Harris County Medical Society

The Harris County Medical Society (HCMS) is monitoring what is happening with health system reform. HCMS encourages all its members to go to the HCMS Web site, www.hcms.org, for updates on health system reform and information about how to contact your senators and representatives in Washington. Want to have the latest information e-mailed to you? Sign up for HCMS Direct Medical Legislation updates by going to www.hcms.org and clicking on News-HCMS Direct in the left margin.

Medicare Corner

Medicare referring/ordering physician changes date extended

The date for physicians and providers to be affected by the changes related to the filing of Medicare Part B claims has been extended to April 5, 2010.

Update - Phase 1 has been extended to April 4, 2010 from Jan 3, 2010.

Update - Phase 2 has been extended to begin April 5, 2010 from Jan 4, 2010.

For more information on the changes, view the Dec. 1 newsletter article regarding Medicare referring/ordering physician changes on the HCMS Web site at www.hcms.org/Template.aspx?id=1049.

Presented by the HCMS Board on Socioeconomics

TMA estimates impact of proposed 2010 Medicare fee schedule

The Centers for Medicare and Medicaid Services (CMS) has published its final rule regarding the 2010 Medicare physician fee schedule. In the final rule is a 21 percent cut, caused by the Sustainable Growth Rate (SGR) formula, and the termination of all consult codes, except for telemedicine.

How will the proposed cuts in Medicare payments to physicians affect your practice if Congress does not act before Jan. 1? The estimated average effect by physician specialty and the estimated impact on physicians and the change in consult billing by going to www.texmed.org/template.aspx?id=8214.

The estimated changes in billing for consultation services are different for every practice. If you would like to estimate the effect on your practice, you can customize the consult impact worksheet with your own data.

The House of Representatives has voted to repeal the formula upon which the Medicare rates are based, but the Senate has not yet acted.

If Congress is unable to complete action on pending legislation to repeal the SGR before Dec. 31, the best course of action would be to pass legislation for a very short-term extension of current payment levels for a 30-day period.

It is not too late to contact your Senators John Cornyn and Kay Bailey Hutchison and tell them to Stop the Medicare cuts. Go to www.hcms.org and click on “Legislative Advocacy” for the contact information for each senator.

Source: TMA Action
Presented by the HCMS Board of Medical Legislation

President's Page

President's Page
Dr. Lewis E. Foxhall

A year in the life...

The year 2009 began with our medical community trying to recover from a destructive hurricane, quickly followed by the biggest economic downturn in decades. Now, it’s ending with Congress debating the future of medicine, after being punctuated by one of the strangest state legislative sessions in recent memory, with a bit of pandemic flu thrown in for good measure. Through it all, Harris County Medical Society (HCMS) focused its efforts on meeting the needs of our member physicians and their patients.

While the storm had passed and the lights were back on, we started the year with many practices still hurting from damage sustained by Hurricane Ike. We worked to find support for the physicians in our area that had serious storm damage and needed help to reestablish their operations and make needed repairs to their clinics. With help from our Texas Medical Association (TMA) and the hurricane relief fund, friends and colleagues, we were able to get most practices back in fighting condition and seeing patients. However, the story was different for our University of Texas Medical Branch neighbors. Old Red was still standing, but the Level 1 emergency services we had learned to count on were gone. This serious blow to our trauma and emergency services prompted HCMS to convene a summit to brainstorm solutions and then aggressively educate our Legislature about the serious nature of the problem. This key support positioned the issue to be successfully addressed during the legislative session.

With the state legislative session off to a slow start due to a change in House leadership and a rancorous argument over voter ID, many issues important to HCMS were put on the back burner, then stuck in the last minute crush to get bills out before the end of the session. Despite that, we were able to see progress on several fronts.

This year in the Texas Legislature, we took great strides to lay an important foundation for greater transparency in dealing with health insurance companies. One bill required insurers to use accurate data and nationally-recognized standards when ranking physicians for their networks. A second bill directed the state to evaluate the adequacy of insurers’ physician networks. We also were able to protect tort reform, corporate practice of medicine prohibition, physician ownership, and scope of practice. Additionally, we saw passage of bills to require insurance plans to pay the routine costs of clinical trials and the state provided initial funding for the Cancer Prevention and Research Institute.

Meanwhile, a novel strain of flu appeared at our backdoor, with several cases of the H1N1 influenza first appearing in Mexico. We had no time to study the virus and learn about its unique characteristics before it migrated into Texas, with the valley and Houston suffering some of the early casualties. As the outbreak evolved, the public and media frenzy stirred many to seek services of their physicians as we were just learning how to deal with the new strain. We gathered as much information as we could from the Department of State Health Services and the Centers for Disease Control and made this available through our Web site and publications. As the initial outbreak waned, we had time to continue our education efforts as the state began to make the vaccine available for our high-risk patients and health care professionals. We will wait and see if this was timely enough to blunt the expected second wave of infection during the traditional seasonal flu season.

To make things even more interesting, we were all hit by another storm of a financial nature, the economic downturn. Make that a major recession. While Texas and Houston have been spared the worst of the financial storm so far, we all saw serious impact to retirement accounts, and in some cases, loss of work by our patients. This led to more and more people joining the ranks of the uninsured.

To round out the year, Congress is still debating health system reform legislation. The reform debate has become highly politicized and very contentious. Despite plans to the contrary, it will likely not be resolved by the end of the year. We are working closely with our TMA legislative team to resolve the many difficult issues of finding ways to provide affordable coverage and move our delivery system toward better quality and effectiveness, while maintaining the vitality and viability of our member’s practices. Highlights of our activities and accomplishments included:

• Assisting physicians in collecting more than $1 million from insurance companies with our Payment Advocacy program, bringing the total to nearly $16 million since 2000.

• Meeting with Texas Department of Insurance commissioner to discuss our health plan survey and how we can work together.

• Meeting with the executive director and chief medical officer of Texas Medical Board to discuss improvement of its process. The discussions were based upon data collected from our third member survey on the topic.

• Creating disaster preparedness materials for physician practices.

• Creating H1N1 materials for physicians and their patients.

• Reaching attendance growth goals at all meetings. Branch attendance increased by 30%.

• Holding more than 25 Business of Medicine programs.

• Holding a seminar on reducing administrative hassles with insurance companies through the use of Web portals.

• Developing a health insurance contact grid.

• Coordinating 128 physician visits during the First Tuesday at the Capitol. We received an award for the highest county attendance in April.

• Hosting three Town Hall meetings to obtain input on Health System Reform proposals.

• Convening health care leaders from Harris and Galveston counties.

• Recognizing 10 local state legislators with Patient Care Champion awards.

• Increasing membership by 2.1%, reaching 10,900 total members.

• Creating a Young Physician Ambassador Program to involve more young physicians in our activities.

• Creating new networking formats at Branch and Young Physician meetings.

• Continued to maintain the lowest dues structure among metropolitan county societies.

For more details on any of these activities or accomplishments, visit www.hcms.org or call HCMS at 713-524-4267.

What a year it’s been! It has been a true privilege to serve you. We had great participation throughout the year by our members as we dealt with the many challenges and opportunities that face us. Without the strong volunteer participation of our members none of this would be possible. For that dedication and commitment, I thank you from the bottom of my heart. I also want to thank all of our tremendous HCSM staff for their exceptional work this year as well. Finally, please join me in congratulating Dr. Bill Gilmer as our next president and the great team you have elected to serve on the Executive Board for next year.

In Memoriam

Dr. Cynthia Y. Rieniets, a radiologist, died Nov. 4. She had been a member of HCMS for 12 years.

Dr. Clyde E. Hesse, a pulmonologist, died Nov. 19. He had been a member of HCMS for 51 years.

Dr. Caroline S. Johnston, a family medicine physician, died Nov. 24. She had been a member of HCMS for 18 years.

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Do You Twitter? Follow TMA

As part of its work to explore new communications technologies, Texas Medical Association (TMA) regularly publishes on Twitter, the hot, 140-character "micro-blogging" service.

Twitter is a free service that lets you keep in touch with people and organizations through the exchange of quick, frequent answers to the simple question: What’s happening?

Join today to start receiving TMA’s tweets on practice management tips, news, and political chatter. Go to http://twitter.com/texmed.

Medserv Spotlight

Hiring staff?

HCMS’ service company, the Medserv Employment Services Division, provides free resources to HCMS practices conducting staff searches in house. Resources include:

• Employment Resources Guide: If your practice conducts staff searches internally, this guide can direct you to information about completing criminal background checks, drug testing, Texas employment laws, and much more.

It also provides strategies to help you successfully integrate your new hire. When hiring an employee, a practice is making an investment. This guide can help start your relationship with your new hire on the right track, so your investment pays off.

• Nurse Practitioner Agreements: When a physician delegates prescriptive authority and other aspects of medical care to an Advanced Practice Nurse, Texas law requires you to have an agreement on site. This information can guide you in creating an agreement for your Advanced Practice Nurses.

• Greater Houston Medical Office Salaries: This information is compiled from the starting base pay of positions filled directly through Medserv by medical practices who hired in the Houston area in the past 12 months. This document can be used to evaluate salary trends, staff retention and hiring decisions.

If you would like to receive any of these useful resources for your in-house searches or would like more information on how Medserv can conduct searches for you, contact Teosha Blaylock at 713-526-7378, ext. 235, or teosha@medserv-hcms.com.

Scam H1N1 registry

The Centers for Disease Control and Prevention (CDC) is warning Americans that e-mails encouraging them to register with an H1N1 flu vaccine registry are part of a scam that could leave those who provide their personal information with a virus on their computers. According to Dr. Megan Davies, state epidemiologist in North Carolina, "We have no [registration] requirement for anybody, and neither does the federal government, in any way, shape or form. People can just show up if they want a vaccination."

Vaccines are distributed to Texas physicians only through the Texas Department of State Health Services’ Web site, www.texasflu.org Patients should call their usual health care provider and if he/she does not have the H1N1 vaccine, then use the flu vaccine locator service on www.texasflu.org.

Ask TMA Knowledge Center

All TMA members can use the Texas Medical Association (TMA) Knowledge Center for help with payment, coding and billing, workers’ comp, legislative/advocacy information, TMA seminars, and more. Its experienced staff can answer all your questions and help you out with any number of situations in your practice. Below is a sample question from the Knowledge Center.

Q. Where can I find a list of conditions, illnesses, and events that I am required to report?

A. The list of conditions, illnesses, and events that health care professionals are required by law to report include communicable diseases, trauma events, gunshot wounds, controlled substance overdoses, immunization reporting, child abuse, and adult/elderly abuse. To request a copy of the detailed list of reporting rules, including information on how to file reports, contact TMA Knowledge Center at 800-880-7955 or knowledge@ texmed.org.

‘HOT’ Member Benefit

Find products & services for your practice

Looking for services/products for your practice, such as accounting, financial, or legal, medical collections, auto leasing, discounted magazine subscription, computer discounts, etc.? HCMS and TMA have a list of vendors to start your search.

For a database go to www.hcms.org and click on Medserv (in the left column) and Practice Resources. For a list of TMA endorsed services, go to www.texmed.org and click on Membership/Benefits and Services/Endorsed Services.

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Business of Medicine

Get your office ready for 2010

Use the below check-off list to help your practice continue to run smoothly in the new year. If you know of additional items that could be added to this list that would help your colleagues, please let us know and we will share them in upcoming issues! Fax your suggestions to HCMS at 713-528-0951 or e-mail at webadmin@hcms.org.

Check-off list:

• Checking eligibility and benefits for all payers, especially on Medicare and Medicaid patients.

• Verify patients’ referrals and authorizations are within effective dates and do not need to be renewed.

• Ensure that front-end staff are asking for a copy of the insurance card on the first visit each year and comparing it to the old card. Also, make sure old information in the system is deactivated and add the new information. The insurance company may stay the same, but the product, copays and deductibles may have changed.

• Check deductibles owed from patients due to the new year.

• Begin gathering tax information for your practice.

• Send out 1099s to independent contractors. (Make sure you have W-9 information in your file prior to sending.)

• Review your staff salaries and health insurance, if it is done on a calendar basis.

• Make sure you send out W-2s to your staff on or before Jan. 31, 2010.

• Order 2010 chart labels.

• Formulate the 2010 weekend on-call calendar.

• Update your files (staff, patients, vendors, etc.) for changes in names, insurance, addresses, phone numbers, dependent care, immunizations, etc.

• Be sure that the 2010 CPT, ICD-9 and HCPCS codes are updated in the system. This also includes deleting codes that are no longer usable in 2010.

• Be sure your EMR is updated to 2010 information.

• Educate your staff on the changes.

• Be sure that the Medicare 2010 fee schedule is loaded into your system.

• Check Medicare and Medicaid for any 2010 policy changes.

• Assess billed charge fee schedule for appropriate changes.

• Reformat superbills, encounter forms, etc., by adding new codes and deleting old codes.

• Review your insurance contracts and fee schedules to ensure they are appropriate for your business.

• Review all forms, standardized letters and any other documents for needed updates (i.e., change date from 2009 to 2010).

• Update office policies and procedures and educate your staff.

• Check HIPAA, OSHA and OIG compliance for updates and have your staff review and sign.

• Check all your insurance policies for renewal (medical liability, Workers’ Compensation, general/commercial liability, E&O/D&O, etc.).

Beware! Check charity legitimacy

As the holiday season approaches, we begin to open our hearts and wallets to those in need. Here are some tips to ensure the charity you give to is legitimate:

• Check stationery to make sure it has an address and telephone number on it. Beware if only a post office box and no telephone number are given.

• Ask for a copy of the organization’s 501C (3) tax-exempt status letter to ensure gifts to it are tax deductible.

• Verify if the charity is registered to solicit. Call the state’s attorney general’s office at 1-800-621-0508. This is not an endorsement. It means the organization has filed the proper paperwork.

• Never give cash. Write a check to the organization using its full name.

• Do not give phone solicitors personal information, such as credit card information.

• Ask the charity for a copy of its annual report so you can review its finances and programs.

• Beware of charities with similar names to ensure that you are giving to the one you had in mind.

• When in doubt, contact the Better Business Bureau at www.bbb.org.

Business of Medicine1

Don’t skimp on these things when reducing costs

Many practices feel the sting of unfilled appointments caused by patients who have lost their jobs and insurance coverage. Since this ultimately slows down revenue, practices must begin to look for ways to shave overhead expenses. However, be sure to take a cautious approach about reducing costs so you don’t compromise efficiency or patient service.

Here are six things not to skimp on:

1. Facility Maintenance. Maintain a clean and professional setting. Some low-cost fixes could include new paint and upholstery and carpet cleaning.

2. Staff. Staffing costs can be a large percentage of the practice revenue, so it is vital to hire good employees and pay them what they are worth. You can help control costs by making sure overtime pay is kept to a minimum. Invest the time to train your new staff properly as soon as they start their jobs. Also, provide them with the tools they need to do their job faster and more efficiently. This will promote better work flow and should result in less errors, improved staff confidence, and better patient service.

For help in finding quality employees, you can contact Medserv, the service company of the Harris County Medical Society. Medserv prescreens candidates according to your needs. The prescreenings include personalized interviews, skills assessment testing, credential verifications, and criminal background checks. Contact Medserv at 713-526-7378 or e-mail info@medserv-hcms.com.

3. Technology. You do not have to break the bank with big investments in technology when money is tight. However, you can invest in low-cost, high benefit technology, such as an automated patient reminder system or an automated payroll system. Both will save time and cut down on errors. The costs must be weaved into a future operating budget. A good plan will ensure investment in the right technology at the best price.

4. Ideas. Talk with your staff about how your practice can better manage costs. You may be amazed at some of the ideas your staff can bring to the table. Shifting to efficient light bulbs was one office’s approach to reducing costs. In another office, looking at material waste resulted in reducing the cost for dry goods by 5 percent.

5. Customer service. Good customer service begins with being friendly with patients. Remember to always introduce yourself to new patients; greet all patients properly on arrival; and make eye contact and nod when passing a patient in the hallway. Continue your excellent customer service by making follow-up appointments and referrals before patients leave your office. And, provide lab and biopsy results to patients promptly. A friendly service does not add to your expenses; it increases your revenue.

6. Communication. Keep communication open, honest and timely. Have regular staff meetings and make daily communication more effective through the use of e-mail and instant messaging. Communicate well with patients at the time of their appointments, making sure physicians and staff watch for visual cues. Ensure that patient needs are met before the end of the visit by asking “Is there anything else we can do for you today?”

Source: Physicians Practice and Medserv
Presented by the HCMS Board on Socioeconomics

Medical Practice Listings

Would you like to receive more referrals from your colleagues, let others know of procedures performed, languages spoken, or office locations? We have a new resource for you.

Medical Practice Listings is a member service in its second year. It's designed to enhance the use of the Harris County Medical Society/Houston Academy of Medicine Pictorial Roster as a patient referral tool for your practice. Medical Practice Listings are located in the Pictorial Roster immediately following and as a companion to the "Physicians by Specialty" section, allowing you to include more information about your practice—details that you cannot include in the individual biographical listing due to space limitations. See the current listings starting on page 77 of the 2009 Pictorial Roster.

The listing content is entirely of your choosing within generally accepted medical ethics. HCMS will provide you a form to fill out exactly as you want the listing to appear.

The cost of the listing is $200. Listing copy and full payment must be received by Dec. 31, 2009.

The 2010 Roster is due to be released in April 2010, with an annual circulation of 12,000. For more information, visit the HCMS Web site at www.hcms.org and click on “New Membership Benefit” in the right margin, or call Holly Smith at 713-526-7378, ext. 274.

HCMS Aeros Day

Buy one – Get one free

Members and their families and friends are offered discounted tickets to the Houston Aeros games on Sunday, Jan. 3 at 4:05 p.m. (Houston Aeros vs. Abbottsford Heat) and on Sunday, Feb. 14 at 4:05 p.m. (Houston Aeros vs. Chicago Wolves).

Get the second seat free with these: lower end-zone seats at $21, corner seats at $26, and club/center-ice seats at $34. To reserve your seats, call Ravi Dubey at 713-361-7934.

Gov. Rick Perry to speak at TMA Winter Conference

Join your friends and colleagues at The University of Texas at Austin AT&T Conference Center Jan. 29-30 in Austin for TMA’s 2010 Winter Conference. Hear Gov. Rick Perry speak on access to care and the future of health care delivery and a best-selling author discuss how to change when change is hard.

Regardless of your interest from advocacy to leadership to health care trends, January’s conference on Leadership for Changing Times offers many opportunities to grow and learn, and earn CME credit. This year it will be held at The University of Texas at Austin AT&T Executive Education and Conference Center, just north of the TMA building.

TMA’s special room rate is $159 for a single or double. Reserve a room by calling the conference center at (512) 404-1900, and ask for the TMA Winter Conference discount, or reserve your room online (visit www.texmed.org, then click on Calendar at the top). The housing reservation deadline for this special rate is Thursday, Jan. 7. Sleeping rooms are subject to a 15-percent occupancy tax rate. Local sales tax is 8.25 percent.

Register at www.texmed.org or contact TMA at 800-880-1300, ext. 1410, or kim.harmon@texmed.org for more information.

Find CME online

Locate CME credit by going to the HCMS Web site, www.hcms.org, and click on “CME” at the top of the page. You can browse home study and online courses that offer CME and ethics CME offered through the Texas Medical Association.

Patient-physician relationship Web seminar

Texas Medical Liability Trust (TMLT) has a Web seminar, which is only available to TMA members. Physicians who listen to “Patient-Physician Relationship” Web seminar can purchase the “Medical Records – Consent for Treatment of a Minor” Web seminar and the “Professional Courtesy” Web seminar for $49 each. TMLT policyholders who complete all three Web seminars will earn a 3-percent discount (not to exceed $1,000) which will be applied to their next eligible policy period.

How does it work?

Step 1: Go to www.texmed.org and click on Practice Management then on Distance Learning Center to download the handouts and evaluation form.
Step 2: Listen to the Web seminar session on Distance Learning Center.
Step 3: Complete and return the evaluation form.

To claim CME credit for this course, you must return the completed evaluation via fax to 512-370-1693 or mail to: Texas Medical Association, Attn: Patient-Physician Web Seminar, 401 W. 15th St., Austin, TX 78701-1680.

CME credit is available for the period of July 30, 2009 to Dec. 31, 2011. Please complete and return the evaluation form prior to the expiration date.

The TMA designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit^TM. This activity has been designated as 1 hour of ethics and/or professional responsibility education.

Public Health Focus

Availability of H1N1 vaccine

The Novel H1N1 flu vaccine is being distributed exclusively through the Texas Department of State Health Services (DSHS). It is not too late to register to receive a shipment from DSHS. To register go to www.texasflu.org. If you are not planning to register for the vaccines, you can direct your staff and patients toward resources where H1N1 vaccination is available.

First, direct individuals to their physicians. Other options include the various clinics open to the public. DSHS recently announced that it is using the Google-powered Flu Vaccine Locator service to help people find the H1N1 vaccine (and the seasonal flu vaccine) in their communities. The Flu Vaccine Locator can be found at www.texasflu.org. By placing a city or zip code in the Flu Vaccine Locator box, a list of H1N1 vaccine providers appear. Those providers may limit H1N1 vaccine availability to those in the CDC-recommended vaccine priority groups, especially until the vaccine supply is more plentiful. DSHS urges the public to check with a listed provider to confirm that information presented in the locator is accurate and current concerning hours, dates, locations, eligibility, and vaccine availability. Providers may experience supply disruptions or run out of the vaccine. Although providers cannot charge for the vaccine itself, they may charge a fee to provide the vaccination. The maximum fee allowed varies with location but ranges from $19.20 to $21.03.

Check out www.hcms.org for more information on H1N1, including an updated flyer on H1N1, and links to other helpful Web sites.

DSHS urges H1N1 vaccine providers to target all priority groups

With H1N1 vaccine availability increasing, the Texas Department of State Health Services is now urging providers to target all priority groups for the vaccine. This includes the addition of anyone five through 24 years of age.

The priority groups are:

• Pregnant women;
• People 6 months through 24 years of age;
• People 25 through 64 years of age with high-risk health conditions;
• Health care workers who provide direct patient care; and
• Those in close contact with infants 6 months or younger.

These groups were established to help protect those most at risk. Providers continue to have the responsibility to determine who should be vaccinated and whether priority groups have been adequately served in their practices and communities.

Source: DSHS
Presented by the HCMS Community Health Improvement & Communications Committee

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December 15, 2009