Nov. 15, 2005

Welcome to the Harris County Physician Newsletter Online!

In this issue. . .

100K Lives

Medicare Cuts

Congratulations

Save the Date

President's Page

Medicare Corner

Medicaid Corner

Branch Opportunities

December Calendar

Medserv Spotlight

News and Updates

Member Mentions

Houston hospitals commit to “100K Lives” Campaign

The most recent data on hospital performance nationwide collected by the Centers for Medicare and Medicaid Services (CMS) ranks Houston hospitals near the bottom percentile in three treatment areas. Out of 40 regions studied, Houston ranked 27th in the treatment of congestive heart failure, 32nd in pneumonia and 33rd in heart attacks.

To improve healthcare, the Institute for Healthcare Improvement is conducting the 100K Lives Campaign, which approximately 141 Texas hospitals have joined. The Institute for Healthcare Improvement created the campaign to reduce morbidity and mortality in health care through the consistent use of proven best clinical practices and methods.

Participating hospitals and their medical and clinical staffs are implementing some or all of the six life-saving best practices that have been proven to significantly improve health care quality and safety. The interventions include:

• Deploying rapid response teams at the first sign of patient decline;
• Delivering evidence-based care for patients with myocardial infarction;
• Implementing medication reconciliation—listing and evaluating all of a patient’s drugs to prevent adverse events;
• Preventing surgical site infection and related deaths by reliably implementing a set of recommended interventions in all surgical patients;
• Preventing central venous catheter-related blood stream infection and related deaths by implementing a set of recommended interventions in all patients requiring a central line; and
• Preventing ventilator-associated pneumonia and related deaths and other complications in patients on ventilators by reliably implementing a set of recommended interventions.
Participating hospitals agree to measure their results by submitting monthly mortality data reported on a quarterly basis.

“This campaign challenges the health care industry to make necessary improvements in the care provided to patients,” said Dr. William Gamel, president of TMF Health Quality Institute.
In addition, the Harris County Medical Society collaborated with the TMF Health Quality Institute, the quality improvement organization for CMS, to convene local meetings to examine hospital processes and the reasons behind the low percentile rankings.

For more information on the campaign, visit the Institute for Healthcare Improvement: www.ihi.org.

Medicare cuts looming -- call our Congressman!

Bad things are afoot in Washington on the Medicare reimbursement front.
In the U.S. House of Representatives, neither the House Ways and Means Committee nor the House Energy and Commerce Committee included Medicare provisions in their respective versions of the budget reconciliation legislation. This is not good news at all.

The bottom line is the bottom line. This House version would result in the scheduled 4.4 percent reduction in Medicare reimbursement rates, effective     Jan. 1.

The American Medical Association, Texas Medical Association and Harris County Medical Society ask that physicians light up the telephone switchboard of every member of Congress.

PLEASE CONTACT your Congressmen today. Many members of Congress will tell you that they support a physician payment fix. Thank them for their support but ask them this question: Is it fixed yet? Tell them time is running out in this session of Congress. The House needs to act promptly to prevent a 4.4 percent cut, effective Jan. 1. Below is the list of our Congressmen along with their Washington and district phone numbers. Call both numbers.

John Culberson (R)
202-225-2571
713-682-8828

Tom DeLay (R)
202-225-5951
281-240-3700

Al Green (D)
202-225-7508
713-383-9234

Gene Green (D)
202-225-1688
281-999-5879

Sheila Jackson Lee (D)
202-225-3816
713-655-0050

Michael McCaul (R)
202-225-2401
281-255-8372

Ted Poe (R)
202-225-6565
281-446-0242

(Hint: You probably will be asked if you live in the Congressman’s district. If you do, say so. If you do not, say, “No, but I sure take care of Medicare patients who do live in the Congressman’s district.”)

The Senate on Nov. 3 passed budget reconciliation legislation that includes a 1.1 percent hike in Medicare physician reimbursements; however it also extends the morturiaum on physician-owned specialty hospitals.

The House must concur with the Senate’s action. If it does not, the 4.4 percent reduction will go into effect.

Presented by HCMS Board of Medical Legislation

Back to top

Congratulations to new officers

At the HCMS Executive Board meeting on Oct. 25, the full board was named. The Nov. 1 issue of the newsletter gave a partial list of officers. Congratulate these physicians on their new positions: Dr. James B. Bennett, chair of the HCMS Council of Hospital Chiefs of Staff; Dr. James O. Wallace, chair of the HCMS Council of Specialty Societies; Dr. Walter P. Moore III, chair the HCMS Board of Medical Legislation; Dr. Lawrence R. Clarke, president of the Southeast Branch; and Dr. Bufford D. Moore, president of the East Branch.

For a full list of the officers, see the Nov. 1 issue of the Harris County Physician Newsletter.

Back to top

President's Page-Dr. Robert Vanzant
Gateway to care

About two years ago, I attended a presentation on charity care at the city health department. We discussed the uninsured, emergency care issues, disease management, and many other topics. The conclusions we reached were: One, there are people without adequate health care insurance; Two, they are going to get some sort of care somewhere; Three, the care they receive is probably expensive and inefficient; and Four, we ought to and can do something about it.

The organization making the presentation was Gateway to Care, a non-profit with its roots in a North Carolina program called Project Access, which started its network in 1997. Gateway has come to Houston, and we have the opportunity to really help our own underinsured population.

The problem is simple and obvious: health care insurance is priced out of reach for almost one in three Houstonians. Many of these uninsured are employed but have no coverage. They don’t qualify for Medicaid, can’t get a Hospital District Gold Card and don’t have the resources to pay out of pocket for health care. These patients will eventually get care but the burden of covering their costs falls on all of us.

It’s ironic that the uninsured among us have guaranteed access to the most expensive, least efficient venue for health care, the hospital emergency department. That’s where about 20 percent of the uninsured wind up, but their costs to “the system” far exceed 20 percent. According to Gateway to Care’s analysis, 71 percent of uninsured people get their care in your offices. You already are doing charity care every day. And, it’s costing you and your staff time and money to do it.

Think of a typical scenario: a non-resource patient arrives with typical gallbladder colic. You try to do the right thing but how? Where can you get an ultrasound for free? Who will read it? What surgeon will you impose on? How will you get the patient into the hospital? What about anesthesia, pathology, etc.? 

Gateway has found a solution. It has received a very generous start-up grant from the Houston Endowment. Gateway has a commitment from Memorial Hermann for across-the-board access to its entire scope of facilities. It also has commitments from other hospitals, labs, imaging facilities, therapists, pharmacies, and virtually every facet of health care. Now it needs a network of willing doctors.

Here is how it works. You can register to accept as many, or as few, patients as you like. These patients will be screened and registered before they ever get to your office. Patients cannot just show up. You can treat them just like any regular patient. If they need a lab test, Gateway will arrange for it—ditto for x-rays. If they need to see a specialist, Gateway will make the referral, and even help with transportation, if needed. Gateway will track the patient to be sure that they complied. If they need to be admitted, Gateway will make arrangements with a participating hospital. 

Gateway will collect accurate data that it can share with legislators and news media. In cities where this program has been implemented, the data has always shown a savings in health care expenses, better care, better outcomes, and a very high degree of doctor satisfaction. There have been NO liability suits filed over a nine-year period with over 450,000 patients served.

Gateway will operate as a 501(c)(3) entity, with blanket liability protection for its doctors. If you don’t like the program, you can opt out at any time. Very few doctors have dropped out of the program around the country.

I think that this program has a lot of potential. The infrastructure is in place to make it easier for us than what we are doing now.The burden of caring for those in need can be spread out fairly, so that none of us get clobbered because of where we practice. Our profession has a long history of caring for the needy. Gateway to Care can remove some of the impediments to our mission to heal.
You will be receiving registration materials over the next few weeks. Please sign up to help. HOUSTON, WE HAVE A PROBLEM, AND YOUR DOCTORS ARE HERE TO SOLVE IT.

Back to top

Medicare Part D

According to Medicare, there is some confusion among Medicare Part B physicians and pharmacies regarding the ability of Medicare Part B providers to bill for drugs covered under Part D, the Medicare prescription drug program.
Being an enrolled provider in the Medicare Part B program does not impart Part D-related billing privileges. Providers must have a separate contractual relationship with a patient’s Medicare prescription drug plan to receive payment for the patient’s covered prescription drugs.
Medicare Part B covers a limited number of prescription drugs and biologicals that generally fall into three categories:

• Drugs furnished incident to a physician’s service;
• Drugs furnished through a Medicare Part B covered item of durable medical equipment (DME); and
• Drugs specifically covered by statute (for example, oral immunosuppressive drugs).
These drugs will continue to be covered and paid for under Part B after the Jan. 1, 2006, effective date for Part D.

Source: TMA eTips
Presented by HCMS Board on Socioeconomics

Medicare measures physicians’ quality

The Centers for Medicare & Medicaid Services (CMS) is initiating a voluntary program for physicians to report quality measures called the Physician Voluntary Reporting Program (PVRP).
Under the new program, physicians will report their quality data on 36 evidence-based measures. The new voluntary reporting system comes as Medicare physicians face payment rate reductions for the next seven years, triggered by a statutorily imposed payment formula. CMS maintains that the reporting program will enable physicians to receive higher payments for better quality care.

During the program’s first interim phase, CMS will use the Healthcare Common Procedure Coding System (HCPCS) G-codes to supplement claims data with clinical data, which it will utilize to measure the quality of services you provide to your Medicare patients. The agency will use the G-codes for quality reporting until electronic health records replace the process.
Physicians who volunteer to submit this data will receive feedback from CMS on their performance by the summer of 2006. The goal of the program is to use this feedback to assist physicians in improving their data accuracy, reporting rate and clinical care.

To find out more about the PVRP and view the G-codes with the measures, go to www.cms.hhs.gov/medlearn/matters/mmarticles/2006/MM4183.pdf.

Source: CMS
Presented by the HCMS Board on Socioeconomics

Back to top

TMHP banner messages
It is extremely important that all physician offices that care for Medicaid patients review Texas Medicaid & Healthcare Partnership (TMHP) banner messages on a frequent basis. The information is very important for the administration of Medicaid patients. To review the latest banner messages and to start reviewing the messages in the future, go to www.tmhp.com and click “banner messages” on the right column.

Source: Texas Medicaid & Healthcare Partnership (TMHP)
Presented by HCMS Medicaid Forum

Back to top

The six branches of the Harris County Medical Society provide a wide variety of opportunities for members throughout Houston. They provide networking receptions, continuing medical education, news on issues that affect your practice, a voice for all HCMS members, and a way for HCMS members to lead. The presidents of the six branches sit on the HCMS Executive Board. The 2006 officers are:

Central City
President, Dr. Paul W. Gidley
President Elect, Dr. Shanti I. Powell
Vice President, Dr. Arlo F. Weltge
Sec./Treasurer, Dr. Robert M. Komorn

East
President, Dr. Bufford D. Moore
President Elect, Dr. Scott P. Aarons
Vice President, Dr. Mary F. Hewitt 
Sec./Treasurer, Dr. Mohammad R. Khoshnevis-Asl

North
President, Dr. M. Elizabeth Sands 
President Elect, Dr. Dexter G. Turnquest 
Vice President, Dr. Jonathan R. Russell 
Sec./Treasurer, Dr. Mohsin K. Bajwa

Southeast
President, Dr. Lawrence R. Clarke
President Elect, Dr. Edward C. Schatte
Vice President, Dr. Janette K. Bateman
Sec./Treasurer, Dr. Kenneth W. Hollis

Southwest
President, Dr. Benjamin Edery
President Elect, Dr. Charlotte B. Alexander
Vice President, Dr. Liliana Diaz
Sec./Treasurer, Dr. Armando J. Jarquin

Western
President, Dr. Madhureeta Achari
President Elect, Dr. Miguel A. Gomez III
Vice President, Dr. Dwane G. Broussard
Sec./Treasurer, Dr. Mina K. Sinacori

If you are interested in becoming active in a branch society, or if you would like more information, contact HCMS at 713-524-4267. For additional information, see page 563 of your 2005 HCMS/HAM Pictorial Roster.

Back to top

December Calendar

Medserv spotlight
Helpful employment information

Medserv’s employment services provide exclusive services for HCMS physicians. Among the many services offered is a free semiannual starting salary information sheet, which lists the average starting salaries of the most common positions filled by Medserv, such as office managers, receptionists, and office nurses, to name a few. It is a useful tool for evaluating salary trends, staff retention and hiring decisions. For a confidential copy, contact 713-526-7378, ext. 235, or e-mail Michelle@medserv-hcms.com. For a comprehensive list of positions listed with Medserv, visit the Medserv Web site at www.medserv-hcms.com.
HCMS created Medserv, a subsidiary of HCMS, to provide assistance to HCMS physicians and their practices.

News and Updates
Beware of license renewal
When you receive your notice to renew your medical license, you could easily throw it away without noticing it. In an effort to increase efficiency and decrease costs, the Texas Medical Board (TMB) has adopted a new license renewal form that looks like a post card. This is the only renewal notice you will receive from the TMB so be on the lookout when your license is up for renewal.

TMA home study courses
Today’s fast-paced medical practice leaves physicians with little free time. The Texas Medical Association (TMA) understands physicians just don’t have time to attend a lot of meetings. That is why TMA presents a variety of home study programs that can be completed in the comfort and convenience of your own home or practice.

To view TMA’s home study courses, visit www.texmed.org and click on CME.

TMA Winter Conference
Mark your calendar for the Texas Medical Association (TMA) Winter Conference on Feb. 3-4 at the Hyatt Regency in Austin. Learn more about patient safety techniques, prompt pay ideas, legislative insight, and high-tech innovations at the conference. Also, you can earn continuing medical education credit and a three percent discount on TMLT medical liability insurance (not to exceed $1,000) by attending the patient safety workshop. Contact TMA at 800-880-1300, ext. 1421, or  gay.anderson@texmed.org for more information.

Member Mentions
Dr. Mario A. Luna received the annual John J. Andujar Citation of Merit Award from the Texas Society of Pathologists to recognize distinguished service and teaching excellence among pathologists.

Dr. Stanley H. Appel received the Texas Neurological Society’s 2005 Lifetime Achievement Award.

Dr. Carlos Moreno and Rosanna Gomez Moreno, his wife, were recognized for their outstanding contributions to the community at the 2004 Hispanic Heritage Month Luncheon hosted by the Metropolitan Transit Authority of Harris County.

Dr. Gabriel N. Hortobagyl was elected president of the American Society of Clinical Oncology for a one-year term.

Dr. James T. Willerson received the Gold Heart Award from the American Heart Association for his continued and distinguished service.

Dr. Thomas M. Biggs was honored by the Houston Society of Plastic Surgeons as the 2005 Distinguished Houston Plastic Surgeon.

Dr. Betty Jo Edwards was elected to be president of the Texas Association of Obstetricians and Gynecologists for 2006-2007.

Dr. O. Howard Frazier was awarded The Distinguished Houston Surgeon for 2005 by the Houston Surgical Society.