Physician Employment Protections
At the onset of the 82nd legislative session, more than 20 bills were asking lawmakers to lift Texas' ban against the corporate practice of medicine. Both rural and urban hospital districts wanted the ability to employ physicians. With only weeks left of the session, TMA accomplished these two major feats:
- Protect Texas' ban against the corporate practice of medicine, and
- Create employment protections for physicians who choose to be employed.
TMA supported bills that included proper and structured physician employment for underserved urban and rural patient populations as long as:
- The patient-physician relationship is protected;
- Physicians, through the hospital district's medical executive committee, are solely and exclusively responsible for all clinical aspects of medical practice;
- Independent medical judgment and the clinical autonomy of physicians – employed and independent – is guaranteed by medical staff oversight; and
- The privilege of employing is for the statutory mission of the district to provide care for the indigent residents of the county.
TMA's chief goal was to ensure that no corporation could dictate how physicians care for their patients. Texas is one of the first states in the nation to take this step.
Employment WITHOUT protections is the corporate practice of medicine. Employment WITH protections is part of the practice of medicine, and that’s what we stand for.
Here is the list of bills moving through the legislative process:
Senate Bill 894 by Sen. Robert Duncan (R-Lubbock) and the committee substitute for House Bill 1700 by Rep. Garnet Coleman (D-Houston) would allow critical access hospitals, sole community hospitals, and hospitals in counties of 50,000 or fewer to employ physicians. Most of these hospitals are run by local governments. The bills contain many features that protect the physician's clinical autonomy against the corporate practice of medicine. They:
- Place the responsibility for all clinical matters – bylaws, credentialing, utilization review, and peer review – under the medical staff;
- Guarantee physicians' independent medical judgment;
- State that all physicians – employed or independent – are subject to the same rights and responsibilities;
- Allow employed physicians to participate in the selection of their liability insurance and have the right to consent to settle in a liability action; and
- Require 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 the Texas Medical Board (TMB) that the hospital is hiring physicians under this bill and that the CMO is the contact with TMB. The CMO has a duty to report instances of interference to TMB.
SB 1661 by Senator Duncan establishes protections for physicians' clinical autonomy and gives to the physician board of directors of nonprofit health care corporations (501[a] corporations) the responsibility for all policies related to clinical care. It also strengthens the role of TMB in supervising the activities of nonprofit health care corporations.
HB 1568 by Representative Coleman and SB 1795 by Sen. Mario Gallegos (D-Houston) would allow the Harris County Hospital District to employ physicians with protections. The Harris County bill provides for a structure for the supervision of all clinical issues related to the practice of medicine in a medical executive board. It imposes no new structure but rather utilizes the existing medical executive board as a physician-led group in charge of the practice of medicine by all physicians – employed or medical school-affiliated – providing care in district facilities. It is the product of local discussions facilitated by TMA that included the district; the Harris County Medical Society; and both medical schools, The University of Texas Medical School at Houston and Baylor College of Medicine. It helps the district meet its statutory mission to provide care to the indigent.
HB 2351 by Rep. Ruth Jones McClendon (D-San Antonio) and SB 1263 by Sen. Leticia Van de Putte (D-San Antonio) would allow the Bexar County Hospital District to employ physicians with protections to meet its statutory mission of providing care to the indigent. TMA, the Bexar County Medical Society, and the hospital district worked together to develop an employment structure that protects a physician's clinical autonomy and the patient-physician relationship. The framework of the employment arrangement constitutes a nonprofit healthcare corporation – a 501(a) – with a physician board of directors to oversee all the clinical issues related to physicians and the care they provide their patients.
HB 840 by Rep. Naomi Gonzalez (D-El Paso) and SB 860 by Sen. José Rodriquez (D-El Paso) would allow the El Paso County Hospital District to employ physicians and other health care providers with protections. Under this measure, the supervision of all matters related to the practice of medicine – by all physicians, employed or not – is the responsibility of the district's medical executive board. The board would be made up of physicians and would establish the rules related to credentialing of physicians, the peer review process, quality assurance programs, and any other function related to the clinical responsibilities of physicians practicing in district facilities. Most importantly, the bill results from a series of discussions we had with the hospital district aimed at understanding its challenges for the future and our need to protect the patient-physician relationship and independent medical judgment. It, too, helps the district meet its statutory mission to provide care to the indigent.
SB 761 by Sen. Royce West (D-Dallas) and HB 2854 by Rep. Vicki Truitt (R-Keller) would allow the Scottish Rite Hospital in Dallas to continue to employ physicians. This charitable fraternal hospital has been providing free care to children for 90 years or more, but because of reductions to its endowment, may begin to bill some costs to its insured patients. Throughout its history, the hospital has been employing physicians because of its charitable mission. The physicians at this facility occupy a unique position at the intersection of academia, research, and charity care. Scottish Rite accepted amendments to ensure that the medical staff remain responsible for all aspects of the practice of medicine and have control of all clinical issues.
TexMed 2011 in Houston This Month
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, 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. As president of Health Futures, Inc., Dr. Goldsmith writes and lectures actively on health policy, financing, and technology, both in the United States and overseas.
Some of the key points he will cover in his General Session presentation include:
Can't make it to TexMed? You may view the General Session broadcast.
- An update on what's happening in Washington.
- What can we expect in the next five to 10 years?
- Manpower issues – providing care for newly insured and aging boomers.
- The hospital/physician relationship and how it has changed.
You may also read Dr. Goldsmith's article, "Accountable Care Organizations: The Case For Flexible Partnerships Between Health Plans And Providers" in the recent edition of Health Affairs.
While at TexMed 2011, you also can:
- Spend some quality time on Friday 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.
- Take part in Friday's health system reform programming, which includes discussions on accountable care organizations and other practice models, as well as physician employment. (View a complete list of CME programming.)
- Attend Saturday morning's featured breakout during the Quality track, "Value-Based Purchasing: Preparing Your Practice for New Delivery and Payment Models."
- Join us at a new event – a reception honoring 2011-12 TMA President C. Bruce Malone, MD, Austin, and TMA Alliance President Bridget McKeever, Corpus Christi. Sponsored by the Texas Medical Association Insurance Trust.
- Smile for the camera at the Portrait Studio! Visit booth #431 at the Expo Hall 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 for 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 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 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 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.
Start the ICD-10 Switch Now!
ICD-10 will replace ICD-9 in 2013. To use the new coding system in electronic transactions, you must convert to HIPAA Version 5010 software standards – or you won't get paid. But that's not the only reason to upgrade to Version 5010.
Embracing the standard by fully integrating it into your work systems and work flow – rather than merely complying with it – will put your practice on the right track. Here's why:
By now, you should be talking to your vendors and taking other steps to prepare for the conversion to Version 5010 (the deadline is Jan. 1, 2012) and to ICD-10.
- Version 5010 corrects many of the flaws of the current 4010 version. Since Version 4010's launch in 2003, software developers have tweaked and patched it to its limits. Version 5010 incorporates hundreds of changes asked for by the medical industry.
- You can begin to realize the administrative simplification and subsequent savings that HIPAA promised. For example, authorizations will be streamlined, saving time and hassles on the phone for you and your staff.
- Version 5010 is a vital component for true standardization and interoperability, smoothing the way for widespread use of electronic health records.
- It will facilitate reporting of clinical data for quality performance measures, which are poised to become a driving factor for payment of claims and performance bonuses.
TMA can help you ease the way to ICD-10 adoptionwith boot camps and webinars that examine all angles of the task ahead. Register now. Also, go to the TMA coding page to find more information, including links to free webinars that Blue Cross and Blue Shield of Texas held in April.
Seventeen Texas HIEs Receive Grants
Texas received $28 million from the Office of the National Coordinator to fund health information exchange (HIE) activities in Texas. In basic terms, an HIE is a way to use technology to make patients' health information available anywhere, anytime.
The funds are being disseminated through the Texas Health Services Authority (THSA). To date, the following 17 entities have applied for funds and have been funded:
|Coalition of Health Services
||Coalition of Health Services
||East Texas Medical Center
||Collaboration that includes Harris County Medical Society
|Health Access San Antonio (HASA)
||Existing HIE, HASA is anchor
|Health Information Network of South Texas
|HIE Southeast Texas
||Christus Hospital System
|Integrated Care Collaboration (ICC)
||Existing HIE, ICC is anchor
||iHealth Trust Physicians (IPA)
|Montgomery County HIE
||Montgomery County Hospital District
|North Texas Accountable Care Partnership
||Dallas, Tarrant, Collin, Denton
||Collaboration of physicians, hospitals, and employers.
|Northeast Texas HIE
||Arkansas, Louisiana, Texas
||Christus Hospital System
|Paso del Norte HIE
||Paso Del Norte Health Foundation
|North Texas Red River Medical Center
||North Texas Medical Center
|Rio Grande Valley HIE
||Rio Grande Valley
||Lower Rio Grande Regional Advisory Council on Trauma Service
|Rio One Health Network
||Rio Grande Valley
||Doctors Hospital and Renaissance
|Southeast Texas Health Systems
||Southeast Texas Health Systems
|Galveston County HIE
||University of Texas Medical Branch
Some already operational HIEs did not apply for grant funding as some of the requirements would have required significant adjustments to their operational model.
For more information about HIEs and what questions physicians should ask before joining an HIE, read, "The Gift of Sharing" in the February issue of Texas Medicine. In addition, information on HIEs, electronic health records, and regional extension centers is available in the health information technology (HIT) section of the TMA website. Questions may also be directed to TMA's HIT Department by telephone at (800) 880-5720 or by e-mail.
EHR Incentive Program Attestation Begins
Attestation for the Medicare electronic health record (EHR) incentive program has now opened on the Centers for Medicare & Medicaid Services (CMS) website for physicians who have completed 90 days of "meaningful use."
CMS is hosting a call on Thursday, May 5, from 12:30 to 2 pm for physicians participating in the Medicare EHR Incentive Program to provide information on the attestation process (Registration is available online.)
The CMS call will cover:
If you are not ready to attest, follow these steps to participate in the EHR incentive programs:
- Path to Payment – Highlighting the steps you need to take to receive your incentive payment;
- Walkthrough of the Attestation Process – Guiding you through CMS' web-based attestation system;
- Troubleshooting – Helping you successfully attest through the CMS system;
- Helpful Resources – Reviewing CMS resources available on the EHR website; and
- Q&A – Answering your questions about the attestation process.
- Make sure you're eligible for the EHR incentive programs. View eligibility guidelines on CMS' eligibility page and select the program in which you want to participate.
- Use the services of the Texas regional extension centers (RECs). The RECs provide technical consulting services to help you select, implement, or upgrade an EHR system in your practice. Federal grants aimed at primary care physicians lower the cost of consulting services to $300 per physician. On April 18, in a letter to physicians [PDF], Texas Medicaid formally encouraged Medicaid physicians to engage RECs to receive assistance and technical support.
- Use certified EHR technology. To receive incentive payments, make sure the EHR technology you're using or are considering buying has been certified by the Office of the National Coordinator (ONC). Visit the Certified EHR Technology page for a list of certified products.
- Be a meaningful user. You have to successfully demonstrate "meaningful use" for a consecutive 90-day period in your first year of participation (and for a full year in each subsequent years) under Medicare and for a 90-day period in the second year of participation under Medicaid.
- Attest for incentive payments. To get your EHR incentive payment, you must attest through Medicare's secure website that you've demonstrated meaningful use with certified EHR technology.
TMA has several health information technology (HIT) resources to help you successfully navigate the Medicare and Medicaid EHR incentive programs:
Still have a question? Contact the TMA Health Information Technology helpline at (800) 880-5720, or e-mailHIT@texmed.org.
New Radio Series Features Texas Physicians
Plainview family physician and TMA leader Sidney Ontai, MD, MBA, is the first physician featured on a new national satellite radio series that premiered in April. TMA suggested that "Voices From American Medicine," found on ReachMD XM 160, interview Dr. Ontai because he cares for patients in rural West Texas, uses telemedicine to extend his medical care into remote areas, and still makes house calls.
ReachMD is an award-winning network for professional medical news, information, and continuing medical education. Its new series features "physicians on the front lines of medicine discussing their personal stories of triumph, tragedy, humanitarianism, and innovation." "Voices From American Medicine" is produced in cooperation with TMA and other medical associations and societies from across America.
The first of these conversations features Dr. Ontai on ReachMD's web and mobile platforms. "These little towns that I've put [remote] clinics in are so small, they don't have pharmacies. They're lucky if they have a retired nurse out there," Dr. Ontai said. Describing the use of his remote clinic to see established patients via telemedicine, he adds, "I use the clinic as if I have another exam room. It just happens to be a hundred miles away."
Dr. Ontai has chaired and served on both the TMA Council on Practice Management Services and the TMA Committee on Rural Health. He also served on TMA's Health Information Technology Ad Hoc Committee, on the Texas Medicine Editorial Board, and as vice president of the Hale-Floyd-Briscoe County Medical Society.
ReachMD plans to air interviews with two other TMA physician leaders: Kim Edwards, MD, an Austin pediatrician who is a one-physician army against childhood obesity, and Stan Wang, MD, JD, MPH, an Austin cardiologist who returned to Texas because of the state's physician- and-patient-friendly medical liability climate. More Texas physicians also will be featured.
Medicaid ID Cards to Change
Starting in June, Medicaid patients will carry credit-card-like identification to help physicians confirm that they are in the Medicaid program, the Texas Health and Human Services Commission (HHSC) said in April.
Like credit cards, the new identification cards will be plastic and have a magnetic strip containing the patient's Medicaid identification number. A physician's office staff member can swipe the card through a reader or enter the patient's identification number to verify Medicaid eligibility.
More information about the cards is on the Frequently Asked Questions page of the HHSC website.
FDA OKs Menactra for Children
The U.S. Food and Drug Administration (FDA) has approved the use of Menactra in children as young as 9 months for the prevention of invasive meningococcal disease caused by Neisseria meningitidis serogroups A, C, Y and W-135.
Menactra already is approved for use in people aged 2 through 55 years.
An FDA news release says Neisseria meningitidis is a "leading cause of meningitis in young children. Even with appropriate antibiotics and intensive care, between 10 percent and 15 percent of people who develop meningococcal disease die from the infection. Another 10 percent to 20 percent suffer complications such as brain damage or loss of limb or hearing."
Although the rates of meningococcal disease are low in the United States, the FDA says infants and toddlers are more susceptible to getting this serious illness. "Meningococcal disease is particularly dangerous because it progresses rapidly and can cause death within hours. Early symptoms are often difficult to distinguish from influenza and other common illnesses."
Two bills currently in the Texas Legislature, Senate Bill 1107 and companion House Bill 1816, would expand current state law by requiring that any new or transfer student at a higher education institution must show they he or she has been vaccinated for bacterial meningitis. The bills were proposed because of the recent death from bacterial meningitis of a Texas college student who lived off campus. Both bills have been passed out of committee. Texas law from 2009 requires that only new students applying to live in on-campus housing be vaccinated.
Currently, the Advisory Committee on Immunization Practices recommends meningococcal conjugate vaccine for children aged 11 or 12 and a booster at age 16, but says the vaccine can be given for certain high-risk groups as young as 2.
Existing Texas vaccine requirements require meningococcal vaccine for students entering seventh grade.
TMF Webinar Addresses Diabetes
The TMF Health Quality Institute will conduct a free webinar, "An Overview of Diabetes Reimbursement in a Primary Care Office" from noon to 1 pm on May 10. The webinar will offer the most up-to-date reimbursement guidelines for diabetes self-management training.
Topics will include the cost-effectiveness of diabetes education and coding to include payment for diabetes self-management training and medical nutrition training. Physicians may earn 1 hour of ethics continuing medical education by participating.
Register at http://events.tmf.org. Click on Create a New Account if you are new user.
For more information, call Heidi Turpin at TMF at (800) 725-2633.
Comment on State Emergency Plan
Physicians have until May 9 to comment on the Texas Public Health and Medical Emergency Management 5-Year Strategic Plan 2012-2016 and its companion document, The Tactical Guide, which the Texas Department of State Health Services (DSHS) is developing. The plan will guide health and medical communities across Texas in preparing, mitigating, responding to, and recovering from public health emergencies and disasters.
The draft plan notes that Texas "has a massive infrastructure with considerable vulnerabilities. These include agricultural, oil and natural gas production systems, hospitals, public water systems, nuclear plants, and governmental facilities. Possible threats and disasters capable of impacting public health in Texas include natural disasters, disease outbreaks, radiological accidents, chemical spills, international threats, and terrorist acts."
DSHS says it has received more than $850 million in federal funds to support public health, hospital, and other health care system preparedness efforts in the state.
This Month in Texas Medicine
The May issue of Texas Medicine describes state officials' desperate attempts to control the burgeoning Medicaid budget, tells you how TMA helped rescue three physicians dealing with overzealous state regulators, and outlines physicians' attempts to reduce teen pregnancy. You'll also learn about a new quality improvement project and find out what TMA did for you and your patients last year.
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.