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
Well, the many victories we can count as we review 2001 include
the validation of our top ranking. In its Aug. 6 issue,
magazine proclaimed TMA "America's best medical society."
Please read -- or re-read --
. 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
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
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
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
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
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.
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
, a free quarterly subscription newsletter for medical office
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.
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
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
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.
magazine provided CME credit to physician members in its
symposium issues on what primary care physicians need to know
about cancer in
, and on end-of-life care in
. 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.
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
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.
, 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
A program designed to improve risk factor
management of patients with cardiovascular disease through
physician and patient education as well as enhanced practice
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
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
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
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
Nobody Does It Better
The Texas Medical Association Political
Action Committee (
) 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
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
TMA Organizational Structure