor" on geographic adjustments made for the physician work component of the Medicare payment schedule;
  • The 5-percent payment increase for certain Medicare mental health services;
  • An exceptions process for the cap on Medicare outpatient therapy services; and
  • Payments for the technical component for certain pathology services.  

TMA Membership Exceeds 45,000

Thank you! TMA ended last year with a record 45,046 members (including physicians and medical students). That means TMA remains the largest (and best) state medical association in the country. The more members we represent, the stronger our collective voice and the more we can accomplish for every Texas physician and the patients you serve.

With the legislature now in session, you should know that no one is better equipped than TMA and your county medical society to fight for and serve you in these difficult times. 

Renew your membership today! Installment options are available. For more information, call TMA Knowledge Center at (800) 880-7955 or e-mail the TMA Knowledge Center.  


TMA Will Train You to Use ICD-10

TMA is partnering with the American Academy of Professional Coders to offer training options to help physician practices make a smooth transition from using ICD-9 codes to ICD-10. Our comprehensive ICD-10 Boot Camps begin Feb. 24-25 in San Antonio. 

The changeover will require equipment upgrades and comprehensive staff training. ICD-9 contains more than 17,000 codes, but ICD-10 will have more than 141,000 codes and will accommodate a host of new diagnoses and procedures. The format is new, with seven alpha-numeric codes instead of five numeric digits. You cannot learn ICD-10 overnight, or even in a few weeks or months. But easing yourself and your staff into a comprehensive understanding of ICD-10 will put your practice on solid footing when the new coding system takes effect.

The ICD-10 code sets take effect Oct. 1, 2013, but on Jan. 1, 2012, the Health Insurance Portability and Accountability Act (HIPAA) standards for electronic health transactions change from Version 4010/4010A1 to Version 5010. This involves updated codes and transactions standards that will cover improvements to electronic claims, insurance eligibility verification, claim status inquiries, requests for authorizations, and electronic remittance data. Unlike Version 4010, Version 5010 accommodates the ICD-10 code structure. This change occurs before the ICD-10 implementation date to allow adequate testing and implementation time.

Examine your office systems and planning budgets for expenses related to the transition. Talk to your practice management system vendor about accommodations for both Version 5010 and ICD-10 codes. Find out when it expects to upgrade, if upgrades are covered under your contract, and any costs you will incur as the information becomes available – and get all the information in writing. If you are purchasing a practice management or related system, be sure it is Version 5010- and ICD-10-ready.







HHSC to Expand Medicaid HMOs

The Texas Health and Human Services Commission (HHSC) is proceeding with plans to expand the STAR and STAR+PLUS  Medicaid HMOs [PDF] to the contiguous counties surrounding the existing HMO service areas by Sept. 1. The expansion involves the Harris, Bexar, Austin, El Paso, Nueces, and Lubbock service areas.

The state also is creating a new Medicaid HMO service area called "Jefferson," which includes the counties of Chambers, Hardin, Jasper, Jefferson, Liberty, Newton, Orange, Polk, San Jacinto, Tyler, and Walker.

The Medicaid HMO expansion is among several Medicaid managed care actions HHSC is taking to help reduce the state's $30 billion budget deficit.

HHSC plans training sessions for physicians and their staff impacted by the expansion. Training for the new Jefferson service area will be from 9 am to noon, Jan. 18, in the Saint Elizabeth Christus Outpatient Pavilion on the first floor of the Christus Hospital at 755 North Street in Beaumont, and from 9 am to noon in the Community Room of the 1st National Bank, 301 E. Houston, in Jasper. Training for the expanded Lubbock service delivery area will be Jan. 24 from 2 to 5 pm at the Northwest Texas Hospital Pavilion, 7201 Evans Blvd, in Lubbock. Counties in the Lubbock service area expansion include Carson, Deaf Smith, Hutchinson, Potter, Randall, and Swisher. Preregistration is not required for any of the training sessions.Training sessions for the other areas have not been announced. For more information about the sessions, e-mail Diane Eberhart at HHSC.

HHSC also plans to expand the Medicaid HMO model to South Texas counties beginning in 2012. However, legislative approval will be required to include Hidalgo, Cameron, and Maverick counties. In 2003, the legislature precluded those counties from the Medicaid HMO model.




Workers' Comp's Quality Review Process

On Jan. 1, the Texas Department of Workers' Compensation (DWC) adopted a new medical quality review process [PDF]. 

TMA and the physician members of its Ad Hoc Committee on Workers' Compensation proposed modifications and protections that would ensure a successful, meaningful, transparent, and fair process. DWC incorporated many of the changes TMA recommended. These provisions are included:

  • Anonymous complaints against physicians will not be permitted.  
  • Physicians will be notified of complaints and given the opportunity to provide any information they believe should be considered in the investigation.  
  • DWC will consider all documentation or information provided by the physician.  
  • DWC expert investigators must verify in writing that they have no real or perceived conflict of interest with the physician being reviewed.   
  • Any expansion of the scope of an investigation must follow the above rules and be in the form of a new written complaint with the original investigator being recused from the new complaint.  

TMB Names New Medical Director

Louisiana ear, nose and throat specialist Linda Gage-White, MD, is the new medical director of the Texas Medical Board (TMB). She replaces Alan T. Moore, MD, who left in July for private practice.

Dr. Gage-White was president, vice-president, and a member of the Licensure Committee and Malpractice Committee of the Louisiana State Board of Medical Examiners between 2002 and 2010.

TMB Executive Director Mari Robinson, JD, said Dr. Gage-White's "extensive, relevant experience, and her passion for patient safety will help fulfill the board's mission of public protection."

Dr. Gage-White received her undergraduate degree from Duke University and her medical degree from the University of Miami School of Medicine. She interned at Mount Sinai Medical Center in Miami and completed her residency in otolaryngology at the University of Iowa Hospital and Clinics.

Dr. Gage-White founded and served as director for the Louisiana State University Health Sciences Center multidisciplinary cleft lip and palate clinic. She is board certified in otolaryngology and has taken part in charitable medical missions throughout the world.


Meet KevinMD at Winter Conference

Kevin Pho, MD, a Nashua, N.H., primary care physician and the "KevinMD" behind the popular and influential blog, will speak at the 2011 TMA Winter Conference  Jan. 28-29 at the AT&T Conference Center in Austin.

Dr. Pho's presentation, "Medicine in the Age of Social Media," will address why physicians should engage in blogs, Twitter, or Facebook, and will include:

  • Examples of how doctors are connecting with patients in social media platforms;  
  • Risks and what doctors should look out for; and,  
  • Reflections on his social media journey over the years.   

The Winter Conference also will include discussions on the impact of the state budget deficit on health care in Texas, the uncertainty regarding health system reform, attempts by hospitals and large groups to employ physicians, and the continuing Medicare meltdown.  

Join your colleagues at the conference to discuss these important issues. Here's the schedule:   






Friday, Jan. 28

8 am-10 pm
TMA business meetings

1-3 pm or 3-5 pm
Legislative testimony training workshop (preregistration required)

Saturday, Jan. 29

6 am-5 pm
TMA business meetings

7:30-8:30 am
Networking breakfast

8:30-11:30 am
General Session: Policy, Politics, and Practicum (Dr. Pho kicks things off at 8:30 am.)

11:45 am-5 pm
County Medical Society Leadership Forum (preregistration required)

You may register online for the conference meetings and events.

For more information, contact the TMA Knowledge Center by telephone at (800) 880-7955 or by e-mail.   



Save the Date!

Mark your calendar for the 2011 Texas State Cancer Advocacy Movement for Colleges and Outreach Cancer Symposium from 9 am to 2 pm Friday, April 29, at the Embassy Suites Hotel, Spa & ConferenceCenter in San Marcos. 

The conference is a joint project of Texas State University-San Marcos and the TMA Physician Oncology Education Program (POEP).

For more information, e-mail Leslie Jones  at POEP or call her at (800) 880-1300, ext. 1671, or (512) 370-1671.   







TMF Hosts CKD Webinar

The TMF Health Quality Institute will host a free webinar on effective care management for patients with chronic kidney disease (CKD) from noon to 1:30 pm on Jan. 27. Representatives from four areas – nephrology, primary care, pharmacy, and cardiology – will focus on the treatment of diabetes, hypertension, and CKD through the use of ACE inhibitors and ARB agents.

To participate, register online. The webinar call-in number is (800) 394-5972, code 9845. 

Participants can earn 1.5 hours of continuing medical education credit.

Questions? Call Virginia Badgley at TMF at (866) 439-8863.


This Month in Texas Medicine

The January issue of Texas Medicine  tells you what TMA learned in its 2010 survey of physicians and interviews several doctors to put faces on all the numbers. It also reports on the budget dilemma lawmakers face this year, how you can use technology in your practice to improve your bottom line, and why the state attorney general is suing six obstetrician-gynecologists in Grapevine. And, you'll learn why AMA is talking about taking a new direction.  


Texas Medicine RSS Feed

Don't want to wait for Texas Medicine to land in your mailbox? You can access it as an RSS feed, the same way you get the TMA Practice E-Tips RSS feed.  


E-Tips RSS Feed

TMA Practice E-Tips, a valuable source of hands-on, use-it-now advice on coding, billing, payment, HIPAA compliance, office policies and procedures, and practice marketing, is available as an RSS feed on the TMA website. Once there, you can download an RSS reader, such as Feedreader, Sharpreader, Sage, or NetNewsWire Lite. You also can subscribe to the RSS feeds for TMA news releases and for Blogged Arteries, the feed for Action


Action, Jan. 14, 2011

Do You Twitter? Follow TMA

As part of its work to explore new communications technologies, TMA regularly publishes on Twitter, the hot, 140-character "micro-blogging" service.

If you Twitter, follow TMA to get practice management tips, news bits, and political chatter – and we'll follow you, too. If you don't know what we're talking about, click here to check it out. 


What Can Practice Production Numbers Tell You?

Consider these factors if your production isn't consistent.

A practice management tip from
TMA Practice Consulting



This Just In ...

Want the latest and hottest news from TMA in a hurry? Then log on to Blogged Arteries. You can hear the latest Podcast TMA episodes and read the most recent news from Action and Texas Medicine


TMA Seminars

Practice Management, Ext. 1421

Recorded Web Seminars

Avoiding RAC Audits
Communication Skills: Why Bother?
Evaluating Your Medicare Options
Meaningful Use
Medical Records-Consent for Treatment of Minors
Patient-Physician Relationship
Patient Satisfaction
Professional Courtesy: Waiving Copays, and Charity Care Requirements
 Revenue Cycle Management  

Physician Health and Rehabilitation, Ext. 1342

PHR Training Session
2/18      Frisco  

PHR Retreat: Disruptive Behavior, Dual Diagnosis, and Relapse Prevention
2-18-19 Frisco  

Family Systems: The Impact of Marriage and Family on Physicians
4/2       Tyler
4/16      Galveston
9/10      Amarillo
10/20    El Paso

About Action

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