• Get Active Texas!

• Orthopaedic Practice Q & A

• This Week In Texas: Mignon McGarry Memos
• Workers' Compensation Alert
• Register Today For The Orthopaedic Specific ~ Texas Workers’ Compensation Workshops

 
Get Active Texas!
  

By Donna Parker TOA Executive Director We are pleased to announce the launch of the TOA’s Get Active! Texas public health campaign.  This public awareness campaign is the

final item of the strategy goals set by the TOA Board of Directors in 2006.  We would like to thank TOA public relations committee chair, Dr. Eddie Seade, for naming the campaign “Get Active! Texas: Movement Promotes Healthy Bones” and getting us started.   We would also like to thank spouse volunteers Stacy Smoot and Kaye Eichler who have offered their public relations expertise, advice and ideas.  However, once the electronic press kit goes up on the TOA website and the media in Texas is contacted it will be up to each of you to properly introduce the campaign to your community.  But first, please take a minute to fill out this survey so we can gather information on your involvement in the community and your interest in Get Active! Texas.  TOA needs to rebuild its orthopaedic speakers’ network to help educate Texans on the importance of good musculoskeletal health. 

Get Active! Texas

The Message
The amount of exercise a person gets - from the beginning of childhood and throughout his/her life – can affect bones, muscles, joints, behavior, weight and much more.  That is why the goal of the Texas Orthopaedic Association (TOA) Get Active! Texas public health campaign is to encourage both children and adults to participate safely in a variety of lifestyle and physical activities. People of all ages should have the appropriate amount of physical activity daily which is essential for musculoskeletal health and obesity prevention. 

The Plan
The Texas Orthopaedic Association will utilize the Get Active! Texas Public Awareness Campaign as a platform for tackling the challenging health issues of Texans living a sedentary lifestyle.  Together with Texas Orthopaedic Association volunteers, the organization will adopt a two-pronged approach.  The first phase of the program will be the TOA Member Engagement Initiative from November 2007 to January of 2008. This program will emphasize orthopedists’ interaction with their patients, communities and local schools.   Its purpose is to educate the TOA membership and their spouses to effectively communicate the health issues facing the sedentary family and the importance of activity for good musculoskeletal health.  Volunteers will be armed with tools to communicate effectively with their patients, local media, and school officials prior to the Get Active! Texas campaign public launch.

To influence TOA members, their spouses and other public relations volunteers, staff will focus on three tactics.  The first will be to send the announcement of the TOA public health campaign Get Active! Texas to the membership via the E-Connect, as well as through faxed messages.  The second will be a survey to gather information regarding the level of activity of orthopaedic surgeons in their communities. The third is to offer talking points and text in the form of press releases and sample letters to the editors in an electronic press kit format. The electronic press kit will be featured on the TOA website and members can pull talking points or statistics from the kit.  Working with TOA staff and the Board of Directors, the Get Active! Texas volunteer team will be selected, and trained spokespersons from each city will be prepared to give presentations and interviews to local groups and media.

The second phase of the Get Active! Texas campaign will involve the Texas media to get the message out.  The credibility and influence of having an orthopaedic surgeon deliver the message, whether it entails hand delivering a PSA to a TV station or writing a letter to the editor, should be more effective than the usual distribution methods.

By tying all the communication elements together, TOA should be able to educate the membership to help them deliver the Get Active! Texas message, as well as educate the media and the citizens of Texas.   Complementary materials can be obtained from AAOS such as Orthopaedic Surgeons – Who are they and what do they do?   AAOS also provides a helpful CD for orthopaedic surgeons regarding Community Outreach.

Stay tuned for more information coming your way.  Contact donna@toa.org if you know now that you want to be one of the first volunteers.  The TOA leaders are on board. Please join us deliver the Get Active! Texas message to all Texans.
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Orthopaedic Practice Q & A
    

By Jamie L. Claypool CMPE J. Claypool Associates Inc. Q:  Why can’t we get our assistants at surgery paid?

A:  Many physician practices have asked the question “why can’t we get paid on our assistant surgery charges”?  Some see an assistant at surgery as a necessary and integral part of good quality care. Payers unfortunately do not always reimburse for these services, even though a good operative note is attached to the claim. If a procedure does not take an assistant in the CPT guidelines or Medicare guidelines, a payer is not likely to pay for an assistant unless there is an “unusual” circumstance. Generally the payers follow Medicare guidelines and if Medicare says a particular procedure does not take an assistant at surgery it will not be paid no matter what your operative note says.  Some pointers: 1.   When your staff verifies or authorizes benefits inquire at this time whether or not an assistant will be paid so you know up front and you can inform your physician. If not then, 2.  upon appeal, send a narrative from your doctor stating why the assistant was necessary. If it was an unusual surgery, then a narrative note and modifier “22” on the surgery code may help get the assistant paid. 3.  If the physician has an assistant solely for the benefit of the patient and good clinical outcome and a payer does not cover this service, it may be possible to inform the patient up front that your doc uses an assistant and it will not be covered by their plan. It is then your decision as to whether or not you bill the patient (check contract for language about non-covered services- some do not allow any balance billing) with Medicare, you may need an ABN (advanced beneficiary notice) to notify the patient first that the assistant charge is non covered because the Medicare will deem it “not medically necessary”, however the doctor considers it a necessary and crucial service to the health and well being of the patient. Unfortunately procedures done for the patient’s health benefit and to promote quality of care are many times not recognized by the payers and it simply becomes a “cost of doing business”. [top] [back to e-card archive page]

This Week In Texas: Mignon McGarry Memos

Workers' Compensation Alert
    

Your response to TDI-DWC Needed ASAP regarding the WC Proposed Medical Fee Guideline! The new workers’ compensation medical fee guidelines have been published.  Please click here to see the proposed rules.

Orthopaedic surgeons who treat injured workers should provide comments on the rules as soon as possible via e-mail to this address: rulecomments@tdi.state.tx.us and please bcc: michael.reed@texmed.org if you can. Summary The Texas Department of Insurance - Division of Workers’ Compensation is required to revise the fees paid to physicians every two years. The last fee schedule adjustment occurred in 2003 when the fees were reduced to 125% of Medicare. In October of 2007 proposed rules were developed for revision to the medical fee guideline that would do the following: Create a new medical fee guideline based on multiple conversion factors (surgical codes paid on a separate conversion factor); Current medical fee guideline is equivalent to 125% of Medicare Proposed conversion factor for E&M codes is equivalent to 140% of Medicare (TMA is requesting 155% of Medicare) Proposed conversion factor for Surgical codes is equivalent to 175% of Medicare (TMA is requesting 190% of Medicare) Adjust the medical fee guideline annually according to the Medical Economic Index (MEI); Make incentive payments equivalent to a 10% increase above what Medicare allows for areas that are demonstrated access shortage areas (identified by zip code) Much advocacy effort has gone into requesting the Division to increase fees to improve access and quality issues in the workers’ compensation system, your response is needed. There is a lot of resistance to these rules, so please respond. The communication does not have to be formal, any response will help. Again, to respond via e-mail the address is: rulecomments@tdi.state.tx.us and please bcc: michael.reed@texmed.org. To respond via mail or courier please use this contact information: Texas Department of Insurance, Division of Workers' Compensation Attention: Victoria Ortega Legal Services, MS-4D 7551 Metro Center Drive, Suite 100 Austin, Texas 78744-1609 [top] [back to e-card archive page]

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