2011 TMA Annual Report

President's Message  

2011 a Success, But More Work Ahead 

As you can see by reading the annual report below, 2011 was another very successful year for the Texas Medical Association. We accomplished a lot for physicians and our patients at a time when we all needed it the most. We had continued growth in membership offset by the worst financial crisis facing Texas for decades and irrational cuts in health care spending for the safety net. We cannot rest until those cuts are reversed. We still face more disruptive change in 2012 with preparations for the Patient Protection and Affordable Care Act.  

We crossed the 45,000-member threshold in 2011, but there are still many physicians who simply don't understand the value of membership in TMA. My successor, Dr. Michael Speer, wants to reach 50,000 members in 2012. Let's help him meet that goal. Talk to your colleagues who are not members. Tell them why you joined TMA, explain to them what we do for them and their patients, and urge them to join us. If they do not want to spend their time helping TMA, at least they can write the check for membership. 

And don't forget to urge them to join TEXPAC as well. TEXPAC is backing some outstanding candidates in this year's elections, many of them physicians or TMA Alliance members. Getting them elected will pay off in next year's session of the Texas Legislature. 

The challenges we face in 2012 are primarily because of misguided state and federal policies that threaten patients' access to care and our ability to remain in practice.  

The state is trying to save money by cutting reimbursement for treating poor and elderly patients who are eligible for both Medicare and Medicaid, the so-called "dual eligibles." Our most vulnerable patients are frightened, and their physicians, especially those in South Texas, have been forced to borrow money or use their savings just to stay in practice. This is unsustainable. We must convince state officials to rescind the cuts for our colleagues whose patients are in danger of losing access.  

And once again in 2011, as they have for more than a decade, Congress and the Centers for Medicare & Medicaid Services (CMS) put physicians and patients through a gut-wrenching experience by threatening us with drastic cuts in Medicare payments. In 2012, we must redouble our efforts to convince Congress to stop the partisan bickering and do what it should have done years ago – repeal the Sustainable Growth Rate formula and establish a fair Medicare payment system. In December 2012, we will go through this charade again with the real danger that CMS will stop payments to doctors in early 2013 while Congress "fixes the problem." 

While we're at it, we must convince Congress to repeal the Independent Payment Advisory Board, an unelected board created by the Patient Protection and Affordable Care Act. The board's only option is to cut Medicare payments to physicians. 

Of course, hanging over all of us is the Patient Protection and Affordable Care Act. At this writing, we don't know what the outcome of legal challenge to the constitutionality of the bill might be. Legal experts differ on what the Supreme Court will decide. But if the bill survives, TMA will continue to help physicians adjust to the new reality of practicing medicine. We know the Patient Protection and Affordable Care Act is unaffordable, and the "exchanges" it creates, with their middle class entitlement program, are not fully funded. 

The legendary baseball pitcher Satchel Paige once advised, "Don't look back. Something might be gaining on you." Well, something is gaining on us. It's the people who want to put themselves between us and our patients. We cannot let this happen. What we do in 2012 will affect medical practice for years. 

It was a great honor for me to serve as your president during the past year. I know that with our new president, Dr. Speer, at the helm, 2012 will be another great year for our association. I pledge to continue to help as much as I am needed.   

C. Bruce Malone, MD, 2011-12 TMA president  

 2011: Winning the Good Fight  

When 2011 began, Texas Medical Association physician leaders and staff knew they faced long and difficult battles with a rogues' gallery of the usual suspects. They knew they would fight those battles in the capitols in Austin and Washington, D.C., in the offices of state and federal regulators, and in the corporate headquarters of the insurance companies. 

There were those who pushed a petty personal agenda to weaken the Texas Medical Board (TMB), thus jeopardizing the public's faith in physicians; hospitals that wanted the power to hire physicians, raising questions whether their true allegiance is to quality care or profit; politicians who wanted to balance the state budget on the backs of physicians and their most vulnerable patients; and a federal government prepared to impose a new claims-coding system that would force physicians to spend thousands of dollars on new technology and at the same time cut Medicare fees.  

And, of course, there were the most usual suspects of all – the nonphysicians who want to act like physicians without going through the rigorous medical school training you endured to earn the right to call yourself a physician. 

During all of this, TMA continued its work to make sure physician practices remain viable so you can do what you do best – take care of your patients.  

And, TMA continued to grow; its membership at year's end totaled 45,548. That's 500 more than in 2010. 

Capitol Victories 
As is the case in all odd-numbered years, much of TMA's efforts in 2011 took place in the legislature. There were many victories and a few setbacks, but when the session ended May 30, the association had scored important wins for physicians and patients.  

Bolstered by hundreds of physicians, medical students, and TMA Alliance members who traveled to Austin for the highly successful First Tuesdays at the Capitol events throughout the legislative session, TMA:  

• Secured legislation that TMA leaders hailed as first-in-the-nation protections for clinical autonomy and independent medical decision making for physicians employed by hospitals and nonprofit health care corporations. 
• Reformed TMB by ending anonymous complaints and giving physicians due process without endangering the 2003 medical liability reforms. 
• Staved off substantial cuts in Medicaid and Children's Health Insurance Program physician fees that could have driven hordes of doctors out of those programs.  
• Stymied efforts by nurse practitioners, podiatrists, optometrists, and other midlevel practitioners to expand their scope of practice. 
• Passed legislation to ban discretionary clauses in health insurance policies.  
• Secured legislation directing the Texas Higher Education Coordinating Board to facilitate the development of graduate medical education positions in relation to the growth of medical school enrollment. 
• Improved public health in Texas by persuading lawmakers to pass bills requiring vaccination of college students against meningitis, ensuring that new mothers receive information about pertussis immunizations, and mitigating planned cuts to tobacco cessation and chronic disease prevention programs.   

Clinical Autonomy Defended 
TMA worked with the Texas Hospital Association, the Texas Organization of Rural & Community Hospitals, Senate State Affairs Committee Chair Robert Duncan (R-Lubbock), and other legislative leaders to hammer out several physician employment bills.  

The legislation:  

• Gives some hospitals greater latitude to employ doctors, but imposes some of the strongest protections in the nation for physicians' clinical autonomy and independent medical decision making. 
• Allows employment by small hospitals, generally in counties of 50,000 or fewer, with strong protections for independent medical judgment and medical staff responsibility for all clinical policies from privileges to credentialing to utilization review. 
• Requires the hospital's chief medical officer to report to TMB any instance of administrative interference in clinical or patient care decision making. That means if independent physicians are required to take call to maintain staff privileges, employed physicians also must take call.  

Strong But Fair 
The TMB fight was particularly bruising. But when it ended, TMA emerged victorious with a series of reform bills designed to make TMB's disciplinary processes fairer for physicians, while maintaining the ability of the board to protect the public.  

TMA defeated opponents with anti-TMA and anti-TMB agendas and won passage of bills that prohibit anonymous complaints and:  

• Require TMB to notify the physician when insurance companies, pharmaceutical companies, or third-party administrators file a complaint. 
• Increase the time for a physician to respond to a complaint notice from 30 days to 45 days. 
• Allow physicians to record the proceedings of a TMB informal settlement conference. 
• Allow TMB to require a remedial action plan rather than impose a fine for a minor administrative violation. 
• Institute a seven-year statute of limitation on bringing a disciplinary action, mirroring the TMB rule on how long doctors need to keep a patient's medical record. 

Patients' Safety Protected 
In just about every session, midlevel practitioners push a number of bills to allow them to practice medicine without a medical school education. It was no different in 2011.  

Nurse practitioners backed at least three bills that would have allowed them to independently diagnose, prescribe drugs, and order tests. None of them passed.  

Meanwhile, physical therapists sought direct access to patients without a physician's referral; optometrists wanted authority to perform certain surgeries and prescribe or administer oral and other medications; chiropractors tried to protect their licensing board against lawsuits from other health licensing agencies when their rules intruded on the practice of other health professionals; and podiatrists sought to push their scope of practice beyond the foot. 

TMA killed nearly all of those bills and stripped virtually all of the objectionable provisions from Senate Bill 1001, which would have allowed chiropractors to form business partnerships with physicians. 

Working for You and Your Patients 
In 2011, TMA did what it has done since a pioneering band of physicians founded it in 1853 – work to improve the health of all Texans. And, as in past years, the association followed goals established by the TMA Board of Trustees as its roadmap to the future.  

Here is a sample of what TMA did for patients and physicians in 2011.  

• Saved millions of dollars in payments to practices by persuading Blue Cross and Blue Shield of Texas to suspend the Procedure Plus Evaluation and Management (E&M) Service Reimbursement Methodology that would have skimmed 5 percent of the payments when the E&M was performed on the same day as a procedure. 
• Recovered $1.6 million for thousands of doctors through the Hassle Factor Log program, including money recovered from incorrectly processed claims, lost or delayed Medicare enrollment applications, and other payment issues. 
• Created the Calendar of Doom to prepare doctors for new rules and regulations. 
• Helped 11,000 physicians with practice issues.  
• Used TMA's provider relationships to save practices more than $20 million. 
• Helped 1,761 Texas physicians – the most in the nation – reach "meaningful use" through regional extension centers, as well as other education and outreach initiatives. 
• Prodded the American Medical Association to lobby federal officials against their plans to force physicians to begin using the ICD-10 coding system in 2013, a move that prompted them to delay it until 2014.  
• Provided expert comments on proposed Internal Revenue Service rules on accountable care organizations (ACOs) that led the IRS to substantially modify those rules to allow recognition of physicians' valuable role in ACO development with nonprofit hospitals.  
• Supported TMA member physicians in significant litigation to protect the right of physicians to own a hospital, protect physicians from losing staff privileges due to discrimination based on national origin, and promote transparency in nonprofit hospitals' financial affairs. 
• Retained 95 percent of association membership, the highest in the nation among state medical societies. 
• Began in-depth analysis of members' needs to identify specific physician segments and matching them with targeted TMA advocacy, services, and benefits. 
• Launched the Me & My Doctor blog to help patients and doctors find a new and better way to talk to each other by creating a dialogue between patients and doctors where they can discuss important health care issues. 
• Began the TMA Diabetes Reporting Pilot Program supporting 26 physician practices with the technical requirements to meet reporting requirements for the Bridges to Excellence programs of the Physician Quality Reporting System and Blue Cross and Blue Shield of Texas. 

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 by email.