July 2, 2007
 

Picture courtesy of http://jsmagic.net/
Happy Independence Day!
 

 
TOA Executive Director's Update
  

By Donna Parker
Executive Director, Texas Orthopaedic Association

We have just a few housekeeping items to mention in this article which can help the TOA staff a great deal this summer.

Please go to the TOA website and login so you can access your member information.  If you are a first time user or if you haven’t been

to the website in a while, you should click on the "First time visitor" link underneath the TOA Socioeconomic Summit Banner to see some of the items we offer through the Association’s site.  If you have any difficulties with your website login, contact Ed Berg, TOA IT Manager at edberg@toa.org.

Once logged in, click on "My Account" and then "Update Information" to see what information we currently have and please make the appropriate changes in address, email or telephone numbers, so that we can make sure your TOA account record has the latest information.  Our last mailing with 3rd notice dues invoices had many non-deliverables.  TOA Bylaws require payment of dues by July in order for a member to be in good standing.  If we don’t have the correct information, your correspondence from TOA is not reaching you.  Please help keep us updated!

Many of our Associate Members have their ABOS certification now and will need to be changed to Active status.  Please notify me at donna@toa.org and we will see that you receive your Active TOA Membership Certificate, as well as make sure your file lists you as Board Certified.  You can find your membership status under the Pay Dues feature in the My Account menu.  (AC=Active and AS=Associate).

Once you are logged in and have checked that your information is correct…you may want to pay dues online if you have not paid for 2007.  This is a simple feature available to you through accessing your account, once you have gotten past the login.  Go to "My Account" and note the "PAY DUES" menu item.  If you don’t know if you have paid dues, this menu item will bring up a 2007 dues balance of $475 or $0.  If it brings up a balance of $950, this means you have not paid 2006 or 2007 dues and you cannot be considered a member of good standing until we receive payment.

While you are checking your information on the TOA website, be sure to visit these features:  TOA Meeting Registration & Hotel Information, the E-Connect Archive, Workers’ Compensation Notices, Dues Online, Legislative and Issue Updates/Surveys, Continuing Medical Education Information, Forum Discussions, and, TOA Leadership Contact Information.  If there is something we don’t provide through the TOA website, you can make a suggestion to add the item.  We will make it happen if we can have your input.

Thank you.  See you in Austin at the TOA Summit.
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TDI-WC Guidance on Requesting Designated Doctor Examinations
     

The new Designated Doctor requirements established by HB7, 79th Regular Session, Chapter 408.0041 and Texas Department of Insurance, Division of Workers' Compensation (TDI-DWC) rules 126.7 and 130.6 became effective January 1, 2007. The TDI-DWC has received many requests for and questions related to Designated Doctor examinations.

The TDI-DWC provides the following direction regarding:

  • Compensability issues

  • Treatment issues

  • Return to Work Exams During the First 2 Years of SIBs Disability issues

  • Double scheduling issues

Compensability issues - There are two components to compensability: 1) Medical - is there an injury resulting from the claimed incident; and, 2) Legal - did the injury occur in the course and scope of employment. When the compensability of the injury has been denied/disputed the TDI-DWC will not schedule a designated doctor to address the legal
issue. The TDI-DWC will only schedule a designated doctor to address the medical issue of whether there is an injury related to the claimed incident, and if so, the extent of the injury. A requestor asking for an examination to address the existence of an injury and extent of injury questions must use the Request for Designated Doctor, form DWC032
and should mark "Block C - To determine the extent of the employee's compensable injury" in Section V, and also mark "Block G - Other" and request the examination to "DETERMINE WHETHER THERE IS AN INJURY RESULTING FROM THE CLAIMED INCIDENT".

The report of the designated doctor indicating the existence of an injury, in and of itself, does not obligate the insurance carrier to initiate the payment of income or medical benefits.

Treatment issues - The TDI-DWC will not schedule designated doctor examinations to address treatment issues. All system participants are required to follow existing statute and rules regarding treatment issues.

Return to Work Exams During the First 2 Years of SIBs - The TDI-DWC will schedule designated doctor examinations to address the employee's ability to return to work during the first 2 years (8 quarters) of SIBs.

Disability issues - The designated doctor's opinion regarding disability may address past and present disability, and may address specific dates of disability.

Double scheduling - If duplicate designated doctor appointments are scheduled and the injured employee attends both exams the presumptive weight will apply to the designated doctor's examination scheduled in response to the first request received.

Additionally, to help facilitate the timely scheduling of the designated doctor exams, the TDI-DWC requests that all Request for Designated Doctor, Form DWC032, be submitted directly to the TDI-DWC Central Office, 7551 Metro Center Drive, Austin, Texas 78744 for processing.

We encourage you to forward this email to a friend or colleague who participates in the Texas workers' compensation system.
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Evidence-based Guidelines Enhance Care for ED Patients

An early release article from the Annals of Emergency Medicine discusses a comprehensive, evidence-based online system to reduce medical errors and improve patient care in local hospital emergency departments (EDs).

Under the system, University of Cincinnati researchers have developed guidelines for more than 20 conditions, including order sets and

discharge sheets for patients. Physicians are not required to use the tool, but are encouraged to do so; those who use it receive a scorecard based on their performance. Researchers admit that current physician participation is low, in part because “the shift from relying on memory to utilizing guidelines is challenging for most practitioners,” according to one of the authors.

The article is available here.
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Non-Coverage Proposal for Lumbar Artificial Disk Replacement
    

After a continued review of the NCD regarding LAD’s made last year, On May 25, 2007 CMS issued a proposal to consider a non-covered decision for Lumbar Artificial Disk replacements on the Medicare population over the age of 60.

For patients under the age of 60, CMS states it will be a decision made at the local level. Medicare is currently seeking comments on this proposal prior to issuing a final memorandum.

The specific proposed change would replace Section 150.1 of the Medicare National Coverage Determination (NCD) Manual to reflect the proposed change from non-coverage for the FDA approved Charite LADR implant to non-coverage for the LADR procedure for the Medicare population over sixty years of age.

 

Readers may review and comment here.  Click here to visit the Department B website.

 

"We appreciate the “heads up” from our friends at Department B. DEPARTMENT B is a national firm that provides back-office services for specialized medical practices. By taking over routine activities such as billing, coding and compliance, transcription, recruiting, and other management duties. Department B streamlines business processes so that physicians can focus on patient care instead of accounting details."
-- Donna Parker, Executive Director, Texas Orthopaedic Association.

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Worth Repeating: How Will Medicaid Rate Hike Work?
  

TMA’s efforts to restore sanity to the reimbursement system for physicians treating Medicaid patients have paid off with a historic victory. Physicians who treat patients on Medicaid will see substantial payment increases for most services starting in September. Click here to go to the TMA Web site for the proposed details on the $1.8 billion increase.

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