TMA 2000 Annual Report: TMA Watches Out for You

President's Message

Some years we make history just by doing the same things over and over, only we do them better and better -- and we do more of them -- with each passing year.

Thus, 2000 was another history-making year for the Texas Medical Association. Once again, we could count on TMA to watch our practices so we could keep a better eye on our patients. As always, our association chalked up triumphs in advocacy, practice management, public health, politics, education, and technology. Yet again, TMA found new venues in which to fight for patients and physicians.

Take a moment to read about the hassle-busting common credentialing form, about Project WATCH's success and its expansion into WATCH for Kids, about the dramatic conclusion to the Zamora case, and about our online evaluation and management tool. Check out TEXPAC's stellar performance at the polls or TMA's never-ending work on prompt payment. See what our association has accomplished in 12 months. You'll know why physicians around the United States envy our membership in the country's most proactive, most effective state medical society. You'll take pride in what you've contributed.

As you read this, TMA is again leading the charge for Texas physicians and our patients in the 77th legislative session. Medicaid reform, tobacco funds, physical education, lawsuit abuse, and scope of practice are just the most prominent of the issues on medicine's plate. Based on our record, we can predict victory on many of those fronts -- even in a highly politicized session.

We must look to the past to know the present and influence the future. That's been my motto as a physician, educator, and leader. TMA's glorious 148-year history explains much of our current success and positions us well to continue to improve the health of all Texans.

Best regards,

Jim Rohack, MD

TMA Speaks Out on Payment Problems, Patients' Rights

TMA is not just watching out for Texas physicians, it's speaking out as well. Advocacy on a wide range of economic and policy issues affecting physicians and their patients is an important part of TMA's mission.

Payment Advocacy
With physicians struggling under the burden of delayed payments despite two legislative fixes, TMA geared up in 2000 to push for new legislation to close a glaring loophole that allows managed care organizations to use their contracts to redefine " clean claims ." TMA and local medical societies also sought to change statutory requirements that place the administrative burden on physicians to document whether patients have other insurance coverage. And, the association urged the Texas Department of Insurance to better enforce existing rules on clean claims.

The association also reported needed reforms in the Medicaid managed care system to Health and Human Services Commissioner Don Gilbert and Texas legislators. TMA backed efforts to gain substantial fee increases, administrative simplification, and a continued moratorium on further rollouts in Texas. TMA favors keeping the primary care case management system intact as a competitive alternative to Medicaid managed care and supports efforts to create alternative models to the current systems.

TMA conducted 17 meetings with insurers in 2000 to address physicians' problems with insurance companies that were identified through 5,000 individual Hassle Factor Logs   members only final compiled during the year. The logs showed downcoding, prompt payment, and denials to be major issues for physicians. Those meetings settled many disputes over payment and insurance company procedures in physicians' favor.

TMA also partnered with county medical societies to stage 27 mini-consultation  visits during the year. These consults covered topics such as Medicare, Medicaid, managed care, and general payment-related coding and billing issues.

Practice Management
To help Texas physicians tune up their practices, TMA Physician Services  provided hands-on practice management consulting expertise to hundreds of TMA members. The most frequently requested services were practice set-ups, operational assessments, and coding and compliance assessments.

Physician Services provided members with information on the newest technology for medical practices, including electronic medical records, Web-based software, and prescription writers. The group developed physician practice policy and procedure manuals available for sale in written and electronic form and published a monograph, How to Hire a Practice Administrator . Physician Services also created a monthly newsletter and regular e-tips on the TMA Web site at  to provide practice management information. The e-tips link to more detailed information within the site.

Advocacy in the Courts
Legal battles were an important part of TMA advocacy efforts in 2000. The association's general counsel helped to develop a new legal remedy for physicians advocating for patients, as well as for patients with chronic and severe, disabling conditions. Along with the American Medical Association's Litigation Center, TMA worked with lawyers for eight patients, a widow of a patient, and rheumatologist Jorge Zamora-Quezada, MD, in challenging managed care practices that discourage proper treatment. The Zamora case ended in a settlement, but not before TMA advocacy resulted in a federal district court decision recognizing that the Americans With Disabilities Act and the Rehabilitation Act protect patients with disabilities and their treating physicians. As a result, the plaintiffs received significant compensation for discriminatory treatment by four health maintenance organizations (HMOs) and a nonprofit, hospital-owned clinic and its for-profit management services organization.

TMA attorneys also helped to block an HMO's effort to seal testimony and documents in a case that resulted in a $20 million jury verdict for John Paul Schulze, MD, of Corpus Christi, who alleged Humana retaliated against him for speaking out against its managed care policies. Because the files remain open, this information about Humana's attempts to silence Dr. Schulze may aid other physicians who are challenging HMOs.

When a panel of the U.S. 5th Circuit Court of Appeals ruled in June that the Employee Retirement Income Security Act pre-empted the use of the independent review process in Texas, TMA and AMA filed an amicus curiae brief in support of the state's appeal to the U.S. Supreme Court.

TMA and AMA advocates worked closely with Texas Attorney General John Cornyn to strictly enforce his settlement with Aetna so that the insurer no longer could use financial incentives to induce physicians to withhold necessary care.

TMA and AMA also worked together to lobby Congress to pass the bipartisan Patients' Bill of Rights.

TMA's legal staff built a strong relationship with a number of attorneys across the nation who have filed class-action lawsuits challenging common wrongful managed care practices. Although TMA is not yet party to any of the suits, its attorneys are seeking new ways for physicians to hold HMOs accountable for their decision-making and business practices.

Project WATCH Focuses on Children

Attacking the state's No. 1 killer -- cardiovascular disease -- is the objective of the multitiered Project WATCH campaign.

TMA, the TMA Alliance, county medical societies, the Texas affiliate of the American Heart Association, the Texas Department of Health (TDH), and other organizations have collaborated to improve professional and public awareness of the five leading preventable risk factors for heart disease and stroke -- Weight, Activity, Tobacco, Cholesterol, and High blood pressure. Project WATCH is underwritten by the TMA Foundation.

Aimed at increasing awareness and accountability by both physicians and patients, the three-year grassroots program has developed and distributed thousands of patient-physician encounter forms, patient brochures, wallet cards, and stickers at special events and exhibits throughout the state. The program has been promoted through multimedia efforts, including magazine articles and radio and television public service announcements that have gained statewide air play.

Last year, WATCH  began focusing on physical inactivity in elementary schoolchildren. TMA produced bookmarks featuring "Wags the Watchdog," with a message on the importance of physical activity. The bookmarks, printed in English and Spanish, were distributed in collaboration with the TMA Alliance, the Texas PTA Association, the Texas School Nurses Association, and others.

Education Tops TMA Priorities

Throughout the year, TMA made strides in all its medical education service areas.

Medical Education Policy
The Council on Medical Education established the Medical Education Financing Task Force in January. This group provided testimony to the Texas Senate Finance Committee's Interim Subcommittee on GME in support of adequate state graduate medical education (GME) funding and reiterated the TMA policy of supporting GME funding through an all-payer approach.

Recognizing that fewer medical students are selecting primary care residencies, TMA conducted surveys and a focus group meeting to assess changing market demand and to identify reasons for this shift. Initiatives and legislative proposals were developed for improving physician distribution in rural areas.

The  TMA Minority Scholarship Program  awarded a $5,000 scholarship to incoming Baylor College of Medicine student Stephanie C. Jones, of Houston.

Continuing Medical Education
The Accreditation Council for Continuing Medical Education awarded TMA four years' accreditation, with commendations, to continue to accredit Texas organizations as providers of continuing medical education (CME). TMA also received the Rutledge W. Howard, MD Award for maintenance of high standards in the intrastate accreditation program.

CME credit was offered for the October Texas Medicine  symposium issue on quality in health care, making TMA the only state medical society to provide such an opportunity. A joint sponsorship program with state specialty societies and county medical societies was expanded to offer additional, largely clinical, programming.

TMA's Physician Health and Rehabilitation (PHR) Committee developed two new ethics courses in 2000, " Nicotine Dependence and Its Treatment " and " Maintaining Professional Boundaries and Treating Difficult Patients ." Of the 3,640 physicians who completed the seven ethics courses developed by the PHR committee, 1,110 completed the courses online.

The association's annual meetings took on a new look in 2000 as Fall Conference and Interim Session of the House of Delegates were combined into TMA Summit 2000, with 669 physicians and medical students attending. More than 2,100 physicians and students took advantage of CME opportunities and other events at TexMed 2000, while Winter Conference drew 599 physicians and students.

The association also endorsed Compliance Trak Inc., which provides online staff and CME sources, plus a reporting and tracking system to comply with regulations of the Occupational Safety and Health Administration.

TMA Library
In 2000, TMA looked ahead to the new millennium and emphasized positioning the TMA Library for the future, which includes offering online resources such as the new ethics course "Medical Ethics and Professionalism." By taking the ethics course in print or online, 1,620 physicians earned AMA PRA Category 1 CME credit. Of this number, 1,080 physicians took the course online.

Librarians taught a monthly three-hour CME course on "The Basics of PubMed MEDLINE Searching" to members and staff. More than 3,600 online database searches were conducted to answer clinical, socioeconomic, and public health research questions for TMA members, and the library responded to more than 3,500 requests for articles through the National Library of Medicine's online Loansome Doc document delivery program.

Disease Management Drives Public Health Efforts

The association achieved firsts on a number of fronts in the areas of public health, science, and quality.

Cancer Education
The Physician Oncology Education Program  (POEP) reached more than 25,000 health care and education professionals in 2000. A $300,000 grant from the Texas Cancer Council was used to establish CME programs for primary care physicians in underserved areas and for those who treat underserved populations. Among the program's educational accomplishments was the development of a skin cancer education initiative for physicians.

POEP and TMA's Committee on Cancer spearheaded an effort to improve the quality of the state's cancer data. The Cancer Data Workgroup received $66,000 from the Centers for Disease Control and Prevention to study the reporting system and recommend ways to improve timeliness and accuracy of data collection and lessen the burden of reporting cancer cases.

TMA conducted a statewide survey to examine physician attitudes and behaviors regarding colorectal cancer screenings. Results will guide the TMA Workgroup on Prevention and POEP in developing programs and policy changes to increase screening for colorectal cancer in Texans.

Disease Management
An electronic chart audit tool, the first of its kind in the nation, was developed during the year for use by participants of TMA's HeartCare Partnership, a program that emphasizes physician and patient education and practical office strategies to improve secondary risk factor management of patients with cardiovascular disease.

The Council on Scientific Affairs held discussions with TDH regarding effective disease management programs for the state, including pilot programs for the treatment of asthma. The council also participated in the TDH effort to implement a statewide asthma coalition.

Through the efforts of the Committee on Infectious Diseases, TMA received a $60,000 grant from Schering-Plough to provide educational programs on hepatitis C focusing on screening, treatment, and patient management. The program has been approved for up to one hour in AMA PRA Category 1 CME credit and will be offered throughout the state in 2001.

Public Health
TMA has been a long-standing, ardent supporter of the U.S.-Mexico Border Health Commission, which opened its offices in El Paso in November. This organization spearheads binational policy development to address public health problems for all states along the U.S.-Mexico border. TMA collaborated last year with the Texas Pediatric Society, forming the Border Health Alliance to address children's health issues in the border region.

In February, the Committee on Child and Adolescent Health began researching and developing a position paper on children's mental health to provide TMA members with tools and resources to address this far-reaching problem.

Common Credentialing Form
TMA actively promoted the use of a common credentialing form  developed by the Dallas-Fort Worth Business Group on Health. Association staff organized statewide meetings with physicians, health plans, hospitals, and employers and held regional meetings with county medical societies to advocate use of the form.

Patient Safety
TMA created the Ad Hoc Committee on Medical Errors early in 2000 to study the controversial Institute of Medicine report and consider policy development and physician education on patient safety. The committee developed policy principles for patient safety reporting systems and conducted survey research on a number of issues relating to medical errors. Of interest, TMA physicians do not support mandatory reporting of errors without adequate peer review and liability protections because it has not been proven to reduce errors.

TMA Technology Delivers the E-Goods

From the launch of a new Web site design to the purchase of a powerful new membership database to the development of a host of e-tools for members, technological innovation was a hallmark of TMA in the year 2000.

The revamped TMA Web site allows members to create a personal page that provides easy access to information relevant to their specialties or areas of interest. It also provides the latest news that affects members' practices and patients, links to credible health information, online CME opportunities and medical research, and more. By year's end, the Web site's new features included an online tool that allows members to compare their evaluation and management coding patterns with those of their peers in Texas and around the nation. The new TMA Knowledge Base gives members access to answers to the most commonly asked questions -- on practice management, legal and legislative issues, TMA membership and member services, continuing medical education, and public health and science.

Work has been under way on a new membership database with plans for completion in mid-2001. The system will significantly enhance TMA's abilities to track members' preferences, offer e-commerce services, provide customized member communications, and maintain accurate membership information. Several of the state's largest county medical societies are implementing complementary systems.

For the first time, the TMA House of Delegates ratified a comprehensive technology plank as part of the association's 2000-2001 Strategic Plan. The four priority goals in the technology section of the plan direct TMA to educate physicians on the growing e-health industry and how it can affect their practices. The plan also calls on the association to promote the sound regulation of telemedicine, protect the confidentiality of patient information that might travel online, and provide access to performance measurement tools that enhance clinical decision making.

TEXPAC Scores Big in November State Elections

The Texas Medical Association Political Action Committee  (TEXPAC) again led the way for medicine, positioning doctors and patients for more legislative success in the future.

The political arm of TMA supported the winners in more than 98 percent of the November state races in which it was involved. TEXPAC-endorsed candidates won in all but four races.

In key Texas Senate races, Rep. Todd Staples (R-Palestine) defeated Democratic attorney David Fisher in the race for Senate District 3, and Sen. David Cain (D-Dallas) survived a hard-fought and well-financed campaign by Republican Bob Deuell, MD, of Greenville. TEXPAC was on the winning side of both races and played a significant role in both campaigns. TEXPAC-endorsed candidates for the Texas House suffered only one loss, that being Rep. David Lengefeld (D-Hamilton), who was the lone House incumbent defeated. As a result of the November elections, Republicans maintained their 16-15 majority in the Senate, and Democrats held onto their 78-72 edge in the House of Representatives.

On the judicial front, TEXPAC continued to lead the charge to change the face of the Texas judicial system. In the 3rd Court of Appeals, Republican challenger David Puryear upset incumbent pro-plaintiff Justice Woodie Jones. TEXPAC was one of the few groups to oppose Justice Jones.

In another key judicial race, Republican David Gaultney won the election over Gerald Bourque in an open seat for the 9th Court of Appeals. TEXPAC worked with the Texas Association of Business and Chambers of Commerce and other tort reform-minded groups to support Justice Gaultney.

Association Boasts Organizational Strength

The year 2000 saw a growing membership and new delegate participants.

Membership increased from 36,398 in 1999 to 37,049 in 2000. The latter figure represents 32,806 physicians and 4,243 medical students. TMA continued its recruitment work with county medical societies, resulting in increased membership for both TMA and the local societies.

TMA did not run any candidates for election at the annual AMA meeting in 2000, but the Texas delegation announced that TMA President Jim Rohack, MD, will be a candidate for the AMA Board of Trustees in 2001. Brad Butler, a student at Texas A&M University System College of Medicine, became speaker of the AMA Medical Student Section (MSS). Angela Siler-Fisher, a student at Texas Tech University Health Sciences Center School of Medicine, became one of two MSS delegates to the AMA house.

TMA Expenditures Reflect Physician Priorities

TMA ended a highly successful programmatic year with income of $15,855,000 and expenses of $16,097,000.

The association's primary source of operating income was dues (55 percent). Additional income was derived from nondues, income-producing programs approved by the Board of Trustees, such as educational workshops, advertising, and member services. An average of $650 per active member was expended on TMA programs and activities in 2000.

2000 Expense by Focus Area
2000 Operating Income

Texas Medicine   March 2001 Contents
TMA Organizational Structure