• TOA President's Update
• Texas District by District: Tom Craddick
• 2006 General Election Update
• Are you receiving your consultation request in writing?
• TOA Work Comp Seminars to be held in Dallas and Fort Worth

TOA President's Update
  

By David Teuscher, MD President, Texas Orthopaedic Association This past Wednesday I participated in a panel discussion on the Texas Workers Compensation Reforms in HB7 at a seminar held in Boston by the Workers Compensation Research Institute (WCRI). The WCRI announced completion of their research which conclusively proves that the Texas Workers Compensation Medical Fee Guideline (MFG) surgical

fee schedule of 125% of Medicare is the fourth lowest of any state.  Worse yet, they found that the prices actually paid for surgery in Texas in 2004 were the worst among 24 states in their study; roughly 50% of surgical prices in the median state. The 125% paid for E&M services is actually the median of the states studied, but 205% of Medicare is the median for surgical services.

The panel discussion included Texas Department of Workers Compensation (DWC) Commissioner Albert Betts, Office of Injured Employee Counsel Norman Darwin, and five representatives of the insurance industry. WCRI members are industry, insurance, and governmental agencies, but I was treated respectfully despite being the only physician in the room. The forum allowed me to describe the frustration, hassles, denials, and no pay/slow pay environment that we are all burdened with in Texas comp, as well as illustrate the many ways that the new networks are offering adequate choices for injured workers and place too great a geographic burden on specialty care access.

The WCRI studies also confirm that medical costs were declining in Texas prior to HB7.  Falling surgery and radiology costs were an important reason, as were fewer visits per claim. Chiropractic visits per claim also fell by nearly 15% for the two years prior to enactment of HB7, yet chiropractic utilization was among the highest of the states studied prior to HB7. I attribute the former to the drop out of orthopaedists on the ADL when the MFG was slashed to 125% of Medicare in 2003, and the latter to the work of the Medical Quality Review Panels (MQRP) to reign in the gross over-utilizers.

As your President, I am fully committed to working with the new DWC to fix the many unfair and antiquated practices of the now extinct TWCC, and to enact a culture of fairness and respect for physicians as we work with insurers and employers to repair, restore, and return injured Texas workers to their jobs. I have asked Commissioner Betts to immediately revise the MFG to reflect a 205% of Medicare payment for surgical services, which is the median among the other states in the WCRI study. The revision of the MFG was due in September of 2005 and every two years by statute. Making this move now will be a good faith gesture to the physician community, and force the networks to negotiate in good faith if they want the “best of the best” physicians and surgeons in their networks. It would have the additional positive impact of paying you fairly for out of network surgery you perform as part of your ER call duties as mandated by EMTALA.

What do I ask of you? Contact your Texas state representative and state senator now with your stories of hassles. Do not let them think that comp was “fixed in 2005” with HB7, and we need their help in January when the new legislature convenes. Secondly, if you have a specific complaint, you or your patients can file an online complaint on the Texas Department of Insurance website. Please print a copy of your complaint and send it to TOA so that we can be aware of your difficulties and represent you better. Likewise, we've created forums to discuss Worker's Compensation Fees and Hassles.  Click on the forum you'd like to enter: Fees or Hassles as these links will take you directly to the forum after logging in to the TOA website.  As George Washington noted, “There is but one straight course, and that is to seek truth and pursue it steadily.”
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Texas District by District: Tom Craddick
    

Tom Craddick's rise to the Speaker's seat parallels the growth of the Republican Party in Texas. On January 11, 2003 he made state history when he became the first Republican Speaker.  Craddick's leadership gave the 78th Legislature much of its impetus for success. After his first session, Craddick helped the state overcome the budget shortfall while producing model ethics, insurance, tort and transportation reforms. Given his successes in these arenas, Craddick was overwhelmingly re-elected Speaker in 2005.

During the 79th Legislative session, he again led the House in passing a solid budget that brought more money to schools, health care and public safety.  Tom Craddick has spent his adult life serving his fellow citizens in the Texas House of Representatives. His tenure is characterized by landmark events. In 1971 he gained respect from both sides when he joined a bipartisan group of reformists dubbed “The Dirty 30” that pushed for changes in House Ethics. In 1975, Speaker Bill Clayton appointed Craddick as the first Republican committee chairman in 100 years. Since his election as Speaker, Craddick has demonstrated an appreciation for diversity and bipartisanship by appointing a record number of women and minorities as chairmen.  In addition to his distinguished career in the legislature, Speaker Craddick is also a successful businessman. He is a sales representative for Mustang Mud, an oilfield supply company, owns Craddick Properties, a Midland investment business, and is president of Craddick, Inc.  Craddick holds both a Bachelor of Business Administration and a Master of Business Administration from Texas Tech University. In 1995, his alma mater honored him with a prestigious Distinguished Alumni Award. He is also an Eagle Scout who has held numerous civic posts in his hometown of Midland.  Craddick and his wife, Nadine Nayfa a native of Sweetwater, have two children, Christi and Thomas Russell, Jr., and one grandchild, Tripp. Email Tom Craddick to thank him for his work! [top] [back to e-card archive page]

2006 General Election Update

Are you receiving your consultation request in writing?
  

A reminder that the 2006 consultation documentation guidelines require one of the following: 1) You as the consulting physician receive a written request for consultation from the requesting provider OR 2) You as the consulting physician document a verbal conversation between yourself and the requesting provider for the consultation on each patient.   Either of these documentations should be kept in the patients’ medical record. [top] [back to e-card archive page]

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