May 11, 2009
 

 
Board Of Councilors Report From The NOLC
  

By Andrew P. Kant, MD
Board of Councilors

The AAOS held the National Orthopedic Leadership Conference (NOLC) during the last week of April in Washington, D.C. During the meeting the State Orthopedic Society Committee, State Legislative and Regulatory Issue Committee, the Communications Committee, and the Legislative Advocacy Committee met along with other AAOS committees.


National Orthopaedic Leadership Conference,
April 30-May 1, Washington DC


Dr. Andy Kant, Congressman Gene Green,
Dr. David Teuscher

There were multiple legislative speakers addressing the NOLC attendees including several Congressmen. Members of Congress were from both sides of the aisle. These included Congressman Ron Kind from Wisconsin, Senator Jack Reed from Rhode Island who is a member of the Appropriations Committee, Dr. David Blumenthal who is the National Coordinator for Health Information Technology, Mr. Tom Kraus who is the health policy assistant from the office of Senator Kennedy (which you are aware heads Health and Education), Mr. Lewis Finkel who is Director of Policy and Outreach on Science and Technology, Mr. Sean McCluski, Legislative Healthcare Aide for Congressman Becerra, and Dr. Mark Frisse from the Vanderbilt Center for Better Health. We also had talks from Congressman Jim Moran from Virginia, member of the House Appropriations Committee, Congressman Chris Van Hollen from the Democratic Congressional Campaign Committee, Dr. Robert Kocher from the White House on President Obama's National Economic Council, Ms. Cybele Bjorklund who is Staff Director on the Committee for House Ways and Means, Mr. Dan Elling from the Committee of Ways and Means, and Dr. Steve Ondra who is Professor of Neurological Surgery in Northwestern University.


 Congressman Louie Gohmert


J. P. Paluskiewicz, Health Aide to Congressman Michael Burgess, MD

As many of you are aware, one of the main emphases for the Board of Councilors at the NOLC is legislative advocacy. The Texas Delegation met with Congressmen from across the state. See some pictures here.  We talked directly with Senator John Cornyn, as well as Congressman Louie Gohmert, Congressman Pete Sessions, Congressman Gene Green, Congressman Chet Edwards, Congressman John Culberson, Congressman Lamar Smith, and Congressman Ted Poe. We also had discussions with Mr. Jay Paluskiewicz from Congressman/Doctor Michael Burgess' office.


Texas Delegation to NOLC with Senator John Cornyn
Dr. John T. Gill with Congressman Pete Sessions

Both Gene Green a democrat, and Mike Burgess a republican, have cosponsored the AAOS HB 1012 to ensure "Access to America's Orthopedic Services Act of 2009." This would include requiring HSS to issue a report to Congress and current governmental musculoskeletal trauma research and rehabilitation, and to establish regulations to ensure an accurate accounting of research on musculoskeletal diseases. It also requires the director of the agency for healthcare research and quality (AHRQ) to develop a standard cost effective modality for measuring bone mass in intervals for follow-up screening, and to continue to provide assistance to state health agencies in establishing or expanding current health and aging activities. It would also require the Office of the Surgeon General to issue a report on childhood musculoskeletal diseases within two years and to report to Congress on Medicaid and CHIP beneficiary access to orthopedic services. It also requests that the Health Resources and Service Administration (HRSA) conduct a study on graduate medical education and the impact of funding on the availability of specialty physicians. As many of you are aware, we have a huge deficit in physicians being trained to take care of our population.


Dr. Kant, Congressmen Chet Edwards and Gene Green, Drs. Mansfield and Teuscher
Drs. Palmer, Brindley, Pace, Kant, Gill, Cong. Ted Poe, Drs. Valdez, Teuscher, Cartwright, DeHart and Parsley

HB 1012 would also require all companies engaged in the manufacture of human cellular tissue or tissue-based products to become accredited by a nationally recognized accredited agency. It would also require the Department of Health and Human Services to conduct studies on the cause of severe trauma. There is much more to the bill.


Congressman Ron Kind, Wisconsin
Drs. Kant, Parsley,
Congressman John Culberson, Dr. Gill

As we talked to the Congressman and Senators who came to our meetings in the Capital and in the House Office Building, we went through all these findings. We also relayed information on specialty hospitals and physician ownership of hospitals which has decreased infection rates, greater patient satisfaction, and decreased length of stay from general hospitals.


Dr. Patrick Palmer and Congressman Lamar Smith
Dr. Andrew Kant, Congressman Kevin Brady,
Dr. David Teuscher

Much information is available from the AAOS online if you want to find out exactly what the AAOS is supporting. The AAOS also has available on its website what should be included for principals of healthcare reform. The main goal of AAOS and the TOA is to "Put Patients First." This would be access to specialty care, fixing the broken medical liability system, emergency care access, and fixing the flawed Medicare Physician Payment Formula, what is called the SGR. It is the recommendation of the AAOS that the physician/patient relationship has to maintain sanctity and privacy. Patients should be in control of their medical care.


TOA Director of Member Services (and photographer),
Angel Moss and Dr. Paul Pace

A total of almost 40 hours of meeting were held over three-and-a-half days. This was a grueling schedule, but necessary.

Many of these Congressmen and Senators will be returning to the Texas District in August. If you are asked to an event, please come. If these Congressmen and Senators do not hear from you, the local orthopedic surgeon who takes care of people, they will not understand how to tailor the healthcare reform laws which may be signed by the president by the end of the year.
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Texas District By District: Lois W. Kolkhorst
     

Rep. Lois W. Kolkhorst is a member of the Texas House of Representatives, serving House District 13, which includes Austin, Grimes, Walker, and Washington Counties. She is responsible for a district spanning over 3,000 square miles, stretching over central Texas, from the pine forests of East Texas to the Coastal Gulf Plains.

As the Chair of the House Committee on Public Health, she helps manage the state's $52 billion health care system and works to set

priorities for the Health and Human Services Commission, which oversees nearly 9,000 state employees at five state agencies.

As a member of the House Committee on Corrections, she oversees criminal justice issues including the Texas Department of Criminal Justice, which is headquartered within her district. She also holds a seat on the Calendars Committee, which determines if and when House and Senate bills are considered on the House floor for passage.

Kolkhorst also currently serves as Chair of the Texas Tourism Caucus, which boasts a membership of 100 State Senators and Representatives and helps to ensure that Texas retains its position as the second most-popular tourist destination in America.

She serves as a member of the Sunset Advisory Commission, making recommendations and carrying legislation that determines the future existence of certain state agencies.

During her career as a lawmaker, she has fostered positive changes in the state's public schools, colleges and universities. As a long time education advocate, she was honored by the Texas Retired Teacher Association as well as the College of Education at Sam Houston State University. Previously, she spent six years on the House Appropriations Committee, where she chaired the education subcommittee, overseeing funds for the public schools, community colleges, universities, and health-related institutions. She also served as the Chair of Budget and Oversight for the House Committee on Economic Development.

Texas Monthly Magazine named Kolkhorst to their list of the 2007 Top Ten Best Legislators. For her work to preserve a strong economy, she's received the Fighter for Free Enterprise award from the Texas Association of Business. As a champion for family issues, she's received the Freedom & Family Award from Texas Eagle Forum. For her support in the criminal justice system, she has been presented with the AFSCME Legislative Service Award to recognize her work on behalf of correctional officers within the nine prison units in her district. For efforts to control state spending and reduce tax burdens, she received the Defender of the American Dream award from Americans for Prosperity.

She has gained accolades for a broad legislative agenda that has had significant statewide impact. Kolkhorst has authored and sponsored a long list of bills, tackling issues as varied as criminal justice and prison reforms, education funding, agriculture policies, consumer rights issues, economic development, community housing issues, and domestic violence legislation. As a staunch supporter of private property rights, Kolkhorst has gained national media attention for questioning the proposed Trans-Texas Corridor system of privatized super-highways. She has also passed legislation to address the costs incurred by illegal immigration.

She played a role in revising the state's worker's compensation system, and has helped shape environmental policies as a past member of the Governor's Clean Coal Technology Council. In 2008, she chaired the Energy and Environment Policy Task Force for the Texas Conservative Coalition.

Over the years, Kolkhorst has been recognized by a variety of statewide organizations. She received the Friend of Children Award from The United Way of Texas for her work with early childhood development. The Texas Farm Bureau has recognized her for her support of statewide agriculture issues. She was honored as Rural Legislator of the Year by the Association of Rural Communities in Texas. Additionally, Kolkhorst received the Texas Hospital Advocacy Tribute Award from the Texas Hospital Association.

Prior to her election in November 2000, she served as CEO for the Washington County Chamber and the Economic Development Foundation of Brenham and she has been a longtime advocate for rural economic development issues. She served terms on the Texas Economic Development Council and the Brazos Valley Workforce Commission. She was also appointed by then-Governor George W. Bush to the One-Call Board of Texas.

A native of Brenham and Washington County, she is a 1988 graduate of Texas Christian University, where she received a BS in Advertising and Public Relations. Upon graduation, she spent eight years with TCU in athletic administration. An accomplished golfer, Kolkhorst served as a four-year letter winner for the TCU Lady Frogs Golf Team and was also named to the Academic All-Southwest Conference Team. Besides the occasional golf game, she enjoys hunting and fishing with her husband, Jim Kolkhorst. They have two children, Lois Kate and Jake. The family lives in Brenham, while they own and operate Kolkhorst Petroleum based in the nearby city of Navasota.

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This Week In Texas: Mignon McGarry Memos

By Mignon McGarry
TOA Legislative Advocate
TOA Online Version: All Memos

 

May 6, 2009, Wednesday
The Texas House passed House Bill 4765 by Rep. Rene Oliveira (D-Brownsville), a bill to temporarily exempt nearly 40,000 more businesses

from the state franchise tax.  Currently, businesses are exempt from the tax if they have $300,000 or less in annual revenues. The bill would exempt those that make $1 million or less.  This tax break would be in effect for two years unless the Texas Legislature votes to extend it during the next legislative session.  The cost of the change is estimated at $172 million in lost revenue.  House Bill 4765 now heads to the Senate.

Bad news on the budget front.  Due to the down economy, more Texans will qualify for free health care under the Medicaid program which will require that the program receive nearly $1 billion more in state funds.  This means that legislators will have to find more money for Medicaid in both the 2010-2011 budget and the supplemental appropriations bill for the current budget.

The Texas House will debate the bill authorizing the continuation of the Texas Department of Transportation (TxDOT) tomorrow.  House Bill 300 by Rep. Carl Isett (R-Lubbock) contains the recommendations of the Sunset Advisory Commission regarding TxDOT.  Considering the agency's financial troubles as well as decisions regarding toll roads and other private partnerships, we expect to see a lot of amendments offered during the debate.

On the gambling front, the House Committee on Licensing and Administrative procedure gave a favorable vote to House Joint Resolution 137 by Rep. Edmund Kuempel (R-Seguin) that would give voters on coastal islands and in populous metropolitan areas the option of allowing casino gambling. The amendment would also expand gaming options for the state's three Indian tribes.  With end of session deadlines approaching, HJR 137 has roughly a week to get placed on a House calendar.  If and when it does, expect a lot of debate on the floor of the Texas House.
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TMA Request for an AMA Response to the April 1, 2009 JAMA CME Editorial
      

Subject: Support for ACCME Standards for Commercial Support Regarding Unrestricted CME Funding

Introduced by: (HCMS Board of Medical Legislation)

Whereas, On April 1, 2009, the editor of the JAMA and ten other doctors expressed their personal opinions that any and all pharmaceutical support for physician-related educational activities should be terminated because of perceived ethical concerns. The disclaimer in small print at the end of the article noting that this opinion reflected the views of the individuals and not their organizations was missed or ignored by secondary media releases, including the Wall Street Journal; and

Whereas, We are currently suffering the most extraordinary economic downturn in a generation; and

Whereas, Medical students, educational institutions, and practicing physicians are under unprecedented financial hardships with no end in sight; and

Whereas, Further strains on Continuing Medical Education (CME) budgets may force further service reductions and/or tuition increases placing many services out of reach to many rural or financially challenged health professionals, and ultimately large segments of the profession in general; and

Whereas, Numerous recent reforms have mandated an unrestricted granting process, regulated by third party certification with Accreditation Council for Continuing Medical Education (ACCME) oversight, utilizing stringent disclosure and transparency requirements; and

Whereas, The ACCME Accreditation Policies have recently reaffirmed these stringent ethical mandates and regulatory standards in their most recent policy statement, thereby explicitly rejecting the global pharmaceutical CME embargo proposed in the JAMA April 1, 2009, editorial; therefore be it

RESOLVED, That the Texas Delegation request AMA to educate physicians and the public about their policy on pharmaceutical industry support and explicitly oppose and reject the April 1, 2009, JAMA editorial proposal for wholesale divestment of unrestricted pharmaceutical industry support; and be it further

RESOLVED, That TMA actively embrace and support the ethical ACCME Standards for Commercial Support regarding unrestricted CME funding and ACCME certification.
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Texas Senate and House Bill Summaries
    

Bill TX H 1392: Physician Ranking Procedures
 Relates to required procedures regarding the ranking of physicians by health benefit plan issuers. Currently, the objective measurement and performance standards are not disclosed to the physician, leaving the physician without the ability to modify his or her practice to meet new standards. The results of the evaluation, which are often imprecise or incorrect, are then made available to the public through a rating or

ranking published on a website or through the physician's inclusion in or exclusion from a preferred tier of the health benefit plan network. A physician can suffer harm to his or her professional reputation when incorrect ratings, rankings, tiering, or comparisons are made public. C.S.H.B. 1392 requires any objective measurement or performance standard to be disclosed to the physician prior to the evaluation period. The bill also requires that the data used to establish the ratings or tiering be made available to the affected physician along with a specified process for the physician to challenge the health benefit plan issuer rating or tiering conclusions. 

Bill TX H 2712: Ambulatory Surgical Centers
Relates to ambulatory surgical centers and to the provision of services at those centers by certain designated physician groups. Under current law, an ambulatory surgical center assigns or shares its license. Authorizing an ambulatory surgical center to assign its license in very limited circumstances will result in better access to quality health care for all Texans and allow such centers to better serve their patients and physicians by fully utilizing the choices paid for and covered under a preferred provider benefit plan and available surgical space. C.S.H.B. 2712 authorizes an ambulatory surgical center to share its license under a sublicense agreement with a designated physician group under certain circumstances. 

Bill TX H 3717: Physical Therapy
Relates to exemptions from the requirement to hold a license to practice physical therapy. Requiring a person to acquire a Texas physical therapy license before allowing the person to legally practice in Texas is not always possible or practical. Current law only exempts two individuals from the holding requirement of a Texas license to lawfully practice physical therapy: those who are in school to obtain an entry-level physical therapy degree and therapists from another state who come to Texas to attend a physical therapy educational program or seminar in which they will perform physical therapy as part of the educational process. Several other exemptions would be beneficial for Texas and the consumer and are now common in many states. C.S.H.B. 3717 adds several new categories of exemptions from physical therapist licensing requirements and further clarifies, limits, and removes exceptions.

Bill TX S 1271: Orthotist and Prosthetist
For the past 20 years, individuals engaged in the practice of orthotics and prosthetics have been required to obtain a license. Recently, some questions have been raised as to whether certain individuals engaged in orthotic and prosthetic services should be required to obtain dual licenses. As proposed, S.B. 1271 clarifies that a professional licensed to practice orthotics or prosthetics will not be required to obtain an additional license under Chapter 431, Health and Safety Code, if he or she is acting under an order from a licensed physician, chiropractor, or podiatrist for the treatment of a specific patient.

Bill TX S 1815: Doctor Liability
Relates to immunity from liability for doctors performing certain services at the request of the Division of Workers' Compensation of the Department of Insurance. As proposed, S.B. 1815 amends Section 413.054, Labor Code, to provide that a doctor performing a required medical examination or an independent medical examination for the division of workers' compensation has the same immunity from liability as the commissioner under Section 402.00123 (Civil Liability Commissioner). 

Bill TX S 2151: Ambulatory Surgical Centers
Relates to ambulatory surgical centers and to the provision of services at those centers by certain designated physician groups. Under current law, an ambulatory surgical center assigns or shares its license. Authorizing an ambulatory surgical center to assign its license in very limited circumstances will result in better access to quality health care for all Texans and allow such centers to better serve their patients and physicians by fully utilizing the choices paid for and covered under a preferred provider benefit plan and available surgical space. As proposed, S.B. 2151 amends current law relating to ambulatory surgical centers and to the provision of services at those centers by certain designated physician groups. 

Bill TX S 2397: Physician Licensing
Relates to the licensing and regulation of physicians, physician assistants, acupuncturists, and surgical assistants. Currently, the Texas Medical Board (TMB) licenses physicians, physician assistants, acupuncturists, and surgical assistants. Some of the professions licensed by TMB are regulated in a manner that not only is inconsistent with how other state boards license and regulate licensees, but is inconsistent with how licensees are regulated by TMB. As proposed, S.B. 2397 makes changes to statutes governing the licensing and regulation of physicians, physician assistants, acupuncturists, and surgical assistants.

Source: Texas Legislature Online
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