Dr. Charles Schwertner Wins State Representative, District 20

By John Early, MD
President, Texas Orthopaedic Association

Congratulations to TOA Member Charles Jeffrey Schwertner, MD, of Georgetown.  Dr. Schwertner won the open seat in Texas House District 20.

Dr. Schwertner is a board certified orthopaedic surgeon with Georgetown Orthopedics. Both Dr. Schwertner and his wife Belinda are

Below are the official results from the District 20 race from the Austin American Statesmen:

More about Dr. Charles Schwertner

A Person Like Yourself:

• Life-long Republican and hard working conservative
• Married 12 years; Wife Belinda is local OB/GYN
• Father of three young boys; two currently attend public schools
• Managing partner and practicing physician of Georgetown Orthopedics, LLC, a medical clinic with over 25 employees that provides annual care to over 20,000 local patients
• Bachelor of Science degree in Pharmacy; University of Texas at Austin
• Worked his way through medical school as a pharmacist
• Active members of St. Helen's Catholic Church in Georgetown
• President of the Williamson County Medical Society
• Son of a farmer and rancher;
  Father retired Air Force Officer;
  Mother retired RN
• In-laws live in Sun City; Father-in-law retired Army Sergeant Major

True Fiscal Conservative:

• Member: Williamson County Republican Party, Texas Right to Life, National Rifle Association, & Texas State Rifle Association

• Charles believes in conservative values, low taxes and neighborhood quality of life.

• His conservative platform called for:

• Lowering homeowner property taxes
• Zero tolerance of illegal immigration
• Improving local traffic mobility
• Protecting pro-family and pro-life values
• Promoting local control and accountability of public schools
• Properly paying our teachers and other public servants
• Creating quality local jobs
• Protecting individual freedoms such as gun ownership
• Protecting private property owner rights.

Expert on Health Care:

"I strongly oppose President Obama's proposed government run national health care reform."

With health care reform at the forefront of political debate, Charles will also use his background as a doctor to protect patient rights from government intrusion, health insurance company abuses and rationing of care, especially as it pertains to care for seniors.

Annual Meeting Reminder:
SAVE THE DATE: APRIL 22 -24, 2010

The 2010 TOA/TOF Annual Meeting will be held at the Great Wolf Lodge in Grapevine Texas. We are looking forward to having you and your family join us for a great meeting and lots of fun for all.

Thank You To Our Sponsor: Austin Radiological Association

Click here to visit their website!

This Week In Texas: Mignon McGarry's Memos

Georgetown Orthopaedic Surgeon, Charles Schwertner, MD Wins TX House District 20 Primary

House District 20: (Georgetown). Dr. Charles Schwertner won the

Republican Primary and since no Democrats filed for the seat, he will be the new state representative from Georgetown. He does not face an opponent in the fall.

Congratulations! Dr. Schwertner

Wednesday, March 3, 2010

The 2010 Texas primary election results are in.  The following is a brief recap.  If you would like to see exact percentages, follow this link to the Texas Secretary of State's website: http://www.sos.state.tx.us

Governor

It will be Perry versus White in November.  In the Republican primary, Governor Rick Perry defeated Kay Bailey Hutchison and Debra Medina with over 51% of the vote. Bill White won the Democratic primary, defeating Farouk Shami and 5 other candidates.

Other Statewide Races

Linda Chavez-Thompson won the Democratic primary for Lieutenant Governor.  She will face Republican David Dewhurst in November.

Hank Gilbert defeated Kinky Friedman in the Democratic primary for Agriculture Commissioner.  He will face Republican incumbent Todd Staples in November.

In the Democratic primary for Land Commission, Hector Uribe defeated Bill Burton and will go on to face incumbent Jerry Patterson in November.

Incumbent Railroad Commissioner Victor Carrillo lost his Republican primary race to David Porter.  Porter will face Democrat Jeff Weeks in November.

There were two contested primary races involving seats on the Texas Supreme Court.  In Place 3, four candidates received just over 18 percent of the vote.  There will likely be a runoff between Rick Green and Debra Lehman but Jim Moseley and Rebecca Simmons are very close. In Place 5, incumbent Eva Guzman defeated Rose Vela in the Republican primary and will face Blake Bailey in November.

Texas Senate

Senate District 2: Sen. Bob Deuell (R-Greenville) defeated Sharon Russell in the Republican primary.  He will face Democrat Kathleen Maria Shaw in November.

Senate District 5: Sen. Steve Ogden (R-Bryan) defeated Ben Bius in the Republican primary. He will face Democrat Stephen Wyman in November.

Senate District 22: Sen. Kip Averitt (R-Waco) defeated Darren Yancy.  Averitt announced that he will not seek reelection but did so after the deadline for removing his name from the primary ballot.  No Democrat filed for the seat so what comes next is the subject of much speculation.

Senate District 19 – Sen. Carlos Uresti (D-San Antonio) defeated Luis C. Juarez, Jr. he will face Dick Bowen, the winner of the Republican primary race.

Senate District 29: This seat is currently held by Sen. Eliot Shapleigh (D-El Paso) who did not seek reelection.  Jose Rodriguez defeated Louis Irwin and Liza Montelongo in the Democratic primary.  He will face Republican Dan Chavez in the general election.

Texas House

Five House incumbents were defeated in the primary elections including: Representatives Betty Brown (R-Terrell); Tommy Merritt (R-Longview); Dora Olivo (D-Richmond); Tara Rios Ybarra (D-South Padre Island); and Al Edwards (D-Houston).  Put Al Edwards in the maybe column since he was only defeated by 11 votes and a recount is likely.

Three House incumbents will face run-offs including: Representatives Fred Brown (R-Bryan); Norma Chavez (D-El Paso) and Delwin Jones (R-Lubbock). There will be run-offs in six other districts including: House Districts 47, 52, 66, 84, 127, and 149.

Democratic Primary Results:

House District 27: Rep. Dora Olivo (D-Richmond) was defeated by Ron Reynolds.

House District 36: This is the seat currently held by Rep. Kino Flores (D-Palmview) who did not run for reelection.  Sergio Munoz, Jr. defeated Sandra Rodriguez. No Republicans filed for the seat.

House District 39: Rep. Armando Martinez (D-Weslaco) defeated Joel De Los Santos.

House District 43: J.M. Lozano defeated incumbent Rep. Tara Rios Ybarra (D-South Padre Island).

House District 45: Rep. Patrick Rose (D-Dripping Springs) defeated Andrew Backus.

House District 76: Rep. Norma Chavez (D-El Paso) will face a runoff with Naomi Gonzalez in April.

House District 100: Eric Johnson defeated Rep. Terri Hodge (D-Dallas).  Hodge had suspended her campaign after pleading guilty to federal felony charges.

House District 105: Loretta Haldenwang defeated Kim Limberg.  She will face Rep. Linda Harper-Brown (R-Irving) in November.

House District 146: Borris Miles narrowly defeated incumbent Rep. Al Edwards (D-Houston) but expect to see a recount in this race that was decided by a mere 11 votes.

Republican Primary Results

House District 1: Jack Ballard defeated George Lavender by a slim margin.  He will face Rep. Stephen Frost (D-Atlanta) in November.

House District 2: Rep. Dan Flynn (R-Van) defeated Richard Linkenauger.

House District 3: Erwin Cain defeated Holland Harper.  He will face Rep. Mark Homer (D-Paris) in November.

House District 4: Lance Gooden defeated incumbent Rep. Betty Brown (R-Terrell).

House District 7: David Simpson defeated incumbent Rep. Tommy Merritt (R-Longview).

House District 11: Rep. Chuck Hopson (R-Jacksonville) defeated Michael Banks and Allan Cain in his first Republican primary.

House District 14: Rep. Fred Brown (R-Bryan) faces a runoff in April with Gerald "Buddy" Winn.

House District 15: Rep. Rob Eissler (R-The Woodlands) defeated Rob Thomas.

House District 20: This is an open seat due to the upcoming retirement of Rep. Dan Gattis (R-Georgetown).  Dr. Charles Schwertner defeated Milton Rister, Stephen Thomas and Patsy Williams.  No Democrats filed for the seat.

House District 33: Raul Torres defeated Nicholas Rodriguez.  He will face Rep. Solomon Ortiz, Jr. (D-Corpus Christi) in November.

House District 44: Rep. Edmund Kuempel (R-Seguin) defeated Robin Walker.

House District 47: There will be an April runoff election between Paul Workman and Holly White Turner.  The winner of the runoff will face Rep. Valinda Bolton (D-Austin) in November.

House District 50: Patrick McGuinness defeated Ryan Lambert.  He will face Rep. Mark Strama (D-Austin) in November.

House District 52: There will be an April runoff between Larry Gonzales and John Gordon.  The winner will face Rep. Diana Maldonado (D-Round Rock) in November.

House District 58: Rep. Rob Orr (R-Burleson) defeated Ted Reynolds.

House District 59: Rep. Sid Miller (R-Stephenville) defeated J.D. Sheffield.

House District 64: Rep. Myra Crownover (R-Denton) defeated Kurt Hyde.

House District 65: Rep. Burt Solomons (R-Carrollton) defeated Mike Murphy.

House District 66: This seat is currently held by Rep. Brian McCall (R-Plano) who

did not run for reelection.  There will be an April runoff election between Mabrie Jackson and Van Taylor.  No Democrats have filed for the seat.

House District 69:  This seat is currently represented by Rep. David Farabee (D-Wichita Falls) who did not run for reelection.  Lanham Lyle defeated Joe Clement. 

House District 74: Thomas Kincaid defeated Yolanda Garza.  He will face Rep. Pete Gallego (D-Alpine) in November.

House District 78: Dee Margo defeated Jay Kleberg and Luis Rene Diaz.  He will face Rep. Joe Moody (D-El Paso) in November.

House District 83: Rep. Delwin Jones (R-Lubbock) will face a runoff election in April with Charles Perry.

House District 84: This district is currently represented by Rep. Carl Isett (R-Lubbock) who did not run for reelection.  There will be a runoff between Mark Griffin and John Frullo.

House District 85: Jim Landtroop defeated David Andrews.  He will face Rep. Joe Heflin (D-Crosbyton) in November.

House District 87: This district is currently represented by Rep. David Swinford (R-Amarillo) who did not seek reelection.  Walter "Four" Price defeated Victor Leal.

House District 91: Rep. Kelly Hancock (R-North Richland Hills) defeated Charles Scoma.

House District 92: Rep. Todd Smith (R-Bedford) defeated Jeff Cason.

House District 93: Barbara Nash defeated Bill Burch.  She will face Rep. Paula Pierson (D-Arlington) in November.

House District 96: Bill Zedler defeated Joy Keller.  He will face Rep. Chris Turner (D-Arlington) in November.

House District 98: Rep. Vicki Truitt (R-Keller) defeated Giovanni Capriglione, Rich DeOtte and Diane Thorpe of Keller.

House District 99: Rep. Charlie Geren (R-Fort Worth) defeated Matt Krause.

House District 101: Cindy Burkett defeated Greg Nochese and Thomas Latham.  She will face Rep. Robert Miklos (D-Mesquite) in November.

House District 102. Stefani Carter defeated Geoff Bailey.  She will face Rep. Carol Kent (D-Dallas) in November.

House District 122: This district is currently represented by Rep. Frank Corte (R-San Antonio) who did not seek reelection.  Lyle Larson defeated Denise Barnhill.

House District 127: This district is currently represented by Rep. Joe Crabb (R-Kingwood) who did not seek reelection. There will be a runoff between Dr. Susan Curling and Dan Huberty.

House District 129: Rep. John Davis (R-Houston) defeated Mary Huls.

House District 134: Sarah Davis defeated Bonnie Parker. She will face Rep. Ellen Cohen (D-Houston) in November.

House District 148: Fernando Herrera defeated Howard Gano, Jr..  He will face Rep. Jessica Farrar (D-Houston) in November.

House District 149: Jack O'Connor and Dianne Williams will face a runoff election in April.  The winner will face Rep. Hubert Vo (D-Houston) in November.

For those of you keeping track, 70 incumbent House members faced no major party opposition in either the primary or the upcoming general election.  48 incumbents faced no primary opposition but will now begin preparations for a general election challenge.

Congressional races

Fourteen Congressional incumbents faced a contested primary but no incumbents were defeated.  In a contentious race, Congressman Ralph Hall defeated five challengers in the Republican primary for CD 4.  The other nine congressional primary races involved contests to see who will take on incumbents in the November general election. There will be run-offs in the following CDs; CD 14 to see who will challenge Congressman Ron Paul (R-Surfside) in the general election; CD 17 to determine who will take on Congressman Chet Edwards (D-Waco); CD 15 to select a general election opponent for Congressman Ruben Hinojosa (D-Mercedes); CD 20 to see who will be Congressman Charlie Gonzalez' opponent (D-San Antonio); CD 27 to find out who will take on Congressman Solomon Ortiz (D-Corpus Christi); and CD 30 to see who will take on Congresswoman Eddie Bernice Johnson (D-Dallas) in November.

State Board of Education

In the Republican primary for District 5, inclumbent Ken Mercer defeated Tim Tuggey.  In the Republican primary for District 9. Thomas Ratliff defeated incumbent Don McLeroy.  In District 10, there will be an April runoff between Republicans Marsha Farney and Brian Russell.  In District 12, longtime incumbent Geraldine "Tincy" Miller lost to George Clayton.  Incumbent Bob Craig survived his District 15 Republican primary challenge from Randy Rives.

Thank You To Our Sponsor: Angiotech

Click here to visit their website!

SGR Update from Senator Cornyn's Office

Dear Texas physicians,

As you know, Medicare's sustainable growth rate (SGR) formula will result in a 21 percent cut to the physician fee schedule starting Monday, March 1st. I understand this is a very serious problem, which will have a profound impact on patient care and your ability to effectively manage your medical practices. Senator Cornyn continues to value your feedback about the SGR and fully agrees that a real,

permanent solution is critical. The purpose of this email is to share with you the events that have taken place up until now and to share what I know about the next steps. I realize this is a very frustrating time.

The SGR has resulted in a negative update for physician reimbursement every year since 2002, and with the exception of that first year, the negative updates have been prevented every single time by legislative action. We fully expect this issue to be resolved again this time. Every time the cuts have been prevented, Congress has found ways to pay for those fixes. The SGR is now a $200 billion-plus problem (which the Administration's Office of Management and Budget, Table S-7 on page 158, estimates may actually be a $371 billion problem), and at a time of a record $1.3 trillion federal budget deficit and a $12 trillion national debt, there are no easy answers.

There were attempts to address the SGR problem during consideration of health care reform, including Senator Cornyn's proposed 3-year fix during the Finance Committee markup which was rejected along party lines. More recently, there was bipartisan agreement between Senators Baucus and Grassley to fully pay for a 7-month fix as part of a bipartisan jobs bill. That 7-month fix could have given sufficient time to find a lasting, bipartisan solution to the SGR problem. Unfortunately, the Senate Majority Leader objected to including this bipartisan fix in what became a highly partisan jobs bill. This past week, there was another partisan effort to pass 30-day SGR "patch" along with some other legislation, but this $10.2 billion bill was not paid for and is not a lasting solution. Unfortunately, partisanship has meant that Congress did not act to fix the SGR before March 1st.

It is still very possible that Congressional leadership comes together to solve the problem in the next week or two. Under consideration are taking up the bipartisan agreement for a 7-month fix, passing a fully offset 30-day patch, or some other reasonable option. Please don't hesitate to contact me for updates on this over the next few days.

Until a fix is enacted, there are some administrative actions that the Center for Medicare and Medicaid Services (CMS) can and is taking to mitigate the disruptions.

Yesterday afternoon (February 26), CMS announced it would delay processing claims for the first 10 business days of March. If Congress is able to address the issue within those 10 days, CMS will be able to reimburse under the "fixed" physician fee schedule and avoid the 21 percent cuts altogether. CMS stated, "The Centers for Medicare & Medicaid Services (CMS) is working with Congress, health care providers, and the beneficiary community to avoid disruption in the delivery of health care services and payment of claims for physicians, non-physician practitioners, and other providers of services paid under the Medicare physician fee schedule (MPFS). The Department of Defense Appropriations Act of 2010 provided a zero percent (0%) update to the 2010 MPFS effective for dates of service January 1, 2010, through February 28, 2010. We believe Congress is working to avoid the negative update that will take effect March 1, 2010. Consequently, CMS has instructed its contractors to hold claims containing services paid under the MPFS for the first 10 business days of March. The holding of MPFS claims will only affect claims with dates of service March 1, 2010, and forward. This hold should have a minimum impact on provider cash flow because, under current law, clean electronic claims are not paid any sooner than 14 calendar days (29 for paper claims) after the date of receipt."

If Congress cannot resolve the problem during those 10 business days, the 21 percent cuts will go into effect. A few years ago, Congress failed to act before the cuts went into effect, but did finally enact a fix. That year the fix was applied to reimbursements retroactively, and it is possible that this could happen again. Of course, this is not an ideal scenario.

Please do not hesitate to contact me, if I can answer any questions or be of any assistance. I understand this is frustrating and it illustrates the problems with Washington running health care programs.

Sincerely,
Stephanie

Stephanie J. Carlton | Legislative Asst. for Health Policy
U.S. Senator John Cornyn (Texas) | (202) 224-2934

API-C: Is Your Practice Ready For RAC?

The Centers for Medicare and Medicaid Services (CMS) enacted the Recovery Audit Contractor (RAC) program in 2005 to recoup improper payments to healthcare providers.  The goal of the recovery audit program is to identify improper payments made on claims of services provided to Medicare beneficiaries. The recouped funds are put back into the Medicare Trust Fund.  Since inception, RAC auditors have recovered nearly $1 billion.  Section 302 of the Tax Relief and Health Care Act of 2006 makes the RAC program permanent and requires

expansion into all 50 states by 2010.  Auditors will review all claims submitted on or after October 1, 2007, to identify inappropriate payments.  RAC auditors have systems in place to flag any claim in which an overpayment is likely to have occurred based on the billing data provided.  There is clear incentive for RAC auditors to find inappropriate payments. The RAC contractors are allowed to keep 9 percent to 12.5 percent of overpayments. Providers susceptible to RAC audits include hospitals, physician practices, nursing homes, home health agencies, durable medical equipment (DME) providers, and any other provider or supplier that submits claims to Medicare.

In the initial phase, RAC auditors focused on high dollar, low volume claims generated mostly from hospitals.  With a broader rollout of the RAC program, physician practice audits are more likely to occur.  Medicare reimbursement is immediately garnished once the auditor confirms any overpayment.  RAC auditors find overpayments when there is a lack of proof of medical necessity.  Without proper documentation there is no proof to prevent overpayment determinations.  Improper payments on claims can include, but are not limited to:

• Payments made for services that were not medically necessary or did not meet CMS medical necessity criteria for the service rendered.
• Payments made for services that are incorrectly coded.
• Failure to submit sufficient documentation to support the claim.
• Duplicate payment.

Knowing what to expect is key. Providers must be ready to respond to audit requests, demand for repayment, review and analyze determinations by the RAC auditors and file appeals if necessary. These reviews require considerable resources and time to fulfill the RAC requests.  Such demands could prove costly for small offices.

Auditors for the CMS RAC program have identified the 10 most common problems being uncovered in the audit process:

• Debridement Coding
• Duplicate Billing
• Stark Violations
• Pharmaceutical Coding in Physician Offices
• Social Work Services in Facilities
• Psychiatric Services
• Medical Necessity
• E/M Billed During Global Periods
• Place of Service Errors
• Incident to Errors

It is more critical than ever to review your current billing and compliance policies and procedures to ensure you comply with the regulations required by CMS so you can identify inconsistencies and take corrective action.  Your office should review the list of common issues for RAC as identified in the pilot program.

Proactive strategies include:

• Perform a pre-audit to identify potential areas of risk.

• Review historical claims history to identify any inconsistencies, incorrect coding or duplicate claims.

• Conduct chart reviews to validate coding accuracy and documentation to determine if medical necessity criteria is present.

Providers, compliance officers and billing staff must continue to educate themselves on coding and documentation as part of the expanding compliance focus of CMS.  There are a multitude of RAC resources and management solutions available online to help providers prepare for and manage a RAC audit.  Involvement of legal counsel in the RAC process should also be considered.

American Physicians Insurance Company (API) offers its physician insureds, as part of their policy, a $100,000 legal expense reimbursement (including fines and penalties) for state and federal disciplinary actions, EMTALA and HIPAA violations, and Medicare/Medicaid fraud and abuse claims. This coverage extends to RAC audits. Additional coverage up to $1,000,000* total is also available for purchase.

For more information, please contact us at 877-API-7007 or info@api-c.com.

*Currently only available in Texas.

Stephanie Duggan, CPC, CPHRM 
Risk Manager
American Physicians Insurance Company
800-252-3628
sduggan@api-c.com
www.api-c.com

TDI/DWC - Informal Rule Proposal for Comment Regarding Designated Doctor Examinations

Informal Proposal - Repeal 28 TAC §126.7 Regarding Designated Doctor
Examinations: Requests and General Procedures and New 28 TAC §§126.7 – 126.75 Regarding Designated Doctor Scheduling and Examination Procedures

The Texas Department of Insurance, Division of Workers' Compensation
(TDI-DWC) is accepting comment on informally proposed rules to repeal 28 Texas Administrative Code (TAC) §126.7 and new 29 TAC

§§126.7 – 126.75.

The informal proposal may be viewed on the TDI website at this link.  The comment period on the informal proposal closes March 25, 2010 at 5 p.m. (Central Standard Time).

This informal working draft is not a formal rule proposal. Accordingly, comments will not be treated as formal public comment for the purposes of the Administrative Procedure Act.  In addition to commenting on this informal proposal, there will be the opportunity to formally comment once the rules are proposed and published in the Texas Register.

TDI-DWC anticipates formal publication of the rules in 2010.  The informal working draft may contain drafting notes and formatting, which will be changed as necessary to comply with the Texas Register formatting. 

Comments may be submitted by e-mailing via this link, or by mailing or delivering the comments to Maria Jimenez at:

Texas Department of Insurance, Division of Workers' Compensation
Workers' Compensation Counsel
MS - 4D 7551 Metro Center Drive
Suite 100
Austin, Texas 78744 -1645

The purpose of the informal proposal is to request input from system participants regarding the implementation of new designated doctor examination and scheduling procedures.  A memorandum containing highlights of the informal rule proposal is located at this link.