On Tuesday, Dec. 20, 2022 the U.S. District Court for the Eastern District of Texas will hear arguments in the Texas Medical Association’s (TMA’s) second lawsuit challenging certain portions of the Aug. 26, 2022, final rules implementing the federal No Surprises Act (NSA). District Judge Jeremy D. Kernodle will preside. This hearing addresses the second of three TMA lawsuits against federal agencies related to rulemaking under the surprise-billing arbitration law.
At issue are the rules affecting how payment disputes are resolved in certain situations in which a patient receives care from a physician or provider who is out of the patient’s insurance plan’s network. The payment disputes occur between health insurers and physicians or providers; patients are not affected or included. TMA is arguing that the challenged provisions of the final rule deprive physicians and providers of the arbitration process the law intended.
“We are, once again, asking for the law to be followed as Congress intended, and for the challenged provisions to be invalidated. There should be a level playing field for physicians and health care providers in payment disputes after they’ve cared for patients,” said TMA President Gary W. Floyd, MD.
TMA’s concern is over a final rule published by the U.S. departments of Health and Human Services, Labor, and the Treasury. In both its Oct. 28, 2021, lawsuit and the lawsuit being heard Tuesday, TMA alleges that the agencies – when implementing the federal surprise billing independent dispute resolution processes – adopted rules that conflict with the law and skew results in favor of insurers. TMA believes these rules are skewed to the detriment of both physicians and the patients they serve. TMA seeks to promote patient access to quality care and guard against health insurer business practices that give patients fewer choices of affordable in-network physicians and threaten the sustainability of physician practices.
“The final rules unfairly advantage insurers by requiring arbitrators to give outsized weight or consideration to an opaque, insurer-calculated amount – called the qualifying payment amount – when choosing between an insurer’s offer and a physician’s offer in a payment dispute,” Dr. Floyd said. “This is unfair to physicians, providers, and the patients we care for, so we had to seek fairness.” The qualifying payment amount (QPA) is an amount that is supposed to be the median in-network rate under the law but is deflated based upon the federal agencies’ methodology.
TMA’s first lawsuit – which the association won at the district court level – alleged that in the rules governing federal arbitrations between insurers and physicians, the federal agencies unlawfully required arbitrators to “rebuttably presume” the bid closest to the QPA was the appropriate out-of-network rate. TMA argued requiring arbitrators to heavily weight figures created by insurance plans provided them an unfair advantage.
Despite the district court’s initial ruling, TMA is arguing the agencies now have doubled down by issuing a new final rule that replaces the earlier presumption with a new set of requirements that give health insurers the same advantage.
Each of the challenged requirements in the federal agencies’ final rule unlawfully tie arbitrators’ hands and place an unmistakable “thumb on the scale for the [health plans’ QPA],” the complaint states, even though the law does not call the QPA the “primary” or “most important” factor, nor does it diminish the importance of any other factors in the law. The final rules, for example, require arbitrators to “first consider” the QPA.
TMA filed its third NSA-related lawsuit in November, challenging certain portions of the law’s July 2021 interim final rules. That TMA lawsuit focuses on four ways in which the rule unfairly deflates QPAs. TMA contends portions of the rule skew negotiations in favor of health insurers so strongly that health insurers will force physicians out of insurance networks and physicians will face significant practice viability challenges, struggling to keep their doors open in the wake of the pandemic.
As for Tuesday’s federal hearing, “TMA was hopeful the federal agencies would write final rules fair to everyone, especially after the federal district court ruled the agencies’ previously challenged rules were not lawful,” Dr. Floyd said. “Unfortunately, the federal agencies returned with a plan tipping scales in health plans’ favor.”
(Dial-in information to listen to the Dec. 20 court hearing: (571) 353-2301; meeting ID: 158301863#.)
TMA is the largest state medical society in the nation, representing more than 56,000 physician and medical student members. It is located in Austin and has 110 component county medical societies around the state. TMA’s key objective since 1853 is to improve the health of all Texans.
The holidays are a time of joy and celebration for many, but they could turn tragic if someone takes one pill they should not. Substance misuse – especially unwittingly taking street drugs that contain fentanyl – can destroy a life.
“The use of mind-altering substances is always more prevalent during the holidays. Unfortunately, this holiday season the risks of death are much higher because so many pills contain illegally manufactured fentanyl (IMF),” said CM Schade, MD, member of the Texas Medical Association (TMA) and past president of the Texas Pain Society (TPS). A very small amount of IMF is deadly, and people taking drugs laced with IMF are completely unaware that the pill they are consuming could kill them.
As uncomfortable a subject as it might be to address, Dr. Schade urges parents to discuss this with teenagers and young adults at home on the holiday school break. He also suggests adults heed this advice, too.
“If you got a pill from a friend or bought it off the street and it has IMF in it, it could seriously harm or kill you. If it was in the medicine cabinet but not prescribed to you, it could seriously harm or kill you as well,” said Dr. Schade. “Don’t take a chance on these; it’s just not worth it.”
Dr. Schade has some tips for Texans to stay safe:
Don’t take pills containing opioids unless prescribed to you by a physician for a health issue like chronic or severe pain relief. The U.S. Drug Enforcement Administration warns that six out of 10 fake pills contain lethal doses of fentanyl. It is very difficult to tell counterfeit drugs from legitimate ones, so the danger is very real that someone may consume a pill that could be deadly.
During gatherings with loved ones, it is important to be vigilant with prescription medication. Lock up your medication. You don’t want anyone taking your prescription drugs knowingly or unknowingly.
If someone is struggling with opioid use disorder and is at risk of an overdose, be proactive and have the opioid antidote naloxone available in case of emergency. In Texas, naloxone is available at most pharmacies under a standing order from a physician.
Throughout the year, TMA and TPS physicians have been raising awareness about the dangers of illegally manufactured fentanyl. In September, Dr. Schade testified before the Texas House Committee on Public Health presenting new legislative solutions to address the problem. Among other recommendations, TMA and TPS advocated for relaxing opioid prescribing guidelines so patients with chronic pain get the help they need and don’t turn to street drugs, making naloxone available over the counter, and legalizing fentanyl testing strips so someone could test whether a pill has IMF in it.
“Whether someone unwittingly took a bad pill for recreational use, or to sleep better, or because they feel depressed, or for whatever reason, it’s simply a bad decision to take something off the streets or not prescribed to you,” Dr. Schade said. “The result could be tragic anytime, but even worse during the holidays.”
TMA is the largest state medical society in the nation, representing more than 56,000 physicians and medical student members. It is located in Austin and has 110 component county medical societies around the state. TMA’s key objective since 1853 is to improve the health of all Texans.
TPS is a 501c6 nonprofit organization that represents over 350 pain specialists in Texas. It is the largest state pain society in the nation.
The Centers for Medicare & Medicaid Services (CMS) recently posted the 2023 Medicare Physician Fee Schedule, which takes effect Jan. 1 and brings with it a mixed bag of consequences for physicians.
The Texas Medical Association continues to fight certain elements of the final rule, including a nearly 4.5% physician pay cut and additional changes to the already-byzantine Merit-Based Incentive Payment System (MIPS). But the association also celebrates the victories in the regulation, including expanded cancer coverage and reduced administrative requirements.
TMA experts discuss the key updates from the final rule in the new, on-demand 2023 Medicare Update webinar. It is free to TMA members, and you can earn 1 AMA PRA Category 1 Credits™ that may count as ethics credit.
A physician paycut and other concerns
The 2023 fee schedule lowers the conversion factor that determines physician payments by 4.47% compared with the 2022 formula, leaving many physicians concerned about their bottom line. Barring intervention by Congress, the cut would be one of many to take effect next year, including a sequester cut and other reductions mandated by law, totaling 8.5%.
Robert Bennett, TMA vice president of medical economics, is hopeful Congress will act to avert the cuts, but he cautions lawmakers could wait until January to do so retroactively.
“There are so many issues being debated in Washington, D.C. right now,” he said during the event. “I’m worried this is a back-burner issue for them.”
TMA urges members physicians to download its Medicare Payment Cuts Toolkit, which outlines ways to press lawmakers to intervene.
In the meantime, TMA joined the American Medical Association and others in organized medicine in writing to Congressional leadership on Dec. 1.
“Put simply, the cost of Congressional inaction is an across-the-board cut that will further amplify the financial hardship physician practices are already facing while inhibiting Medicare from delivering on its promises to seniors and future generations,” the signatories wrote.
TMA also has joined forces with AMA and scores of state and specialty medical societies to push for comprehensive Medicare physician payment reform. Such a long-term fix would prevent the need for physicians to lobby their representatives multiple times a year about impending pay cuts – or risk their practice viability.
As in previous years, the fee schedule also includes changes to MIPS, one of two pathways under Medicare’s Quality Payment Program. CMS says the changes focus on MIPS Value Pathways (MVPs) – a new, optional reporting framework set to debut in the 2023 performance year – and limit adjustments to traditional MIPS in an effort to spur participation in MVPs.
TMA has repeatedly asked CMS to reconsider MVPs and to focus instead on the development of voluntary, physician-led alternative payment models (APMs). Still, Mr. Bennett encouraged physicians who participate in MIPS to consider MVPs, which he said function as a hybrid between fee-for-service MIPS and value-based care APMs.
CMS is hosting a webinar on Dec. 14 from 1-2 pm CT about MVPs, including its rollout and how physicians can submit an MVP candidate for consideration. You can register for the virtual event via Zoom.
Fee schedule gains
Despite these concerns, the 2023 fee schedule includes meaningful gains when it comes to the Medicare Shared Shavings Program (MSSP), evaluation and management (E/M) coding and payment, certain pandemic-era flexibilities, electronic prescribing of controlled substances, and colorectal cancer screening.
TMA welcomes some of the changes to MSSP, which its experts say could reduce barriers to participation. For instance, CMS will make advanced investment payments available to certain new accountable care organizations, which they could use to purchase the technology and data management resources and to hire the care coordinators necessary to participate in the program.
At the same time, TMA has asked CMS to consider phasing in – and even limiting – recoupment of any advance funding to encourage long-term participation as well as providing new opportunities to engage specialists in Medicare’s value-based programs.
CMS also will institute significant changes to E/M coding in the new year, heeding recommendations from TMA and AMA. These include simplified documentation requirements and increased payment for services provided at several sites, including hospitals, emergency departments, nursing homes, and patient’s homes.
Although this is a positive development, Mr. Bennett said these payment increases contributed to the 4.47% reduction in the conversion factor, given federal budget neutrality requirements.
CMS also delayed the implementation of a confusing policy related to split (or shared) visits, which determines who should bill for a shared visit. The fee schedule maintains the existing guidelines, and CMS will revisit the issue in its 2024 fee schedule.
In addition, the 2023 fee schedule offers some guidance on telehealth coverage once the federal public health emergency (PHE) related to COVID-19 ends. With it, CMS has extended certain telehealth flexibilities for 151 days after the PHE ends, including allowing:
Practices to use non-HIPAA complaint telehealth platforms; and
Medicare patients to access telehealth services anywhere, including at home, and via audio-only options, among other changes.
This aligns with Congress’ action in March, when it passed a spending package extending these same flexibilities for 151 days after the PHE ends.
Shannon Vogel, TMA associate vice president of health information technology, said physicians should anticipate making changes once the PHE and the 151-day grace period end, such as phasing out non-HIPAA compliant telehealth platforms and audio-only telehealth services. But she added that they still have time to do so.
“At this point, we feel pretty confident that the PHE will probably extend through about mid-April or so,” she said, which would put the end of the grace period in mid-September.
The PHE is currently slated to expire in January. However, the federal government has said it will give states 60-days’ notice of its end, a deadline that came and went in mid-November. Although the government hasn’t announced a new deadline, it previously has extended the emergency declaration in 90-day increments.
As recommended by TMA and others in organized medicine, CMS will delay until 2025 financial penalties for physicians who don’t electronically prescribe controlled substances. Although TMA supports this move, it has pushed CMS to go further by scrapping such penalties altogether, especially for those practices that do not do high volume e-prescribing.
Starting next year, Medicare patients also will benefit from expanded coverage of colorectal cancer screening tests, following advocacy by TMA and others in organized medicine. CMS gradually will reduce coinsurance payments for Medicare patients who undergo unplanned colorectal screening tests until 2030, when the federal agency will waive such copayments altogether.
TMA endorsed this policy change in its comment letter, writing that it would “reduce the financial burden facing Medicare [patients] whose screenings result in a diagnostic procedure” as well as “promote utilization of colorectal cancer screenings that save lives.”
When Dr. Gregory Phillips starts seeing patients for the day, it isn’t in his office, as you might expect for an internist. No—he begins by making rounds at Texas Health Harris Methodist and HCA Medical City hospitals, checking up on any of his patients who are currently admitted.
“I am usually at the hospital, I don’t know, 6:00, 6:30?” Dr. Phillips says. “And then I usually get to my office at 8:00.”
Going to see his patients in the hospital makes Dr. Phillips a bit of a unicorn in the medical world; the red tape of credentialing complications and readily available hospitalists have made the practice nearly obsolete. But Dr. Phillips has seen admitted patients throughout his over 40 years of practicing medicine in Fort Worth, and it means the world to them.
“I saw a 94-year-old lady in the office today with her daughter, and I said, ‘What was your good experience and bad experience with your hospitalization at Harris?’’ says Dr. Robert Keller, who works with Dr. Phillips at his private practice, Fort Worth Medical Specialists. “And they said, ‘Dr. Phillips showed up every day at the same time, and we could ask all of our questions and he knew all of the answers.’”
Dr. Keller, who spent years as Dr. Phillips’ call partner before joining his practice in 2021, pauses to reflect as he recalls the conversation. “That’s a classic story for Greg. He is devoted to his patients . . . I call it ‘covenantal care.’ His contract with his patients is not simply economic, it’s not simply medicine – it’s covenantal. You’re in this together.”
But Dr. Phillips’ commitment to medicine and the community extends beyond his own practice. Throughout his career he has been dedicated to organized medicine, educating medical students, supporting the arts, and advocating for the underserved of our community. And, yes, his patients.
That is why Dr. Phillips’ colleagues are recognizing him as the 2022 Tarrant County Medical Society Gold-Headed Cane recipient, an honor that is given to the “Doctor’s Doctor” for their excellence in patient care and impact on the practice of medicine in Tarrant County.
“Dr. Phillips is a ‘Doctor’s Doctor,’” says his friend and fellow physician Dr. David Donahue. “Colleagues consult him for care and counsel. Dr. Phillips’ possession of the golden cane represents a credit to his fellow physicians and is a justifiable tribute to him. The award takes on a new significance. We congratulate him.”
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For Dr. Phillips, becoming a physician wasn’t inspired by a single moment or person. You might say it is part of his nature – because if you ask him, it was always a defining part of his life.
“I can remember from my earliest days,” he says.
“You know, people ask you what you want to be, and I think I always said I wanted to be a doctor. I’ve never really thought of anything else. And if I weren’t a doctor, I honestly don’t know what I’d be doing.”
Perhaps it isn’t surprising – his family has a strong medical background. His father was a dentist, his mother a nurse, and his two uncles and grandfather were doctors. Dr. Phillips likes to joke that his lifelong commitment to medicine took a weight off of his five younger siblings and their cousins.
“Once I said I’d be the doctor, no one else had to do that,” he says, laughing. “I was going to be the doctor out of our generation. They were all free to do whatever they wanted.”
Dr. Phillips never wavered from his vision and began his journey to becoming a physician in Fort Worth shortly after graduating from high school – but he didn’t necessarily plan to stay here.
“I never thought I’d be spending my life in Texas,” he says. “I think of myself as a West Coast kind of guy.”
After graduating Summa Cum Laude with a degree in biology from Texas Wesleyan University in 1970, he attended medical school at UT Southwestern in Dallas, and completed his residency in internal medicine at the St. Louis University Medical School in Missouri. It was when he began a fellowship in clinical nutrition at the University of California Davis that Dr. Phillips hit a bump in the road.
“I went to California, thinking I would take this fellowship and stay in academics, but the state of California ran out of money in 1978; as a result, the medical school eliminated the entire clinical nutrition program,” says Dr. Phillips. “I found a job in Fort Worth that year in 1979, and I’ve been here ever since.”
Though he has been in private practice since coming back to Texas, Dr. Phillips has still been involved in the educational side of medicine through Tarrant County’s two local medical schools—he is an adjunct clinical professor of medicine at the Texas College of Osteopathic Medicine at UNT and an assistant professor of internal medicine at the Anne Burnett Marion School of Medicine at TCU.
Though it was a deviation from his original academic plans, Dr. Phillips has found his work as in internist incredibly rewarding. Throughout his career he has built a thriving practice that has fostered long-term relationships with patients and given him ample opportunity to exercise his passion for nutrition and preventative healthcare.
“I didn’t even know what internal medicine was when I started medical school,” says Dr. Phillips. “I knew I wanted to be a doctor and had spent summers working as a surgical orderly here in Fort Worth at one of the hospitals, so I knew that I didn’t want anything to do with surgery. So then, when you go through training in medical school, you realize that there’s this whole specialty called ‘internal medicine.’ You don’t do operations, you don’t deliver babies, you don’t see kids. It’s all adult primary care medicine. Once I realized that was an actual specialty, that was what I decided that I wanted to do.”
Dr. Phillips smiles. “It’s almost like they made that specialty just for me.”
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While he impacts the Tarrant County community every day by caring for his patients, Dr. Phillips’ dedicated involvement in organized medicine gives him a much broader reach. Beyond his TMA and TCMS membership, he is a member of the American Heart Association, American College of Physicians, National Lipid Association, and the Association of Black Cardiologists (ABC).
“My friend who was presenting about the ABC at a meeting was saying, ‘If you care for minority and underrepresented populations, you should join our organization,’” Dr. Phillips explains, noting that it might seem odd that he is a member of the Association of Black Cardiologists when he is neither Black nor a cardiologist. “But Dr. Ferdinand said, ‘You don’t have to be a cardiologist; you don’t even have to be Black. You can join our organization.’”
So that’s what Dr. Phillips did.
“It’s just one example of getting involved with an organization that has part of its mission to see what it can do to help healthcare for disadvantaged, disenfranchised populations,” he says.
Throughout his work in organized medicine, Dr. Phillips has served in numerous roles, including as our 2016 TCMS president and as a Project Access volunteer. He has sat on many boards and committees, including the Board of Directors for the American College of Physicians Texas Chapter, the Southwest Lipid Association, and the Recovery Resource Council.
Eric Niedermayer, CEO of the Recovery Resource Council, says that Dr. Phillips has had a tremendous impact on the organization, which is focused on fostering wellness and recovery for those struggling with addiction and trauma.
“[Dr. Phillips] has truly given of his time, talents, and resources every year,” he says. “During the summer of 2022, he helped the Council’s Overdose response team obtain $100,000 of Narcan to distribute to survivors of fentanyl and other opioid overdoses by providing the necessary authorization for this life-saving intervention . . . To me, he is a person I can count on to do whatever he can whenever he is asked to help. That makes him a rare find for any non-profit that is always faced with new challenges or opportunities.”
He uses the same approach for each organization he has joined – if he is going to be a member, he is going to be involved. This is what eventually led to one of his career highlights: from 1990 to 1991, he served as the president of the Texas Affiliate of the American Heart Association, and he was then appointed to the American Heart Association’s National Board of Directors from 1993 to 1995.
“So this little kind of average internal medicine doctor from Fort Worth would have no business there,” says Dr. Phillips. “I don’t do research; I don’t write grants. I’m not the chairman at the department of a famous medical school. But I’m at these meetings with all of these famous people. And it’s because I demonstrated a commitment to the mission of the organization and showed that I participate and help whatever needs to be helped.”
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While medicine is certainly a passion for Dr. Phillips, it isn’t the cap on his interests. He loves supporting the arts and is especially involved in sponsoring local efforts. He is a patron of both the Circle Theatre and Bruce Wood Dance.
“It’s also been very rewarding because I’m not in any way an artistically talented person, but being able to work with the theater group or the dance company . . . to support their work with both time and money, is something that I’ve been able to do,” Dr. Phillips says.
He has also been an active member of Texas Wesleyan University’s Board of Trustees for over ten years, and he is currently serving on their Executive Committee. Much like his interest in the arts, Dr. Phillips views this as a way to broadly make an impact for good through the value his alma mater brings to its students and the greater Fort Worth community. Dr. Tom Cockerell, his former neighbor and longtime friend, says that civic involvement has always been a priority for Dr. Phillips, alongside his work in medicine.
“Through the years Greg has been able to continually balance a busy practice with family and civic and professional leadership demands at the local and national level,” says Dr. Cockerell. “Anyone who knows Greg admires his amiable nature, his recognition of and loyalty to important enterprises, and his good sense.”
Though he says his hobby is going to meetings, Dr. Phillips also enjoys playing golf when he has the chance. But between his practice and the different groups he is involved in, he always makes time for his family.
“I save my time off to go be with them,” says Dr. Phillips.
Whether it’s visiting his son, Lauren, in Lubbock; or his daughter, Karen, her spouse, Kyle, and his two grandchildren, Elodie and Ezra, in Santa Fe; getting to spend time with them is the highlight of his year.
As Dr. Phillips looks to the future, two things are very clear to him: he wants to keep practicing medicine and fighting for equity.
“I don’t have a plan to retire,” he says. “And I do think that people in the profession who do have time and financial resources and influence to try bringing the whole population up is something to try to focus on. I don’t know exactly where I fit into that whole puzzle, but I hope that during the rest of my career that can be one of the priorities that I have – to continue working on improving the healthcare of people who have been disadvantaged for so long.”
It is Dr. Phillips’ legacy of driven yet compassionate care for the patients of Tarrant County that has led his colleagues to recognize him as the 2022 Gold-Headed Cane recipient. With much appreciation for his service, past, present, and future, we congratulate Dr. Phillips as “the Doctor’s Doctor.”
December 9, 2022 – (Tarrant County) – Tarrant County Public Health hosts numerous pop-up COVID-19 clinics across Tarrant County each week in partnership with public and private organizations listed below. Each site has the Moderna, Pfizer, and Novavax vaccines. Infants six months and older are eligible for the vaccination. Parents need to bring proof of the child’s age and their own ID for the vaccination. Booster vaccinations are available at all of the vaccination locations.
TCPH would like to bring a COVID-19 vaccination clinic to businesses, churches, and organizations in the community that are interested in hosting a pop-up clinic. It’s easy and free to host a clinic.
In addition to the vaccination opportunities below, the cities of Arlington, Fort Worth, Mansfield, North Richland Hills, Hurst, and Tarrant County College have also added opportunities for vaccinations. To find a local vaccine site, the County created a vaccine finder page: VaxUpTC website.
Pop-Up COVID-19 locations:
FWISD-Eastern Hills High School Saturday, Dec. 10: 9 a.m. to 2 p.m. 5701 Shelton Street. Fort Worth, TX 76112
R.D. Evans Community Center Tuesday, Dec. 13: 12 p.m. to 4 p.m. 3242 Lackland Rd. Fort Worth, TX 76116
Federacion Zacatecana Wednesday, Dec. 14: 10 a.m. to 2 p.m. 4323 East Lancaster Ave. Fort Worth, TX 76103
Patriot Pointe Apartments Friday, Dec. 16: 12 p.m. to 2 p.m. 2151 Southeast Loop 820 Fort Worth, TX 76119
Tarrant County Public Health CIinics:
Northwest Public Health Center Monday to Friday: 8 a.m. to 12 p.m. and 1 to 5 p.m. 3800 Adam Grubb Road Lake Worth, TX 76135
Bagsby-Williams Health Center Monday to Friday: 8 a.m. to 12 p.m. and 1 to 5 p.m. 3212 Miller Ave. Fort Worth, TX 76119
Southeast Public Health Center Monday to Friday: 9 a.m. to 12 p.m. and 1 to 5 p.m. 536 W Randol Mill Arlington TX, 76011
Main Public Health Center Monday to Friday: 8 a.m. to 12 p.m. and 1 to 5 p.m. 1101 S. Main Street Fort Worth, TX 76104
Southwest Public Health Center Monday to Friday: 8 a.m. to 12 p.m. and 1 to 5 p.m. 6551 Granbury Road Fort Worth, TX 76133
Watauga Public Health Center Monday to Friday: 8 a.m. to 12 p.m. and 1 to 5 p.m. 6601 Watauga Road Watauga, TX 76148
For more information go to coronavirus.tarrantcounty.com or call the Tarrant County Public Health information line, 817-248-6299, Monday – Friday 8 a.m. to 6 p.m.
Dr. Combs giving her first speech as the 2022 TCMS president
And just like that, my year as the Tarrant County Medical Society president is nearly over. It has been a pleasure to serve in this role, and while my time is almost up, I wanted to look back over the past year.
My time started at the end of last year during an early reprieve from the COVID pandemic. The Gold-Headed Cane and President Installation was our first in-person event since the start of COVID. It was an amazing night of getting to see old colleagues and meet new ones. It was also amazing to have four female physicians being honored in one night; it was great to share the evening’s celebration with Drs. Susan Bailey, Teresa Godbey, and Angela Self.
Being inducted by Dr. Angela Self as the new TCMS president
Unfortunately, the year took a step back due to the COVID pandemic, and we once again had to change to a virtual meeting for the TMA Winter Conference. As we have done multiple times during the pandemic, we were able to pivot and carry on. Locally, our TCMS leadership came together to promote fellow physicians to seek out positions at TMA.
As we moved to April, we started to see light and were finally able to hold TexMed in person, the first time since 2019. The best part of the meeting was seeing the inauguration of our own Gary Floyd as TMA president. Moving into summer, we were able to have a Women in Medicine event where we gathered for some much-needed stress relief making bath bombs. While we were not all successful at making the bath bombs, we had a great time gathering again in person.
Making bath bombs at the Women in Medicine event
When the Dobbs decision came out in June, I had multiple opportunities to speak with local and national media about the importance of the patient/physician relationship, and how this decision has many far-reaching implications in medicine. I will continue to work on advocating for doctors and patients to make their own medical decisions without intervention from outside forces.
At the Young Physicians Mixer
During July, I had the privilege to welcome our new Tarrant County medical students from the Texas College of Osteopathic Medicine and the Anne Burnett School of Medicine at TCU to TCMS and the world of organized medicine. It was refreshing to meet with these young students and to cheer them on as they begin their journey to having the greatest job on the planet: being a physician.
As we moved into the fall, we had another opportunity to gather again at the TMA Fall Conference. We are slowly finding our way through this COVID pandemic, returning to some form of normalcy. While I cannot quite say it seems to be over, as this has been said too many times before, we continue to find a way through.
Speaking to the incoming class of medical students
While my tenure as TCMS president may be coming to an end, I will continue to contribute to the work of our county, state, and national medical societies. If I have learned anything over the past year, it is that we must be at the table and part of the discussion; otherwise, people who don’t practice medicine will continue to try to tell us how to do our job. We have worked too hard to become physicians to allow others to practice medicine for us, and it isn’t in the best interest of our patients or our vocation – the work that still is, despite so many challenges, the best job on the planet.
Amid concerns about threats to patients’ access to physicians’ care, the Texas Medical Association (TMA) has filed a new lawsuit in the U.S. District Court for the Eastern District of Texas, challenging certain portions of the July 2021 interim final rules implementing the federal No Surprises Act (NSA).
This is the third lawsuit TMA has filed against federal agencies related to rulemaking under the law.
In its latest lawsuit, TMA is challenging certain parts of the rules that artificially deflate the “qualifying payment amount” or “QPA.” The QPA is an insurer-calculated amount that arbitrators are required to consider, among other factors, when deciding between the physician’s and the health insurer’s offer as the appropriate out-of-network rate in federal arbitrations. Under the law, the QPA is generally supposed to be the median in-network rate for the service provided by a physician in the same or similar specialty in the relevant geographic area. The challenging parts of the rule set forth a methodology for calculating QPAs that conflicts with how the NSA requires insurers to calculate QPAs. The lawsuit also challenges the lack of transparency around QPA calculations.
“TMA is concerned that these provisions unfairly disadvantage physicians in payment disputes with health insurers and will ultimately rob patients of access to physicians’ care,” said TMA President Gary W. Floyd, MD. “Calculating QPAs the way the agencies have required means that physicians have the scales tipped against them from the outset of negotiations. Shrouding these calculations in secrecy further disadvantages physicians, by preventing them from raising errors in QPA calculations to the agencies.”
TMA contends the challenged provisions of the rule skew negotiations in favor of health insurers so strongly that health insurers will force physicians out of insurance networks and physicians will face significant practice viability challenges, struggling to keep their doors open in the wake of the pandemic.
TMA’s lawsuit focuses on four ways in which the rule unfairly deflates the QPA. Those are that the rule:
Permits insurers to include “ghost rates” in their QPA calculations, which are contract rates with physicians and providers who don’t actually provide the health service in question. This unfairly lowers QPAs as there is little motivation for physicians or providers to negotiate rates for services they do not actually provide. For example, some of these “ghost rates” are $1, which clearly would not be reflective of market rates or the cost of providing care.
Permits insurers to include rates of physicians who are not in the same or similar specialty as the physicians involved in the payment dispute.
Requires insurers to use an amount other than the total payment in calculating a QPA when a contracted rate includes “risk sharing, bonus, or penalty, and other incentive-based and retrospective payments or payment adjustments.”
Permits self-insured group health plans to allow their third-party administrators to determine the QPA for the plan sponsor by calculating the median contracted rate using the contracted rates recognized by all self-insured group health plans administered by the third-party administrator. This allows self-insured plans to essentially opt into a lower QPA for payment disputes with physicians.
Physicians argue this unfair process is compounded by the opaque nature of QPA calculations and the heavy weighting of the QPA provided by the federal agencies’ final rules, the latter of which is the subject of a separate legal challenge by TMA.
“This all adds up to rigging the arbitrations against doctors in favor of health insurance companies, and to patients’ detriment,” said Dr. Floyd. “It’s setting up a race to the bottom, which will leave patients scrambling to get the care they need.”
TMA filed its second lawsuit in September challenging the law’s Aug. 26, 2022, final rules published by the U.S. Department of Health and Human Services, Labor, and the Treasury. In the September lawsuit, TMA alleges the final rules unfairly advantage health insurers by requiring arbitrators to give outsized weight or consideration to the QPA. The hearing on that lawsuit is scheduled for Dec. 20 in Tyler, Texas.
TMA’s first lawsuit – filed in 2021 – alleged that in the interim final rules governing arbitrations between insurers and physicians, the agencies unlawfully required arbitrators to “rebuttably presume” the offer closest to the QPA was the appropriate out-of-network rate. TMA won at the district court level, arguing that requiring arbitrators to heavily weigh figures created by insurance plans conflicted with the law and provided health insurers with an unfair advantage not intended by Congress. The federal government declined to pursue its appeal of this court loss.
TMA is the largest state medical society in the nation, representing more than 56,000 physicians and medical student members. It is located in Austin and has 110 component county medical societies around the state. TMA’s key objective since 1853 is to improve the health of all Texans.
Physicians participating in Medicare’s 2021 Quality Payment Program (QPP) have until Dec. 20 to preview their performance ratings before they are made publicly available in 2023.
The Centers for Medicare & Medicaid Services (CMS) publicly reports QPP performance information for physicians, clinicians, groups, and accountable care organizations (ACOs) on Medicare Care Compare and in the Provider Data Catalog (PDC). (The performance information was previously reported on Physician Compare profile pages and in the Physician Compare Downloadable Database.)
Physicians and groups can see their Merit-Based Incentive Payment System (MIPS) and Qualified Clinical Data Registry quality measures; MIPS promoting interoperability measures and attestations; MIPS improvement activities attestations; and final scores plus those in the four individual reporting categories (quality, promoting interoperability, improvement activities, and cost). The information is later displayed on Care Compare and in the PDC using star ratings, percent scores, and checkmarks.
CMS notes the 2021 performance data planned for public reporting in 2023 “will be added to Care Compare and/or the PDC after all targeted reviews are completed. If you have an open targeted review request, you’ll still be able to preview your 2021 QPP performance information.”
ACO-level data, however, is not available for viewing via the QPP site during the preview period, the agency said: “MIPS-eligible clinicians who participate in Medicare Shared Savings Program ACOs can preview their performance information in their 2021 MIPS Performance Feedback. Shared Savings Program ACOs can also review quality performance information in their previously provided 2021 Quality Performance Reports.”
Check out your scores via the Doctors and Clinicians Preview section of the QPP website. CMS also provides several resources to guide you.
The preview period opened on Nov. 21 and will close on Dec. 20 at 7 pm CT.
(2022, Nov. 30) Preview Your MIPS Performance Data Before It Goes Public. TMA Publications.
December 1, 2022 – (Tarrant County) – Tarrant County Public Health hosts numerous pop-up COVID-19 clinics across Tarrant County each week in partnership with public and private organizations listed below. Each site has the Moderna, Pfizer, and Novavax vaccines. Infants six months and older are eligible for the vaccination. Parents need to bring proof of the child’s age and their own ID for the vaccination. Booster vaccinations are available at all of the vaccination locations.
TCPH would like to bring a COVID-19 vaccination clinic to businesses, churches, and organizations in the community that is interested in hosting a pop-up clinic. It’s easy and free to host a clinic.
In addition to the vaccination opportunities below, the cities of Arlington, Fort Worth, Mansfield, North Richland Hills, Hurst, and Tarrant County College have also added opportunities for vaccinations. To find a local vaccine site, the County created a vaccine finder page: VaxUpTC website.
Pop-Up COVID-19 locations:
Mount Olive Baptist Church Saturday, Dec. 3: 10 a.m. to 2 p.m. 301 Sanford St. Arlington, TX 76012
Como Community Center Tuesday, Dec. 6: 9 a.m. to 1 p.m. 4660 Horne Street. Fort Worth, TX 76107
Diamond Hill Community Center Tuesday, Dec. 6: 9 a.m. to 1 p.m. 1701 Northeast 26th St. Fort Worth, TX 76106
Chisholm Trail Community Center Saturday, Dec. 6: 10 a.m. to 12 p.m. 4936 McPherson Blvd. Fort Worth, TX 76123
Haltom City Senior Center Wednesday, Dec. 7: 10 a.m. to 2 p.m. 3201 Friendly Ln. Haltom City, TX 76117
Highland Hills Community Center Thursday, Dec. 8: 10 a.m. to 2 p.m. 1600 Glasgow Rd. Fort Worth, TX 76134
Polytechnic Community Center Friday, Dec. 9: 9 a.m. to 1 p.m. 3100 Avenue I Fort Worth, TX 76105
Tarrant County Public Health CIinics:
Northwest Public Health Center Monday to Friday: 8 a.m. to 12 p.m. and 1 to 5 p.m. 3800 Adam Grubb Road Lake Worth, TX 76135
Bagsby-Williams Health Center Monday to Friday: 8 a.m. to 12 p.m. and 1 to 5 p.m. 3212 Miller Ave. Fort Worth, TX 76119
Southeast Public Health Center Monday to Friday: 9 a.m. to 12 p.m. and 1 to 5 p.m. 536 W Randol Mill Arlington TX, 76011
Main Public Health Center Monday to Friday: 8 a.m. to 12 p.m. and 1 to 5 p.m. 1101 S. Main Street Fort Worth, TX 76104
Southwest Public Health Center Monday to Friday: 8 a.m. to 12 p.m. and 1 to 5 p.m. 6551 Granbury Road Fort Worth, TX 76133
Watauga Public Health Center Monday to Friday: 8 a.m. to 12 p.m. and 1 to 5 p.m. 6601 Watauga Road Watauga, TX 76148
For more information go to coronavirus.tarrantcounty.com or call the Tarrant County Public Health information line, 817-248-6299, Monday – Friday 8 a.m. to 6 p.m.
Tarrant County Physician Online 