2006 TMA Annual Report

President's Message: "A Resounding Cry of Victory"

By Ladon W. Homer, MD, 2006-07 TMA President

Our 2006 Annual Report shows that the Texas Medical Association again enjoyed an outstanding year on behalf of the people of Texas and their physicians.

Boy, are we spoiled. Reporting TMA's long list of achievements each year has become a commonplace occurrence. It's what we've come to expect.

While I encourage you to read and appreciate the remainder of this annual report, I urge you to ask yourself, "Why?" What are the reasons behind our success and how can we grow and cultivate them?

I suggest you start by looking in the mirror. You - the individual, hard-working, caring physicians of Texas - are the source of your association's strength and vitality.

Whether you simply belong to TMA, become involved in our activities and programs, or take an active leadership position, you are the reason why TMA is the largest and best state medical society in America.

But I hope you also take a wide-angle look in that mirror. Be sure to notice who is standing behind you. You will see the leaders and staff of our 120 county medical societies, the TMA Alliance and its many chapters, our state specialty societies, and the faculty and students at our eight outstanding medical schools.

We are who we are because each of us and all of these organizations stand in solidarity with us on behalf of our patients.

We have many trusted leaders - many voices speaking out for medicine - but one message. Whether it is speaking for your county society, your state association, or the American Medical Association; whether it is speaking as a physician or an alliance member; whether your specialty is OB or psychiatry, many voices ring out within the family of Texas medicine with one message: a resounding cry of victory for our patients.


In 2006 , the Texas Medical Association once again proved it is there for you and your patients. When the federal government tried to cut your Medicare reimbursement, TMA was there. When the state's largest insurance company decided to rate you on arbitrary and questionable cost and quality measures, TMA was there. When state lawmakers tried to place an onerous tax on your practices, TMA was there. And when people who never went to medical school decided they could perform procedures they weren't trained to do, TMA was there.

TMA was there, fighting for the rights of patients and physicians, trying to make insurance companies treat you fairly, teaching you how to better manage your practices, working with our colleagues in allied health professions to better the public health of Texas, bolstering the education of the next generation of physicians, and enhancing your skills through continuing medical education courses.  

TMA's accomplishments in 2006 were many, but five stand out:

  1. Convinced Congress to stop a planned 5-percent cut in Medicare physician reimbursement.
  2. Persuaded Blue Cross and Blue Shield to modify its BlueCompare physician-rating program by eliminating its "gray ribbon" policy, agreeing to a process for verifying the validity of its rankings, and allowing physicians to opt out of the ranking program.
  3. Lobbied the Texas Legislature to minimize the impact on physicians of new state taxes passed to fund public education.
  4. Convinced state insurance regulators to back off plans to make the managed care credentialing form even more complicated than it already was.
  5. Mounted a scope-of-practice battle by filing a lawsuit to invalidate a Texas Board of Chiropractic Examiners rule allowing chiropractors to perform clinical needle electromyography and spinal manipulation under anesthesia.

All of this was done with an eye to the future. Responding to the priorities set by the TMA Board of Trustees, the association followed the goals of TMA 2010, our roadmap to the future. TMA 2010 is the trustees' strategic plan to allow TMA to remain successful, stick to our core values, and address issues affecting physicians' ability to care for patients. Its goals are Practice Viability, Healthy Environment, Trusted Leader, and One Voice.

With that clear vision of the future, TMA remains America's largest and strongest state medical society, effectively representing member physicians in nearly all venues and providing members with quality education, information, and tools they can find nowhere else.

Practice Viability

The power of organized medicine's voice echoed through the halls of Congress again in 2006 as the House and Senate voted to stop the Centers for Medicare & Medicaid Services (CMS) from cutting Medicare fees. Thanks to your calls, e-mails, letters, and faxes to senators and representatives, Congress blocked the 5-percent cut that would have taken effect on Jan. 1.

Without TMA's persistence and galvanizing physicians to let Congress know how disastrous the cuts would have been, CMS would have imposed an across-the-board cut in all physician Medicare payments. In addition, location-specific cuts would have added another 1.9-percent reduction for physicians in most parts of Texas.

The association headed off another potentially devastating financial hit to your practice when it convinced the Texas Legislature to minimize the impact of higher taxes passed last summer to finance the state's public school system.

At TMA's insistence, the tax bill - which was designed to reduce local school property taxes and replace them with a new statewide business tax and a $1 increase in the cigarette tax - allows you to exclude all revenues from Medicare, Medicaid, TriCare, the Indigent Care Program, Workers' Compensation, and the Children's Health Insurance Program from your taxable income. You also may exclude the cost of providing any uncompensated charity care.

TMA also helped maintain the viability of your practice by establishing the Health Information Technology Department. The new department:

  • Created a helpline to give physicians and office staff guidance or resources to help with electronic medical records and other office technologies. Just call (800) 880-5720 or e-mail  HIT .
  • Developed educational materials and other resources to help physicians adopt health information technology, including seminars, articles, white papers, Web-based tools, and an electronic medical record implementation guide.
  • Delivered health information technology programming to county medical societies.
  • Formed the physician Ad hoc Committee on HIT to oversee activities.

Healthy Environment

You need to keep your practice's bottom line as healthy as you keep your patients. TMA physician leaders and staff worked to make sure insurance companies pay you what they owe you for treating patients.

Part of the effort to maintain a healthy environment for your practice is making sure the HMOs that TMA and 19 other state medical societies sued in a 2001 landmark federal class action antiracketeering case live up to the promises they made when they agreed to settle the lawsuit and change the way they do business. Compliance actions have been robust and successful in requiring these companies to adhere to the settlement agreements to which they agreed. Millions have been paid to physicians as a result of these actions.

Reacting to complaints filed by physicians, TMA attorneys and other members of the compliance team kept a close eye on the companies and held them accountable. As a result, Aetna, for example, agreed to recalculate and correct payment for claims with modifier 25 and other CPT modifiers attached to evaluation and management codes.

TMA also swung into action in 2006 when the Texas Department of Insurance (TDI) decided to further complicate the already complex managed care credentialing form. As a result, TDI agreed to put the new form on hold and ultimately made changes. "The revised form is significantly less hassle for physicians and a win for TMA since the association adamantly objected to the form TDI was using before this one," said Susan Strate, MD, chair of the TMA Council on Socioeconomics. "The changes are minimal, and many are the direct result of TMA input."

Trusted Leader

You, not insurance companies, treat patients.   As the trusted leader of the health care team, you make your decisions on what's best for the patient, not what's best for an insurance company's bottom line.   That's why TMA   swung into action when Blue Cross and Blue Shield of Texas announced it would launch the BlueCompare physician-rating program on its Web site in January 2007. The company planned to award blue ribbons to physicians who fall into the top 60 percent of its quality rankings and brand with a gray ribbon physicians who ranked in the bottom 40 percent, physicians for whom it doesn't have enough claim forms to rate, and those who practice in specialties for which Blue Cross has no rating system.

But after TMA raised objections, Blue Cross agreed in December to suspend the program until a special committee of physicians and quality experts appointed by Dr. Homer could evaluate BlueCompare.

The committee's work and a series of meetings between TMA physicians and staff and Blue Cross officials led to an agreement for extensive changes in the program in early 2007. Blue Cross agreed to:

  • Replace the gray ribbon and recognize physicians in its network with a light or dark blue ribbon;
  • Upon request, provide physicians with their individual information derived from the claims data used in the evaluation process to determine their BlueCompare rating;
  • Implement a "robust review process" that gives physicians an opportunity to respond to their ratings;
  • Allow physicians to opt out of having their BlueCompare ribbon displayed on the Blue Cross Web site in 2007;
  • Seek external, objective evaluation of the ratings measurement system;
  • Retool how it communicates BlueCompare ratings to network physicians; and
  • Work with an expert advisory committee appointed by TMA to review the 30-plus BlueCompare performance measures for their scientific basis, clinical appropriateness, and potential for cost reduction.

TMA also took steps to maintain your role as a trusted leader by fighting to make sure that you, a medical school graduate, are the one making medical decisions for your patients. The association filed a lawsuit against the Texas Board of Chiropractic Examiners to overturn its rule that allows chiropractors to perform clinical needle electromyography and spinal manipulation under anesthesia. Texas law prohibits chiropractors from performing surgery and from diagnosing physical diseases, disorders, deformities, or injuries. The case is still making its way through the courts.

TMA also worked to maintain physicians' trusted leader position by:

  • Establishing the TMA Patient Safety Resource Center with materials on patient safety for physicians, joining the national 100K Lives patient safety campaign, and adopting three goals to help improve Texas patients' outcomes: preventing surgical site infection and related deaths by reliably implementing a set of recommended interventions for all surgical patients, preventing deaths among patients hospitalized for acute myocardial infarction by ensuring the reliable delivery of evidence-based care, and preventing adverse drug events through medication reconciliation.
  • Building 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.
  • Holding the physician-led Healthy Vision 2010 summits, which resulted in the adoption of 24 proposals to reduce the number of uninsured Texans and increase the use of community- and employer-based wellness programs. The proposals formed the heart of a joint legislative agenda.
  • Persuading the American Medical Association to adopt a Texas resolution calling for an enforceable and efficient influenza 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 will have first priority for almost 2 million doses of FluArix influenza vaccine this fall.
  • Organizing a three-day trip to Washington, D.C., by 17 Border Health Caucus physicians to draw attention to the special health care problems that plague the Texas-Mexico border.
  • Funding by the Texas Medical Association Foundation of nearly $350,000 in physician-led public health improvement programming, including Be Wise - Immunize SM , Hard Hats for Little Heads, and the Ernest and Sarah Butler Awards for Excellence in Science Teaching, as well as numerous health improvement initiatives of TMA's county medical societies and alliance and medical student chapters.
  • Using the lessons learned from hurricanes Katrina and Rita in 2005 to develop a disaster preparedness plan.

One Voice

The strength in the voice of medicine in Texas comes from our close working relationships with county medical societies. TMA worked closely with county societies to tap into the membership strengths at the local level. TMA supported the recruitment and placement of membership directors in both the Dallas and Harris county medical societies for recruiting and retaining members in those growing markets.

County societies now benefit from remote access to the TMA membership database. This also allows medical society staff to assist in maintaining physician contact and group information to ensure greater accuracy for all users.

TMA's high-tech wizards implemented new ScanTron technology, which allows you to make sure your membership contact information is up to date and to complete a short survey so that the association can better meet your needs.

The technology team also wrote software that tracks information regarding physician phone calls, which helps TMA keep its pulse on the needs and concerns of Texas physicians, including the ability to better target membership communications and to aid in the legislative and regulatory arena.  

2006 by the Numbers

Record total TMA membership at the end of 2006
        4,654   Student memberhsip in TMA
        4,096 Resident physician membership in TMA
      10,059 Physicians educated in 256 CME activities offering 842 credits
        1,622 Physicians completing online CME courses
        1,252 Physicians participating in health information technology seminars
           998 Physicians' complaints to TMA Hassle Factor Log in 2006
          97% TEXPAC's winning percentage in 2006 elections
2,485,027    Visits to TMA Web site ( www.texmed.org ) in 2006

2006 Income and Expenses

TMA ended 2006 with revenue of $19,507,500 and expenses of $18,829,000. Membership dues were the primary source of income.

TMA 2006 AR charts

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