April 16, 2007

 

 
TOA Executive Director's Update
  

By Donna Parker
Executive Director, Texas Orthopaedic Association

 
We want to thank our TOA members who are taking the time to fill out our brief surveys. The latest survey on workers' comp billing and collections (silent PPOs or "ghosting") indicates there is a larger problem than we initially thought. We would like to thank Dr. Stephen Wilson for submitting this short survey. The results are very interesting. Click here to view the Survey Results.

Please take a look at the TOA Home Page and review the items in the Headlines - Quick Links box. You will find the surveys at the bottom of the boxed information. We encourage our members to voice their opinions and let your concerns be known by the TOA Leadership.

Other Texas Orthopaedic Association Surveys:
TOA Member Survey
Diagnostic Examinations of Joints Performed on MRI Units Survey
Trailblazer Survey
Key Contact Survey
On Call Survey

If you have not registered for the 2007 TOA Annual Meeting May 10-13 at the Austin Four Seasons Hotel please do so NOW! You can view the entire program and register here. The Four Seasons' cut off date was last week but you may still be able to obtain the TOA price - so make your reservations by calling 512-478-4500 today.
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Texas District by District: Veronica Gonzales
 
  

State Representative Veronica Gonzales was first elected in November, 2004 to represent District 41 in the Texas House of Representatives. District 41 is contained entirely in Hidalgo County and includes portions of McAllen, Edinburg, and Mission. Representative Gonzales sits on the Judiciary, and Public Health Committees. She is the first female elected to represent District 41.

Representative Gonzales distinguished herself during her first session

among her colleagues by passing the highest percentage of bills by any Democrat legislator in the House and was subsequently recognized as Freshman of the Year by the Mexican-American Legislative Caucus and named a legislator to watch by the Texas Observer and as an Emerging Leader by the Dallas Morning News.

Representative Gonzales was raised in San Marcos, Texas. She is the eldest daughter and has two younger brothers.  As the first in her family to go to college, Gonzales understands the importance of a quality education.  To remain close to her family, she attended Southwest Texas State University. She earned Bachelor of Arts degrees in English and Spanish while working full-time and graduated cum laude 1986. After completing her undergraduate studies, she enrolled in the University Of Texas School Of Law and earned her Doctorate of Jurisprudence in 1991.

Following graduation and being admitted to the Bar, Representative Gonzales moved to McAllen and began practicing law at Jarvis and Kittleman, P.C. where she became a partner after only four years.   She joined her partners to create a successful firm where she continues to practice law at Kittleman, Thomas & Gonzales, LLP.

During the 80th Legislature, Rep. Gonzales has filed legislation that would restore full health coverage for the Children's Health Insurance Program (CHIP), promotes prevention of STDs and reduces unplanned pregnancies through increased access to preventative health care services and education programs.  She also filed legislation that requires any seller to disclose if they have knowledge that the house was previously used as a methamphetamine lab.  This bill would protect not only any buyer from the hazardous long-term effects of toxic residue, but the realtor from liability from selling the house.

Her commitment to youth advocacy has made Rep. Gonzales a popular featured speaker at commencements and student functions at South Texas College government panel and Young Texas Democrats at UTPA.  At the Capitol, she has visited with countless students to encourage civic participation and involvement with student government. Representative Gonzales is a member the American Heart Association and supports local community advocacy causes such as the Miracle Riders Bicycle Team, which raises awareness and supports research for histiocytosis.  She serves as an Education Advisory Board Member for South Texas College and as an Advisory Counsel Member to Texas Rural Legal Aid. Rep. Gonzales is active in  McAllen Hispanic Chamber of Commerce and has been recognized by the Veterans of Foreign War and the South Texas School District Association for community involvement.

Email Veronica Gonzales to thank her for her work!
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This Week In Texas: Mignon McGarry Memos

By Mignon McGarry
TOA Legislative Advocate / Memos: Thu Apr. 12 & Tue Apr. 10, 2007
TOA Online Version: All Memos

 

April 12, 2007, Thursday
The Senate took up their version of the budget bill today. The debate was considerably shorter than the 16 hour House budget debate, largely

because of the Senate’s practice of not introducing floor amendments on budget bills.

Present to vote on the budget was Senator Mario Gallegos (D-Houston), who has been recovering from a liver transplant back home. This was his first appearance on the Senate floor since opening day.

The Senate approved the budget by a vote of 26 to 5.  It now heads to a conference committee made up of five Representatives appointed by the Speaker and five Senators appointed by the Lt. Governor. The identity of the ten conferees is still up in the air.

Meanwhile, intense negotiations continue at the committee level in both the House and Senate. House committees have until the first week in May to get bills out of committee and set on a House calendar before May 8th, the date the last House Calendar with House bills must be printed and distributed.

The Senate has roughly a week more to get Senate bills out of Senate committees.

As these deadlines approach, bills heard on the House or Senate floor quickly become potential vehicles for legislation still languishing in committee.


April 10, 2007, Tuesday
It is now the fourteenth week of the session and the pace at the Capitol will increase steadily until we run out of road on May 28.

Although this legislature has broken the record, established in 1999 when George W. Bush was governor, for the number of bills filed, the constitution only requires they pass one—the budget. The Senate Finance committee passed their budget bill out of committee today and we expect it to be heard on the Senate floor Thursday.

Late last week, the question about how much money is on the table for the budget was clarified somewhat when the state reached a tentative settlement in Frew v. Hawkins, the 14 year old class action lawsuit regarding the claim that Texas did not provide adequate care to children enrolled in the Medicaid program.

The latest figure we have on the state’s settlement is $706.7 million over the upcoming two year budget cycle. This sum is significantly better than the multi billion dollar amounts being bandied about at the beginning of the session.

The final agreement is due to federal Judge William Wayne Justice on April 27, but both sides told the judge in a hearing Monday that they were satisfied with the settlement.

At issue now is whether the judge will require a June hearing to review the state’s budget to ensure settlement funds are secure. The state says it’s not necessary but the plaintiffs would like one. Judge Justice adjourned Monday’s hearing without ruling on it.

Meanwhile, another issue impacting this budget is Texas’ 2007 Water Plan. Legislators are currently wrestling with how to address the recommendations from regional and state planners to spend $30.7 billion over the next decade on a new round of reservoirs, pipelines and other infrastructure needed to stretch our water resources.
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Workers' Compensation Update
 
  

By Steve Norwood, MD

According to most pundits, the current legislative session was not supposed to be a “Comp Session”.  After all, the previous passage of HB7, the omnibus Comp legislation of the decade, should have solved enough problems for a while.  To the surprise of many, over 50 bills have been filed related to Texas workers' compensation.  Many of these bills probably have little relevance to practicing orthopaedic surgeons.  Most of this legislation represents clean-up activity related to the HB7 implementation.

Nonetheless, a handful of the bills, if passed, could actually benefit our members and our patients.  Representative Helen Giddings, chair of the House Business and Industry Committee, has personally sponsored bills that would require all peer review to be performed by Texas licensed providers.  This means that peer reviewers will be accountable to the Texas Medical Board and the Texas Department of Insurance.  In addition, at our request, she added legislation to require same specialty peer review.  This should decrease some of the hassle factor of having to communicate with reviewers not trained in our specialty.  These bills have passed in the House and moved to the Senate.

TOA Drs. Andy Kant and Stephen Wilson have crafted legislation, filed by Representative Garnet Coleman, which would prevent comp carriers from later denying pre-authorized medical and surgical services, and improving several time-frames for filing claims.

Other interesting bills attempt to prevent kickbacks or inducements, and require all participating Third Party Administrators to be certified by the Texas Department of Insurance (to prevent Silent PPO or Ghost network activity).  We will continue to closely monitor the activities of the legislature the next several months.  Stay tuned and strongly consider participating in the TOA May meeting where we will all be updated on the latest Texas politics as well as hot topics in Workers' Compensation.

Helpful Links

  • Click here to view the Top 10 TOA Workers' Compensation Bills.

  • The Texas Department of Insurance (TDI), Health and Workers’ Compensation Certification and QA Division has published the third issue of WCNet News.  To view the current issue, click here.

  • Click here to view the results from the TOA Silent PPO Survey.

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Important Information about the CMS Physician Quality Reporting Initiative (PQRI)
  
By David S. Nilasena MD, MSPH, MS 
Chief Medical Officer Centers for Medicare & Medicaid Services
Email: david.nilasena@cms.hhs.gov

As the Chief Medical Officer for CMS Region VI,  I am writing to make sure that you are aware of the Physician Quality Reporting Initiative (PQRI) which will begin July 1, 2007. This initiative, which was created through the Tax Relief and Health Care Act of 2006 (TRHCA), is a voluntary program that will provide a financial incentive to physicians and other eligible professionals who successfully report quality information related to services provided under the Medicare Physician Fee Schedule between July 1 and December 31, 2007. I wanted to bring a few key aspects of the program to your attention.

  • This program includes a broader set of health professionals than physicians. A number of other practitioners and therapists are eligible to participate and potentially qualify for the financial incentive. The complete list of eligible professionals can be found here.  

  • The reporting of quality measures for this program will use the current claims processing system. Eligible professionals who wish to participate must include the appropriate specified quality-data codes on claims for services paid under the Medicare Physician Fee Schedule and provided between July 1 and December 31, 2007.  They must also include the correct NPI number on these claims in order for the reporting to be counted. Information about obtaining an NPI can be found here.

  • Each eligible professional will need to identify the quality measures which are applicable to their practice and the patients they treat. A list of the measures with detailed specifications for the 2007 PQRI program can be found here.

  • An overview of the program and other resources such as FAQs and a PowerPoint presentation can be found at the main PQRI website.  This site will be updated frequently with the latest information about how to participate in PQRI.

  • The Centers for Medicare & Medicaid Services (CMS) will host the second in a series of national provider conference calls on the 2007 Physician Quality Reporting Initiative (PQRI).  This toll-free call will take place from 1:00 p.m. – 3:00 p.m., EDT, on Thursday, April 19, 2007. To register for the call, participants need to click here and complete the registration by 1:00 PM ET on April 18th.

I hope you will review the above information and share it with the physicians, practitioners, and therapists within your organization. As a key health care leader in this region, you can more directly reach a large number of providers who could benefit from participation in this program. The July 1st start date is approaching quickly and our goal is to make sure that all eligible professionals have the opportunity to participate in the PQRI program this year. If you have any questions, feel free to contact me at the number below. Also, if there is a better contact person within your organization responsible for provider communication and outreach, I would be happy to correspond directly with them in the future. We plan to send regular updates about the PQRI program to our key regional contacts as we approach the July 1st implementation.

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Department B: Are You Ready?
 

By Voncil Webb, CPC, CPC-H
Senior Consultant

Are your physician’s ready for PQRI documentation?  July is fast approaching and the new Medicare Physician Quality Reporting Initiative soon begins.  Using the CPT Category II codes or HCPCS “G” Codes physicians will report on the quality of patient care.  The final specifications on reporting have yet to be published; however a few categories include:

  • Screening for Fall Risk

  • Osteoporosis: Communication with the Physician Managing Ongoing Care Post Fracture

  • Stroke and Stroke Rehabilitation: Consideration of Rehabilitation Services

  • Screening for Therapy for Osteoporosis for Women Aged 65 years and older

  • Osteoporosis Management Following fracture

  • Osteoporosis Pharmacologic Therapy

  • Osteoporosis: Counseling for Vitamin D, Calcium Intake, and Exercise

You can find additional guidelines for the 2007 PQRI on the CMS website.   
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2007 TOA Annual Meeting Update - Agenda For The Workers' Compensation Seminar
 

Register today for the TOA Annual Meeting!

For reservations, call the Four Seasons Hotel at 512-478-4500!

Hurry! The Reservation Cut-Off Date is Friday, April 20th.  Click here to register.  Workers' Compensation Update Seminar agenda below.

 

Friday, May 11, 2007

   
1:00 – 2:00 pm

Welcome – Opening Remarks

WCRI Overview
David Teuscher, MD – President, TOA

DWC: Where It Is Today and Where It Is Headed
Albert Betts – Commissioner, DWC

Office of Injured Employee Council – How Can Physicians Help?
Norman Darwin, Public Council

   
2:00 – 2:30 pm

Legislative WC Update – Plugging the Holes in HB 7
Representative Burt Solomons / Bonnie Bruce
Andrew Kant, MD
Greg Herzog – TMA Lobbyist

 

   
2:30 – 3:00 pm

Workers’ Compensation Networks – Are They Working?…Will They Work???
Creg Parks & Stephen Norwood, MD – Physicians Cooperative Network
Edward Smith, DO – North Texas Innovative Healthcare Network, Inc.
Donna St.Claire – Omni Health Systems
Jennifer Aherns, JD – Associate Commissioner, DWC

Alternative to Workers’ Comp – The Non-Subscriber Option
Steve Bent – Texas Association for Responsible Non-Subscribers

   

3:00 – 3:10 pm

Break

     

3:10 – 3:20 pm

The Role of the Medical Advisor in WC
Howard L. Smith, MD – DWC Medical Advisor

   

3:20 – 4:00 pm

May 1….Preparing for the Change: Treatment Guidelines & Disability Management
Michael Reed – Texas Medical Association
Chuck Whitacre – DWC
Howard L. Smith, MD – DWC Medical Advisor

   

4:00 – 5:00 pm

House Bill 7 and Workers Compensation Spinal Treatment with focus on DWC rules of Disability Management and Treatment Guidelines
Moderator:  Stephen Wilson, MD

Appeals Panel decisions concerning Compensability and Extent of Injuries
Dan Berry, Esq.

Physical Therapy Treatment
Addressing treatments within the purview of ODG, and
Applying medicare rules and billing practices
Matt Zurek, PT

The Benefits of the Disability Management Rules
Bill Nemeth, M.D.

Orthopedic care of workers compensation spinal injuries within the parameters of ODG and EBM
James Walter Simmons, M.D.

Liability issues for Treating Doctors and Designated Doctors Administrative violations and the State Board of medical examiners
TBA

Panel Questions and Answers
Disability Management
Liability

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