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October 9, 2006
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TOA
President's
Update
David Teuscher, M.D. |
By
David Teuscher, MD
President, Texas Orthopaedic Association
The
common public perception is that diseases and conditions of
the musculoskeletal system do not require the level of
attention and urgency devoted to those of human organ
systems such as the heart. But musculoskeletal complaints
were the No. 1 reason patients visited the doctor in 2004.
One in seven physician visits is for a musculoskeletal
condition, and around 28 million cases are reported every
year. The economic burden is more than $2 billion annually.
Combine that with the pain and suffering of these conditions
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and
you easily can see that a renewed focus on the health of
bones and joints is overdue.
October
12-20, 2006 is Bone & Joint Week. President
George W. Bush and Governor Rick Perry have signed a
proclamation designating the years 2002-2011, as the Bone
and Joint Decade. In fact, the declaration is endorsed by
all 50 states and 60 foreign nations. Orthopaedic surgeons,
rheumatologists, physical therapists and medical and patient
health associations worldwide will join together for Bone
and Joint Decade to advance understanding and treatment of
musculoskeletal disorders through prevention, education and
research.
How
does this affect our patients? Chronic musculoskeletal
conditions are responsible for one in every three physician
visits. Women over 50 years of age have a 50 percent chance
of enduring an osteoporosis-related fracture, and men have a
25 percent risk. More than half of the 40 million Americans
with arthritis are under the age of 65. Each year, three of five physician visits for injuries are
related to the musculoskeletal system, and musculoskeletal
conditions and deformities deprive children of a normal
development. These are important statistics that have real
meaning in the lives of our patients.
From
arthroscopy and minimally invasive surgery to powerful new
medications and gene therapy, our ability to treat and
restore the human musculoskeletal system continues to
astound. Celebrate bone and joint health in your community
this week. You can access more information at the United
States Bone and Joint Decade or the American
Academy of Orthopaedic Surgeons websites.
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On The TOA
Radar Screen: Trailblazer's Analysis of Your Billing
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Veiled as an “educational tool to alert you to potential problems with documentation and billing,” you may have received a similarly worded letter from Trailblazer (the CMS contracted intermediary for Texas) regarding your billing practices. CMS maintains that an unacceptably high percentage of benefit dollars have been paid in error for Evaluation and Management (E/M) services. Thanks to members’ alerts, this letter and its attached “Comparative Billing Report” have shown up on the TOA radar screen.
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Consequently, we need to know what percentage of our membership Trailblazer has “found through statistical analysis to bill the CPT codes 99201-99205 in a significantly different pattern as compared to their peers during July through December 2005.” This could be a real problem. This could be a subtle way of encouraging physicians to under-code.
Many members have responded to this article from last week’s TOA E-Connect. We will continue to collect responses and will run the article again for those of you who haven’t had the chance to contact us. When we have gathered more information, we will take this issue to Trailblazer. Discussions with TMA and other specialty groups are taking place so they can let us know if their memberships are receiving Trailblazer’s Comparative Billing Report.
Once again, we are asking you to look at these codes for the same time period. Please let us know if you think their numbers are correct and your Comparative Billing Report is accurate. If your office cannot compare this information, TMA’s coding expert,
Teresa Devine, can assist. Please email her and ask how you can send her this information to be HIPAA compliant. You are also encouraged to go to the TMA website and use their “Hassle Factor Log.”
Members may continue to contact Donna
Parker, TOA Executive Director via email. All replies to this issue will be held in confidence.
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Liability
Reforms Helping Sick and Injured Texans
Ladon W. Homer, M.D. |
By
Ladon W. Homer, MD
President, Texas Medical Association
Sick and injured Texans now have more physicians who are willing and able
to give them the medical care they need closer to home thanks to the
state’s 2003 health care liability reforms according to the results of a new Texas Medical Association survey.
We announced these results on the third anniversary of the liability
reforms and Proposition 12. This is our “anniversary present” to the
people of Texas: The reforms have worked. They’ve lived up to their
promise. |
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This is also a reminder to all Texas physicians. It reminds us of what we
can achieve when the many voices of medicine speak out clearly with one
message on behalf of our patients. It reminds us that the 2003 liability reforms were good medicine, the
right medicine, for Texas. Gov. Rick Perry, the Texas Legislature, and the
voters reined in the epidemic of health care lawsuit abuse. We now have a much healthier and robust system that is much
better at giving Texans the medical care they need.
The online survey of 1,154 physician members of TMA found that since
September 2003:
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Doctors
find it much easier to recruit new physicians to their communities, even
among high-risk specialties and in the “lawsuit war zones” of south
and east Texas.
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Texas
physicians are much more likely to accept patients with complex or
high-risk problems, and many feel comfortable offering their patients new
services.
From the Uvalde family physician who is still delivering babies to the
Tyler ophthalmologist providing charity care to the huge Houston clinic that has invested millions in a state-of-the-art electronic medical record
system, Texas physicians rushed to tell us how the liability reforms have helped them help their patients.
As it should be, Texas physicians’ No. 1 challenge is how to cure the patient, not how to avoid a frivolous lawsuit.
The Texas Medical Board is anticipating a record 4,500 applications for new physician licenses this year. That is 40% increase from in 2005, which
had been the board’s busiest year on record. Texas Medical Board Executive Director Donald Patrick, MD, JD, said the success of Texas’ liability
reforms is the “only one viable hypothesis” to explain the huge increase.
The TMA survey bolsters that analysis. Of the 117 survey respondents who were not practicing in Texas in September 2003, 90% say the Texas
professional liability climate was “very important” or “somewhat important” in their decision to begin practicing in Texas and 83% say the
current liability climate for physicians in Texas is “much better” or “better” than the state from which they came.
Other
key findings from the survey include:
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Texas
physicians say the 2003 liability reforms have made it much easier for
them to recruit new physicians to their communities, even among high-risk
specialties
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Since
the 2003 liability reforms and the passage of Proposition 12, Texas
physicians are much more likely to accept high-risk patients and offer new
services or procedures.
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The
professional liability climate for Texas physicians has improved
significantly since the passage of the 2003 liability reforms and
Proposition 12.
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Texas
District by District: Dianne White Delisi
Dianne
White Delisi |
Dianne White Delisi is a Texas Legislator, representing the people of the
55th District in Bell County. She was first elected to the Texas House of
Representatives in 1990.
Now serving her eighth term, Representative Delisi is the chairman of the
Committee on Public Health and a member of the Committee on Public
Education. Her previous committee work includes ten years on the House
Appropriations Committee, including four years as its vice-chairman. |
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Representative Delisi has authored noteworthy legislation in the areas of
education, transportation, and healthcare, and has been honored for her
efforts on these issues. She has been recognized by Texas Monthly as one
of its “Ten Best Legislators" in both 2003 and 2005. Delisi also earned a
Champion for Free Enterprise award from the Texas Association of Business
in 2005 and a Citation for Exceptional Service in National Defense for
2004 by the Association of the United States Army.
Representative Delisi received the Dr. Nathan Davis Award for Outstanding
Government Service as a State Representative from the American Medical
Association in 2005.
A fifth generation Central Texan, Representative Delisi graduated from
Temple High School, received her B.A. at Southern Methodist University,
M.A. at the University of Colorado, and a Certificate of Special Studies
at the Episcopal Theological Seminary of the Southwest. She has two
children and two grandchildren.
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Texas Work Comp Crisis Solution Is Here Now!
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Texans now have access to specialty medical services through the
Physicians Cooperative of Texas, a Physician-Sponsored Certified Work Comp
Network recently approved by TDI! |
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The Physicians Cooperative of Texas “PCTexas” announced today that the
Commissioner of Insurance of the Texas Department of Insurance has
approved PCTexas for certification as a Workers Compensation Health Care
Network. PCTexas is currently certified in DFW, Austin and San Antonio,
and is expanding to cover the entire state of Texas.
Currently, Texas is in an access to care crisis when it comes to finding a
specialist, usually an Orthopedic Surgeon, that is willing to accept an
injured worker because of the hassle factors associated with the old
failed system. Some of the major problems with this issue have been for
our police officers and firefighters in certain geographic areas. The new
HB7 Work Comp Network reforms require employers to be contracted with a
network. These regulations also allow employers or their carriers to send
an injured employee on an as-needed case by case basis to a network that
has made arrangements with their participating providers to accept these
patients. PCTexas is such a network and if you notice their provider panel
diversity of specialists, they have been more successful at recruiting
these specialist compared to the other certified networks.
Dr. Stephen Norwood, Orthopedic Surgeon and co-founder for PCTexas said,
“The current and historical adversarial relationship between Managed Care
Networks, Employers and Payers has interfered with the Provider-Patient
relationship which should simply be more focused on clinical outcomes. It
is time for a change in this delivery system to promote this quality,
especially in an era of Physician shortages in Texas. Our vision is for
the PCTexas Physician Sponsored model to shape the attitudes of both
payors and employers to improve their collective perception that they
greatly need high-quality Providers; and to deliver what is required to
keep the best and brightest providing those healthcare services for
themselves and their employees.”
Changes in our health care system are occurring in response to market
forces for cost control, to regulatory initiatives on cost and quality,
and to consumer demands for quality care and greater flexibility in
provider choice. The PCTexas Physician Sponsored approach for a new and
improved healthcare delivery system offers high quality appropriate
medical services that are easily accessible resulting in improved clinical
outcomes, return to work and cost savings. This model has a high respect
for its participating providers and, together, they focus on clinical
outcomes. PCTexas Providers have a more involved interest in the best
medical treatment practices of injured workers and are partners with
PCTexas in reducing unnecessary costs associated with treating work injuries and improving clinical outcomes. PCTexas has
selected the Official Disability Guidelines “ODG” treatment guidelines to
help assist their providers in this effort at a more standardized
treatment plan. PCTexas is committed to developing the best proven tools
to meet these goals for quality and to meet the needs of their providers,
patients and employers.
Creg Parks, PCTexas Chief Executive Officer stated, “We have created the
Physician Sponsored model based on the leading Managed Care delivery
systems in the US. Studies indicate that this model is successful because
the Networks primary focus is on the high quality delivery of healthcare
services and a higher respect for the Providers which provide these
services.”
If you are interested in more information about PCTexas or the latest
update on the Texas Workers Compensation reforms and how the Physician
Sponsored Network option may benefit you, please visit the Physicians Cooperative of Texas
website.
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Bone and Joint Decade National Action Week, Oct.
12-20
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