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TOA
Executive Director's
Update
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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. |
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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
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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
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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
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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
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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
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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
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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
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Click
here to view the Top 10 TOA Workers' Compensation Bills.
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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.
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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)
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By David S. Nilasena MD, MSPH, MS
Chief
Medical Officer Centers for Medicare &
Medicaid Services
Email:
david.nilasena@cms.hhs.gov
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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.
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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.
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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.
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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.
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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.
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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?
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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: |
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Screening for Fall Risk
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Osteoporosis: Communication
with the Physician Managing Ongoing Care Post Fracture
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Stroke and Stroke
Rehabilitation: Consideration of Rehabilitation Services
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Screening for Therapy for
Osteoporosis for Women Aged 65 years and older
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Osteoporosis Management
Following fracture
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Osteoporosis Pharmacologic
Therapy
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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
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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. |
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Friday, May 11, 2007 |
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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 |
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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 |
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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 |
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3:00
– 3:10 pm |
Break |
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3:10
– 3:20 pm |
The Role of the Medical Advisor in WC
Howard L. Smith, MD – DWC Medical Advisor |
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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 |
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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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