Action: April 15, 2011

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


INSIDE: Congress Repeals 1099 Requirement

Congress Repeals 1099 Requirement
TMA Explains New Medicaid Coding Edits
HHS Issues ACO Rules
EHR Incentive Program Timeline
Make Your Plans for Houston in May
TexMed 2011 is Going Social!
Texas Measles Alert!

POEP, TSU Cancer Conference Set April 29
It’s Easy Being Green!  
Sublease Office Space in San Antonio
This Month in Texas Medicine
Do You Twitter? Follow TMA
Legislature Debates Chiropractors, Employment, Budget   

Congress Repeals 1099 Requirement

Physicians' offices will not have to file a 1099 form with the Internal Revenue Service when they spend more than $600 a year with another business if President Obama signs legislation repealing the requirement, part of last year's health system reform bill to offset the cost of expanded insurance coverage.

On April 5, the Senate joined the House of Representatives in passing the Comprehensive 1099 Taxpayer Protection and Repayment of Exchange Subsidy Overpayments Act of 2011 by a vote of 87-12.  

But a White House statement after the Senate vote did not say if the president will sign the bill, nor did it threaten a veto. "As the president said during the State of the Union, we are open to working with Republicans and Democrats to improve the health reform law and we are pleased Congress has acted to correct a flaw that placed an unnecessary bookkeeping burden on small businesses," the statement said. "Small businesses are the engine of our economy and eliminating the 1099 reporting requirement is the right thing to do. As we move forward, we look forward to improving the tax credit policy in this legislation to ensure we protect small businesses and middle-class families. And the Administration remains eager to work with anyone with ideas about how we can make health care better or more affordable for all Americans." 

According to AMNews, President Obama previously said he does not support the bill's method of paying for the repeal. Under the approved language, AMNews said, certain recipients of health insurance assistance under the health reform law would need to repay those subsidies if their incomes were to increase above a certain threshold later in the year.

The American Medical Association urged President Obama to sign the legislation because the 1099 requirement is an unnecessary burden on physicians' practices and other small businesses. "Existing administrative burdens already weigh heavily on physicians, taking up time that is better spent caring for patients," said Jim Rohack, MD, AMA's immediate past president.


TMA Explains New Medicaid Coding Edits

On Feb. 25, as required by the health system reform law, Medicaid implemented the National Correct Coding Initiative (NCCI) edits.

The edits tell you when two procedures can be reported together and when they cannot. For example, cutting through lesions during surgery is part of the surgery and not a separate payable service. The edits are not the same as those in Medicare, partly because of differences in the Medicaid program's patient populations and partly because of Texas Health and Human Services Commission policy decisions.  

TMA's Payment Advocacy staff is preparing a free presentation to help physicians understand the implementation of the Medicaid NCCI edits. The presentation also covers Medicare NCCI edits, the differences between the Medicare and Medicaid edits, commercial edits, and other helpful billing tips.

When completed, the presentation will be posted on the Medicaid page of the TMA website.


HHS Issues ACO Rules

Health and Human Services Secretary Kathleen Sibelius issued proposed rules to regulate the Medicare accountable care organizations (ACOs) created by the health system reform law. Issues addressed by the rules include shared savings, quality improvement, and antitrust.

"An ACO will be rewarded for providing better care and investing in the health and lives of patients," said Donald M. Berwick, MD, administrator of the Centers for Medicare & Medicaid Services. "ACOs are not just a new way to pay for care but a new model for the organization and delivery of care."

TMA physician leaders and staff experts are reviewing the 429-page document and have many concerns. TMA will complete the analysis shortly and release that along with reports from other medical organizations to provide guidance to physicians who are contemplating joining or creating an ACO.

For more information on ACOs and what they mean to you, read "ACO Frenzy" in the December 2010 issue of Texas Medicine.


EHR Incentive Program Timeline

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.

Mark your calendar and plan ahead for these important deadlines to earn maximum incentives and avoid potential penalties. Attestation for physicians enrolling in the Medicare EHR Incentive Program opens April 18. CMS has released a sneak peak [PDF] of the attestation system.  


Physicians are encouraged to register as soon as possible, even if they do not yet have a certified EHR or enrollment record in PECOS.

  • May 2011 – Medicare and Medicaid EHR incentive payments begin.  
  • June 30 – E-prescribing deadline for Medicare physicians to avoid a 1-percent penalty in 2012 by reporting 10 claims using G-code G8553 (2011 E-prescribing Incentive Requirements).  
  • Oct. 1 – Last day for physicians to begin their 90-day reporting period for calendar year 2011 for the Medicare EHR Incentive Program.  
  • Dec. 31 – E-prescribing deadline for Medicare physicians to avoid a 1.5 percent penalty in 2013 by reporting 25 claims using G-code G8553. Submitting 25 claims by this date also allows Medicare physicians to earn a 1-percent incentive in 2012 on the Medicare physician fee schedule (2011 E-prescribing Incentive Requirements).  
  • Feb. 29, 2012 – Last day for physicians to register for Medicare EHR Incentive Program and attest to receive an incentive payment for the calendar year 2011.  

Upcoming Milestones



Last year to join the Medicare EHR Incentive Program


Medicare penalties begin for physicians and other providers that are not meaningful users of EHR technology


Last year to receive a Medicare EHR Incentive Payment

Last year to join the Medicaid EHR Incentive Program


Last year to receive a Medicaid EHR Incentive Payment


The federal government has established the Texas Regional Extension Centers (RECs) to help physicians so they are not forced to go this journey alone. If you are a primary care physician, federal subsidies are available through the Texas RECs at a rate of $300 per eligible physician. The RECs can offer assistance if you are looking to select and implement an EHR in your practice or if you are an existing EHR user seeking to optimize your workflow and reach meaningful use. 

The Medical Group Management Association (MGMA) conducted a survey in 2011 and found physicians who effectively implement EHRs save money and increase productivity.  According to the MGMA survey results, 20.7 percent of EHR users said they had optimized their EHR post-implementation, 41.1 percent reported an increase in office productivity, 16.5 percent said there was a decrease in productivity, and 42.4 percent reported no change.  While examining only those who said they had optimized their EHR, 26.8 percent indicated an increase in operating costs, 39.7 reported decreased costs, and 33.5 percent reported no change in operating costs.  

For more information, contact TMA's Health Information Technology Department by telephone at (800) 880-5720 or by e-mail.  




Make Your Plans for Houston in May

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.

See into The Future of Medicine Under the New Health System  with Jeff Goldsmith, PhD, at the General Session. Dr. Goldsmith is president of Health Futures and one of the nation's foremost health industry analysts, specializing in corporate strategy, trend analysis, health policy, and emerging technologies. He has worked across the health system advising senior management and boards including hospitals, health plans, physician groups, pharmaceutical companies, and biotechnology and health manufacturing companies, as well as in distribution sectors.

Some of the key points he will cover in his General Session presentation include:

  • An update on what's happening in Washington.  
  • Market consolidation ― what's happening? 
  • What can we expect in the next five to 10 years?  
  • The importance of health information technology.  
  • Manpower issues – providing care for newly insured and aging boomers.  
  • Hospital-physician relationship and how it has changed.
  • Performance-based payment models and new Centers for Medicare & Medicaid Services incentives.
  • Can the small practice survive? What role can TMA/organized medicine play?  

While at TexMed 2011, you also can:

  • 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.  
  • Portrait Studio: Smile for the Camera! Visit booth #431 at the Expo Hall during TexMed 2011 to have your professional portrait taken by RCL Portrait Design. These photos will be used for the TMA online directory, the new TMA Mobile App, and public relations. View your proofs on the spot through an instant video system, and choose your favorite photo to have in your TMA file. Additional photos are available for purchase, but there is no pressure to buy. This is a free service. Call (800) 951-8712 for an appointment before you arrive at TexMed.   
  • Enjoy fine wine at the Texas Oenological Society annual wine dinner at 7 pm, Thursday, May 12, at Charivari Specialty Restaurant, 2521 Bagby. Tickets are $125. You may register online on the TexMed website.  
  • 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, or contact the TMA Knowledge Center by telephone at (800) 880-7955 or by e-mail.

TexMed 2011 is Going Social!

Use the conference hashtag #TexMed11 in your tweets to get your message out to the other attendees at TexMed 2011. Check the feed to get live updates on meetings and events and what other physicians are saying about the event in real time.

For more information leading up to the conference, follow @TexMed and check out TMA on Facebook.  


Texas Measles Alert!

State health officials warned in mid-April that a child in Houston and two adults in Fort Worth were diagnosed with the measles in the previous two weeks.

"Although these cases are believed to have been exposed at an event in Florida, community spread may have occurred from these or other unreported cases," said a Department of State Health Services (DSHS) advisory. "Additionally, the City of Lubbock Health Department is following up on an out-of-state resident with measles who was seen in a local emergency room. Because of these cases, all health care providers in Texas are asked to consider measles in the differential diagnosis of febrile rash illness."

The advisory reminds physicians that they must report measles immediately to their local health department or DSHS. "Do not wait for laboratory confirmation to report the patient. Laboratory testing for measles includes a serological assay for measles IgM and viral isolation (usually from a throat swab). The state or local health department can provide information and assistance on laboratory testing at the DSHS lab or other labs," DSHS said.  

DSHS says physicians who suspect a patient may have measles should isolate the patient. In hospitals, negative air pressure rooms are recommended. In addition, the department says, all visitors and staff working with the patient should use airborne precautions.

For additional information, contact Rachel Wiseman at DSHS at (512) 458-7111, ext. 2632.



POEP, TSU Cancer Conference Set April 29

Breast cancer, human papillomavirus infection and vaccine, prostate cancer, and pain management will be among the topics discussed at the 2011 Texas State Cancer Advocacy Movement for Colleges and Outreach 3rd Annual Cancer Symposium, April 29, at the Embassy Suites Hotel, Spa & Conference Center in San Marcos.

The conference, which will run from 8 am to 2 pm, is a joint project of TMA's Physician Oncology Education Program (POEP) and Texas State University (TSU).

Physicians can earn up to 5 hours of continuing medical education credits by attending the conference. Registration fees are $75 for physicians and $50 for physician assistants and nurses.

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


It’s Easy Being Green!

A little change can go a long way to help the environment. If you switch to a green energy source, you can drastically reduce your carbon footprint. Texas is the nation's largest producer of wind power; wind turbines supply about 20 percent of the electricity in the state's main power grid.

According to Energy Plus®, the preferred electricity supplier of TMA, benefits of wind power include:

  • Smaller environmental impact – Windmills do not release emissions that pollute the air or water, and using wind offsets the pollution created by fossil fuel power plants. Less pollution also reduces the negative impacts on our health.  
  • Economic benefits – Wind farm development is an excellent source of local jobs. It also provides steady and significant revenue to the rural landowners, farmers, and communities in which turbines are located.  
  • Save some green – Wind energy is an inexpensive green option and is cost-competitive with fossil fuels.  
  • Infinite supply – Wind energy is renewable. It is an inexhaustible resource and won't deplete our world's natural resources.  
  • Diversification – Wind power diversifies America's energy portfolio and reduces reliance on imported fuels. This stabilizes the cost of electricity and improves the quality of product and service.  

To learn more, visit or call (877) 770-3373 and mention Offer Code TMA-5515.

What Can Practice Production Numbers Tell You?

Consider these factors if your production isn't consistent.

A practice management tip from
TMA Practice Consulting


Sublease Office Space in San Antonio

This is a wonderful opportunity to decrease your office overhead with an inexpensive leasing rate for the San Antonio area. The building has been recently renovated and has easy patient access with a first-floor entrance. If interested, office equipment and furnishings may be included.

Check out this listing (and others) in the TMA Online Classifieds. You may also post your own medical job opportunities, products and services, continuing medical education offerings, and more­ – for as little as $25.

Questions? Email TMA Advertising, or call (800) 880-1300, ext. 1423.


This Month in Texas Medicine

The April issue of Texas Medicine details TMA's efforts to protect patients by keeping chiropractors from performing procedures they're not adequately trained to do and reports on other health professionals' attempts to practice medicine without a license, explains why TMA backs public health legislation that would save lives and save money, and reports on how physicians can use quality as a revenue stream. You'll also learn about attempts to create a statewide health insurance exchange.


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


Legislature Debates Chiropractors, Employment, Budget

With roughly six weeks remaining in the regular session of this year's Texas Legislature, important reforms at the Texas Medical Board, a scope-of-practice battle with chiropractors, bills to ensure employed physicians maintain clinical autonomy, an overhaul of the way Medicaid pays for physicians and other services, and finalizing a 2012-13 budget are keeping things interesting for lawmakers and the Texas Medical Association.  

Exactly how those issues will turn out is still very much uncertain. Political observers will tell you that the end of a legislative session is like a crescendo where either everything comes together with lawmakers passing a budget and key legislation or everything falls apart and they end up in special session later in the year. As of mid-April, it was unclear which scenario would play out, so stay tuned.

TMA's TMB-Reform Package
TMA's bills to reform the Texas Medical Board (TMB) are moving. "We understand many physicians' frustration with the board, and we are behind a package of bills that would improve how TMB handles complaints against physicians without undermining the board's responsibility to protect the public from bad actors," said TMA Executive Vice President and Chief Executive Officer Louis J. Goodman, PhD.

The Senate has passed Senate Bills 190 and 191 by Sen. Jane Nelson (R-Flower Mound). SB 190 would allow physicians to tape the proceedings of a TMB informal settlement conference, which eliminates the truly anonymous complaints. It would provide a physician with notice if an insurance company files a complaint. It would prohibit the granting of a license to an applicant who has had a medical license suspended or revoked by another state or country. SB 191 would bind TMB to the ruling of an administrative law judge in a proceeding supervised by the State Office of Administrative Hearings.

SB 177 by Sen. Joan Huffman (R-Houston) is waiting to be voted out of the Senate Health and Human Services Committee. It requires the board to do all of the above.   


SB 227 by Senator Nelson was passed by the Senate Health and Human Services Committee and is now waiting for debate in the full Senate. SB 277 would provide discretion for TMB to waive a fine in lieu of a remedial action plan for a minor administrative violation.

"I've seen lots of e-mails crowing about a small step taken by House Bill 1013, a self-serving piece of legislation designed to remove legitimate oversight from those who practice outside the scientific basis of modern medicine," Dr. Goodman said. "HB 1013 weakens TMB to the point that it would place our 2003 health care tort reforms at risk. If doctors are unable to police themselves through a strong and fair medical board, then today's complaint is tomorrow's lawsuit."

Chiropractic Carte Blanche
A major scope-of-practice battle took front and center in early April when the Senate Business and Commerce Committee approved legislation that essentially would have given the Texas Board of Chiropractic Examiners (TBCE) carte blanche authority to do whatever it wants – by rulemaking – without having to worry about legal action from another state health licensure agency. Working with the bill author, however, TMA was able to remove all of the objectionable provisions.

As approved by the Senate Business and Commerce Committee, SB 1001 by Sen. John Carona (R-Dallas) would have prevented TMB from taking legal action to stop an individual chiropractor from violating the Medical Practice Act if the chiropractic board says the chiropractor is practicing within his or her scope. 

The bill also would have circumvented current insurance code provisions concerning nondiscrimination against nonphysicians, which would enable more than 30 nonphysician health care groups to get paid for more services and also would increase utilization. And, lastly, the bill would have allowed those groups to create partnerships and other professional organizations with physicians, circumventing current law that sets out how these organizations are structured.

Under the compromise bill, the measure requires fair payment and nondiscrimination in payment by health plans for services that chiropractors provide. It also allows chiropractors and physicians to establish business relationships as long as the physician affirmatively reports and updates those relationships to TMB.

In an April 14 letter to Senator Corona, TMA Council on Legislation Chair Dan McCoy, MD, thanked him for working with TMA to compromise and said TMA supports the amended bill.

Meanwhile, its House companion bill – House Bill 3441 by Rep. Warren Chisum (R-Pampa) – was heard in the House Licensing and Administrative Procedures Committee in mid-April. TMA testified against that bill, which was left pending in committee.  

Physician Autonomy
Compromise legislation that would allow critical access hospitals, sole community hospitals, and hospitals in counties with populations of 50,000 or less to employ physicians directly passed the Senate in early April. Senate Bill 894 by Sen. Robert Duncan (R-Lubbock) resulted from extensive negotiations among TMA, the Texas Organization of Rural & Community Hospitals, and others. The bill contains many features that protect physicians' clinical autonomy, including:    


  • Placing the responsibility for all clinical matters – bylaws, credentialing, utilization review, and peer review – under the medical staff;  
  • Guaranteeing physicians' independent medical judgment;  
  • Ensuring that all physicians – employed or independent – are subject to the same rights and responsibilities;  
  • Allowing employed physicians to participate in selecting their liability insurance and having the right to consent to settle in a liability action; and  
  • Requiring the medical staff to designate a chief medical officer (CMO) who must be approved by the hospital board. The CMO has the duty to report to TMB that the hospital is hiring physicians under this bill. The CMO has the duty to report instances of interference to TMB.  

Meanwhile, three bills are moving forward to allow hospital districts in Harris County, El Paso County, and Bexar County to directly employ physicians. Under the Harris County and El Paso County bills, the district's medical executive board would supervise all matters related to the practice of medicine by all physicians, employed or not. The board would be made up of physicians and would have sole authority over the rules on credentialing of physicians, peer review, quality assurance, and any other function related to the clinical responsibilities of physicians practicing in district facilities. 

The Bexar County bill would use a nonprofit health care corporation (commonly called a 501a), with a physician board of directors, to employ physicians.

The bills resulted from a consensus of their respective county medical societies, hospital districts, and medical schools. TMA officials say the measures are directed at helping the hospital districts meet their statutory requirement to care for indigent populations through employing physicians while maintaining physician supervision and control of clinical matters

TMA also has testified in support of SB 1661 by Senator Duncan, which establishes protections for physicians' clinical autonomy and gives the physician board of directors of nonprofit health care corporations [501(a)s] the responsibility for all policies related to clinical care. It also strengthens TMB's role in supervising the activities of nonprofit health care corporations.  

Budget Watch
In early April, the House passed a $164.5 billion budget for fiscal 2012-13 that includes a 10-percent cut in physician Medicaid and Children's Health Insurance Program (CHIP) fees, deep cuts in the state's mental and public health safety programs, and reductions in funding for programs designed to recruit and retain physicians.

The Senate has yet to pass its budget bill, but TMA officials say the Senate's bill likely will include $8 billion to $10 billion in additional spending, most of that coming in health and human services and education spending. As the Senate's bill stood in mid-April, the Medicaid physician fee cut would be eliminated. The Senate version also includes funding for Medicaid caseload growth and restores funding for important TMA priorities, including community-based and crisis mental health services and tobacco cessation and prevention programs. Senators also added back some of the funding for primary care residencies administered by the Texas Higher Education Coordinating Board.

The Senate was expected to vote on its budget bill soon, with the final budget bill to be written in a House-Senate conference committee. That means the fate of funding for Medicaid, graduate medical education, and other health-related programs depends largely on the five senators and five representatives appointed to that conference committee. TMA officials say the makeup of that committee is highly uncertain beyond House Appropriations Committee Chair Jim Pitts (R-Waxahachie) and Senate Finance Committee Chair Steve Ogden (R-Bryan). There is speculation that state Rep. John Zerwas, MD (R-Richmond) is a likely House appointee, which would be a plus for organized medicine. But House Speaker Joe Strauss (R-San Antonio) may have difficulty choosing any Democrats to serve on the conference committee. Traditionally, conference committees include members who voted for the bill from both parties, but no House Democrats voted in favor of the budget bill this time.

Meanwhile, both the House and Senate are looking for ways to come up with additional revenue without a tax increase. Senator Duncan, chair of the Senate Finance Subcommittee on Fiscal Matters, was directed to find $5 billion in additional nontax revenue. Among options for generating additional money that subcommittee is considering are:

  • Liquidate the tobacco settlement endowment funds ($590 million);  
  • Liquidate the permanent public health fund ($379 million); and  
  • Extend the small business exemption from the franchise tax – an item that costs the state an estimated $150 million.   

Getting Collaborative
As lawmakers wrestled with how much Medicaid pays physicians, two bills were moving forward that would change how they are paid by Medicaid, as well as CHIP and private health plans.

SB 7 by Senator Nelson shifts the focus in Medicaid and CHIP away from fee-for-service payments to quality-based payments. The bill establishes a new quality-based payment advisory committee to recommend ways to improve outcomes to the Texas Health and Human Services Commission. Further, the bill would reduce Medicaid and CHIP hospital payments when patients are readmitted for preventable illnesses; establish copayments for unnecessary emergency department visits; provide incentives for hospitals, physicians, and health plans to reduce waste and improve quality of care; and order a study of whether pay-for-performance is workable for long-term care.

SB 8, also by Senator Nelson, establishes a statewide plan for improving quality and increasing efficiency through performance-based measures, tests collaborative models between physicians and health care providers, and requires public reporting of preventable readmissions and complications.

TMA initially had serious concerns about SB 8, but negotiations with the Texas Association of Health Plans and the Texas Hospital Association led to significant changes that protect physicians in collaborative arrangements, including giving physicians an equal say and vote in a collaborative arrangement's governing board and providing due process protections and the ability to participate in more than one collaborative arrangement in their community. The bill also protects Texas' ban on the corporate practice of medicine.

The Senate Health and Human Services Committee approved both bills, and they were pending on the Senate Local and Uncontested Calendar.

Smoking Calendar
TMA-backed legislation to ban smoking in public places statewide cleared the House Public Health Committee, but the House Calendars Committee has not yet set it for debate. The Senate version of the bill also has cleared committee, but supporters say they lack the 21 votes they need to bring it up for Senate consideration.

TMA is working with both bill authors on potential amendments to help them gain the necessary votes to bring up the measure for Senate consideration. Under Senate rules, a two-thirds vote is required to consider a bill out of its regular order of business. Traditionally, the Senate places a bill at the top of its calendar at the beginning of a day's session and leaves it there, thereby forcing all other legislation to gain a two-thirds majority to reach the floor.

And on an issue involving end-of-life care, TMA was set to testify in mid-April against legislation that requires physicians to continue providing treatment they believe to be unethical and inappropriate. HB 3520 by Rep. Bryan Hughes (R-Mineola) mandates that treatments such as artificial nutrition and hydration not be withheld, even if the hydration harms the patient, as in the case of an already fluid-overloaded patient with kidney failure or heart failure who can't go on dialysis. If passed, this bill could lead to prolonged suffering and, in some cases, accelerated death of patients.

TMA officials say it also would subvert processes set up under the Texas Advance Directives Act for resolving end-of-life care issues, would interfere with the patient-physician relationship, and potentially prolong the suffering of some patients.

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


TMA Seminars

Practice Management, Ext. 1421

Billing and Compliance
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
Prepared for ICD-10?
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
4/16      Galveston
9/10      Amarillo
10/20    El Paso

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