A Capitol Year: TMA Victorious in 2013
By Crystal Zuzek
Texas Medicine Editor
America's biggest and best medical association emerged from three intense special sessions of the Texas Legislature in 2013 with long-sought, even precedent-setting victories that focus on patient safety and medical practice viability. The Texas Medical Association successfully advocated passage of bills that reduce the red tape binding your practice, give your patients new protections, bolster the state's graduate medical education (GME) program, promote transparent insurance markets, and prevent unqualified health professionals from delivering care outside their expertise.
More than 1,000 physicians, medical students, and TMA Alliance members personally lobbied their lawmakers during the monthly First Tuesdays at the Capitol program. This marked the 10th year of the "white coat invasion" of the Texas Capitol.
Key milestones in legislation that will help solve problems you contend with include:
- Landmark regulation of third-party payers or "silent PPOs" that take physician-contracted discounts without doctors knowing about it;
- A new standard for physician-led, team-based care and for future legislative scope-of-practice discussions;
- Widespread reductions in practice red tape, including a streamlined process for renewing controlled substances registration (CSR) permits and development of uniform prior authorization forms across payers;
- Due process protections in Medicaid fraud investigations;
- Increased access to immunizations;
- More money for GME, mental health, and women's health; and
- Preservation of tort reforms and a strong Texas Medical Board (TMB).
Vigilance at the Capitol
The 2013 legislative session saw the usual flurry of scope-of-practice bills by allied health professionals looking to practice beyond their expertise.
Chiropractors wanted to conduct mental and physical examinations of school bus drivers. Physical therapists sought direct access to patients without a diagnosis. Pharmacists wanted to vaccinate children.
Those efforts went nowhere, however, due to TMA's advocacy efforts and to a new collaborative standard TMA and key lawmakers set for addressing scope-of-practice issues. A compromise TMA struck in 2011 with hospital groups over employment paid dividends this legislative session. Last session, medicine contended with more than 20 hospital employment bills; in 2013, there were only two.
TMA physicians' personal testimony helped deter a swath of bills that would have required physicians to give patients up-front binding quotes of the price of their care and would have subjected them to financial penalties and medical board sanctions for deviating from those quotes. TMA supports transparency in health care pricing but testified such approaches could be administratively burdensome, especially when it's impossible for physicians to predict all the medical services a patient may need, not only from that physician but also from others.
Legislation filed in the 2013 session aimed to update the Texas Advance Directives Act to give patients more time and help with end-of-life decisions, while maintaining doctors' legal rights to do what they believe is ethically and medically best for patients in their last days. Although last-minute debates derailed the legislation, physicians retained the same protections that have worked for many years. The collective effort will aid TMA in future legislative discussions on a topic that is equally difficult for physicians and patients' families.
While not all of medicine's bills succeeded, TMA didn't lose any ground thanks to the association's ongoing vigilance at the Capitol.
Cutting Red Tape
TMA's red-tape reduction effort in 2013 will help your practice run more efficiently and will help you regain valuable time and money wasted away from patient care. Some of the common-sense fixes breezed through the legislature, while other bills, despite some hiccups along the way, passed the final week of session.
TMA won passage of bills that will:
- Streamline the standards practices must follow in training staff on privacy laws and for notifying patients in the case of a breach of private information.
- Allow you and your staff members to check in patients using the electronic strip on the back of their Texas driver's licenses.
- Align renewal of your CSR permits with the biennial online medical license renewal with TMB.
- Standardize prior authorization forms for prescription drugs and health care services for public and private payers.
- Subject third-party payers or other companies and secondary networks that sell, lease, or share doctors' privately contracted discounts, known as "silent PPOs," to Texas Department of Insurance oversight and to other regulations.
- Ensure you know when your discounted contract rates under Medicaid managed care or the Children's Health Insurance Program are applied to commercial products.
Fighting for Fairness
TMA took action to protect the practice of medicine after the Texas Health and Human Services Commission Office of Inspector General (OIG) adopted program integrity rules physicians objected to. The association fought during the legislative session to improve due process in OIG investigations of physicians accused of Medicaid fraud, waste, or abuse, and secured legislation that lends greater transparency to the agency's investigative and payment hold processes.
TMA won passage of legislation that:
- Promotes transparency and due process in the OIG's investigation and resolution of Medicaid overpayment and payment holds based on a credible allegation of fraud;
- Describes the information that must be included in the notice to physicians who are subject to a payment hold or proposed recoupment;
- Provides timelines and procedures for seeking informal resolution of a payment hold or alleged overpayment;
- Details a physician's right to appeal a final overpayment determination or payment hold and the applicable timelines for exercising appeal rights;
- Directs OIG to hire a medical director and dental director to assist with investigations; and
- Directs OIG to post on its website, http://oig.hhsc.state.tx.us/oigportal, the policies and procedures used to determine whether to impose a payment hold on a physician.
Working for Physicians
In addition to a strong presence at the Texas Capitol, TMA helped improve medical practice sustainability and the health care landscape in Texas. Here's how:
- The Hassle Factor Log Program, which allows you to bring payment problems to TMA's attention, processed 400 complaints and recovered more than $1.3 million, including money recovered from incorrectly processed claims, lost or delayed Medicare enrollment applications, and other payment issues.
- TMA joined all nine Texas medical schools, all regional medical school campuses, and other health-related institutions to produce the 2013 consensus statement on medical education and the physician workforce.
- By facilitating the withdrawal of an opinion request letter with the Texas attorney general that could have subjected you to new HMO licensure and certification requirements and to premium taxes, TMA saved you potentially billions of dollars.
- To identify systemic burdens, as well as problems and solutions within the Medicaid managed care program, TMA revived the Statewide Medicaid Managed Care Advisory Committee.
- A physician/staff leadership team laid the groundwork for the TMA Physician Services Organization (PSO). With a premarket valuation of more than $17 million, the PSO will be a game changer — providing needed services to allow physicians to lead business and clinical strategies in their local markets.
TMA strengthened physicians' trusted leader status in 2013 by:
- Creating and coordinating production and distribution of the "Hey Doc" multimedia public information campaign on the Affordable Care Act health exchange marketplace;
- Launching the Choosing Wisely program with a $50,000 grant from the ABIM Foundation to the TMA Foundation; and
- Expanding the Walk With a Doc program with a $40,000 grant from Aetna Foundation to the TMA Foundation.
In 2013, the TMA Foundation provided TMA programs with $388,000 in grant support, an increase of more than $50,000 over 2012 levels.
Looking Ahead to 2014
In 2013, TMA fought to protect the patient-physician relationship and defended the practice of medicine from those who sought to increase administrative burdens and infringe on your clinical autonomy. The association continues to follow its strategic roadmap for state and federal advocacy initiatives: Healthy Vision 2020, a comprehensive plan for improving health care and maintaining the viability of physicians' practices in Texas.
To order a copy of Healthy Vision 2020 from the TMA Knowledge Center, call (800) 880-7955, or email TMA Knowledge Center.
The association's plan makes eight key recommendations:
- Ensure an adequate health care workforce;
- Protect physicians' independent medical judgment;
- Promote efficient and effective new models of care;
- Repeal harmful and onerous state and federal regulations;
- Invest in prevention;
- Protect and promote a fair civil justice system;
- Provide appropriate state and federal funding for physician services; and
- Establish fair and transparent insurance markets for patients, employers, taxpayers, and physicians.
In 2014, TMA will focus on:
- Successfully launching the PSO to provide you with relevant services and establish physician-led health care financing and delivery systems across Texas;
- Defending friends of medicine through a successful 2014 political cycle;
- Preparing for an outstanding 2015 legislative session, including drafting proposals to improve hospital medical staff legal status, rebuff managed care abuses, enhance your ability to provide high-quality care, and address key public health and workforce issues;
- Achieving a positive impact on final SGR repeal and Medicare revision legislation in Congress;
- Advocating to restore appropriate funding for physicians who care for Medicaid and dual-eligible patients; and
- Improving your successful participation in performance incentive programs.
Crystal Zuzek can be reached by telephone at (800) 880-1300, ext. 1385, or (512) 370-1385; by fax at (512) 370-1629; or by email.
2013 by the Numbers
900,000 Visits to the TMA website
47,355 TMA members at the end of 2013
13,980 Inquiries fielded by the TMA Knowledge Center
6,800+ Physicians who earned continuing medical education (CME) through the TMA Education Center
2,667 Physicians who participated in person or online in 93 TMA ethics and Physician Health and Wellness CME programs
627 Physicians who attended TMA on-site seminars
300+ Physicians helped with practice issues through customized on-site consulting
18 Physician graduates of TMA Leadership College
2013 TMA Financials*
$23,833,852 Operating Income
$24,804,076 Operating Expense
$2,960,258 Operating Reserve Investment Gains
$1,990,034 Net Income
2013 TMA Income
62.6% Membership Dues
11.4% Member Services
5.2% Rental Income
4.2% Related Organizations
3.5% Educational Programs
1% Investment Income
2013 TMA Expenses
43.6% One Voice
23.7% Healthy Environment
17.9% Practice Viability
14.8% Trusted Leader
*Subject to audit.
Dear Colleagues and Friends:
One of the perks that accompanies the privilege of serving as your president is the ongoing opportunity to spread the word about our wonderful organization: the largest state medical society in the country … some of the world's greatest physicians among our membership … outstanding physician leadership … an expert staff. While I often recount our decades-long history of service to our profession and our patients, I'm grateful to have plenty of answers to the “what have you done for me lately” question.
As this annual report documents, 2013 marked another stellar year for the Texas Medical Association. We enjoyed outstanding legislative successes ranging from insurance reform to scope of practice to women's health. We laid the groundwork for a physician services organization that will help many of you thrive in the new health care marketplace. We launched new programs that improve both the public's health and the image of Texas physicians.
Looking ahead, I see several particular challenges that illustrate the many strengths and capabilities of this association. Despite high hopes based on some real progress, Congress failed to pass legislation repealing Medicare's Sustainable Growth Rate (SGR) formula. However, we have many good friends in Washington who are committed to working with us to finally rid physicians of this albatross. While Congress did heed our pleas for a 12-month respite in the transition to the ICD-10 coding system, we know that many physicians are woefully behind in preparing for this change, despite the delay. That's why we've developed seminars and webinars and videos and hands-on tools to give every one of you the best possible chances for success.
Many more challenges lay in the future ― some we have in our sites, others are hiding in the bush. Either way, TMA will be here making sure Texas physicians can surmount these hurdles and continue doing what we do best: improving the health of all Texans.
Thank you for all you do.
Stephen L. Brotherton, MD
2013-14 TMA President