TMA Milestones: 1986 - 2008

The shape of medicine and medical practice in Texas has changed at a revolutionary pace in the past 20 years. Similarly, Texas Medical Association has revamped its structure and priorities to continue to provide stellar member services and advocacy for Texas physicians and medical students and their patients. This document highlights the progress we've made in this tumultuous two decades.

 [ 1986 - 1990  |  1991 - 1995  |  1996 - 2000  |  2001 - 2005  |  2006- 2008  ] 

1986 - 1990

  • Brought more physicians to underserved areas by winning passage of the Omnibus Rural Health Care Rescue Act to increase health care manpower in rural areas, create the Center for Rural Health Initiatives, and increase Medicaid payments to rural hospitals.
  • Educated the federal government about blood and turnips, and stopped its recoupment of $15 million from 5,000 physicians and 200,000 patients.
  • Returned fairness to peer review by forcing major changes in how the Texas Medicare Peer Review Program operates and stopping the illegitimate sanctioning of rural physicians.
  • Improved cancer treatment by creating the Physician Oncology Education Program to give physicians the latest information on cancer.
  • Created the TMA Foundation and improved public health in Texas.
  • Faced down trial lawyers and enacted the most significant tort reforms in a decade, including new limits on joint and several liability, punitive damages, and prejudgment interest, and sanctions against frivolous lawsuits.
  • Gave indemnity insurance plan patients their rights back by filing a lawsuit that led to preferred provider plan rules giving patients freedom of choice in indemnity plans.
  • Reminded motorcycle riders they're not immortal and enacted laws requiring them to use helmets, and delayed by two years the inevitable deaths of teenagers who smoke by raising the legal age to purchase tobacco products from 16 to 18.
  • Reached the 30,000-member milestone in 1990.

Top of page  

1991 - 1995

  • Moved out of the cramped, antiquated building on North Lamar into a modern new building on 15th Street.
  • Stood up to HMOs' bullying and passed the nation's first Patient Protection Act to protect patients and physicians from insurance companies' predatory marketing tactics. Although Gov. George W. Bush vetoed it, the bill led the state insurance commissioner to adopt similar patient protection regulations.
  • Restored numerous physicians to Aetna and Humana provider panels by suing the companies for their malodorous "deselection without cause" policy.
  • Shamed major insurance companies into meeting regularly with TMA physician leaders and staff to resolve members' reimbursement problems through establishment of the TMA Hassle Factor Log© that allows physicians to document reimbursement hassles. MembersOnlyRed  
  • Laid the foundation for a legislative juggernaut by creating Legislative Summits allowing key leaders from specialty societies to discuss the benefits and strategies of working together.
  • Helped make physician practices more efficient and profitable by establishing the Mini-Consultation Program.
  • Led a successful coalition that kept the tax collector at bay through defeat of a 4.5-percent franchise tax on physicians' net income.

Top of page  

1996 - 2000

  • Kneecapped HMOs by securing passage of sweeping package of managed care reforms that put Texas at the forefront of the battle to protect patients' rights in managed care plans.
  • Enacted legislation making it harder for health plans to sit on doctors' money by requiring them to pay  clean claims  within 45 days. Made the Texas Department of Insurance adopt rules that define the elements of a "clean claim," and specify the requirements for prompt payment of clean claims.
  • Made it easier to take drunken teenagers off the streets with passage of a zero-tolerance law for underage drivers that outlaws anyone under age 21 driving with a blood alcohol level above zero.
  • Removed state Medicaid officials' hands from physicians' pockets by forcing suspension of bureaucrats' attempt to unfairly  recoup reimbursements  going back to 1976.
  • Made  TMA Physician Services  even more valuable to physicians by expanding its services to include on-site practice management consulting.
  • Enhanced the effectiveness of small county medical societies by offering them executive/management services through Specialty Society Management Services.
  • Gave independent physicians more clout to reject contract provisions that are bad for patients' health with enactment of legislation allowing independent physicians to negotiate jointly with managed care plans.
  • Launched the award-winning  TMA Web site  that offers physicians a wealth of information vital to the health of their patients and their practices.
  • Stood side by side with physicians and patients with disabilities by generating review and AMA support of the Zamora v. HealthTexas case that resulted in a court opinion that the Americans With Disabilities Act protects physicians who advocate for patients with disabilities.
  • Appointed Louis J. Goodman, PhD, TMA's executive vice president and chief executive officer upon the retirement of Robert Mickey.
  • Reached the 35,000-member milestone in 1998.

Top of page  

2001 - 2005

  • Forced greedy trial lawyers to look elsewhere for easy marks with passage of a $250,000 cap on noneconomic damages in health care liability lawsuits, and voter approval of  Proposition 12 , a constitutional amendment ensuring that the cap could not be challenged in court. The new law reversed a lawsuit abuse epidemic that had caused Texas physicians liability insurance premiums to skyrocket. It also led to a 26-percent jump in the number of licensed physicians in the ensuing 5 years.
  • Exposed the corrupt business practices of the country's largest, for-profit health plans by joining state medical societies from around the nation in a class action,  antiracketeering lawsuit . The result was restitution for past damages and significant patient- and physician-friendly changes in the business practices of plans that settled the lawsuit (including Aetna, CIGNA, and Humana).
  • Medical Economics  magazine recognized what Texas physicians already knew and declared TMA " America's Best Medical Society ."
  • Saved physicians' practices and vulnerable patients' access to care by blocking planned reductions in physicians' Medicare reimbursement rates for 2004 and 2005, and thwarting deep proposed cuts in Medicaid reimbursement for 2004 and 2005.
  • Celebrated TMA's rich 150-year heritage of improving the health of all Texans at the association's sesquicentennial on Jan. 17, 2003.
  • Reacted to the devastation of 9/11 and subsequent anthrax scare with a bioterrorism toolkit to educate physicians on the signs, symptoms, and potential treatment of the deadly weapons that bioterrorists might use.
  • Told podiatrists, optometrists, psychologists, and other allied health professionals to quit trying to play doctor and defeated unsafe proposed expansions of their scopes of practice.
  • Dragged the now-defunct Texas Workers' Compensation Commission into court to stop adoption of workers' compensation fee guidelines that lowered the pay for most specialists, and threatened the availability of doctors for injured workers.
  • Made the case that while Medicaid patients may be poor, their doctors don't have to be, and convinced the legislature to approve the first significant Medicaid provider fee update in nearly a decade and pass laws making it easier for low-income children to access Medicaid.
  • Saved lives by launching  Project WATCH  to battle the five preventable risk factors that cause cardiovascular disease (weight, activity, tobacco, cholesterol, and hypertension), and  Be Wise - Immunize  to reverse the state's terrible childhood immunization rankings. Both programs operated jointly with the TMA Alliance and funded by the TMA Foundation.
  • Threw out the books and brought in computers to transform the TMA Library into a 21st century  Knowledge Center , which houses an impressive range of real and virtual clinical and practice management resources. Physicians can access the association's expertise in health care, health law, medical economics, and practice management by fax, letter, e-mail, the TMA Web site, or telephone.
  • Celebrated its 100th anniversary of Texas Medicine and became the only state medical association journal in the nation to offer continuing medical education credit to its readers.
  • Told hospitals and their corporate masters they can't have the only game in town and defeated the hospitals' attempt to ban physician ownership of specialty hospitals.
  • Protected physicians' rights by stopping health plans from prohibiting out-of-network doctors from balance billing patients.
  • Recognized that an association without members is useless and adopted the  TMA 2010  strategic plan  to make sure the association meets members' needs in the future. The plan's four goals are to:  
  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.  
  • Helped physicians go electronic with $3 million project to assist them in learning about, implementing, and effectively using health information technologies such as electronic medical records.
  • In the 2004, TMA reverses national trends with a new, money-saving employee health plan. Since introducing the program, which includes a consumer-driven health plan, TMA has incurred absolutely no increase in premiums. This has saved TMA more than $70,000, on the assumption that the insurer could have imposed increases of about 15 percent each year.
  • Refused to stand by while people suffered and mobilized volunteer physicians to help care for victims of hurricanes  Katrina  and  Rita ; and established a fund to help physicians rebuild their medical practices damaged by the storms.
  • Reached the 40,000-member mark in 2005.

Top of page  

2006- 2008

  • Thwarted cuts in  Medicare physician reimbursement  in 2006, 2007, and 2008, and secured a 1.1-percent increase for 2009, then successfully used our political muscle to convince Congress to override President Bush's veto of the increase.
  • Saved physicians thousands of dollars under the state franchise tax by persuading the legislature to allow physicians to deduct Medicare, Medicaid, workers' compensation, and the cost of free care from taxable revenues.
  • Persuaded Blue Cross and Blue Shield to modify its questionable BlueCompare physician-rating program by  eliminating its physician-hated "gray ribbon" policy , agreeing to a process for verifying the validity of its rankings, and allowing physicians to opt out of the ranking program. Stopped Blue Cross from using its economic credentialing formulas for its Blue Choice Solutions network.
  • Strengthened the political power of public health advocates by forming the  Texas Public Health Coalition, a collection of organizations that share an interest in advancing core public health principles at the state and community levels.
  • Gave physicians priority over supermarkets in obtaining flu vaccine by persuading the American Medical Association to adopt a Texas resolution calling for an enforceable and efficient vaccine distribution system that gives priority for early shipment to physicians and other health care professionals who care for high-risk populations. AMA and two pharmaceutical companies later announced that physicians would have first priority for almost 2 million doses of FluArix influenza vaccine.
  • Helped stop the exodus of physicians from the Medicaid program with passage of legislation that resulted in the largest increase in Medicaid funding in the program's history -- a 25-percent increase in physician payment rates for children's Medicaid -- as well as a 10-percent hike in fees for adult Medicaid.
  • Repulsed trial lawyers' attempt to weaken tort reform defended the current Texas end-of-life treatment safeguards.
  • Made the workers' compensation system more attractive to physicians by working with the Texas Department of Insurance Division of Workers' Compensation to scrap the four-year-old fee schedule and adopt new rates for non-network services that potentially could generate more than $600 million in new reimbursement for treating injured workers.
  • Increased the number of physicians available to treat the sick and injured by raising legislative funding of the Texas Medical Board by nearly $4 million to help the agency clear a backlog in licensure applications, but stopped the board from raising physician-licensing fees to pay for the increase because doctors pay enough already.
  • Made Texas children healthier by convincing lawmakers to restore most of the cuts made to the Children's Health Insurance Program in 2003, including the 2.5-percent cut in physician fees.
  • Protected patients from treatments by unqualified people by defeating 78 pieces of scope-of-practice legislation, including a bill to loosen physician supervision of retail health clinics, and another to allow chiropractors to gain statutory authority to perform school physicals.
  • Reduced the spread of disease and incidence of injury by proving resources to promote immunizations through the Be Wise - Immunize SM  immunization awareness program, and reduce bicycle-related head injuries with the  Hard Hats for Little Heads  program.
  • Maintained physicians' rights to own an interest in health care facilities by blocking legislation that would have limited that right.
  • Preserved the sanctity of the patient-physician relationship by defeating efforts to pass legislation that would have weakened the ban against the corporate practice of medicine in Texas.
  • Enhanced the state's future physician workforce by obtaining nearly $86 million for graduate medical education, and an appropriation of $81 million to expand the medical schools at Texas Tech University Health Sciences Center in El Paso and Texas A&M University.
  • Put cancer on the Endangered Species List by passing legislation that created the Cancer Prevention and Research Institute of Texas and convinced voters to approve a state constitutional amendment authorizing the state to sell $3 billion in general revenue bonds to fund research and prevention.
  • Won a court ruling that told UnitedHealthcare it couldn't shirk its responsibility to pay claims by contracted independent practice associations.
  • Developed the Texas Medicare Manifesto I and II to outline TMA's plan to drive a stake through the heart of the blood-sucking Sustainable Growth Rate formula and make Medicare payments fair to physicians and preserve patients' access to care.
  • Explained to the Texas State Board of Podiatric Medical Examiners just what a "foot" is and won a court ruling that the board exceeded its authority by adopting a rule that expanded the definition of the foot to include the bones in the ankle.
  • Came to the rescue of physicians whose practices were blown away by  Hurricane Ike  with establishment of the $1 million Hurricane Ike Disaster Relief Program to help them rebuild, and created the UTMB Medical Student Recovery Program to help University of Texas Medical Branch students recover.
  • Kept the books clean. Celebrated the 25th straight squeaky clean TMA financial audit in 2008.
  • Reached 43,000-membership mark in 2007.

Top of page