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March 1, 2007
Welcome to the Harris County Physician Newsletter Online!
In this issue. . .
TMA's Winter Conference
Spring Business Expo
Installation photos
Delivering Medicines' message
President's Page
In Memoriam
Ledger
News and Updates:
Raising funds
It's a big deal
CME Seminars
BRAIN exhibit
At the Capitol
AMA honors Dr. John P. McGovern
Holding Company
Targeting Physicians
HIPAA Update
Member Mentions
Business of Medicine
Classifieds
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TMA’s Winter Conference: Preserving physicians’ practices
Nearly 700 TMA member physicians and medical students gathered in Austin for the Texas Medical Association’s Winter Conference. The Texas Legislature and preserving the economic viability of Texas physicians’ practices were the main topics of conversation. Two state lawmakers were the featured speakers. House Public Health Committee Chair Dianne White Delisi (R-Temple) spoke on the state’s push for interoperable health information technology systems, Medicaid reform and the funding needs of medical schools and graduate medical education. State Rep. Patrick Rose (D-Dripping Springs), chair of the House Human Services Committee, outlined his multipronged proposal to make health insurance companies more accountable and more transparent to patients and physicians.
HCMS President Dr. Michael V. Kelly II and HCMS President Elect Dr. A. Tomas Garcia III met with presidents and president elects from 17 other Texas county societies at the end of the conference. The leaders outlined their plans for the year and areas where TMA could assist. Dr. Kelly requested that TMA assist with the managed care companies’ flawed attempts to measure quality, providing adequate funding for the Texas Medical Board, and prohibiting chiropractors from performing school physicals.
TMA pushes for more licensing resources
Since HCMS and TMA successfully advocated for Proposition 12 and the 2003 liability reforms, Texas has ranked the highest of any state for curbing frivolous lawsuits, according to a report by Pacific Research Institute. Consequently, thousands of new physicians are coming to Texas, but the flood of new license applications has drowned the understaffed Texas Medical Board (TMB). Instead of processing routine license applications in six weeks, TMB is taking nearly nine months.
TMA leaders met with TMB Executive Director Donald Patrick, MD, to discuss the licensing backlog and what TMA can do to help. TMA will urge the Texas Legislature to appropriate a much larger share of physicians’ license fees to TMB. Over the past biennium, the state collected nearly $55 million in physician license fees but used only about $15 million to run TMB. If you know of some good physicians forced to sit on the sidelines waiting for their new license, contact by email jennifer_snyder@hcms.org or fax the information to HCMS Communications at 713-526-1434, for the Medical Society’s records and for possible stories in the media.
Medserv Spotlight
HCMS Spring Business Expo
Get ready for the Spring 2007 HCMS Business Expo on Saturday, April 14, at Reliant Center, 9 a.m. to 3:15 p.m.
Attendance at the Expo and seminars is free to physicians who are members of any Texas county medical society and their office staff and families. The Expo offers many products and services for the physician’s office, seminars for CME credits, door prizes, networking opportunities, and more.
The free seminars are:
• Legislative Briefing, 9:15 to 9:45 a.m., by Dan Finch, director of Legislative Affairs at TMA.
• EMRs and Risk Management, (one hour of ethics CME), 10:15 to 11:15 a.m., by Dr. David Bauer. Dr. Bauer will discuss medical record documentation and how EMRs can assist in diagnoses and treatments, serve as a communication tool among multiple caregivers, and provide a snapshot of the physician’s medical decision-making process to justify payment of services. He also will discuss how EMRs can lower risk exposure, while increasing efficiency and decreasing expenses.
• Texas Overview of Part D Medicare (noon to 1 p.m.) one hour CME seminar by Dr. Abraham Delgado, medical director at TMF Health Quality Institute and Jim Turpin, quality improvement consultant at TMF Health Quality Institute.
• Avoiding the Courthouse: Ten Practice Pitfalls, (one hour ethics CME), 1:45 to 2:45 p.m., by Stacey Agnew, risk management department manager at Texas Medical Liability Trust. This seminar is for physicans of all specialities who are interested in practical ways to reduce the potential for malpractice liability.
For more information, visit www.hcms.org and click on the Expo box in the right hand margin.
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Installation photographs
Photographs of the Harris County Medical Society/Houston Academy of Meidcine Installation of Officers are ready for viewing. To view or order photographs, visit the HCMS Web site at www.hcms.org.
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Delivering Medicines' message
Nearly 200 physicians and Alliance members from around the state invaded the Capitol in their white coats on Feb. 6 during TMA’s First Tuesdays at the Capitol. Their mission was to preserve patient care in Texas.
Twenty-nine physicians and Alliance members represented the Harris County Medical Society. After a short briefing on the key issues, the physicians and Alliance members headed off in teams to meet with their elected representatives.
The House Gallery filled up with white coats as Gov. Rick Perry gave his State of the State address. The governor acknowledged the doctors in the Gallery several times during his speech.
During the day, the groups were able to visit the offices of every state representative and state senator from Harris County. They talked to them about transparency and the problems with managed care in Texas. They stressed the need to take advantage of federal matching funds for Medicaid programs such as Childrens’ Health Insurance Program (CHIP) and Graduate Medical Education (GME). They urged legislators to protect the successful medical liability reforms of 2003 and to oppose expanding the scope of practice of those who want to practice medicine but have not gone to medical school. The elected officials had various interests and our teams of physicians were well prepared and ready to talk about anything.
Meeting back at the TMA offices found physicians with aching feet and tired tongues, but feeling well rewarded for their efforts. New relationships were made and some old ones rekindled. Medicine’s message was delivered loud and strong. Several legislators mentioned that they look forward to First Tuesdays because that was when they hear the real stories of medicine in Texas.
Sign up now for one or more of the remaining First Tuesday dates: March 6, April 3 and May 1. Be a part of the team that tells legislators how they can preserve patient care in Texas. For more information or to sign up, go to www.hcms.org.
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President's Page - Dr. Michael V. Kelly II
Medicaid and CHIP...What to do?
Did you know that 700,000 uninsured children in Texas are eligible for, but not enrolled in, Medicaid or the Children’s Health Insurance Program (CHIP)? Why? This is occurring because the Texas legislature has refused to use all the Medicaid funding available under current federal law. Consequently, since 1998, Texas has forfeited $832 million in federal CHIP funds to other states.
Unfortunately, reimbursements are often less than the cost of providing the care. Consequently, only 38 percent of Texas physicians are currently accepting new Medicaid patients. And, this number has been steadily declining from 67 percent in 2000, so even patients with insurance have difficulty accessing medical care.
A physician medical home is the most cost effective way to deliver care. Medical homes for Medicaid and CHIP patients are grossly inadequate, driven largely by physician reimbursement rates that have not been increased since the early 1990s. Rebuilding the physician network is absolutely critical to the state’s efforts to increase preventive care, improve treatment of the chronically ill and reduce inappropriate emergency department visits.
Inadequate Medicaid reimbursement not only defeats the state’s efforts to assure all Medicaid patients receive care in the most cost-effective manner, but it also shifts costs to other insureds, increases employers’ health care premiums and reduces access to emergency departments for everyone.
The Texas Medical Association in collaboration with the Texas county medical societies has formulated a legislative agenda for the Texas legislators. The agenda is as follows:
• Promote a medical home for Medicaid and CHIP patients by adopting a five-year plan to assure competitive reimbursement rates. In 2008-09, the plan would:
• Restore the 2.5 percent cut in physician fees enacted in 2003; and
† Increase fees by an additional 10 percent across-the-board in 2008 and 2009.
† Support integrating Medicaid well-child care services (Texas Health Steps) into the patient’s medical home.
• Restore 12 months continuous coverage for children’s Medicaid and CHIP.
• Promote an adequate supply of future primary and specialty care physicians by restoring state funding for Medicaid graduate medical education.
If these ideas are to be implemented, we need to get involved. Our legislators need to hear from you about your patients and your problems with Medicaid and other legislative issues. Call them, write e-mails or, best yet, sign up for First Tuesdays at the Capitol (March 6, April 3, May 1) and tell them in person how they can preserve patient care in Texas. Sounds like a good plan. What do you think?
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In Memoriam
Dr. Marc Moldawer, an endocrinologist and diabetes specialist, died Feb. 7. He had been a member of HCMS for 48 years.
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Ledger
Members who have information about these physicians should contact a member of the Board of Ethics by March 8. Members are: Dr. Philip A. Matorin, chair; Drs. Judi A. Shaw-Rice, Richard D. Jablonski, Fred M. Sutton, Gary J. Sheppard, and William J. Riley
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CANDIDATES FOR VOTE: March 8, 2007:
Mark S. Adickes, MD
James E. Baumgartner, MD
Kerri M. Charles, MD
Madhuri Chilakapati, MD
Cynthia L. Cotton, MD
Eric C. Eichenwald, MD
Catherine M. Gannon, MD
Juan A. Garcia, MD
Paul A. Guttuso, MD
Kimberly Hawkins, MD
Shannon M. Hawkins, MD
Glenda G. Hickman, MD
Stephen J. Incavo, MD
John L. Jefferies, MD
Alphonse E. Mehany, DO
Conrad R. Murray, MD
Mark A. Murray, MD
Selvarani Nallusamy, MD
Michael J. Pawlik, MD
Jochen Profit, MD
Robert E. Rakel, MD
Victor F. Rodriguez, MD
Arlene O. Siefker-Radtke, MD
Elias M. Stephan, MD
Durga P. Sunkara, MD
Eric S. Tait, MD
Cole T. Thomson, MD
Jocelyn Tinsley Greely, MD
Jennifer K. Youngblood, MD
Nikolaos M. Zacharias, MD
Michael E. Zwillman, MD
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INTERN/RESIDENT/FELLOW:
Kristin L. Bussey-Smith, MD
Jabeen F. Naqvi, MD
Bernhard Suter, MD
MEMBERSHIP TRANSFER/WITHDRAWS:
Michael A. Berry, MD
Martni A. Boyd, MD
Robert J. Chiu, MD
Stanley D. Gertzbein, MD
Larry C. Gilstrap, III, MD
Frederick E. A. Griffiths, MD
Elizabeth Half, MD
Kathleen A. Hunzicker, MD
Emmie H. Ko, MD
Misba S. Lateef, MD
Michael D. McKinney, MD
Rita S. Mezzatesta, MD
Michael J. Miller, MD
Uday K. Reddy, MD
Jeremy C. Roebuck, MD
Ali R. Shahen, MD
Michael P. Wenzel, MD
Georgios Ziakas, MD
Laurel E. Zollars, MD
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News and Updates
Raising funds for HFM’s exhibit to inspire youth
The Houston Medical Forum has launched a fundraising campaign for an online exhibit of the history of Houston’s African-American medical community. To Bear Fruit for Our Race, the title of the exhibit, comes from a quote by Dr. J. Edward Perry who stated in 1947 at the opening of the Houston Negro Museum “our beginning is humble, but through hard work we’ll bear fruit for our race.”
The exhibit will be viewed online and will be incorporated into the Junior High and High School curriculum to inspire students to choose careers as physicians and display how African-Americans overcame adversities to become physicians and leaders in the medical community. The exhibit has been developed in partnership with the University of Houston Center for Public History and the John P. McGovern Museum of Health & Medical Science.
For more information, contact Houston Medical Forum President Dr. JoAnne Rogers at 713-980-0414 or joannemd@flash.net. To make a donation in support of the exhibit, send a check payable to Houston Medical Forum Museum Project, P.O. Box 20448, Houston, TX 77225-0448 or online at www.hmfonline.org and send joannemd@flash.net an email for confirmation of the donation.
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CME Meetings
The HCMS branch societies provide ethics CME credit and networking opportunities as well as exceptional information to help your practice. To attend a meeting, make your reservation online at www.hcms.org and click on “Meeting RSVPs” in the left-hand margin or call HCMS at 713-524-4267.
SOUTHWEST BRANCH
6 p.m., Thursday, March 8
Avoiding the Courthouse: Ten Practice Pitfalls
Tanya Babitch, TMLT
1 Hour Ethics CME
BraeBurn Country Club
CENTRAL CITY BRANCH
6 p.m., Tuesday, March 27
Sex, Drugs & Rock n’ Roll
Cynthia Marcotte Stamer, JD
Trevisio
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At the Capitol
One Down, 181 to go
After listening to the Governor’s State of the State address, many physicians were excited to hear Gov. Rick Perry talk about so many health care issues. In his address, he discussed Medicaid reform, cancer funding, the uninsured, Childrens’ Health Insurance Program (CHIP), new medical schools, Graduate Medical Education (GME) funding, childhood obesity, nursing, trauma funding, and finding more money for the Texas Medical Board. It is good to know that our issues have gotten the governor’s attention; however, it’s the folks in the big pink building who will ultimately decide what happens.
The TMA is currently tracking 550 bills that would affect medicine in Texas. Some of those catching our attention include:
• HB 1094 by Rep. Bryan Hughes is for patients with advanced directives. His bill would require life-sustaining treatment to be continued by a physician who is unwilling to comply with the directive until the patient is transferred to another physician or facility that is willing to comply with the directive.
• SB 468 by Sen. Rodney Ellis removes the “willful and wanton negligence” clause from the standard of proof for medical liability cases involving emergency medical care, making it much easier to prove a claim against a physician or health care provider.
• SB 290 by Sen. Jane Nelson adjusts the definition of a niche hospital. Her definition requires that niche hospitals be staffed by at least one physician who is board certified in emergency medicine and adds new reporting requirements for hospitals.
For more information, go to www.hcms.org or www.texmed.org. To sign up for TMA’s legislative updates, go to www.texmed.org/Template.aspx?id=3590.
Source: HCMS Board of Medical Legislation
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It’s a big deal in Big D! at TexMed 2007
TexMed 2007 is the Texas Medical Association’s premier conference, in which physicians from across Texas come together to learn, exchange ideas and rededicate themselves. Don’t miss the biggest event of the year ... TexMed 2007, April 26-28, in Dallas. As always, TexMed offers 120+ hours of free CME offerings.
For more information, go to www.texmed.org.
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BRAIN exhibit opens at Health Museum
The nationally acclaimed interactive exhibit, BRAIN: The World Inside Your Head, will be on view at the John P. McGovern Museum of Health & Medical Science, also known as The Health Museum, until May 6.
The limited-engagement exhibition for all ages, illustrates how the brain functions and malfunctions. Using innovative special effects, hands-on learning activities, video games, optical illusions, and interactive displays, BRAIN provides a hands-on and up-close look at the human body’s most essential and fascinating organ by exploring its development, geography and function. In the process, the exhibition makes brain-related disorders easier to understand. Visitors walk through a shimmering tunnel of flashing fiber optics that illuminates networks of neurons firing and communicating. The exhibit invites guests deeper into the brain to discover its basic workings and understand brain development and physiology.
The Health Museum is offering a variety of brain-related spring break activities, such as spring break camps for children ages 8-13 (March 12-16), Boy Scout two-day merit badge camps (March 13-17), speaker series, and special events, including a “Mind-Body Balance Day”-- designed to help de-stress your brain and relax your mind -- a Home School Family Science Day and brainy crafts throughout the week.
To supplement the exhibit, experts from Methodist Neurological Institute will present a series of lectures at The Health Museum. Admission to the speaker series is free with a general admission ticket. Lectures are:
• Sunday, March 11, 2 p.m., Dr. Priscilla Ray will present an overview of the history of mental illness;
• Wednesday, March 14, 2 p.m., Dr. Milam Leavens will discuss ways to protect the brain and maintain integrity;
• Thursday, March 15, 4 p.m., Dr. John Byrne will speak about memory, how it works and how it fails;
• Friday, March 16, 2 p.m., Dr. M. Alejandro Chaoul will speak about brain meditation; and
• Sunday, March 18, 4 p.m., Dr. Milam Leavens will discuss ways to protect the brain and maintain integrity.
For hours of operation, ticket or membership information, visit www.the healthmuseum.org.
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AMA Foundation honors Dr. John P. McGovern
Dr. John P. McGovern is the recipient of the 2007 AMA Foundation President’s Award. The award honors an individual who exemplifies the true spirit of the Foundation’s mission – to advance health care through dedication to medical education, research or public service. Throughout Dr. McGovern’s distinguished career, he has been an influential physician, educator, historian, humanitarian, and philanthropist.
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Holding Company
The Harris County Medical Society (HCMS) has a wholly-owned subsidiary, Medserv Inc., which provides services to physicians. Due to a 34 percent growth in Medserv’s staffing division, the division that helps physicians hire staff, Medserv has moved out of the HCMS offices. A new employee has been added to handle the increased physician de-mand. Medserv contact information is:
Medserv Inc.
3801 Kirby Drive
Houston, TX 77098
713.526.7378
There is another company in Harris County that HCMS believes is inappropriately using the name Medserve, Inc. Medserve, Inc. is a medical waste company that serves physicians and hospitals. This company was required by the Texas Secretary of State to file an assumed name to do business in Texas because the name Medserv (the name of the Medical Society’s subsidiary) was already taken. This company registered to do business in Texas under the name of Medserve Holding Company. We believe Medserve, Inc. was created with the merger of MedShred and Enserv.
The Medical Society’s Medserv Board of physicians has sent a cease and desist letter to Medserve Holding Com-pany, requesting it stop using Medserv’s name in Texas, but it has continued to use it in spite of the Medical Society’s request. Hopefully, this is not its method of dealing with its customers.
Member Benefit
Targeting physicians
Are you opening a new practice, joining a new practice, adding associates to your practice, relocating your practice, or promoting an educational program? HCMS can help you target your mailing pieces to the right physician audience through zip codes or specialties for these instances.
HCMS does not provide physicians’ information for any solicitation or commercial purposes. Member physicians receive the mailing label service at a discounted rate.
For more information, contact HCMS at 713-524-4267.
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HIPAA Update - NPI number
Documenting the assignment of your NPI
As a part of HIPAA compliance, the Centers for Medicare & Medicaid Ser-vices (CMS) is requiring that all physicians have their National Provider Identifiers (NPIs) in advance of the May 23, 2007, deadline. To date, more than 1.3 million NPI numbers have been issued.
Do you have your NPI yet? Use this documentation when you need to share it.
If you applied online for your NPI, the National Plan and Provider Enumeration System (NPPES) will e-mail a notification to you or the contact person identified in your application.
If you applied for your NPI using the paper form (CMS-10114), you (or the designated contact person) will receive a notification letter from NPPES. The letter will display logos for CMS and the NPI enumerator, Fox Systems.
If you applied for an NPI through an electronic file exchange organization (EFIO), you will be notified either by letter or e-mail. In some cases, the notification, which the EFIO generates, will go to the contact person; in others, it will go to you. An EFIO is an organization — a large group practice, for example — certified by CMS to send in batches of applications electronically.
Lost track of your notification? If you applied online or with the paper application, you can request that Fox Systems generate another NPI notification by calling 800-465-3203. If an EFIO handled your application, contact that organization for a copy of its notification.
Or you can log in to your NPPES account and print out a screenshot that displays your name, NPI, entity type, and NPI status. If you applied online, the first page you see when you log in to your account will be the screen to print. If you applied via paper or EFIO, click on “Create Login to View or Update Your NPI Data.” After successfully completing the Web log-in, you will see the screen containing your NPI number. The NPPES Web site address is https://nppes.cms.hhs.gov/NPPES/StaticForward.do?forward=static.npistart.
CMS has developed resources to help answer your NPI questions. These include an NPI Resource Sheet and NPI Frequently Asked Questions. For links to these and other resources go to http://www.hcms.org/template.aspx?id=27#NATIONAL_PROVIDER_IDENTIFIER.
Even if you do not file claims electronically and are not formally considered an “entity” under HIPAA rules, you will need to obtain an NPI number so that you can refer patients. Physician who receive your referred patients must provide the referring doctor’s NPI. If the treating physician is unable to provide the referring physician’s NPI, then the treating physician will not be paid for services. Share your NPI with appropriate parties. Additionally, in Texas a clean CMS 1500 paper claim will require an NPI number.
Source: TMA and CMS
Presented by the HCMS Board on Socioeconomics
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Member Mentions
Dr. Spencer R. Berthelsen was appointed by Gov. Rick Perry to the Texas Health Care System Integri-ty Partnership, an advisory group for the development of the Texas Health Care System Integrity Authority.
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Business of Medicine
Dollars and sense?
United Healthcare
LabCorp Exclusive - Effective Jan 1, 2007, United Healthcare reached a 10-year agreement with Laboratory Corporation of America (LabCorp) to be its single national provider for laboratory services. This change applies to United Healthcare and PacifiCare’s commercial book of business, Evercare and Secure Horizons. This does not apply to laboratory services provided by physicians in their offices.
How will physicians be impacted by this change?
• It is required;
• After March 1, 2007, continued referrals to non-participating laboratories may, after appropriate notice, subject the referring physician to one or more of the following administrative actions:
1. Financial penalty of $50
2. Change in eligibility for Premium Designation and Practice Rewards programs;
3. Decreased fee schedule; and
4. Termination of network participation, as provided in the Participation Agreement.
For more information on this topic, go to http://www.hcms.org/Template.aspx?id=389.
Modifier recognition delayed - Announced in the May 2006 Network Bulletin, modification to the United Healthcare Preventive Medicine and Screening Reimbursement Policy was approved, allowing a preventive medicine service and a problem-oriented E/M service for the same patient by the same physician on the same date of service to be separately reimbursed if the E/M code represents a significant, separately identifiable service and is submitted with modifier 25* appended.
The implementation of this policy revision was anticipated to occur during the first quarter of 2007. Unfortunately, due to claim platform issues, this policy change has been delayed, and implementation is now anticipated for December 2007. Until that time, under current United Health-care reimbursement policy, when a physician submits a claim for both a preventive medicine service and a problem oriented Evaluation and Management (E/M) service for the same patient on the same date of service, United Healthcare will reimburse one of the services. The service reimbursed will be the code having the higher current CMS Relative Value Unit (RVU) from the National Physician Fee Schedule (NPFS) Fully Implemented Non-Facility Total Value.
* Modifier 25 – Significant, separately identifiable E&M service by the same physician on the same day of a procedure or other service.
CIGNA
New contract - CIGNA is sending out new contracts. In the contract is an additional amendment on Workers’ Compensation. According to CIGNA staff, you do not need to sign the additional amendment if you are not going to take Workers’ Compensation and you will still be enrolled in its other products. You do have to write a letter to CIGNA (the address shown on the amendment) signed by the physician(s) stating nonparticipation in Workers’ Compensation. Physicians need to be aware that the Texas Workers’ Compensation system is moving to a network based system.
Aetna
MedSolutions – Effective March 1, 2007, MedSolutions will assume responsibility for precertification for all high-tech outpatient diagnostic imaging procedures for Aetna patients with commercial and Medicare Advantage benefit plans. This applies to MRI/MRA, PET scan, CT/CTA and nuclear cardiology. You can contact MedSolutions by phone at 1-888-693-3211, by fax 1-888-693-3210, or at its Web site, www.medsolutions online.com.
Presented by the HCMS Board on Socioeconomics
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