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TOA
President's Update
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By
David Teuscher, MD
President, Texas Orthopaedic Association
The good news I have for you today, is that there is now a
light at the end of the tunnel for workers comp. We are now
enduring the fourth year of living under the tyranny of an
artificial price control scheme in the form of the Texas
Workers Compensation Medical Fee Guideline (MFG), placing
the maximum allowable fee at 125% of current Medicare
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rates. Rather than updating and revising the MFG as dictated in Texas
statute every other year beginning in September of 2005, the Texas
Department of Insurance (TDI) and its Department of Workers
Compensation (DWC) are now over 30 months overdue.
Fortunately, the many
meetings and correspondence we have had with TDI Commissioner Geeslin
and DWC Commissioner Betts has finally resulted in their admission
that there is a problem. In a recent meeting, they have acknowledged
that the current MFG has had a negative impact on access to care for
injured workers, as well as impairing the market forces needed for
formation of workers comp networks as called for in HB7. In fact, the
Commissioners have published a Rule Development Schedule for revision
of the MFG by October of 2007. You can view the document on the TOA
website by clicking
here.
You may not realize it, but
the MFG applies to all non-network and out-of-network professional
services you provide, whether you are on the Approved Doctor List (ADL)
or not. Surprisingly, comp coverage is optional for employers in
Texas, but is mandatory for all physicians. Even if you are not on the
ADL and think you are out of the comp system, you must accept the
current fees as payment in full if you see such a patient in an ER/on
call situation and provide care. It is my opinion that this amounts to
legalized stealing of your services without your permission or by
contract, simply because you do the right thing for the injured
patient.
In previous communications
with you, I have indicated that there are independent studies
confirming that Texas surgical services are grossly underpaid in the
comp system compared to other states. We will continue to press the
TDI and DWC for fair surgical fees for the expert and skilled work you
provide to injured workers, and the great job you do restoring them to
maximum employability.
Rest assured that we know
that the fees are not the only problem with the broken system, and we
will seek to achieve a comprehensive solution. To their credit,
Commissioners Geeslin and Betts are taking a proactive approach to
reform, as reflected in the document listed above. I encourage you to
read it in its entirety, and become familiar with the rules and
potential changes ahead as you evaluate your decision to remain on the
ADL and/or to join a workers comp network.
I remain cautiously
optimistic and our volunteer leadership team will be vigilant during
the rule making process to ensure that fairness prevails, hassles are
reduced, and your get paid a fair amount for your services on time.
For more information on this and the many changes in the comp system,
be sure and register for the Workers Compensation Seminar on Friday
May 11th, at the TOA Annual Meeting in Austin by clicking
here.
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Texas
District by District:
Juan "Chuy" Hinojosa
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State
Senator Juan "Chuy" Hinojosa proudly represents the people
of District 20 in the Texas Senate.
During
the 79th Session, the Senator successfully passed
legislation to protect Texans from identity theft and
increase penalties for identity thieves. He also passed
legislation to create the Texas Forensic Science Commission
to ensure that Texas' forensics labs properly process
criminal evidence. Hinojosa also passed SB 425, which limits
the
development of colonias in Nueces County by requiring
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before
land is sold to homebuyers. And to honor our veterans, he
passed legislation to create a monument to Vietnam veterans
on the State Capitol grounds.
During
the 78th Session, the Senator passed legislation to
strengthen restraining orders used to protect families from
domestic violence, and he authored numerous bills such as SB
1934, which increased the representation of the Port of
Corpus Christi, expanding the South Texas economy.
Senator
Hinojosa served in the Texas House from 1981 to 1990 and
from 1997 to 2002, where he passed landmark legislation
establishing the Regional Academic Health Center (RAHC)
which promotes physician training on the Texas/Mexico
Border. As the Chairman of Criminal Jurisprudence, the
Senator sponsored the Texas Fair Defense Act, reforming
procedures for providing court-appointed defense counsel to
indigent defendants.
As a
member of the Senate Finance Committee, Senator Hinojosa
secured $84.7 million for the construction of new facilities
at universities in District 20. He has also fought hard to
ensure that South Texans are charged fair utility rates and
has advocated for the rights of working families to enroll
their children in state-supported health insurance.
Hinojosa
served his country with distinction in the U.S. Marines as a
squad leader in the Vietnam War from 1966 to 1968. In 1974,
he received his law degree from Georgetown University. After
returning to South Texas, he served as staff attorney for
the Legal Aid Society of Nueces County and as an Assistant
Attorney General for the Office of the Attorney General.
Hinojosa started his own private practice in McAllen in
1980.
Senator
Hinojosa was twice named one of Texas' "Top 10 Legislators"
by Texas Monthly magazine, and he was named "Legislator of
the Year" by the National Organization for Women. In 2005,
he was recognized as a Legislator of the Year by the
Justices of the Peace and Constables Association of Texas,
and he received the John Henry Faulk Award from the American
Civil Liberties Union. In 2006, Senator Hinojosa was awarded
the Public Servant of the Year Award by the Texas Coalition
of Texans with Disabilities.
Occupation:
Attorney
Education: BS Pan American University, JD Georgetown
University
Legislative Experience: House member,
1981-1991/1997-2002; Senate member (2002)
Hometown: Mission
Party: Democrat
Email
Juan "Chuy" Hinojosa to thank him for his work!
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This Week In Texas: Mignon
McGarry Memos
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By Mignon McGarry
TOA Legislative Advocate / Memos: Thu Mar. 15 & Tue
Mar. 13, 2007
TOA Online Version: All Memos
March 15, 2007, Thursday
Both chambers passed high profile legislation this week.
On Wednesday the Texas House voted 118-23 in favor of HB 1098,
the bill that would
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overturn Gov. Rick Perry’s
executive order mandating the HPV vaccine for girls before they enter
the sixth grade. It will now move to the Senate where there is an
identical bill, with over half the Senate signed on as sponsors.
On Thursday, the Senate unanimously passed a package of three electric
regulation bills, all authored by Sen. Troy Fraser (R- Marble Falls),
the chairman of the Senate Business and Commerce committee.
To give you an idea of the flow of legislation this past week, here are
some statistics:
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Total number of bills reported out of Senate Committees this week: 58
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Total number of bills passed by the Senate this week: 72
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Total number of bills reported out of House Committees this week: 85
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Total number of bills passed by the House this week: 46
The House Appropriations committee wrapped
up their work on a budget bill and turned it over to the Legislative
Budget Board to get an official fiscal note. The bill should be ready
for floor debate by March 26. The Senate will finalize their own version
of a budget bill in the next week. Both bills will ultimately be
reconciled in a conference committee.
March 13, 2007, Tuesday
A grand total of 5,921 bills
were filed by close of business Friday. There were 3,977
House bills and 1,944 Senate bills filed. It will take the
rest of this week and possibly into next week for
all those bills to be
referred to committees.
The Texas Constitution requires that
all bills be referred
to and reported by a committee in both houses before
becoming law, but committees are not required to consider
all legislation referred to them. A majority of bills die in
committee, with some bills never receiving a committee
hearing and others left pending until a deadline kills them.
The committee chair decides which bills will be heard in
committee.
Bills must receive a favorable
committee vote to reach the House or Senate floor. Once a
bill has been passed by one chamber and moves to the other,
its odds of passage improves greatly. Altogether it’s easier
to kill a bill than to pass one, which is good news if
you’re playing defense.
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Department B: All Systems Negative
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When
completing the review of systems during an evaluation and
management service, it is best practice to eliminate the
statement “all other systems negative”. Discussions have
arisen regarding the use of such statement and although it is
acceptable to state “all other systems are negative” all
systems reviewed must be identified by either writing the name
of the system or checking a box on a form. This helps to
identify how many and which systems were reviewed in order to
determine if the ROS was pertinent, extended or complete. It
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important to
remember the review of systems is a question and answer session
pertinent to the chief complaint.
Obviously, if there
is nothing positive or pertinently negative about the remaining systems
the examiner need only identify as stated above.
Contractor medical
reviews have found that a single statement saying all other systems
negative without actually mentioning the name(s) of the remaining
systems reviewed has shown in review of medical records that higher
levels were being billed when work has not been shown to have been
performed. This is not a guideline produced within a manual therefore
the allowance of such statement in documentation remains carrier’s
discretion.
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Urgent - AAOS Needs
Your Help Again!
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Last week, we sent you a
request to complete surveys for the upcoming RUC meeting.
We have more codes that we
need your help on.
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CPT codes for several Orthopaedic
procedures were recently approved for inclusion in CPT 2008.
We now need to value these new codes under
the Medicare Resource-based Relative Value Scale (RBRVS) to reflect the
work and other resources involved in providing these procedures.
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External Fixation |
Computer Navigation |
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Three-Column Osteotomy |
Epicondylitis Procedures |
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Femoral Head Fracture Treatment |
Arthroscopic Biceps Tenodesis |
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Posterior Malleolar Fracture Treatment |
Open Knee Osteochondral Autograft |
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Fibula Malunion |
Open Osteochondral Talus Graft |
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Subtalar Arthroscopy |
Application of Cranial Tongs |
If you do these types of procedures,
the AAOS needs your help to properly value them. And we need your help
very quickly!
Please contact AAOS staff member Matt
Twetten at 847-384-4338 or via email at
Twetten@aaos.org, to get information on the surveys, including how
to complete them online. They’re fast, simple and will provide
essential information for the Medicare system.
Thank you in advance for your
assistance!
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