Action: Feb. 15, 2011

TMA Action Feb. 15, 2011
News and Insights from Texas Medical Association


INSIDE: CMS to Reprocess 2010 Medicare Claims   


CMS to Reprocess 2010 Medicare Claims
Medicine Makes Feds Delay Medicaid RACs
Physicians Derail NCSL-AARP Deal
TMA Concerned About Sonogram Bill
Save Medicine on Tuesdays
Legislative Hotline Keeps You Informed
Renew Your Dues Today
Keep On Registering Deaths Electronically
CMS Schedules Medicaid EHR Call 

CMS Starts Federal EHR Incentives Listserv
E-prescribe in 2011 to Avoid 2012 Penalty
Fight the Vaccine Myths
TMA Will Train You to Use ICD-10
TexMed 2011 Set May 13-14 in Houston
Beaumont Program Wins McGovern Award
This Month in Texas Medicine
Do You Twitter? Follow TMA   

POLITICAL PROGNOSIS:  TMA Fights Budget, Patient Safety Battles

CMS to Reprocess 2010 Medicare Claims

The Centers for Medicare & Medicaid Services (CMS) says many physicians' claims filed under the 2010 Medicare physician fee schedule will be reprocessed because the fees were affected by the retroactive dates of some of the provisions of the health system reform law passed last year. President Obama signed the Affordable Care Act (ACA) in March 2010, but some of the changes to the fee schedule were retroactive to January 2010.

CMS says it is "taking steps to ensure that new claims coming into the Medicare program are processed timely and accurately, even as the retroactive adjustments are being made. CMS will begin to reprocess these claims over the next several weeks. We expect that this reprocessing effort will take some time and will vary depending upon the claim-type, the volume, and each individual Medicare claims administration contractor."

The CMS statement added that in most cases, "you will not have to request adjustments because your Medicare claims administration contractor will automatically reprocess your claims."

The Texas Medical Association's Payment Advocacy Department says physicians should note that:  

  • Physicians should not resubmit claims.  
  • Claims should be reprocessed automatically as long as the original billed charge wasn't lower than the corrected Medicare allowable amount.  
  • If their billed charge was lower than the corrected Medicare allowable, physicians must request that the claim be reopened.
  • If physicians were overpaid, they will receive an overpayment refund request from TrailBlazer Health Enterprises, the Texas Medicare administrative contractor.
  • CMS reminds physicians of the Office of Inspector General policy on the routine waiver of patients' cost-sharing amounts when federal laws or regulations change.

Contact TrailBlazer if you need additional information.

Medicine Makes Feds Delay Medicaid RACs

Concerns by TMA and 80 other state and national medical societies have helped convince the Centers for Medicare & Medicaid Services (CMS) to delay a requirement that state Medicaid directors implement the Medicaid Recovery Audit Contractor (RAC) program by April 1. CMS now says it will come up with a new implementation deadline when it issues final rules later this year.

The Medicaid RAC program is part of the health system reform bill Congress passed last year and is intended to reduce fraud and waste. It is an expansion of the current Medicare RAC program.

In January, TMA, the American Medical Association, and other medical societies expressed their worry about the Medicaid program in a letter to CMS Administrator Donald Berwick, MD. The letter cited numerous problems with the Medicare RAC program, including administrative burdens, poor education of physicians about what would trigger an audit, and an inadequate appeals process.

"We continue to have concerns about the perverse incentive structure and burdensome nature of the Medicare Recovery Audit Contractor (RAC) program, and firmly believe that the best way to reduce improper coding is through education and outreach," the letter [PDF] said. "In regard to the Medicaid RAC program, while we support CMS's efforts to identify improper or fraudulent activity in the Medicaid program, we are concerned that the proposed rule does not provide sufficient guidance to States in establishing and implementing their Medicaid RAC programs. We urge CMS to review the improvements already instituted in the Medicare RAC program, and to require that similar safeguards are put in place for the Medicaid RAC program. We ask CMS to be mindful of the multitude of new challenges facing physicians as a result of health system reform, in addition to the implementation of health information technology and the transition to ICD-10-CM and ICD-10-PCS codes, and request that CMS set forth streamlined and straightforward requirements for the Medicaid RAC program to ensure efficient and high quality care delivery."

In another RAC-related development, CMS has set the number of medical records [PDF] that a RAC can request from a physician. This means RACs can begin doing complex reviews – the type that require medical records of physicians' claims.


Physicians Derail NCSL-AARP Deal

Complaints from organized medicine about a November National Conference of State Legislatures (NCSL) webinar for lawmakers promoting an Institute of Medicine (IOM) report on the role of nursing in health system reform prompted NCSL to cancel further plans to work with AARP on the issue.

In a letter to American Medical Association Board of Trustees Chair Ardis Hoven, MD, NCSL said it had "declined the contract with AARP intended to help them publicize the report." NCSL President State Sen. Richard T. Moore (D-Mass.) said the NCSL staff agreed "that the webinar would have been improved if it had included the physician perspective."

AMA, TMA, and other medical societies protested the Nov. 17, 2010, webinar entitled, "States Implementing Health System Reform: Advancing Health through Nursing," because it "suggested, without evidence or criticism, that the nation's serious health care workforce challenges could be solved by eliminating important patient safety provisions in state law regarding non-physicians' scope of practice.” Specifically, a letter to NCSL said, "the Webinar promoted the advocacy agenda of certain nursing and other organizations who argue against the value of all health care professionals working together in a coordinated, team-based fashion."

The letter said physicians "believe that the future of our nation's health care system is contingent on highly effective and efficient team models of care – not autonomous practice. It is also our belief that a health care professional's scope of practice should be determined by one's education and training.

"A physician has more than 10,000 hours of medical education and training while a nurse practitioner only is required to have 500 hours of nursing education and training. We believe this difference in education and training matters. It matters during times of medical emergencies. It matters in primary care situations when seemingly 'simple' conditions actually mask underlying, complex conditions. And it matters to ensure that the right diagnosis and treatment plan is made from the beginning to help save patients – and our nation's health system – money on unnecessary prescriptions, tests and referrals."

The letter noted that an NCSL staff decision to rescind an offer to AMA to participate in the webinar "eliminated the possibility of a balanced presentation and allowed, instead, a very one-sided presentation to a very complex set of issues."


TMA Concerned About Sonogram Bill

Proposed legislation requiring a sonogram before an abortion "not only sets a dangerous precedent of legislation prescribing the details of the practice of medicine, but it also clearly mandates that physicians practice in a manner inconsistent with medical ethics," TMA warns in a letter to the chair of the Senate State Affairs Committee.

The letter from TMA President Susan Rudd Bailey, MD, to Sen. Robert Duncan (R-Lubbock) concerns Senate Bill 16 by Sen. Dan Patrick (R-Houston). The bill requires all women to have a sonogram before an abortion.

"TMA's member physicians fall on both sides of the abortion debate," Dr. Bailey's letter says. "TMA's concerns regarding SB 16, however, do not pertain to that highly political issue. However, TMA is concerned about the dangerous precedent SB 16 and related legislation would set for health care in Texas – a precedent that would lay the foundation for future lawmakers to establish the details of the interaction between physicians and patients, and allow nonphysicians to mandate what tests, procedures, or medicines must be provided to patients and in what time frame."

She added that the "sanctity of the patient-physician relationship is the foundation of health care in America, and it must be preserved to ensure candid communication and allow patients to evaluate their care options. The legislature's role should not be to dictate how physicians and patients communicate with one another or what procedures and diagnostic tests must be performed on a given patient."

The State Affairs Committee approved a revised version of the bill and sent it to the full Senate after a hearing Feb. 9. The vote was 7-1.

As originally filed, the measure would require a physician to perform a sonogram before an abortion, explain the procedure as it is performed, and require the patient to view the image and hear the heartbeat. However, the committee approved a substitute with several amendments. The measure now gives a patient the option to refuse seeing and hearing the sonogram altogether. It also changed the amount of time between sonogram and abortion from 2 hours to 24 hours.


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 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.    


e-MDs Ad  


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.


Renew Your Dues Today

Please don't wait any longer to renew your membership in TMA and your county medical society. The 2011 Texas Legislature has begun, and it will be 140 very difficult days for medicine.

Legislators already have filed bills that expand the scope of practice of nonphysician practitioners and threaten physicians' independent medical judgment through direct employment of physicians. Additionally, the projected $30 billion budget shortfall means big cuts could be in store for Medicaid, graduate medical education, and public health programs.

No one is better equipped to fight for and serve you in these difficult times than TMA and your county medical society. We have a plan, and we need your help to be successful. Only with grassroots support can we kill or amend the bad bills and pass the ones that are good for medicine and patients. Renew today! Installment options are available.

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


Keep On Registering Deaths Electronically

Even though the Texas Medical Board (TMB) has suspended disciplinary action for not completing death certificates electronically, physicians should continue registering to use – and using – the Texas Electronic Registrar (TER) Death Registration system. The suspension won't last forever, and you eventually will face a $500 fine if you don't use the system. 

Last November, TMB said it would refund money to physicians already fined and suspend pending cases because of physicians' complaints about the registration system. TMB said the delay in disciplining physicians would last until the 2011 session of the Texas Legislature ends in May. That, according to;TMA staff, resulted in fewer physicians using the system and an increase in paper death certificates.

If you haven't registered and aren't using the system, now is a good time to do so. Here's what TMB says about it in the January TMB Bulletin: "It's important to note that electronic death certification is here to stay. The health department adopted this system because it is faster for all parties involved, and it's less susceptible to fraud than paper. Therefore, doctors can take advantage of this new grace period to sign up and work through any glitches with DSHS."


CMS Schedules Medicaid EHR Call

The Centers for Medicare & Medicaid Services (CMS) will conduct a conference call  on the Medicaid Electronic Health Record (EHR) Incentive Program  for physicians and other health care professionals from noon to 1:30 pm on Feb. 18. Registration for the call closes at noon Feb. 17.

Physicians who join the call will learn if they are eligible for the program, how to register, and other steps needed to receive an incentive payment. Switching between the Medicare and Medicaid programs, reassigning incentive payments, and getting help also are on the agenda. A question- and-answer session will follow.

A transcript and audio recording of the call will be available about three weeks later at on the CMS website.  




CMS Starts Federal EHR Incentives Listserv

The Centers for Medicare & Medicaid Services (CMS) has debuted a new listserv designed to keep physicians informed about the Medicaid and Medicare federal incentive programs. For those who subscribe to the mailing list, CMS will provide information about the programs, including important deadlines, and answers to common questions and concerns. Join the CMS electronic health record (EHR) listserv today or visit the CMS EHR Incentive Programs website for the latest incentive program information.

Starting in 2011, physicians who demonstrate meaningful use of certified EHR technology can qualify for Medicaid and Medicare incentive payments. You must register to participate. To enroll, visit the Centers for Medicare & Medicaid Services (CMS) registration and attestation webpage. Have your tax identification and National Provider Identifier numbers handy when registering and be prepared to select one of the two available programs, Medicare or Medicaid. The Medicare incentives are up to $44,000 over five years. Medicaid incentives are up to $63,750 over six years but require a threshold of 30 percent Medicaid encounters (20 percent for pediatricians).

If you're feeling overwhelmed, help is available. Regional extension centers (RECs) provide federally subsidized consulting to help physicians select and implement an EHR system and to meet federal "meaningful use" requirements for EHR incentive eligibility. Primary care physicians and specialists who can attest to providing primary care services are eligible for the consulting services, which cost $300 per year (valued at $5,000). For more information, visit TMA's Texas REC Resource Center.

For answers to questions on these programs or other health information technology (HIT) issues, contact TMA's HIT experts by calling (800) 880-5720, or e-mailing TMA HIT Department.  



E-prescribe in 2011 to Avoid 2012 Penalty

To avoid penalties in 2012 (1 percent of Medicare Part B claims), TMA recommends all physicians report e-prescribing via claims on at least 10 unique Medicare encounters by June 30, 2011 and report at least 25 unique Medicare encounters during the full 2011 year to qualify for the 2011 incentive (1 percent of Medicare Part B claims).

The Centers for Medicare & Medicaid Services (CMS) has offered the e-prescribing incentive since 2009 to encourage the use of e-prescribing to improve the efficiency and safety of health care. E-prescribing is a way to prevent medication errors that arise due to difficulties in reading or understanding handwritten prescriptions.    






1 percent

1 percent

0.5 percent




1 percent

1.5 percent

2 percent




 If you plan to apply for the Medicare EHR incentive in 2011, note that you can't receive the e-prescribing incentive in the same year. Physicians enrolled in the federal Medicare EHR incentive program can still be penalized in 2012 if they do not report 10 e-prescriptions via claims method using G-code G8553. Part of the “meaningful use” criteria set for the federal EHR incentives requires e-prescribing.

Physicians applying for the Medicaid EHR incentive are still eligible for e-prescribing incentive payments.  

What type of encounter will count as an event?  
A physician must generate at least one electronic prescription using a qualified system during a patient visit from a set of defined services. Multiple prescriptions to the same patient will constitute only one event. 

How do I report e-prescribing data?
To avoid the penalty in 2012, physicians must report by using G-code G8553 on claims. The incentive, however, gives physicians three options for reporting data.  

  • Claims-based reporting of the eRx measure. Report only one G-code (G8553) for 2011.  
  • Registry-based reporting using a "CMS-selected" registry to submit 2011 data to CMS.  
  • EHR-based reporting using a "CMS-selected" EHR product, submitting 2011 data to CMS.   

Visit the "Getting Started" webpage on the CMS website for more information. CMS also maintains lists of qualified e-prescribing registries [PDF] and qualified EHR vendors [PDF]

Do you need technical consulting help? The Texas regional extension centers support primary care physicians with individualized on-site services, technical assistance, guidance, and ongoing support.  Visit  TMA's Texas REC Resource Center for more information.

Fight the Vaccine Myths

Texas Medicine will report in March that Texas physicians reacted strongly to charges by the British Medical Journal that British physician Andrew Wakefield, MD, falsified data and committed an "elaborate fraud" in his 1998 report that linked the measles, mumps, and rubella vaccine to a new syndrome of autism and bowel disease. Some of them charge that Dr. Wakefield's actions frightened parents into refusing to have their children immunized, leading to illnesses that could have been prevented. 

Even though Dr. Wakefield's work has been discredited, some parents still fear vaccinations. To help you counter the erroneous – and dangerous – myths about vaccines, TMA's Be Wise — ImmunizeSM program offers two fact sheets, Talking to Parents About Vaccines and Childhood Vaccines: Fact and Fiction, and a YouTube video, Vaccines Don't Cause Autism.

The fact sheets and video are powerful evidence that immunization works and is vital to stopping preventable diseases. Use them to talk with your patients and their parents.

Be Wise — Immunize is a service mark of the Texas Medical Association.


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.


TexMed 2011 Set May 13-14 in Houston

"Caring for Patients in a Time of Change" is the theme of TexMed 2011, May 13-14, at the George R. Brown Convention Center in Houston. The conference offers more than 100 hours of clinical and business continuing medical education (CME), an exhibit hall with some 100 exhibits, and a chance to learn how to enhance patient care, stay abreast of clinical updates, discuss key issues with experts in the field, and help set TMA policy on issues that are important to you and your patients. Attendance at TexMed is free for TMA members. 

TexMed 2011 Highlights

Friday, May 13   

7 am-4:30 pm
Expo Hall


7:30 am-3:30 pm
CME programming

8 am
Opening Session of the TMA House of Delegates

11:30 am-1:30 pm
Networking lunch
ponsored by Blue Cross and Blue Shield of Texas

4-5 pm
General Session: The Future of Medicine Under the New Health System With Jeff Goldsmith
Sponsored by the Texas Medical Liability Trust

5-6 pm
TMLT Welcome Reception
Sponsored by the Texas Medical Liability Trust

6-7 pm
TMA/TMA Alliance 2010-11 Presidents' Installation Reception
Sponsored by the Texas Medical Association Insurance Trust

7-11 pm
TMA Foundation's 18th Annual Benefit: Picture of Good Health

Saturday, May 14

7 am-12:30 pm 
Expo Hall

8:30 am-Noon
House of Delegates Business Meeting

9 am-5 pm
CME programming


Make your housing reservations at the Hyatt Regency Houston, 1200 Louisiana St., by April 18 to receive the special TMA rate of $149 single/double. All rooms are subject to a 15-percent state and room tax. Call the Hyatt Regency Houston at (713) 654 1234.

Thanks to our silver sponsor, the Hyatt Regency Houston, a portion of your room rate will be used to offset TexMed costs, ensuring TexMed remains a free member benefit.

You may register for the conference and make your housing reservations online on the TexMed 2011 webpage or contact the TMA Knowledge Center by telephone at (800) 880-7955 or by e-mail    



Beaumont Program Wins McGovern Award

A partner with physicians in the fight against cancer, the Julie Rogers "Gift of Life" Program of Beaumont, recently received the TMA Foundation's 2011 John P. McGovern Champion of Health Award.

The program offers uninsured and underinsured patients free education, cancer detection, and access to treatment. Local physicians volunteer their time and services to Gift of Life, and several medical partnerships support the program's mission. The program has given patients nearly 17,600 free mammograms and 6,000 free prostate screenings since its inception in 1994. Gift of Life also implements antismoking campaigns and provides educational outreach to more than 18,000 people annually – teaching about breast and testicular health.

The award is named after John P. McGovern, MD, who founded the John P. McGovern Foundation in Houston. Dr. McGovern established a permanent endowment at the foundation, which supports this award. 

For more information about the TMA Foundation and the award, visit the TMA Foundation webpage or call (800) 880-1300, ext. 1664, or (512) 370-1664.


This Month in Texas Medicine

The February issue of Texas Medicine tells you what you need to know about health information exchanges and why they're important, explains why Medicare still needs fixing, and warns you about what can happen if you sign a noncompete clause. You'll also learn about a new workers' compensation prescription preauthorization program and how screening of newborn babies' hearing can head off problems for them later in life.


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


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.


TMA Fights Budget, Patient Safety Battles

The 2011 session of the Texas Legislature convened Jan. 11 and, as expected, the state's dire budget situation became lawmakers' immediate focus. Even before committees were appointed, House and Senate budget writers laid out proposed budget bills that slashed tens of billions of dollars from current state spending levels. Health and human services programs and medical education were hit hard by the proposed cuts. 

Meanwhile, the scope of practice and physician employment wars also heated up with the filing of several bills to give nurse practitioners authority to practice independently and to allow individual county hospital districts to directly employ physicians.   


Finally, lawmakers also began the debate on implementing at least one major provision of the national health system reform law.

Doctors and patients couldn't have asked for much more when it came to placing members of the Family of Medicine on key Texas House and Senate Committees. Three TMA member-legislators and one TMA Alliance member were appointed to the Texas House Appropriations and Public Health committees by House Speaker Joe Straus (R-San Antonio). These two powerful committees make critical budget and public health decisions. The new members are Reps. Susan King (R-Abilene); Charles Schwertner, MD (R-Georgetown); Mark Shelton, MD (R-Fort Worth); and John Zerwas, MD (R-Simonton). Representative Zerwas, the only one of the four not serving on the Public Health Committee, will also chair the House Appropriations Subcommittee, writing health and human services portions of the budget.

Across the rotunda, Sen. Bob Deuell, MD (R-Greenville), the only physician and the only TMA member in the Senate, already has spent weeks examining the budget on the Senate Finance Committee. Dr. Deuell also is vice chair of the Senate Health and Human Services Committee.

Budget Battle Begins
Just days into the new legislative session, House Appropriations Committee Chair Jim Pitts (R-Waxahachie) unveiled a proposed budget bill for the 2012-13 biennium that whacked more than $31 billion from the current two-year budget. Senate Finance Committee Chair Steve Ogden (R-Bryan) followed a few days later with his own budget proposal, which was only slightly less draconian, cutting spending by $28.8 billion.

The proposed cuts were in response to State Comptroller Susan Combs' revenue estimate that showed projected tax and other revenues for the biennium could fall as much as $27 billion short of meeting current spending levels or covering caseload growth in Medicaid and the Children's Health Insurance Program (CHIP) or enrollment growth in the state's public schools.

Health and human services and medical education would see major cuts under both appropriations bills. House Bill 1 would slash Medicaid payments to physicians, hospitals, and other providers by 10 percent. The bill also makes deep cuts in CHIP, trauma funding, the Children with Special Health Care Needs program, children's mental health services, and tobacco cessation programs.

On the medical education front, the bill cuts medical school formula funding by 23 percent and graduate medical education (GME) formula funding by 33 percent. It also eliminates two physician education loan repayment programs and cuts funding for primary care residencies and preceptorships administered by the Texas Higher Education Coordinating Board.

Senator Ogden's bill makes similar cuts to Medicaid and CHIP but provides about $3 million more for GME and about $2,000 more per student per year for medical school formula funding than was included in HB 1. Like the House bill, Senate Bill 1 eliminates the Medicaid physician loan repayment programs set up under the Frew v. Hawkins lawsuit settlement. But, unlike the House bill, the Senate bill maintains $17 million for the Physician Education Loan Repayment Program, which was expanded just two years ago.

The Senate Finance Committee began hearings on SB 1 in early February. In written testimony to the committee, Texas Medical Association urged the panel to reconsider proposed cuts in medical education, saying they would devastate the state's efforts to produce more homegrown doctors to combat existing physician shortages across the state.

Fighting Over Scope
While the budget is getting most of the attention among lawmakers and legislative observers, several other key health care issues already have lit up TMA's radar scope, including scope of practice and direct physician employment by hospitals.

At least three bills that would allow independent practice by advanced practice nurses have been filed. Those bills – HB 708 by Rep. Kelley Hancock (R-North Richland Hills), HB 915 by Wayne Christian (R-Center), and HB 1266 by Rep. Garnet Coleman (D-Houston) – include diagnosing, prescribing, ordering tests, and making referrals without physician supervision within nurse practitioners' scope of practice.

Meanwhile, Gov. Rick Perry raised the idea of creating a super regulatory agency that would assume authority for licensure and regulation of all health professions in his State of the State address. TMA officials say the association is unlikely to support that idea, unless it utilizes a model in which the Texas Medical Board has oversight over the other health professions.

While the scope battles heated up, so too did the fights over direct employment of physicians by hospitals. At least two bills that would give individual county hospital districts authority to hire physicians, among them the El Paso County Hospital District, have been filed. Several other bills likely will be filed, including one to grant the Harris County Hospital District authority to hire doctors.

TMA officials say several other bills have been filed dealing with county hospital district boards of directors that easily could be amended to include employment authority.

TMA is watching all of those bills closely.

In 2009, Sen. Robert Duncan (R-Lubbock) sponsored a bill that would have given certain critical access hospitals across the state authority to employ physicians, but Governor Perry vetoed it at TMA's request because of a last-minute amendment that would have weakened the state's 2003 medical liability reforms. Senator Duncan is expected to file a similar measure again this year.

Creating An Exchange
On another front, TMA and an unusual coalition of other groups support a measure by Representative Zerwas to create a state health insurance exchange required under the Affordable Care Act (ACA).

While Representative Zerwas acknowledges that he is a vocal opponent of the reform law, he and the groups supporting HB 636 say the state cannot afford to wait to see if the courts will declare ACA unconstitutional before creating an exchange.

Under the reform law, states must have their health insurance exchanges operating by Jan. 1, 2014, or the federal government will create one for them. Representative Zerwas says he filed HB 636 to ensure that Texas maintains control over its own health insurance marketplace.

As envisioned by ACA, the exchange would allow individuals and small employers to shop for affordable health coverage. Health plans in the exchange would have to offer a standard set of benefits, and the exchange would give consumers information allowing them to easily compare price and coverage options between the plans.

In addition to TMA, groups supporting the bill include the Texas Association of Business, the Texas Hospital Association, and the Texas Association of Health Plans

Kicking Off First Tuesdays
Finally, TMA held its initial First Tuesdays at the Capitol event on Feb. 1. Despite ice and snow in many parts of the state, the event drew more than 150 physicians, medical students, and TMA Alliance members who fanned out around the capitol to discuss Medicaid, medical education funding, and other issues with their representatives and senators.

Future First Tuesdays events will be held March 1, April 5, and May 3.

Ken Ortolon, senior editor of Texas Medicine, prepared this special supplement to Action.   


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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