2004 TMA Annual Report: Your Vision. Your Voice. Your TMA.

President's Message

By Bohn D. Allen, MD

Inertia and momentum. As scientists, we learned those concepts in our earliest studies. An object in motion tends to stay in motion until acted upon by an outside force. The faster the object is moving and the larger it is, the greater the force needed to deflect it off course.

Coming off our outstanding tort reform and managed care victories of 2003, the Texas Medical Association began 2004 with a tremendous momentum and forward inertia. Thanks to our great speed and mass -- America's largest state medical society passed the 40,000-member mark in December -- we closed the year in even better shape.

Our profession and our patients already are reaping the benefits of another milestone year for TMA. You can thank the volunteer physician leaders who serve on TMA boards, councils, and committees and the TEXPAC Board of Directors for doing their homework last year. As a result, we were very well prepared, with solid policy and solid politics, when the 2005 Texas Legislature began debating taxes, scope of practice, and workers' compensation and Medicaid.

Your TMA Board of Trustees and our outstanding staff spent much of 2004 looking even further into the future. You'll soon hear much more about the TMA 2010 planning process and our new mission statement: "TMA aggressively supports Texas physicians by providing distinctive solutions to the challenges they encounter in the practice of medicine." Isn't that what we expect?

I encourage you to read this 2004 Annual Report. Only when it's all printed in one place can you appreciate what we've accomplished. From fighting Medicaid HMOs to launching the Be Wise - Immunize SM project to getting the most from the Aetna and CIGNA settlements in our nationwide lawsuit against for-profit managed care, TMA was there -- aggressively supporting us with distinctive solutions to the challenges we encounter.

Remember the noble roots and traditional virtues that brought us into medicine: dignity, honesty, sincerity, and simplicity.

It has been a humbling pleasure to be your president in such an exciting and invigorating time for Texas medicine.


A lesser medical association might have taken a break in 2004 and rested on its laurels. In the 2003 legislative session, the Texas Medical Association reformed the state's professional liability system, passed a prompt pay bill to make sure insurers pay you on time, averted drastic cuts in physician reimbursement and other Medicaid funding, and improved the availability of childhood vaccinations. But that's not how we earned our reputation as America's best medical society.

TMA and your physician leaders worked even harder last year to build on the 2003 triumphs and prepare for 2005. Physicians and TMA staff spent much of 2004 on projects to improve the state of Texans' health, while at the same time gearing up for the important issues legislators are debating this spring. TMA honed medicine's position to fend off possible taxation of doctors' practices and to preserve physicians' rights during the sunset review of the Texas State Board of Medical Examiners and the Texas Workers' Compensation Commission; readied the defense against the expected assault on liability reform by trial lawyers; and prepared to defeat any attempt by non-medical school graduates to expand their scope of practice.

If the issue was important to physicians and their patients, TMA was there, advocating for fair treatment for both. Just a few examples: We convinced Blue Cross and Blue Shield of Texas to modify its Blue Choice Solutions health plan to address physician concerns about economic credentialing. We provided technical assistance to help the Texas Department of Insurance (TDI) make prompt pay rules effective and true to the legislature's intent for physicians to be paid on time for their services. We mobilized grassroots efforts to fight replacement of the popular Medicaid Primary Care Case Management model with an HMO-only model, and organized a delegation of Texas-Mexico border physicians to go to Washington, D.C., to educate the Texas congressional delegation on the unique public health, workforce, and health care access challenges facing border physicians and patients.

TMA also worked on behalf of the physicians of the future in 2004.

We assumed the lead role in recommending that the Texas Legislature increase funding for graduate medical education (GME). We provided testimony at all related interim legislative hearings and submitted a briefing document for legislators and staff on the critical need for increased funding. We supported increased state funding for undergraduate education.

In light of anticipated physician shortages, TMA recommended expanding medical schools and residency slots in Texas and collaborated with the American Medical Association to push for equitable Medicare GME funding for Texas teaching hospitals and removal of Medicare GME funding caps.

While doing all this, we helped you maintain healthy practices with continuing medical education (CME) programs and practice management workshops throughout the state.

Meanwhile, our membership topped 40,000 in 2004, thus increasing physicians' influence at the state Capitol. TMA remains a member-driven organization that represents all physician specialties and groups, and provides services that benefit you at every stage of your career.

Preserving Texans' Health

Although immunization is one of the most effective weapons against disease, Texas ranks well below the national average of immunized citizens. In 2004, TMA set out to change that by launching the immunization awareness program Be Wise - Immunize, one of our most ambitious public health programs.

A joint initiative of TMA and the TMA Alliance, and funded through a grant from the TMA Foundation, the program promotes immunization to the public as important, effective, and safe through education, communication, and action.

The first stage of Be Wise - Immunize focuses on children, while the second targets adolescents, and the third stresses adult immunization.

The ever-worsening obesity problem in Texas also drew attention from TMA in 2004. Association physicians and Division of Public Health, Quality, and Medical Education staff:

  • Worked closely with state officials to develop and promote better school nutrition policies.
  • Joined the Texas State Strategic Health Partnership to promote obesity prevention through education, partnerships, and coalitions to make physicians and the public more aware of nutrition and physical activity issues.
  • Organized physician testimony before the legislature's Joint Interim Committee on Health and Nutrition in Schools and helped the committee draft recommendations to fight childhood obesity.
  • Took an active role in the Texas Action for Healthy Kids Alliance to address childhood obesity in Texas through legislative, policy, and community efforts.
  • Developed obesity legislation guidelines adopted by the American Cancer Society, American Heart Association, and other groups.
  • Participated in Gov. Rick Perry's Texas Round-Up health fair in Austin in April to promote physical fitness by offering information on nutrition.
  • Advised Austin PBS television station KLRU in developing community antiobesity initiatives for "The American Family" and "Sesame Street" programs, and worked with the station on a public obesity awareness campaign.

Besides obesity and immunizations, TMA and its team of public health and science experts also:

  • Developed a policy on stem cell research that supports research on embryonic and adult stem cells and therapeutic cloning in biomedical research, but opposes cloning to produce a human child.
  • Endorsed a physician's right to discuss any and all treatment options, including medical marijuana, with a patient without fear of regulatory, disciplinary, or criminal sanctions.
  • Coordinated physician participation in the XLHealth disease management demonstration project to improve care for chronically ill Medicare patients in Texas.
  • Helped develop and distribute clinical office tools and a physician recognition program for the Texas Cardiovascular Disease Patient Safety and Quality Initiative.
  • Conducted two symposia on major cancers and pain, helped update the Texas Cancer Plan, and helped the American Cancer Society update its C-Tools handheld software for physicians.

Guaranteeing Your Rights

CIGNA and Aetna settled their portions of organized medicine's federal antiracketeering lawsuit against some of the nation's largest for-profit HMOs. That means physicians finally will be paid millions of dollars for claims the companies failed to pay for years. But because the claims-filing process is complicated, TMA's Office of the General Counsel educated physicians on how to make sure they are paid what they are owed. It also arranged a members-only discount with the Managed Care Advisory Group to help physicians file their claims.

TMA attorneys participated in monthly enforcement meetings and biweekly conference calls that resulted in substantial improvements in making the two settlements meaningful for physicians.

Also in 2004, TMA's legal team:

  • Joined the Texas State Board of Medical Examiners and Baylor College of Medicine in their court battle to reverse a Texas attorney general's opinion that would make physicians' licensing files subject to open records disclosure.
  • Successfully argued in a brief filed with the attorney general that a state law against injuring an unborn child does not force physicians to turn in pregnant women who have used illegal drugs or alcohol.
  • Prevailed in an appeals court decision that TMA and the Texas Orthopaedic Association do have the right to sue the Texas Board of Podiatric Examiners over its definition of the foot and delineation of hospital privileges for podiatrists. The case is set for trial in August.
  • Joined the California and Georgia medical societies in filing a brief supporting AMA in its appeal of a court ruling that restricts medical associations' ability tocommunicate on proposed settlements of pending and future lawsuits against HMOs.
  • Filed a brief supporting two physicians who appealed a court decision that overturned sanctions against an attorney who sued them even though there was no evidence they prescribed an allegedly unsafe medication.
  • Developed policy on the state's prompt pay law and standardized managed care contracts.
  • Upgraded existing physician drug screening programs through expanded testing panels, increased technical services, and enhanced randomization of the drug screen process so that computer-generated test dates are based on an entire year, as opposed to a monthly basis.

Protecting the Bottom Line

You can't treat patients if you can't stay in business. Our Division of Medical Economics and the Council on Socioeconomics worked throughout 2004 to maintain the fiscal health of your practice.

The division:

  • Held 16 meetings with insurance carriers toresolve claims-payment problems and resolve other disputes created by health plan practices.
  • Conductedmore than 700 mini-consults across Texas to educate physicians and staff on Medicare, Medicaid, managed care, payment-related coding and billing issues, and other topics; and distributedmore than 1,200 consultation handbooks statewide.
  • Answered 2,028Hassle Factor Log complaints about reimbursement problems from physicians throughout Texas.
  • Represented your interests in addressing Medicaid, Medicare, workers' compensation, and TDI regulatory problems.
  • Served as faculty for successful seminars on practice management, coding, and Texas prompt payment requirements.

Planning for the Future

Recognizing that the Texas today is not what it will be tomorrow, TMA's Board of Trustees under the leadership of Chair Dennis Factor, MD, launched the TMA 2010 program in 2004 to make sure the association meets members' needs in the future.

The process began with an environmental scan that included an examination of demographers' predictions of an "older, poorer, sicker, and less educated" population; physician demographics and supply and demand; the changing health care team; trends in health care financing and delivery; information technology; and association and membership trends.

Among the questions asked during the process were how predicted changes will affect physicians and their practices in 2010, what kind of help physicians will expect from TMA in 2010, and what kind of physician leadership will best suit TMA in fulfilling that need.

The process identified four major goals:

  1. Protect, improve, and strengthen the viability of medical practices in Texas.
  2. Ensure continued success in legislative, regulatory, and legal interventions to enhance the statewide environment in which Texas physicians practice medicine.
  3. Strengthen physicians' trusted leadership role within their communities and the health care team.
  4. Enhance the powerful, effective, and unified voice of Texas medicine.

In 2005, trustees and staff will prioritize strategies to meet the goals, allocate resources, define measurements, and evaluate the governance structure to implement the TMA 2010 plan.

2004 by the Numbers

TMA members
Medical student members
Resident physician members



Physicians, medical students, and other health professionals educated on cancer prevention, early detection, and control by TMA's Physician Oncology Education Program
Free copies of TSBME: The Devil's in the Details home study course mailed to members
Physicians and staff attending 120 TMA practice management seminars
Physicians who took advantage of free CME courses at TexMed 2004
Physicians and staff members who benefited from TMA publications, including home studies on ethics, documentation, and billing compliance
CME credit hours offered in 201 courses on issues such as HIPAA security, obesity, and diabetes
Record number of CME professionals at TMA's Texas CME Conference
Physicians at children's mental health workshop at TexMed 2004
New services endorsed by TMA: medical collections, equipment leasing, physician recruitment, credentialing services, and an online career center

Maintaining Financial Health

TMA ended 2004 with income of $19,085,890 and expenses of $18,554,620. The association's primary source of operating income was membership dues. Additional income came from programs approved by the Board of Trustees, such as educational seminars, publications, consulting services, advertising, and member services. An average of $720 per active member was expended on TMA programs and activities in 2004.

2004 Expenses  


  2004 Income


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