TMA 2001 Annual Report: 'America's Best Medical Society'

President's Message

We've been saying it for years because we know it's true. The Texas Medical Association is a unique and superior organization. When it comes to advocating for physicians and our patients, TMA is No. 1.

Well, the many victories we can count as we review 2001 include the validation of our top ranking. In its Aug. 6 issue, Medical Economics magazine proclaimed TMA "America's best medical society."

Please read -- or re-read -- this article . It's on our Web site for your convenience. Here are two excerpts so you can gauge immediately the incredible national image TMA has earned: "Frustrated by changes in health care, many Texas doctors and their office staffs view the organization as a white-hatted cowboy battling valiantly on their behalf. … As a grassroots advocate and in-your-face political force, the TMA may be without peer within organized medicine."

TMA earned its stripes again in 2001. We won tremendous legislative victories in Medicaid, public health, and -- despite a governor's veto we're working hard to correct -- an excellent prompt pay bill. At your direction, TMA filed an antiracketeering class action lawsuit against two of the state's most offensive for-profit managed care organizations. Project WATCH, our cardiovascular disease prevention program, has the legislature's endorsement and is fast becoming a "get-off-the-couch" program for schoolchildren all across Texas. We gave you tools to prepare for -- and help your patients prepare for -- a bioterrorism attack.

The new year is almost one-quarter complete, and we're determined to stay "America's best." Our great staff and volunteer leaders are an important part of it, but TMA's real strength lies with you and our ability to speak for the physicians of Texas in one strong voice.

Thanks for all you do.


Tom B. Hancher, MD

TMA Rises to a Challenging Year in the Legislature

The 2001 legislative session was bittersweet for the Texas Medical Association. Battling valiantly on behalf of medicine for months, TMA succeeded in passing hard-hitting legislation on a number of fronts, only to see Gov. Rick Perry veto several important bills.

Still, much was accomplished: the first significant Medicaid provider fee update in nearly a decade, a major overhaul of the workers' compensation system, and, in the wake of the prompt pay legislation (House Bill 1862) veto, TMA's efforts to resolve physician payment problems through numerous venues, including state regulatory agencies and the courts.


Responding to physician concerns about a declining Medicaid provider base, the legislature allocated $197 million to update reimbursement rates for physicians, allied health professionals, dentists, hospitals, and Medicaid health plans. The 2002!!-03 budget earmarked $50 million for physicians and allied health practitioners, which will be matched by another $75.4 million in federal dollars.

Those funds will pay for a substantial bump in fees for Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)/Texas HealthSteps, including a "bonus" for providing care within the recommended time frames. The money also will target office-based evaluation and management codes to promote preventive care and reward high-volume Medicaid practitioners.

Lawmakers also made it easier for low-income children to access Medicaid, bringing an estimated 600,000 eligible children into the program. Senate Bill 43 establishes a consolidated application for Medicaid and the Children's Health Insurance Program (CHIP); allows a mail-in application and recertification for children's Medicaid; creates a simplified, self-declared assets test that is the same as CHIP's; and phases in up to 12 months' continuous eligibility for children through age 19. Unfortunately, Governor Perry vetoed legislation to overhaul Medicaid managed care and carry out other needed Medicaid reforms.

TMA will work closely with the Medicaid agencies to try to revive the Medicaid managed care reform package through the regulatory process.

Workers' Compensation

TMA joined with labor and key business groups to forge a comprehensive workers' compensation bill intended to redirect the Texas Workers' Compensation Commission's (TWCC's) efforts toward a medical model of regulating this complex system. The more important components of House Bill 2600 include holding the TWCC's fee guidelines to a "fair and reasonable" standard, and relying on physicians and other health care professionals for input on all policy decisions, including the hiring of a TWCC medical director.

TMA and its allies continuously warned the TWCC that its current fee guideline proposals, which were initiated before the enactment of HB 2600, would be illegal under this new statute. TMA pledged to take aggressive legal action to halt further consideration of a proposal that violates Texas law and limits injured workers' access to care.

Prompt Payment

Undoubtedly, the biggest disappointment of the 77th legislature was Governor Perry's veto of HB 1862, the prompt pay bill. The purpose of the legislation was to close the loopholes and establish "fair pay" rules for the compensation of physicians and providers by HMOs and PPOs. Since the veto, Governor Perry has taken a "get-tough" attitude with the health plans, and ordered Insurance Commissioner José Montemayor to revise prompt pay regulations to carry out the intent of HB 1862.

Unfortunately, the new rules capture little of the intent of HB 1862. And, it appears many physicians had not received restitution by a November deadline or had been paid only a fraction of the amount owed them.

TMA worked with Commissioner Montemayor and his staff throughout the second half of 2001 to address these problems, and TMA leaders met regularly with Governor Perry and his chief of staff, Mike McKinney, MD, to keep them apprised of the progress.

Advocacy in the Courts

TMA continued its assault on unfair HMO market practices in the courts. In March, TMA joined a lawsuit by medical societies in California and Georgia, alleging that several of the nation's largest for-profit health plans had violated federal antiracketeering laws. TMA's suit specifically alleged that Humana and CIGNA purposefully had enriched themselves as part of a scheme to defraud physicians and patients. Other health plans have been named as defendants by individual physicians and other medical societies involved in the case. The Florida Medical Association has voted to join the Miami RICO suit pending in federal district court in Miami (but has not formally done so). The state prompt pay actions sponsored by the Medical Society of the State of New York and the Connecticut State Medical Society have been removed to Miami and are currently consolidated with the pending RICO actions filed by TMA, the California Medical Association, the Medical Association of Georgia, and 20 physicians.

Meanwhile, the association threw its support behind a state court action that a group of Texas physicians and physician groups filed against CIGNA for its downcoding and bundling practices. CIGNA attempted to have that case removed to federal court, but a U.S. district judge in Austin sent the case back to state court, where the physicians can use both state and federal law to attack CIGNA's business practices.

Expert Practice Assistance Is What Makes TMA So Dang Good

Tapping TMA staff resources for high-quality help with practice matters is one of the membership benefits that keeps the association ahead of the game. TMA provides physician members with assistance and support, ranging from consulting services for setting up new practices to online access to medical journals.

Practice Assistance

Running a practice is a major part of medicine these days, and TMA helped physicians manage their practices by conducting more than 120 seminars on such topics as managed care, reimbursement, and reducing professional medical liability. The association also continued to publish Sneak Preview , a free quarterly subscription newsletter for medical office staff.

A key component of the practical assistance is TMA Physician Services, the in-house consulting staff who provide a variety of services to member physicians at competitive prices. Physician Services consultants conduct operations and business office assessments, coding and documentation review, strategic planning, staff recruitment and training, policy and procedure manual development, and interim office management. Consultants helped 17 new Texas medical practices open their doors in 2001.

TMA provided publications that helped members with practice management issues such as reimbursement, managed care, developing policies and procedures, and workers' compensation. TMA-endorsed companies also provided professional services and products: Platinum and Gold MasterCard, automobile leasing, discount office and computer supplies, financial and investment planning, and discount magazine subscriptions.

Electronic Resources

In 2001, TMA began upgrading its library services through the use of Internet technology, giving members the opportunity to access medical research from anywhere in the state. The TMA Library is conducting a pilot study in 2002 of several services that give members full access to a wide range of medical journals and textbooks through the TMA Web site. For a two-month period at the end of 2001, 50 members participated in a beta test of medical electronic resources that provided full-text journal articles and books. The library used members' feedback on their clinical searching experiences to determine the online databases to license and make available during 2002.

The TMA Library also compiled links to free electronic resources and commercial document delivery services, and an online catalog of books, audiovisuals, continuing medical education (CME) home study programs, and journals on the TMA Web site. Members were able to submit interactive order forms to request library services. With software installed in early 2001, the library began scanning and sending documents requested by members via e-mail.

For those physicians who want to use the Internet for projecting information as well as for gathering it, TMA entered into an agreement with Medem, a consortium founded by the American Medical Association and six national specialty societies. TMA members can use Medem's free service to create their own Web site, complete with clinical and patient information provided by the participating medical societies.

Continuing Education

TMA presented physicians abundant opportunities for meeting their CME requirements. Approximately 200 credit hours of CME were offered as part of the TexMed Educational Showcase & Expo in Houston. More than 13,900 Texas physicians took part in TMA-sponsored CME courses in 2001.

To make life easier for physicians whose CME requirements are yet another item on an overcrowded schedule, TMA finished planning and implementing a new online CME system. The system debuted in February 2002 with a course on ethics and professional responsibility; further courses are slated for rollout later in 2002.

Texas Medicine magazine provided CME credit to physician members in its symposium issues on what primary care physicians need to know about cancer in February , and on end-of-life care in August . The end-of-life care issue generated a tremendous response, with more than 600 physicians earning 2 hours of CME credit in ethics and professional responsibility.

Texas Medicine is the only state medical association journal in the nation to offer CME credit to its readers.

TMA Connects With the Community

In 2001, TMA made impressive strides in public health on the advocacy and educational fronts, delivering expanded services to members and keeping physicians armed with information on topics ranging from cardiovascular disease and obesity in children to genetically modified foods and bioterrorism.         

Project WATCH

To address the growing public health concern of childhood obesity and inactivity, the association spearheaded the formation of the Texas Coordinated School Health and Physical Education Coalition, an alliance of statewide groups that understands the vital short- and long-term consequences of improving child and adolescent health in this state. The coalition helped to gain passage of Senate Bill 19, which authorizes the Texas Education Agency to require students in kindergarten through sixth grade to participate in daily physical activity. This law helps equip the youngsters of Texas with healthier school environments while teaching them lifelong habits for good health.

TMA's Project WATCH , which stands for the five preventable risk factors that cause cardiovascular disease (Weight, Activity, Tobacco, Cholesterol, and High blood pressure), focused on physical inactivity in schoolchildren in 2001.           

HeartCare Partnership

A program designed to improve risk factor management of patients with cardiovascular disease through physician and patient education as well as enhanced practice management, TMA's HeartCare Partnership extended its reach and effectiveness in 2001 with the introduction of easy-to-use electronic chart audit software. Free to physicians who participate in the program for one year, the audit software allows physicians to produce immediate individualized outcomes reports and comparative aggregate reports as part of their efforts to track outcomes data.

Genetically Modified Foods

In May, TMA President Tom B. Hancher, MD, appointed a multidisciplinary task force on genetically modified foods to study the current science of food safety. A report of the group's findings will be presented to the House of Delegates at TexMed 2002 in April.


TMA is on the front line, working closely with the Texas Department of Health, Centers for Disease Control and Prevention, and other state and federal agencies to inform and alert physicians about what to look for and how to respond to bioterrorism events. The TMA Taskforce on Bioterrorism produced a toolkit that was made available to all Texas physicians, the media, and the public late in December, and the TMA Web site continuously posted the latest bulletins, articles, and Internet links to improve physician preparedness and ability to identify, treat, and reassure patients should bioterrorism occur. 

TMA Is Without Peer in Organized Medicine

From the heights of the American Medical Association to the entering class of the next generation of physicians, TMA displayed the fruits and roots of its greatness within the House of Medicine.

Less than six weeks after Jim Rohack, MD, completed his term as TMA president, the Temple cardiologist won a seat on the AMA Board of Trustees. Dr. Rohack is the first Texan to serve on the board since 2000.

Texas physicians maintained their AMA leadership role in numerous other ways in 2001: serving on almost every major appointed and elected council, forging policy at the microphone and behind the scenes at meetings of the AMA House of Delegates, and representing the nation's largest state medical society in efforts to reorganize the federation of medicine.

Although Texas membership in the AMA slipped some in 2001, TMA continued to experience overall growth in numbers. Membership increased from 37,049 in 2000 to 37,120 in 2001. The latter figure represents 32,986 physicians and 4,134 medical students. Because much of the association's strength depends directly on its size, TMA leaders redoubled their recruitment efforts with county medical societies, devising a strategy for long-term growth.

Maya Perez, who began her studies in the fall at The University of Texas-Houston Medical School, won TMA's 2001 Minority Scholarship Award. Ms. Perez is the fifth winner in this annual scholarship competition for incoming minority medical students.

Searching for new and better ways to meet member needs, TMA also created the TMA Knowledge Base , a searchable database filled with the answers to questions members most frequently ask TMA staff. It's open 24 hours a day, seven days a week on the TMA Web site. In addition, the association endorsed Phynance, the automated health care claim and payment contract verification service of Medical Present Value, Inc.

Nobody Does It Better

The Texas Medical Association Political Action Committee ( TEXPAC ) had a banner membership recruitment year in 2001, with a 15.3-percent increase in its membership and a 180-percent increase in membership in the American Medical Association Political Action Committee (AMPAC) among Texas physicians.

Also,TMA Alliance membership in TEXPAC jumped 70 percent, while Capitol Club membership rose 133 percent. Capitol Club membership requires a contribution of $1,000 per couple.

TEXPAC held two successful grassroots and campaign educational programs during 2001 for more than 250 physicians and spouses. And, TEXPAC nominated and successfully coordinated the campaign of alliance member Carole Thompson, of San Antonio, who won AMPAC's national Belle Chenault Award for political action.

Although 2001 saw few elections in the state, TEXPAC continued its winning tradition by endorsing Republican Craig Estes (R-Wichita Falls) in his successful special election bid to fill the Senate District 30 seat left vacant by the death of Sen. Tom Haywood.

Association Expenditures Reflect Physician Priorities

TMA ended a highly successful programmatic year with income of $17.5 million and expenses of $17.3 million. The association's primary source of operating income was dues (55 percent). Additional income was derived from programs approved by the Board of Trustees, such as educational workshops, advertising, and member services. TMA spent an average of $690 per active member on programs and activities in 2001.


2001 Expense by Focus Area
2001 Operating Income

March 2002 Texas Medicine Contents
TMA Organizational Structure