Action: March 15, 2011

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

INSIDE: TMA Urges Bipartisan Medicare Fix

TMA Urges Bipartisan Medicare Fix
Burgess Files Texas-Style Tort Reform Bill
Flu Season Continues in Texas
ImmTrac Takes Adult Immunization Data
New TMA Discount Electricity Program
TexMed 2011 May 13-14 in Houston
Do You Qualify for “Meaningful Use” Exclusions?

Top 10 Reasons to Attend the TMAF Gala
Science Teaching Nominations Hit Record
TMA Discount for Epocrates' Guides
This Month in Texas Medicine
Do You Twitter? Follow TMA  

Scope Fight, Budget Dominate Legislative Session



TMA Urges Bipartisan Medicare Fix

In the face of a report that federal officials plan to cut Medicare payments to physicians by just under 30 percent in 2012, TMA joined the American Medical Association and other state medical societies to urge Congress to "begin working in a bipartisan, bicameral manner" to eliminate the Sustainable Growth Rate (SGR) formula "and lay the groundwork for adoption of broader physician payment and delivery reforms."

"Last year, Congress was required to act five times to pass short-term measures (for as short as one month) to stop Medicare physician payment cuts scheduled for 2010," the groups said in a letter to Congress. "On three occasions Congress failed to act before cuts were implemented, causing disruptions in processing Medicare payments. These payment uncertainties and delays created serious problems for many physician practices and jeopardized seniors' access to care."

Ultimately, the letter said, "Congress and the Administration worked together in a bipartisan manner" to stop the planned fee cuts and stabilize Medicare physician payments through 2011. "It is our hope that Congress can again work together this year to end the cycle of temporary patches once and for all and develop a long-term and meaningful solution to this issue."

The letter reminded lawmakers that throughout the past year both Republican and Democratic members and President Obama said they supported eliminating the SGR, as did the National Commission on Fiscal Responsibility and Reform and the president's 2012 budget.

"The physician community is committed to taking a leading role in developing and pilot testing payment and delivery reforms that can provide a foundation for replacing the SGR and improving the Medicare physician payment system," the letter said. "We look forward to building upon last year's bipartisan effort to permanently replace the SGR with a workable system that keeps pace with practice costs and ensures that seniors, the disabled, and military families receive the high quality care that they have been promised for years to come."  

Burgess Files Texas-Style Tort Reform Bill

U.S. Rep. Michael C. Burgess, MD (R-Texas), has again filed legislation to improve patient access to physicians by ending unnecessary lawsuits by trial lawyers, just like a similar law has done in Texas since 2003.

"Physicians are forced to trim their budgets in order to cover their insurance costs, often resulting in laying off staff, limiting access to certain aspects of their practice, or closing their practice all together," said Dr. Burgess. "We need national, across-the-board change in the tort reform system, and my bill would do just that. Runaway lawsuits are unnecessary and costly, and reforming medical liability must be a part of the national health care debate."

His bill, House Resolution 896, the Medical Justice Act, regulates civil actions for an injury or death resulting from health care by, among other things, limiting the noneconomic damages that an individual could recover. Medical litigation and soaring liability insurance premiums contribute significantly to the rising cost of health care, Representative Burgess said. Physicians are forced to practice defensive medicine in fear of being second-guessed by trial lawyers, which results in millions of dollars in unnecessary tests, procedures, and imaging. Furthermore, seasoned medical professionals are retiring early because staying in practice is no longer financially feasible, further contributing to our nation's doctor shortage, he added.

"Texas has led the nation in medical justice reform and is now a model state for what successful tort reform looks like," Dr. Burgess said. "Unfortunately, only a few states have followed suit, leaving too many Americans trapped in a system that is harmful to patients and doctors."

Dr. Burgess says his bill mirrors the tort reforms Texas passed in 2003. The legislation led to lower liability insurance premiums, more physicians licensed in Texas, and improved access to care for patients.  

"All Americans deserve to enjoy the benefits Texas has seen thanks to the eradication of our epidemic of health care lawsuit abuse," said Texas Medical Association President Susan R. Bailey, MD. "Since our law took effect, Texas has licensed 21,000 new physicians, including a record 3,621 in fiscal year 2008. This has been good medicine for the people of Texas, and Dr. Burgess' plan would apply this lifesaving treatment to the rest of the country."  


Flu Season Continues in Texas

Patients across Texas continue to visit physician offices with cases of influenza. Flu activity in the state is considered widespread, according to the Department of State Health Services' surveillance. Influenza A (H1N1), influenza A (H3N2), and influenza B have been identified by laboratories as circulating in Texas.

The Advisory Committee on Immunization Practices (ACIP) recommends antiviral treatment as soon as possible for patients who have severe illness or who are at higher risk for influenza complications. Oseltamivir and zanamivir are the recommended medications for circulating virus strains.

ACIP recommends universal vaccination this flu season. This includes health care personnel (HCP). Flu vaccination rates among HCP peaked last year at 62 percent after years below 50 percent. A November 2010 Centers for Disease Control and Prevention (CDC) survey indicated 55 percent of HCP received a flu vaccination. A follow-up survey will be conducted in April.

The TMA website offers a continuing medical education course, Increasing Influenza Immunization Coverage of Health Care Workers [PDF]. You can receive 1 AMA PRA Category 1 CreditTM and 1 credit in medical ethics and/or professional responsibility. To request a copy of the booklet be mailed to you, contact the TMA Knowledge Center by telephone at (800) 880-7955 or by e-mail. You may also download and read the PDF, print it, and complete and return the course evaluation to the TMA Knowledge Center, 401 W. 15th St., Austin, TX 78701, or fax it to (512) 370-1693.

The CDC website has several online resources that summarize guidance for physicians:

TMA's Flu Fighters also have information you can use in treating patients with the flu. You may get the information on the TMA website. The Flu Fighters are infectious disease experts who provide as-needed updates on this year's flu season.

Texas Vaccines for Children (TVFC) Program providers can order vaccine for the 2011-12 influenza season onlinebut they must do so by March 23. Vaccine deliveries will begin around September.

Providers may request preferred influenza product brands and formulations, and these requests will be honored to the extent possible. Choice is limited to products and funding allocated to TVFC by CDC. Orders may be filled in their entirety or in partial shipments as vaccines become available next fall.

Online submission of influenza orders is preferred; however, if a provider site does not have access to the Internet to place the order, a physical order form may be used. Contact the local health department or health service region where you submit your regular TVFC orders to obtain a physical form. 

Free 2011-12 Influenza Vaccine Information Statements in English or Spanish will be available for order in late summer or early fall of 2011 at Scroll down to C-93 or C93-A.

Call (800) 252-9152 if you need more information.

ImmTrac Takes Adult Immunization Data

Physicians now may submit immunization data for adult patients who want their records to be included in the statewide ImmTrac registry. Physicians must be registered with the Department of State Health Services (DSHS) [PDF] and must retain a patient's signed consent form [PDF] to add an adult patient to the web-based registry. The immunization records can either be entered into the online ImmTrac application or sent electronically to DSHS.

In 2009, TMA strongly supported the Texas Legislature's expansion of ImmTrac to include adult data.

Physicians already may submit immunization data of adult first responders and their family members. Texas law requires physicians to report to ImmTrac any immunizations given to children or as part of a public health emergency. The registry currently includes records of more than 89 million immunizations for more than 6 million Texas children. 

More information on adult records is available at the DSHS Immunization Branch website. Questions can be e-mailed to   




New TMA Discount Electricity Program

Get more for your TMA membership and enroll your medical practice in Energy Plus.

TMA can help members save on their electricity bill while earning exclusive benefits. You can enroll your office and residence with Energy Plus to receive an activation bonus, annual cash back, and a low monthly rate. Energy Plus does not charge a monthly service fee, nor sign-up or cancellation fees. You may try Energy Plus risk free, as there are no long-term commitments required with its month-to month plan.

Check out Energy Plus online or call (877) 770-3373 and mention Offer Code TMA-5516.


TexMed 2011 May 13-14 in Houston

Take advantage of your TMA membership by attending TexMed 2011, May 13-14, at the George R. Brown Convention Center and Hyatt Regency Houston.

"Caring for Patients in a Time of Change" is the theme of the conference, which 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.

Here are some highlights:  

  • See into The Future of Medicine Under the New Health System with Jeff Goldsmith, PhD, at the General Session. Sponsored by the Texas Medical Liability Trust.  
  • Spend some quality time with colleagues and friends at the Networking Luncheon in the Expo Hall. After lunch, stroll through the Expo Hall and preview the latest technology, products, and services for your practice. Boxed lunch tickets are $15. Sponsored by Blue Cross and Blue Shield of Texas  
  • Check out the breakout session on accountable care organizations; the Public Health CME track on new incentives and tools that allow physicians to track and benchmark preventive services; and the Quality track, which will help physicians meet the demands of public and private payers as they push forward value-based purchasing programs that offer rewards for efficiency and quality outcomes.  
  • Join us at a new event – a reception honoring 2011-12 TMA President C. Bruce Malone, MD, Austin, and TMAA President Bridget McKeever, Corpus Christi. Sponsored by the Texas Medical Association Insurance Trust  
  • Get your photo taken for TMA's database and the new TMA Mobile App by RCL Portrait Design, a professional photographer who will be set up in the Expo Hall. You may purchase a portrait if you like, but there is no obligation or pressure. Call (800) 951-8712 to reserve your spot.
  • Eat, drink, and be merry at the TMA Foundation's 18th annual gala, Picture of Good Health. This annual fundraiser is a chance to have fun with friends while supporting TMA's health improvement programs.   

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

Do You Qualify for “Meaningful Use” Exclusions?

For those physicians looking at the Medicare and Medicaid electronic health record (EHR) incentive programs, it pays to be prepared. Incentives are available to eligible physicians who "meaningfully use" a certified EHR – up to $44,000 under Medicare and up to $63,750 under Medicaid.

All eligible physicians who participate in the EHR incentive program must meet all of the meaningful use objectives, unless the objective provides an exclusion.  An exclusion can be claimed if the meaningful use objective or measure is not applicable to the physician.  

Meaningful use requires physicians to complete a set of 15 core criteria and to choose 5 of 10 criteria on a menu set.  Of these criteria, 14 of 25 allow for certain exclusions.  If you are eligible for an exclusion, you can attest this information during the reporting process and be excluded from meeting the measure of that objective.   

There are no blanket exclusions among physician specialties; eligible physicians must evaluate whether they individually meet the exclusion criteria applicable for each objective. 


Meaningful Use Core Measures: 1-15
(Program requires that physicians complete all 15 core measures.)

Measure Number




CPOE for medication order

Any physician who writes fewer than 100 prescriptions during the EHR reporting period.


Drug interaction check

No exclusion.


Maintain an up-to-date problem list of current and active diagnoses

No exclusion.


Generate and transmit permissible prescriptions electronically (eRx)

Any physician who writes fewer than 100 prescriptions during the reporting period.


Maintain active medication list

No exclusion.


Maintain active medication allergy list

No exclusion.


Record demographics

No exclusion.


Record vital signs

Any physician who either sees no patients 2 years or older, or who believes that all three vital signs of height, weight, and blood pressure of their patients have no relevance to the scope of their  practice.


Record smoking status

Any physician who sees no patients 13 years or older.


Clinical quality measures (CQMs)

No exclusion.


Clinical decision support rule

No exclusion.


Electronic copy of health information

Any physician who has no requests from patients or their agents for an electronic copy of patient health information during the EHR reporting period.


Clinical summaries

Any physician who has no office visits during the EHR reporting period.


Electronic exchange of clinical information

No exclusion; however, an unsuccessful test of electronic exchange of key clinical information will still meet the measure of this objective.


Protect electronic health information

No exclusion.



Meaningful Use Menu Set Measures: 1-10
(Program requires that physicians choose five of 10 measures.)

Measure Number




Drug formulary checks

Any physician who writes fewer than 100 prescriptions during the EHR reporting period.


Clinical lab test results

Any physician who orders no lab tests whose results are in either a positive/negative or numeric format during the reporting period.


Patient lists

No exclusion.


Patient reminders

A physician who has no patients 65 years or older or 5 years or younger with records maintained using certified EHR technology


Patient electronic access

Any physician who neither orders nor creates lab tests or information that would be contained in the problem list, medication list, or medication allergy list during the reporting period.


Patient-specific education resources

No exclusion.


Medication reconciliation

Any physician who was not the recipient of any transitions of care during the EHR reporting period.


Transition of care summary

Any physician who neither transfers a patient to another setting nor refers a patient to another provider during the EHR reporting period.


Immunization registries data submission

No exclusion.


Syndromic surveillance data submission

A physician who does not collect any reportable syndromic information on his or her patients during the EHR reporting period or does not submit such information to any public health agency that has the capacity to receive the information electronically


For more information, see the Centers for Medicare & Medicaid Services (CMS) in-depth guide to the Meaningful Use Criteria [PDF]. 

More than 50,000 physicians and providers have signed up to receive services from the regional extension centers (RECs).  Four Texas RECs, each with teams of experts, are ready to provide on-site consultation to help your practice reach the meaningful use criteria.  To learn more about available services, eligibility, and federal incentive guidelines, visit the Texas Regional Extension Center Resource Center on the TMA website, call the TMA Health Information Technology Helpline at (800) 880-5720, or e-mail

Save this date – Friday, April 1, 12:30-2 pm – for a national call on registration for the Medicare EHR Incentive Program. More information, including registration details, will follow soon on the CMS website



 Top 10 Reasons to Attend the TMAF Gala

The 18th annual TMA Foundation (TMAF) Benefit Gala on Friday, May 13, at TexMed 2011 in Houston, offers a night celebrating the foundation's mission to "improve the health of all Texans." Highlights include a silent auction, a live auction with a focus on luxury, and a sumptuous dinner, followed by live entertainment and dancing. All gala proceeds benefit TMAF and the health improvement programs it makes possible.

Here are the top 10 reasons you should attend:

  • 10. See your friends from across the state without having to pass a resolution.  
  • 9. It's guaranteed to be infinitely more fun than being on call.  
  • 8. Connect with our Houston Health Leaders: Medicine – antitobacco activist Joel Dunnington, MD, professor, Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas M.D. Anderson Cancer Center; H-E-B Houston President Scott McClelland; and Gracie Cavnar, creator of hands-on nutrition education to prevent childhood obesity and encourage long-term health.  
  • 7. See who wins Drs. Edward and Dawn Buckingham's ski trip package. (It might be you!)   
  • 6. … and the Caribbean cruise from SeaDream!  
  • 5. Enjoy a delicious and heart-healthy dinner.  
  • 4. Get your exercise and dance the night away to music by the incomparable Richard Brown Orchestra.  
  • 3. Show off your most "artful" cocktail attire.  
  • 2. Celebrate 187,000 shots or 97,000 helmets, or more than $3.2 million in grants made to local communities across Texas.  
  • And the No. 1 reason we want to see you at the TMAF benefit on May 13 – it won't be a party without you.   

Purchase your tickets for the gala when you register for TexMed 2011, or call TMAF at (800) 880-1300, ext. 1664, or (512) 370-1664.

Science Teaching Nominations Hit Record

TMA received more than 800 nominations for the 2011 Ernest and Sarah Butler Awards for Excellence in Science Teaching.

The awards reward outstanding elementary, middle, and high school teachers who exhibit a personal commitment and enthusiasm for teaching any area of science. Three teachers will receive $5,000 each, and their schools will receive $2,000 awards. The winners will be honored at TexMed 2011 in Houston. 

The U.T. Charles A. Dana Center has volunteered its science team's expertise to participate as round one judges of the awards. It will determine finalists in each of the three categories, and a three-member TMA Board of Trustees committee will select the winners.

If you know outstanding science teachers in your community, nominate them online for the 2012 award. The deadline is Oct. 16. In addition to the $2,000 previously available to winners, TMA added a second-place prize of $500 per category to be given to the recipients' school science curriculum.

This program's name recognizes the generosity of Dr. and Mrs. Ernest C. Butler of Austin, who established an endowment at the TMA Foundation to provide core support for the award. To be part of the 2012 award program and ensure outstanding science teachers are recognized for their excellence, consider making a donation now to the TMA Foundation.  


TMA Discount for Epocrates' Guides

If you are one of thousands of Texas physicians who use the Epocrates® Rx free drug guide on your mobile device, you now can upgrade to a one- or two-year premium-level subscription at a discount. If you already subscribe to one of Epocrates' drug, disease, and diagnostic references, and want to upgrade – or plan to continue at your current level – you can do that at a discount, too.

TMA has partnered with Epocrates to offer TMA members a 20-percent discount on premium-level subscriptions to Epocrates point-of-care references for smartphones, other mobile devices, and the web. 

More than 19,000 Texas physicians and almost one of every two U.S. physicians use some version of these TMA-endorsed products. Never used an Epocrates reference? Try out the free version. You'll get drug monographs, including information on hundreds of brand name over-the-counter products; health plan formularies; a drug interaction checker; pill identification with pictures; and content updates and medical news.

Upgrade options offer two or more of the following: information on alternative and complementary medicines; an infectious disease treatment guide; disease monographs with images; information on hundreds of tests and panels to help with lab preparation, interpretation, and follow-up; ICD-9 and CPT codes; clinical tables and guidelines, patient education handouts, and a medical dictionary.

For pricing and to subscribe or upgrade, visit the TMA website.  



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 Month in Texas Medicine

The March issue of  Texas Medicine  explains why the Affordable care Act may have some good news for patients and physicians, details the grim financial news coming out of Austin, and tells you about the devastating impact of a now discredited vaccine "safety" study. You'll also learn how TMA helped kill an unfair insurance policy provision and why you need a policy and procedure manual in your practice.  

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. 


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. 


Scope Fight, Budget Dominate Legislative Session 

As the 2011 session of the Texas Legislature raced toward its halfway point in March, the battle over scope of practice for nonphysician practitioners was heating up, with a number of bills filed allowing incursion into the practice of medicine by nurse practitioners, podiatrists, and others. Among those bills is one that Texas Medical Association officials say would allow the Texas Board of Chiropractic Examiners to set chiropractors' scope at just about anything it deems appropriate.

Also, bills to allow hospitals to directly employ physicians continue to mount. The bills are aimed at urban county hospital districts as well as rural hospitals. Some of the bills include provisions to protect the patient-physician relationship – and physicians' clinical autonomy. Others are silent on protections.

Meanwhile, budget woes continue. Steep cuts proposed for education prompted demonstrations at the capitol. House and Senate budget writers tried to figure out how to trim billions from spending on Medicaid and other health care programs without decimating services.

While legislative committee debated all these issues, TMA lobbyists and leaders worked closely with lawmakers to minimize the impact of cuts to health care programs, defend the practice of medicine, and push forward with public health issues, such as the statewide ban on public smoking and antiobesity legislation.


Scoping Out Scope

A number of bills to allow nonphysician practitioners to expand their scope of practice were filed early in the session, including three giving nurse practitioners independent practice and another allowing direct access to physical therapists without a physician's referral. But that list continues to grow.

Senate Bill 1001 by Sen. John Carona (R-Dallas) prohibits any other state agency from interfering with scope-of-practice regulations handed down by the Texas Board of Chiropractic Examiners. The bill is designed to stop situations such as occurred when the Texas Medical Board joined TMA's suit against the chiropractic board over a rule allowing chiropractors to do needle electromyocardiograms (EMGs). The bill addresses in legislation what the chiropractic board lost through litigation as the courts agreed with TMA that needle EMG and manipulation under anesthesia constitute an unwarranted expansion of their scope.

SB 1001 also would allow chiropractors to set up joint ventures with physicians to be co-owners of physician practices and would require health plans to pay for chiropractic services.

Meanwhile, Sen. Carlos Uresti (D-San Antonio) filed a bill to allow podiatrists to do surgery on the ankle. Again, the legislation opens another front in their quest for expanded scope after a successful lawsuit by TMA challenged their board's ability to arbitrarily expand scope by board rule alone. And, optometrists seek authority to perform a number of different types of surgery around the eye.

TMA's position on these scope bills continues to be that nonphysician practitioners need to show evidence that they have the education and training to  safely provide the services or procedures they wish to provide. TMA officials say most cannot.


Who's the Boss?

More than 20 rural hospitals and a number of urban hospital districts continue to seek authority to directly employ physicians. Last session, TMA was able to agree with a Dallas County hospital district on legislation that allowed employment of physicians for purposes of meeting the mission of the district to care for the poor and indigent of Dallas County, but it also ensured that patient care decisions remained between the patient and the physician and that they would not be unduly influenced by the hospital administrator.

This year, local discussions in Houston involving the Harris County Medical Society, the Harris County Hospital District, Baylor College of Medicine, and The University of Texas Health Science Center at Houston have led to a similar agreement, with the responsibility for all clinical matters vested in a medical executive committee. Similar negotiations are proceeding in San Antonio and El Paso.

Sen. Robert Duncan (R-Lubbock) filed SB 894 to allow rural or critical care hospitals statewide to employ physicians. The bill varies significantly from a compromise bill that Senator Duncan succeeded in passing in 2009. Governor Perry, however, vetoed that bill at TMA's request because of a last-minute amendment that would have altered the state's 2003 medical liability reforms.

TMA is negotiating with Senator Duncan over that bill and is seeking to ensure clinical autonomy of the hospital medical staff is maintained in any employment situations that are allowed.


The Budget Battle

TMA leaders say the budget continues to be the focal point of the session, and a dire one. Lawmakers are looking at an emergency appropriation of $4.3 billion to plug a hole in the current budget and are staring at a $27 billion shortfall for the 2012-13 budget.

"There are going to be cuts in this budget; there is no question that there are going to be cuts," said Darren Whitehurst, TMA vice president for advocacy. "The question becomes exactly what they look like and who absorbs them."

A 10-percent, across-the-board cut in Medicaid physician and other provider payment rates in both the initial House and Senate budget bills is still being considered, but budget writers in both houses are looking for other ways they can reduce spending in Medicaid and the Children's Health Insurance Program (CHIP) that might have less impact than cuts in provider rates.

Among proposals considered is expanding Medicaid managed care statewide, including three counties in the Lower Rio Grande Valley where Medicaid HMOs currently are prohibited. Other ideas include imposing copayments for inappropriate use of hospital emergency rooms, limiting the number of prescriptions that adult Medicaid enrollees could receive each month, and cutting podiatry services except for diabetes patients.

A Medicaid subcommittee of the Senate Finance Committee is soliciting recommendations on ways to save money in Medicaid and CHIP from a wide array of interest groups, including TMA. Among recommendations TMA submitted were to:

  • Reduce unplanned pregnancies by simplifying enrollment in the Women's Health Program and expanding outreach;  
  • Reduce inappropriate use of neonatal intensive care units through evidence-based clinical best practices and targeted utilization management strategies;  
  • Implement strategies to reduce low-birth weight and pre-term babies;  
  • Implement a coordinated patient education and home visitation program for patients with asthma; and  
  • Expand use of managed care, accompanied by new statutory provisions to hold health plans accountable for improving availability and quality of care.  

Meanwhile, the House Appropriations Committee is close to moving its budget bill out of committee. That panel is examining recommendations from its health and human services subcommittee that would give the Texas Health and Human Services Commission (HHSC) the authority to expand Medicaid HMOs, implement copays, and reduce emergency department usage to achieve $450 million in savings.

Committee members also discussed the potential impact of the proposed 10-percent cut to physician payments and other health care providers. Those cuts would make up almost $2 billion of the overall proposed cuts to health and human services in the House budget. Rep. John Zerwas, MD (R-Simonton), said the committee's goal is to hold the rate reductions to 2 percent for physicians who treat children.

TMA officials also say HHSC supports the need to establish medical homes for Medicaid patients and acknowledge it will be virtually impossible for many physicians to continue to see Medicaid patients if the 10-percent cuts go through.

The question is whether lawmakers can close the budget gap without some new revenues. Gov. Rick Perry and others are reluctant to spend even the $9 billion-plus now in the state's rainy day fund, but a growing number of lawmakers – both Democrat and Republican – seem to lean in that direction.

And TMA lobbyists say many lawmakers recognize they can't balance the budget with current revenues without doing irreparable harm to Medicaid and CHIP, education, and other programs. Although there are proposals to tax sugary drinks and legalize casinos, TMA officials say there is little appetite, particularly in the House, for any type of tax bill.

Meanwhile, TMA leaders and lobbyists are looking closely at Senate bills 7 and 8, which seek to rein in Medicaid spending, in particular, and health care spending, in general, through payment and delivery system reforms.

SB 7 would shift Medicaid from a fee-for-service basis to a quality-based payment system, while SB 8 allows creation of health care collaboratives – similar to accountable care organizations – in both Medicaid and private health plans.

TMA wants to make sure these Medicaid reforms and collaboratives result in improved care and value for the patients and that physicians lead the clinical efforts.

Best of the Rest

A TMA-supported statewide public smoking ban passed out of the House Public Health and Senate Health and Human Services committees in early March, but TMA officials say that bill has a "tough row to hoe." They say it will be difficult to pass a bill that does not allow for any exceptions. The measure was dealt a blow when the Legislative Budget Board (LBB) issued a statement that the ban would not cut costs in Medicaid or other state health care programs, though the LBB admitted savings were possible. HHSC released a written estimate that the legislation could at a minimum save Medicaid $31 million in a tough fiscal biennium.

Meanwhile, antiobesity measures that would place mandates on school districts or any public health bills that cost the state money also will be difficult to pass in this session, TMA leaders say. In fact, HB 400 by Rep. Rob Eissler would roll back and nearly eliminate the requirement of FitnessGrams that track the fitness of Texas students. This, in combination with 60-percent cuts to other obesity education and prevention measures in Article III public education funds, could be a devastating blow to antiobesity efforts in Texas, which continues to be among national leaders in obesity and related health care costs, according to the Archives of Pediatrics and Adolescent Medicine.

At a news conference March 1, TMA and the Texas Public Health Coalition (TPHC) encouraged lawmakers to support public health initiatives now for the future health of Texans and the state budget. They said solid science has shown that cutting budgets for tobacco-control and obesity-reduction programs has a negative impact on both the physical and the fiscal health of the state.

"We hope our legislators will make healthy choices now that can both help them balance the budget and help Texans live longer, healthier, more productive lives," said TMA President Susan Rudd Bailey, MD. "For starters, Texas can no longer afford to indulge the smoking and eating habits of some at a huge cost to all Texas taxpayers."

TPHC officials said the cost to the state of the indoor smoking ban is zero but the potential savings are immense for the state, for Texas business, and for individuals.

TPHC members also opposed deep cuts in funding for state obesity-prevention programs and public school health programs.

Lastly, Rep. Craig Eiland (D-Galveston) filed a TMA-backed bill to rein in so-called silent PPOs, where health plans inappropriately utilize discounts that physicians have negotiated with other plans.

Texas Medicine Senior Editor Ken Ortolon prepared this special supplement to Action.



TMA Seminars 

Practice Management, Ext. 1421

Billing and Compliance
4/12     San Antonio
4/14     Austin
4/26     Houston
4/28     McAllen
5/4       Dallas
5/5       Fort Worth

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

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

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