April 7, 2008
 

 
TOA President's Update: Texas Makes It Work
  

By John T. Gill, MD, President, Texas Orthopaedic Association
and
Douglas Hawthorne

This Modern Healthcare article, was published March 31, 2008

Major Systems Successfully Partner With Doctor-owned Hospitals To Benefit Of All

"This town ain’t big enough for the both of us.” Sounds like an old John Wayne Western, but often this is the relationship between large general hospitals and physician-owned, short-stay hospitals. A recent article in Forbes, “Stop that patient,” points out the lengths to which some general hospitals will go to prevent competition in the healthcare marketplace. But this is not always the case deep in the heart of Texas.Texas is home to more physician-owned short-stay hospitals than any other state in the nation. Rather than resist them, some prominent hospital systems, such as Texas Health Resources, Arlington, and Baylor Health Care System, Dallas, have chosen to embrace them. Between them, these two major faith-based hospital systems have partnered with physicians to develop 14 such hospitals in the Dallas-Fort Worth area. The jointly owned hospitals consistently earn high ratings in patient- and physician-satisfaction scores. One is even rated by HealthGrades as one of the top 10 cardiovascular hospitals in the nation.

Texas Health Resources has been a pioneer in developing collaborative models for hospitals and physicians to jointly develop facilities that provide expanded access to quality care for our patients and meet the needs of independent physicians. Texas Health Resources’ revenue from the investor-owned organizations is invested back into the not-for-profit hospitals to support their community-focused mission.

One such hospital is the Texas Institute for Surgery at Presbyterian Hospital of Dallas. It has nine operating rooms, nine inpatient beds and a pain-management center. It performs about 1,000 procedures a month. It is a 50-50 partnership between the hospital and physician-investors, but has both investors and noninvestors on the active medical staff.

Satisfaction scores among patients run at 98% “excellent” or “good” while post-operative infection rates are one-twentieth the national average for general hospitals, at around one patient in 1,000. This low infection rate is particularly relevant, in a country where the federal Centers for Disease Control and Prevention has concluded a patient dies every six minutes (10 per hour, every hour, every day) from hospital-acquired infections. All of Texas Health Resources’ facilities that involve physician-investors have physicians on-site 24-7 to provide emergency care. And like other small hospitals, they have transfer arrangements in place with nearby larger acute-care hospitals to handle the most serious cases.

Unfortunately, some members of Congress are trying to prevent Texas hospitals, as well as those in all other states, from partnering with physicians to develop some of the best and safest hospitals in our country, merely because the hospital will be owned in whole, or in part, by physicians. The argument is that physicians will perform unnecessary procedures simply because they have an ownership interest in the facility.

This ignores the fact that no investigation—by the Medicare Payment Advisory Commission, HHS or other federal agency—has found that physicians are billing Medicare for services provided in physician-owned hospitals that are not medically necessary. What these critics fail to point out is that increased choices for patients in the community have led most hospitals to upgrade their technology and services to better meet patient needs and desires.

If Congress succeeds in removing physician-owned hospitals from participation in the Medicare program, Medicare’s elderly, low-income families, including children covered by Medicaid and federal employees and their families, will be forbidden from accessing some of the best and safest hospitals in the country. This is in stark conflict with the goal of health policymakers in both parties and presidential candidates who want to expand access, not reduce it.

Physicians have driven innovation in America’s healthcare system starting with the very first hospitals built and funded by physicians, such as the Mayo brothers. Over time, nearly every industry has recognized the benefits of specialization, and medicine is no different. Cancer treatment clinics, centers for women’s health and children’s hospitals are commonplace. From this initiative have evolved short-stay hospitals specializing in cardiovascular care, orthopedics and other specialized services.

Texas has found a way for hospitals and physicians to collaborate, while still raising the bar on safety, quality and satisfaction in our hospital systems. Perhaps critics should look to Texas to see how to handle the physician-owned hospital situation rather than throwing the baby out with the bathwater. Add this to the tremendously successful medical liability reform passed five years ago by the Texas Legislature, and Texas becomes an even more attractive place for physicians to settle. It could be that more doctors will soon subscribe to the famous words of Tennessee native and Texas hero Davy Crockett: “You may all go to hell and I will go to Texas.”

John Gill is an orthopedic surgeon in private practice in Dallas and a physician-investor in the Texas Institute for Surgery at Presbyterian Hospital of Dallas. Douglas Hawthorne is the chief executive officer of Texas Health Resources.
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Texas Pain Society:  Annual Pain Symposium
     

The Texas Pain Society's Annual Half-Day Pain Medicine Symposium will be held in conjunction with TexMed 2008 on Friday, May 2, 2008 between 8 am and Noon at the Henry B. Gonzales Convention Center, Street Level, Room 103A in San Antonio, Texas.

Presented by Texas Pain Society under the direction of C. Stratton Hill, Jr, MD, Houston and C.M. Schade, MD, PHD, Garland.

TARGET AUDIENCE
Physicians, residents, and health care professional caring for patients suffering with chronic pain

ACCREDITATION
This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of Texas Medical Association and Texas Pain Society. Texas Medical Association is accredited by the ACCME to provide continuing medical education for physicians.

REGISTRATION
You can register online by clicking here or by calling the Texas Medical Association at (800) 880-1300. There will also be onsite registration.

OBJECTIVES
Upon completion of this program participants should be able to:

  • prepare criteria for the use of dual action Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin Norepinephrine Reuptake inhibitors (SNRIs) and/or Antiepoleptic (AEDs) medications in the treatment of neuropathic pain;
  • integrate requirements from rules 170 and 164.4 regarding prescribing for pain treatment and the proper way to advertise your pain practice;
  • integrate moral and ethical responsibility to relieve pain in the current regulatory ambiance of uncertainty and oversight that puts the pain physicians career in jeopardy; and
  • determine indicators of drug-seeking/addictive behavior.

Complete agenda of this event can be found by clicking here.
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This Week In Texas: Mignon McGarry Memos

By Mignon McGarry
TOA Legislative Advocate / Memo: Wed. November 28th, 2007
TOA Online Version: All Memos

 

April 2nd, Wednesday

Kenneth Shine, executive vice chancellor for health affairs for the University of Texas System, was named interim chancellor of The

University of Texas System, effective May 1.  He will oversee the system while the regents search for a replacement for Chancellor Mark Yudof who was named President of the University of California System.  Shine, a cardiologist and physiologist, currently oversees the system’s six health campuses. 

The Republican primary race for House District 73 isn’t over yet.  After requesting a recount of the votes cast on March 4th, Rep. Nathan Macias (R-Bulverde) remained 17 votes behind challenger Doug Miller.  On Monday, Macias filed suit to invalidate the results of the March 4th primary due to a number of irregularities in the race.  Stay tuned as the ultimate victor in this battle must face Democrat Daniel Boone in the November general election. 

Speaking of those March primaries, they were expensive.  The final numbers on candidate’s spending aren’t due at the Texas Ethics Commission for another couple of months but I have seen estimates in the hotly contested races of up to $148 per vote cast in favor of the big spender. 

Last week, the State Board of Education kept a proposal for a revised English language arts reading curriculum moving.  These ELAR standards have been hotly contested over the last year and the delayed adoption will have ramifications for textbook publishers as well as the development of end-of-course exams mandated by the Texas Legislature during the last legislative session. 

Forms to report the revised Texas franchise tax based on the new margin calculation are now available on the Comptroller’s web site for the May 1st due date for initial and final filers and the May 15th due date for annual filers. The forms can be found here.  Answers to franchise tax questions can be found here or by calling (800) 252-1381.
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Texas Orthopaedic Foundation
    

Dear Doctors,

Please join the Texas Orthopaedic Association in welcoming our sister organization, the Texas Orthopaedic Foundation (TOF)! The Texas Orthopaedic Foundation is a registered 501(c)(3) charitable non-profit organization dedicated to research and education within the orthopaedic community. Our new Foundation is publicly supported and tax-exempt.

On behalf of the Texas Orthopaedic Foundation Executive Committee, I am writing to ask for your support in building upon our

vision to establish the primary orthopaedic education and research resource for Texas.

In addition to providing sustainable orthopaedic education and research opportunities, the Texas Orthopaedic Foundation was formed by TOA leaders to raise the publics’ awareness of orthopaedic medicine in Texas. Several years ago, I was proud to serve as president of the Texas Orthopaedic Association. I am now honored to serve as the Chair of the Foundation’s Board of Trustees.

We believe you share our appreciation for the many years of easily accessible, quality medical education and public relations programs that have been offered by the Texas Orthopaedic Association. The Texas Orthopaedic Foundation will now be dedicated to providing CME programming, including resident education, best paper awards and resident events such as the Resident Quiz Bowl. Our Foundation will also be the primary funding source for the Get Active! Texas public health campaign, promoting bone health and obesity prevention.

While TOA is nationally recognized for successfully tackling critical socioeconomic concerns and the regulatory issues facing orthopaedic practices in Texas today, the mission of the Texas Orthopaedic Foundation is to advance orthopaedic education and public awareness. The Foundation and TOA will work together to build a stronger orthopaedic community in Texas.

 

The Texas Orthopaedic Foundation has the same dedicated team of physician volunteers and industry leaders as TOA. Through the Foundation, our orthopaedic leaders will be free to develop high quality continuing medical education opportunities in accordance with ACCME guidelines. Dr. Marc DeHart, of Austin, serves as the Chair of the Continuing Medical Education Committee for the Texas Orthopaedic Foundation.

The ACCME guidelines will direct our choice of speakers and programming surrounding CME events. Under the Foundation, we hope to be the source of fine orthopaedic programming and will continue selecting physician faculty known in their fields. The Foundation strives to select speakers whose expertise will equip the orthopaedic community with superior CME course instruction to secure the best outcomes for our orthopaedic patients.

The Foundation also aims to impact the lives of Texans by increasing their knowledge of preventive orthopaedic care and by stressing the importance of maintaining a healthy musculoskeletal system. The Foundation’s public awareness programs will help bring awareness to orthopaedic treatment and conditions, creating a better understanding of how the citizens of Texas can improve their health through increased activity levels.

The Mission of the Texas Orthopaedic Foundation is to:

  • Create public awareness of the importance of musculoskeletal health in the State of Texas.

  • Encourage scientific, educational, and charitable endeavors which will promote and advance the science and art of orthopaedic surgery.

  • Support research and education on diseases and injuries of bones, joints, nerves, and muscles.

  • Enhance clinical care, leading to improved health, increased activity, and a better quality of life for patients in Texas.

This is how you can help.

To fund its programs, the Texas Orthopaedic Foundation will depend on contributions from the orthopaedic community, other caring individuals and our friends of orthopaedics in business. Your contributions will be dedicated to orthopaedic research and education in Texas.

By making a donation to the Texas Orthopaedic Foundation, you will become a member of the Board of Trustees. The Foundation’s website and meeting exhibit will list you as a donor Trustee, unless you wish to remain anonymous. Memorial or tribute gifts will list both donor and the person named for tribute.

While we encourage your donations and annual gifting at any point in the future, by giving $1,000 or more during 2008, you will become a member of the TOF Founders’ Circle. Please donate today and become a founding member of the Texas Orthopaedic Foundation.

There are many benefits to supporting the Texas Orthopaedic Foundation. By donating to the Foundation you will be able to:

  • Support orthopaedic continuing medical education and research

  • Support orthopaedic residents and their Texas training programs

  • Give a gift that will remain in Texas

  • Receive an income tax deduction; reduce capital gains tax or estate taxes

  • Help the Texas Orthopaedic Foundation develop clinical treatment guidelines

  • Facilitate public education of orthopaedic surgery and orthopaedic treatment.

If your gift is intended as a memorial or tribute, please indicate such on your contribution form. The Foundation’s first Memorial pledge was in honor of Albert Tisdale, MD. Many of you may remember Dr. Tisdale as the “TOA Photographer/Historian.” He faithfully attended and photographed the TOA annual meetings and the past presidents breakfasts. Dr. Tisdale was also a former president of TOA from Austin.

Our Fund Development Committee is chaired by Dr. Jay Mabrey, of Dallas, and he welcomes any ideas for Texas Orthopaedic Foundation endowments. Ideas that have been mentioned by the TOF leadership have ranged from tributes to specific Texas orthopaedic residency training programs…to endowments to help fund orthopaedic medical missions in which our Texas pediatric orthopedists participate. Feel free to contact Dr. Mabrey or myself if you wish to serve on the Fund Development Committee.

The TOF Executive Committee has asked Howard Epps, MD, of Houston, to Chair the Grant Committee. Dr. Maureen Finnegan (TOA past president), of Dallas, has also agreed to serve on the Foundation’s Grant Committee. The Grant Committee is presently charged with selecting CME resident paper awards and research. As other programs are developed and funded, the Foundation’s Grant Committee will also be responsible for reviewing and approving scientific research grant applications, grants for clinical treatment guideline production and endowment fund distribution. Please remember that all funds are designated for Texas distribution only.

The Foundation will send an announcement, as well as the enclosed brochure, to all of our friends of orthopaedics in business and academia regarding the formation of the Texas Orthopaedic Foundation. We are certain that they will also benefit from quality orthopaedic education and will have an interest in keeping the orthopaedic community strong.

We are happy to bring this positive message to you about how and why the Foundation was formed. And, again…we ask you to join the TOA in welcoming the Texas Orthopaedic Foundation. The Foundation needs your help to support this important mission to build a stronger orthopaedic community through research and education.

I encourage you, as an orthopaedic surgeon, to accept our invitation to donate to the Texas Orthopaedic Foundation and become a member of the Founders’ Circle by calling 1-512-370-1500.

With best wishes,

Bill Schreiber, MD, Chair
Board of Trustees
Texas Orthopaedic Foundation
www.toafoundation.org


P.S. As you consider my request, please know that your donation is an investment in orthopaedic education and research in Texas.

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