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TOA
President's
Update: TOA In Washington
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By John T. Gill, MD
President, Texas Orthopaedic Association
Later
this month, the National Orthopaedic Leadership Conference
will take place in Washington, DC. As AAOS Board of
Councilors Chair for this NOLC, it will be my
responsibility to lead a couple of hundred orthopaedists
to Capitol Hill on Thursday, May 1st. TOA has 15
orthopaedists attending NOLC and we are planning on
contacting every
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Texas
US Representative and Senator. Medicare is the number one issue we will
address while we are in Washington.
The article below reports on Capitol Visits made by TMA members and
their recent trip to Washington, DC.
Texas physicians swarmed Capitol Hill last week,
personally delivering the
Texas Medicare Manifesto
to every member of the Texas delegation in Congress. Our calls for a
rational Medicare physician payment system that automatically keeps up
with the cost of running a practice and is backed by a stable funding
source were well received. We also discussed problems with health
insurance companies’ inadequate payments for vaccines and the need to
preserve physicians’ rights to own hospitals and other health care
facilities. TMA President Bill Hinchey, MD, led the group, which
included 12 physicians, 10 TMA Alliance members, five medical students,
and six TMA staff members, all participating in the
American Medical Association’s National Advocacy Conference.
A highlight of the event was our joint meeting with two AMA members in
Congress: Rep. Michael Burgess, MD (R-Lewisville), and Rep. Tom Price,
MD (R-Georgia).
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TDI/WC: Updated Medical Fee
Guidelines Training Module
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The Texas
Department of Insurance, Division of Workers’ Compensation, has
posted an updated Medical Fee Guidelines Training Module on the
Division’s website. The updated Medical Fee Guidelines Training
Module addresses the new Medical Fee Guideline rules for
professional services that became effective on March 1, 2008.
Please click
here to view the Medical Fee Guidelines Training Module.
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This Week In Texas: Mignon
McGarry Memos
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By Mignon McGarry
TOA Legislative Advocate / Memo: Wed. November 28th,
2007
TOA Online Version: All Memos
April 9th, Wednesday
The results of the run-off
elections are in. There were five Republican primary races
for House seats that were up for grabs yesterday.
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In Williamson County, Bryan
Daniel defeated Dee Hobbs to become the Republican nominee in
the race to replace retiring
Rep. Mike Krusee in
District 52. Daniel will face Democrat Diane Maldonado in
November.
In Bell County, Ralph Sheffield
defeated Martha Tyroch and will face Democrat Sam Murphey in
November in the race to replace retiring
Rep. Dianne Delisi
in District 55.
In Ector County,
Rep. Buddy West
(R-Odessa) was defeated by Tryon Lewis in the run-off for
District 81. There is no Democrat in this race so Lewis
becomes the presumptive winner.
In Dallas County, Angie Chen
Button defeated Randy Dunning to become the Republican nominee
for District 112, currently held by retiring
Rep. Fred Hill.
Button will face Democrat Sandra Phuong VuLe in the November
general election.
In Harris County, Ken Legler
narrowly defeated Fred Roberts in the Republican primary
run-off for District 144, the seat currently held by
Rep. Robert Talton.
Legler will face Democrat Joel Redmond in November.
In other election news, Pete
Olson defeated Shelley Sekula Gibbs in the Congressional
District 22 runoff to see who will take on
Congressman Nick Lampson
(D-Houston) in the general election. This district, formerly
represented by Tom Delay, is still considered by many to be a
Republican district so look for this race to attract a lot of
attention in November.
Ken Anderson has left his
position as appointments director for Governor Perry after six
years. He will be replaced by Theresa Spears who has worked
on grassroots issues in Perry’s political office.
Glenn Shankle, Executive
Director of the Texas Commission on Environmental Quality, has
announced his retirement. Shankle will serve until the
Commission appoints his replacement.
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TDI/WC: FY 2008 Medical Quality
Review Plan & Selection Criteria
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By Michael Reed,
Director of Managed
Care Delivery Systems
Texas Medical Association
The Texas Division of Workers’ Compensation on Monday
announced the categories and elements of workers’ compensation system
health care
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for review in fiscal
year 2008.
The division is charged with monitoring the quality of health care in
the workers’ compensation system, with reviews conducted by the Medical
Quality Review Panel to ensure that employees receive “reasonable and
medically necessary healthcare in a timely and cost-effective manner
that facilitates recovery and appropriate return to work.”
Each year the division selects categories of workers’ compensation
system healthcare for review, based on recommendations from the medical
adviser, the Department of Insurance Research and Evaluation Group and
stakeholder input.
The medical adviser and review panel apply evidence-based medical
standards including adopted fee, treatment, and return to work
guidelines in reviews of health care providers.
Review factors and elements for fiscal 2008 for various categories
include:
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Designated Doctor Decisions
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Number of overturned decisions
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Very high or low impairment ratings
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Frequency of letters of clarification
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Frequency and severity of complaints
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Thoroughness of examination
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Accuracy of maximum medical improvement date
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Accuracy of impairment rating
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Independent Review Organizations
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If the reviewer has appropriate education, training and experience to
address medical issues in question
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Frequency and severity of complaints
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Proof of professional certification
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Appropriate medical records supplied for review
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Use of evidence-based decisions
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Insurance Carriers
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Excessive approval or denial of payments for medical care
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Frequency and severity of complaints
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Payments for medical services
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Accuracy of peer review findings
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Peer-Review Doctors
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If the reviewer has appropriate education, training and experience to
address medical issues in question
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Frequency and severity of complaints
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Proof of professional certification
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Appropriate medical records supplied for review
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Use of evidence-based decisions
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Utilization-Review Agents
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If the reviewer has appropriate education, training and experience to
address medical issues in question
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Frequency and severity of complaints
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Proof of professional certification
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Appropriate medical records supplied for review
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Use of evidence-based decisions
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Surgery/Spine Fusions
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Number of surgical spine patients
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Surgical re-admission rates
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Percent of surgeries with fusions
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Total amount billed
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Accurate diagnosis and testing
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Use of evidence-based medical treatment
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Compliance with accepted medical standards
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Reasonable cost
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Pain Management
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Total number of patients
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Average number of services per patient
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Total billed charges
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Accurate diagnosis and testing
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Use of evidence-based medical treatment
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Compliance with accepted medical standards
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Reasonable cost
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Prescription Medications
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Total number of prescription medications
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Total amount billed per patient
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Dose and duration of medications in review
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Accurate diagnosis and testing
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Use of evidence-based medical treatment
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Compliance with accepted medical standards
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Reasonable cost
For additional
information, click
here.
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Texas Medical Board Update
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Texas Medical Board •
News Release • Thursday, April 10, 2008
Media contact Public Information Officer Jill Wiggins via email by
clicking
here or by phoning (512) 305-7018. Non-media contact:
(512) 305-7030 or (800) 248-4062
Dr. Donald Patrick to retire as Texas
Medical Board Executive Director
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At today’s meeting of the Executive
Committee of the Texas Medical Board, Donald Patrick, M.D., J.D.,
announced that he will retire from his position as Executive Director on
August 28, his 70th birthday.
Dr. Patrick joined the agency in September, 2001. During his nearly
seven years with TMB, he oversaw a reorganization of the licensure
application process, increasing efficiency and reducing the time for
licensing a qualified physician in Texas. After a series of news
articles revealed lax prosecution of disciplinary cases, followed by
legislative action giving TMB additional staff, resources and powers,
Dr. Patrick and agency staff improved the enforcement functions of the
agency, increasing the number of board orders issued each year while
reducing the time it takes to resolve cases. Most recently, TMB issued a
rule allowing minor administrative violations to be fast-tracked and
treated like traffic violations, further reducing the amount of agency
time and resources spent in minor cases, allowing it to focus on more
egregious standard of care and behavioral issues.
Dr. Patrick graduated from Baylor College of Medicine in 1962 and
trained in neurosurgery at Baylor and the University of Washington. He
served in the U.S. Army as the Chief of Neurosurgery at the 24th
Evacuation Hospital, Long Binh Vietnam, which, during his tour of duty
in 1967-68, was the busiest neurosurgical trauma hospital in the world.
He received a Bronze Star Medal for his work there. Dr. Patrick began
his practice as a neurosurgeon in Austin in 1969 and has been the Chief
of Staff at both Brackenridge Hospital and The Rehabilitation Hospital
of Austin (now Health South). He served as an on-call neurosurgeon at
Brackenridge Hospital Emergency Department for 23 years. Dr. Patrick was
the Chief of Surgery at Round Rock Medical Center at the time of his
appointment as TMB Executive Director. He received a law degree from U.T.
Austin in 1996. He is married to Dr. Carolyn Biebas, an
anesthesiologist.
After the announcement, TMB’s Executive Committee began the process of
forming a search committee. If the committee has not found a replacement
by the time Dr. Patrick retires, TMB’s Director of Enforcement Mari
Robinson will serve as Interim Executive Director until a new Executive
Director is hired.
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UTMB Austin Visiting Professor
Lecture Series: "Shoulder Resurfacing Update"
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The University of Texas Medical Branch
Department of Orthopaedic Surgery and Rehabilitation
Austin Visiting Professor Lecture Series
"Shoulder Resurfacing Update"
Lecture presented by: |
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Lonnie Paulos, MD
Medical Director
Texas Sports Medicine Alliance
Houston, TX
WEDNESDAY
April 16, 2008
6 P.M.
Doors open @ 5:30 P.M. for reception
Texas
Medical Association
401 West 15th Street
Austin, TX 78701
The
University of Texas Medical Branch at Galveston (UTMB) is
accredited by the Accreditation Council for Continuing Medical
Education to provide continuing medical education to
physicians. The University of Texas Medical Branch at
Galveston designates this educational activity for a maximum
of 1 (one) AMA PRA Category 1 CreditTM. Physicians
should only claim credit commensurate with extent of their
participation in the activity.
Dr. Paulos
discloses that he has no financial interests or affiliations.
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