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TOA
President's
Update
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By John T. Gill, MD
President, Texas Orthopaedic Association
Please mark your calendars and plan to attend the TOA
Socioeconomic Summit at the Driskill Hotel in Austin,
August 10-11, 2007!
On
Friday, August 10th
there will be a Capitol Visit by our members in the afternoon
to kick off the general Summit program. You and your |
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family are also
invited to join us during the evening reception for TOA members, Texas
leadership, and orthopaedic industry sponsors.
We will present The Business of Orthopaedics for 4th
& 5th year residents on Friday, August 10th from
10:00 am to 3:00 pm. Our 5th annual practice management
course was specifically developed for orthopaedic residents although
it could be interesting to our members who are new to their practice.
Dr. David Teuscher and Dr. Eddie Seade will conduct the
course.
Saturday’s session,
August 11th,
will be filled with socioeconomic issues as well as a legislative
updates, work comp news and discussions on national health care
reform. Along with these issues, TOA is developing a new public
relations campaign to promote bone and joint health in Texas and there
will be corresponding media training.
Exhibit space is first come, first serve, so hurry and reserve your
space today for the TOA Fall Meeting. Click
here for the Exhibit Space and Event Application.
Save the date for
the TOA Socioeconomic Summit. We hope to see you in August.
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WC Net News -
June 2007
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The Texas
Department of Insurance (TDI), Health and Workers' Compensation
Certification and QA Division has published the fourth issue of
WCNet News. To view the current issue, click
here.
The purpose of
this publication is for the TDI to provide helpful information that
will facilitate the understanding of certified workers' compensation
networks for all system participants. |
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Through WCNet News, we will provide noteworthy information
about certified workers' compensation networks, give tips
for applicants, and improve communication between
applicants, providers, interested parties and TDI. The information contained in this newsletter
should be helpful to all parties and will clarify questions related
to certified workers' compensation networks.
The
current issue contains articles regarding the following
topics:
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Disability Management Information and Training
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Provider Workshop
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Employer Workshop
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Update Regarding Independent Review Requests
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Telephone Access Requirements
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Accessibility and Availability Requirements for Networks
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Subsequent Notice of Network Requirements
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Network Applicant and Provider Open Conference Calls
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Frequently Asked Questions (FAQs)
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Calendar of Events
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Worth Repeating - Study: P4P Didn’t Improve Hospital Care
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A study published in the June 6 edition of the Journal of the
American Medical Association finds no significant difference in
quality of care improvement between hospitals that received financial
pay-for-performance (P4P) incentives and hospitals that participated
in a purely voluntary initiative. Researchers analyzed the cases of
105,383 patients with acute non–ST-segment elevation myocardial
infarction at 54 hospitals taking part in a national P4P incentive
program and 446 control hospitals.
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They found a slightly higher rate of
improvement for two (aspirin at discharge and smoking cessation
counseling) of six targeted therapies at pay-for-performance vs. control
hospitals. Yet there was no significant difference in a composite
measure of the six rewarded therapies between the two hospital groups.
One of the study’s authors stressed that the survey results do not
necessarily mean that P4P doesn’t work, only that more study may be need
to be done to find its optimal implementation.
For more information click
here. The abstract of the survey can be viewed
here.
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TDI/WC Issues To Pre-Authorization Rules
Questionnaire
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The Texas Division of
Workers' Compensation is working on addressing issues related to the
pre-authorization rules as they interact with the new disability
management rules.
In preparation for an
upcoming meeting related to pre-authorization rules, DWC would
appreciate it if you would complete and return the attached
Preauthorization Questionnaire to them by next Tuesday, June 12. |
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Please e-mail the survey to DWC at
jaelene.fayhee@tdi.state.tx.us, please CC a copy to
michael.reed@texmed.org
as well. If you have any questions, you can call DWC's Jaelene Fayhee
at 512-804-4406. To download the questionnaire in MS Word format -
please click
here, in PDF format - please click
here.
Preauthorization Questionnaire
1.
Volume of preauthorization requests for treatment outside the
treatment guidelines (please express in terms of requests per week or
month).
2.
Types of services now subject to preauthorization due to 134.600
(p)(12). Estimate percentage of requests for:
Office Visits
Pharmaceuticals
Radiologic diagnostics
Other (please enumerate)
3.
Are the preauthorization requests for treatment outside the
guidelines in essence a "treatment plan" or is the request limited to a
specific service?
4. Are
physicians/health care providers and/or carriers using ODG's UR Advisor,
and if so, how?
5. How are
physicians/health care providers and carriers using MDA in the claims
administration process?
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