Rejoin Today – Our Work Is Never Done
By Michael E. Speer, MD
Past TMA President (2012-2013)
Physicians often ask me what TMA and their county medical society has done for them lately. I quickly tell them it's not what they've done for you lately, but what would you do without them?
Since our founding in in 1853, TMA has worked for physicians and patients. How? Here are a few examples: When the trial lawyers tried to bankroll their high-rolling lifestyle through jackpot justice, TMA and the county societies were there. When the for-profit health care companies tried to tell you how to practice medicine, we were there. When state lawmakers tried to place an onerous tax on your practices, we were there. And when people who never went to medical school decided they could perform procedures without the proper training, we were there.
But our work is never finished. You need TMA today more than ever. And, frankly, we need you.
Only TMA stands up for your right to practice autonomously. Only TMA respects your clinical judgment as the bond between you and your patient. We guarantee that bond, but only with your support through membership.
So what have we done for you? Here's a look back at what TMA and your county medical society has already done for you, your practice, your profession, and your patients, and what we're still doing today.
Passed Liability Reform
The list starts with the passage of the landmark health care liability reforms -- and the voters' approval of Proposition 12 -- in 2003. Texas physicians worked to end to the days of frivolous and expensive lawsuits and skyrocketing liability insurance premiums. Since 2003, all major physician liability carriers in Texas have cut their rates, most by double digits. Ninety-percent of Texas doctors have had rates slashed 30 percent or more. Texas physicians have saved a cumulative $1 billion. Physicians insured by the Texas Medical Liability Trust (TMLT) – the liability carrier that TMA created just for members –have saved more than $700 million in premiums.
Thousands of new doctors flocked to Texas, thanks to our stable liability climate. In 2012, for example, Texas licensed more than 3,600 new physicians, a record. The ranks of critical specialists – such as neurosurgeons, obstetricians, and emergency medicine physicians – have swelled once again. And Texans in vast regions of the state again have access to their lifesaving services.
TMA has remained vigilant against the trial bar's counter-offensive since 2003. We've stopped their moves to nullify our reforms in the courts and in the legislature. We encouraged Gov. Rick Perry to veto a 2009 bill that would have unraveled these protections. He did.
And we're still at it. Trial lawyers are conniving to reverse our reforms and spike premiums to unsustainable levels. They continue to paint doctors as unsafe purveyors of pain and damage. Only TMA, your county society, TMLT, and our allies stand between you and a resurgent epidemic of health care lawsuit abuse.
Opposed President Obama's Health Plan
When the Patient Protection and Affordable Care Act came for a vote in 2010, we told Congress it was bad medicine and we could not support it. Our position was and is steadfast: Keep what's good in the health care system, and fix only what's broken.
Just because the bill is law doesn't mean we give up and roll over. Since the day the bill passed, TMA leaders have worked with our senators and representatives on a long list of changes we need to see. We're helping them find what's missing, what Congress left out that they should have put in. We want them to keep what works, to make sure that those needed reforms are protected. And we're urging them to fix what's broken, to rewrite, or eliminate the many pieces of the law that are anti-patient and anti-physician.
Reformed Health Insurance Practices
By March 2001, Texas physicians were fed up with the for-profit health insurance companies' fraudulent marketing schemes and heavy-handed attempts to run their practices. TMA took them to court under the Racketeer Influenced and Corrupt Organizations Act and won some dazzling settlements.
Working with a team of active states, we won more than $500 million in damages for physicians in redress for the plans' past injustices. More importantly, we secured more than $1.5 billion worth of changes in how big insurance companies do business. We won new definitions of medical necessity, fairer bundling and editing rules, the elimination of automatic downcoding, and much, much more.
We know the health plans still don't take too kindly to treating you and your patients fairly. That's why TMA continues to participate in suits challenging unfair out-of-network payment determinations and why we work with a coalition of associations in challenging the plans' ongoing illegal practices.
Ended "Slow Pay"
It's bad enough that health plans say they'll pay you a pittance for your services. It's even worse when the check takes forever to arrive – or doesn't come at all. In 2003, we passed a bill through the Texas Legislature that set new standards for prompt payment of claims. Insurers face heavy penalties for late payments. In fact, thanks to TMA advocacy, the Texas Department of Insurance fined UnitedHealthcare $4 million in 2006 and $3 million in 2007 for violating the prompt payment law. Soon after that, we won a court ruling that UnitedHealthcare is responsible for unpaid claims by contracted independent practice associations.
TMA's Hassle Factor Log® helps you keep up the fight against the health plans' egregious tactics. In the past 10 years, we've recovered more than $10 million for Texas physicians and won countless changes in the companies' business practices.
Stopped Scope Expansion Cold
Since 2000, not one single bill expanding allied health practitioners' scope of practice made it through the Texas Legislature unless TMA said it was okay. And we gave our approval only when the change was safely within the providers' education, skills, and training. When they tried to go around the legislature, we put a stop to it. TMA won important court rulings that mean their licensing boards can't allow podiatrists to operate on the foot or chiropractors to practice medicine.
After years of hard work, TMA has agreed to legislation that brings physicians, nurse practitioners, and physician assistants together to improve access to care through what all parties agree is an improved delegated model for team-based health care. The agreement will help establish a more flexible and collaborative practice model that improves on current site-based restrictions that had both doctors and nurses mired in a web of old rules.
Blocked Medicare Cuts
Because of an extremely flawed payment formula called the Sustainable Growth Rate (SGR), physicians face Medicare payment cuts every year. We've lobbied Congress to prevent drastic fee cuts. In 2003, we turned a 4.5-percent cut into a 1.5-percent increase. In 2008, we convinced Congress to override a presidential veto and replace a 10.6-percent cut with another 1.5-percent increase. And, in 2010 and 2011, we stopped 25-and 27-percent cuts. In 2012, we worked to convince Congress to stop a 27-percent cut and freeze Medicare fees for a year.
But we won't rest until the SGR is gone. We're working now to pass legislation in Congress to repeal the SGR and to eliminate the just-as-bad Independent Payment Advisory Board created by Obamacare. We need your help. Your membership in TMA adds your voice to the call for action by Congress.
Proposed Medicaid Fix Medicaid
We've worked for years to improve the Medicaid system in Texas When lawmakers wanted to balance the 2003 state budget on the backs of physicians, we turned their planned 33-percent Medicaid cut into a 5-percent reduction, which we won back in later years. Then, in 2007, we secured a historic 25-percent increase in physician payment rates for children's Medicaid and a 10-percent hike in fees for adult Medicaid.
Now in 2013 we're working for a Medicaid solution for Texas that fixes our broken system and allows you to provide patient care in a more efficient and affordable fashion. We want to improve Medicaid patients’ access to timely and affordable medical care by increasing physician payments to equal Medicare rates, reducing red tape and administrative hassles, and ensuring fair fraud-and-abuse investigations. We have a clear message for our federal and state policymakers on the issue of Medicaid expansion: Reform first, then expand only with a state-specific plan that targets the unique health care needs of our state’s population and that Texas taxpayers can afford.
Prevented Onerous Taxes on Medical Practices
In 2005, and again in 2006, TMA headed off potentially devastating financial hits to your practice when lawmakers wanted to tax health care. The association stopped the 2005 tax bill outright. In 2006, we convinced lawmakers to allow physicians to exclude from the new business tax all revenues from Medicare, Medicaid, TRICARE, the Indigent Health Care Program, Workers' Compensation, and the Children's Health Insurance Program. We saved physicians thousands of dollars more when TMA persuaded the state comptroller to allow physicians to deduct copayments and deductibles from taxable revenue.
Protected Your Autonomy
TMA responded quickly to legislative efforts in 2011 to allow hospitals to directly employ physicians. As a result, we preserved the long-standing ban on the corporate practice of medicine with several carefully controlled expansions for physician employment that included strong protections for clinical autonomy and independent medical judgment. While most states generally ban corporate practice – but provide a general hospital exception – Texas became the first state to pass statutes specifically protecting physicians' clinical judgment.
- Worked with Federation of Medicine partners to delay implementation of ICD-10 for a year, giving practices more time to prepare for this fundamental change in coding;
- Responded to immense volumes of new federal and state regulations with practice management education to keep physicians out of trouble;
- Established the TMA Education Center offering traditional and online practice management, cancer, and physician health courses you can browse through by topic, number of CME credits, date or location, delivery type (such as recorded webinar, publication by mail, e-book, or live seminar), and availability of a liability insurance discount;
- Created the Health Information Technology Department to help physicians transition to electronic medical records and meet federal "meaningful use" criteria to earn Medicare and Medicaid incentives;
- Began offering DocbookMD as a free member benefit to allow physicians to transmit text messages and images to each other that meet Health Insurance Portability and Accountability Act (HIPAA) encryption and security requirements;
- Worked with county medical societies to organize physician volunteers who treated victims of Hurricane Katrina, and provided financial assistance to physicians whose practices were blown away by Hurricanes Rita and Ike.
- Created a Task Force on Bioterrorism to develop a toolkit on physician protocols for smallpox, botulism, anthrax, and plague, and established the TMA Flu Fighters to provide practical advice to help Texas doctors fight the H1N1 influenza pandemic.
Renew Your Membership Today
There is still much to accomplish, and we need your support. Our voice is strongest when we work together. Renewal questions? Contact the TMA Knowledge Center at (800) 880-7955 or firstname.lastname@example.org.