Design a site like this with
Get started

TMA Seeks to Protect Patients’ Access to Care in New “No Surprises Act” Rules Lawsuit

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.

Preview Your MIPS Performance Data Before It Goes Public

Originally published by Texas Medical Association on November 30, 2022.

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.

COVID-19 Vaccine Clinics for the Week of December 3

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 or call the Tarrant County Public Health information line, 817-248-6299, Monday – Friday 8 a.m. to 6 p.m.

Medical Student Syndrome

By Sujata Ojha, MS – III

This article was originally published in the July/August 2022 issue of the Tarrant County Physician.

As medical students, we have an incredible opportunity to discover a vast amount of medical knowledge, learn about the normal and the pathological, and to immerse ourselves in clinical settings where we witness the complexity of diseases. In the process of learning about life-threatening diseases, the risk of nosophobia, or illness anxiety disorder, can develop. More commonly termed “Medical Student Syndrome,” it is a concept that medical trainees are well acquainted with. 

What is Medical Student Syndrome? It is the phenomenon that causes fear of contracting or experiencing symptoms of the disease that the students are studying or are exposed to.  

Medical students learn the pathophysiology, the diagnosis, the treatment, the prognosis, the best-case scenario, and the worst-case scenario of diseases. We learn about teenagers diagnosed with melanoma and hear stories about patients in their early 20s diagnosed with breast or cervical cancer. The worst-case scenario tends to grab our attention. This reinforces us to not ignore a patient or symptom that doesn’t follow the general pattern of the disease, allowing us to widen our baseline scope of clinical suspicion when it comes to debilitating pathologies. The constant medical stimulation and limited clinical experience earlier on in our education can cause students to become preoccupied with symptoms and construct connections between what we are experiencing with the worse-case scenarios we learn about. 

“I booked an appointment with the dermatologist because I thought I had a melanoma,” said one classmate after we shortly finished our dermatology unit. After undergoing a biopsy, the classmate discovered that the melanoma in question was a benign nevus. During the cardiopulmonary block, another medical student said he went to the ER after experiencing mild epigastric pain and tachycardia, thinking he was experiencing symptoms of atypical myocardial infarction. He had recently encountered a patient in his late 30s with a history of MI who presented with similar symptoms, further reinforcing the “worst-case scenario” in this trainee’s mind. After hours spent in the ER, he was diagnosed with gastritis and sent home with a prescription for a proton-pump inhibitor. 

Throughout my medical training, I have heard countless stories resembling these. This is not an uncommon phenomenon that trainees experience. It is a topic that everyone in medicine is familiar with, whether through personal anecdotes or through stories discussed with classmates, mentors, and acquaintances. Understanding the complexity of medicine takes more than four years of medical school. Medicine is a field that requires life-long learning and an internal motivation to be updated with evidence-based practice. Expertise comes with clinical experience and after encountering numerous successes and failures. I believe that these experiences can help future physicians connect with their patients more effectively. If we as medical trainees can fall victim to an overwhelming fear of vague symptoms, how can we expect our patients with limited medical knowledge to be immune to this? With Dr. Google, a benign tension headache can be escalated to look like brain cancer. Understanding these fears and reflecting on the days when we experienced these uncertainties can bridge the gap in patient-physician encounters. It allows us to effectively address the patient’s fears without judgement, urging us to educate our patients about their symptoms instead of dismissing or minimizing them. 

TCMS Legislative Committee Kickoff

Join us for a night of fun and advocacy training as we kick off our 2023 TCMS Legislative Committee meeting.

In partnership with TMA lobby staff, you will learn about the top issues, challenges, and techniques we will use to advocate on behalf of physicians and patients during the upcoming session.

The TCMS Legislative Committee is one of the most active advocacy groups in all of Texas, and we need a strong bench of leaders who continue to be involved here in Tarrant County, Texas, and Washington D.C.  Please RSVP to Elizabeth Bowers at

TMA Report

The development of TMA policy

by Gary Floyd, MD, TMA President

This article was originally published in the September/October 2022 issue of the Tarrant County Physician. You can read find the full magazine here.

Over the past year, the Texas Medical Association has had to weigh in on one sensitive topic after another—from issues impacting the patient-physician relationship to how physicians practice medicine and the prevention of further cuts in the Medicare program.

Often, after TMA publishes its stance in the association’s daily newsletter, Texas Medicine Today, we receive inquiries from members on how TMA came up with that position since no one surveyed them individually or asked for their opinion. This has made me realize many of our members don’t understand who runs TMA or the process TMA uses to develop its policy, which drives the association’s communications and advocacy. 

The association is governed by a 500-member House of Delegates, the legislative and policymaking body. The House is made up of elected county medical society delegates (one delegate per 100 members or fraction thereof) and the following ex officio members: members of the Board of Trustees; 15 councilors; Texas delegates and alternate delegates to the American Medical Association; members of the Council on Legislation and chairs of the other councils; delegates from the Young Physician Section, International Medical Graduate Section, Resident and Fellow Section, Women Physician Section, LGBTQ Section, and Medical Student Section; and delegates of selected specialty societies.

The House of Delegates meets every year at an annual session held during TexMed in the spring. In 2023, TexMed will be in Fort Worth on May 19–20.

The best way to get your idea adopted as TMA policy is to begin at the grassroots level. 

1 Present your idea or change to an existing policy at your county medical society meeting. Ideas and actions also are developed by association boards, councils, committees, and sections. You can work with these groups to develop a policy recommendation.

2 If the county society, section, or other entity agrees, it can submit your idea as a report or resolution to be considered at the next meeting of the House of Delegates. Instructions for writing a resolution are at

3 Every report and resolution is assigned to a reference committee that vets it further through open hearings at which any TMA member can testify. The reference committees then send their recommendations on each report and resolution to the house. If you would like to serve on a reference committee, let our House of Delegates speakers know by filling out the form at 

4 If your idea is adopted by the house, it is incorporated into the TMA Policy Compendium ( If it has nationwide appeal, it may also be forwarded to AMA for action.

As TMA president, I am obliged to represent our TMA policies. As you can imagine, we have members on both sides of several very sensitive issues. Some members would like TMA to issue an immediate, strong opinion favoring their stance. However, by working with our legislators, we have learned that calm, measured, commonsense approaches are far better received than knee-jerk responses. Therefore, in our responses we tend to emphasize areas of commonality for our members, like protecting the sanctity and privacy of our patient-physician relationships and creating a safe environment for our physicians to exercise their best medical judgment in providing the appropriate standard of care for all their patients. 

Please reach out to your county medical society and learn more about TMA’s policymaking process. We want to hear from you!

Linda Siy, MD, named Texas Family Physician of the Year

Linda Siy, MD, of Fort Worth, Texas, has been awarded the highest honor among Texas family doctors by the Texas Academy of Family Physicians. She was named the 2022 Texas Family Physician of the Year during TAFP’s Annual Session and Primary Care Summit in Grapevine on Oct. 29. Each year, patients and physicians nominate extraordinary family physicians throughout Texas who symbolize excellence and dedication in family medicine. A panel of TAFP members chooses one as the family physician of the year.

“It truly is an honor to join the ranks of those who have received this distinction, and I’m very humbled to be considered with those distinguished colleagues who previously were Family Physicians of the Year,” Siy said as she accepted the award.

Siy has been a family physician for over 30 years, and currently practices at John Peter Smith Health Network at the Northeast Medical Home in Tarrant County, a practice she’s been a part of since 1995. She is also faculty at the University of Texas Southwestern School of Medicine, the University of North Texas Health Science Center/Texas College of Osteopathic Medicine, and the Texas Christian University Burnett School of Medicine.

Throughout her years in organized medicine, Siy has served on many committees and councils for both TAFP and the American Academy and has been president of the TAFP Foundation since 2017. She serves on the Acclaim Multispecialty Group’s Physician Board of Directors, and previously served as president of the Tarrant County Medical Society and TAFP’s Tarrant County chapter.

Siy has spent her career in medicine treating her loyal and multi-generational families of patients, many of whom are underserved, suffer from housing and food insecurity, and struggle with mental health and substance abuse. Many of her nominators mentioned her willingness to speak up and ask the questions others are too afraid to ask, as well as her dedication to teaching the next generation of family physicians.

“I think what’s kept me in the game for so long at the place where I work now are those rewarding relationships with your patients, with your staff, with your colleagues,” Siy said of her career in family medicine. “It’s really not a job. It’s a calling.”

It’s Not Okay

President’s Paragraph

by Shanna Combs, MD, TCMS President

This article was originally published in the September/October 2022 issue of the Tarrant County Physician. You can read find the full magazine here.

On June 23, 2022, the Tarrant County medical community lost an amazing physician, who died by suicide.  He was a remarkable person whose work touched so many lives—he was always willing to help others.  He is greatly missed by all who knew him.     

Unfortunately, physician suicide has become an all-too-common occurrence in the United States.  

• Approximately 300–400 physicians die by suicide each year in the U.S.

• Among male physicians, the suicide rate is 1.41 times higher than the general male population.  

• Among female physicians, it is even more pronounced at 2.27 times higher than the general female population.1  

As terrible as this sounds, there is hope.  Physicians who are proactive about their mental health are able to take better care of their patients as well as have more resilience in the face of stress.  However, this is not so easy to accomplish.

There is already a stigma associated with mental health, and it is made even worse for physicians due to the concern of needing to report a diagnosis to our medical boards, licensing organizations, as well as to credentialing offices in the hospitals and health systems we work in.  We as physicians also have difficulty taking care of ourselves in general, let alone when it comes to mental health, as we are the healers and must be perfect.  

The truth is, being a physician is hard.  We train for many years to be able to do the work that we do.  We often share our war stories about medical school and residency, but when it comes to the deeper struggles we have, we tend to keep those to ourselves.  We push them down and hide behind a smile (or a mask) and continue to pretend that everything is okay.  

But it’s not okay.

We as a profession need to start taking care of ourselves and looking out for our colleagues.  It is okay to tell someone when you are struggling and to seek out help when you need it.  A psychiatrist friend puts it best—“Everyone needs a therapist.  I have one.”  At some point we all learned the physiology of the human body, and of the brain specifically. Sometimes that brain needs a little extra help from chemistry, and that is okay as well.  If you have a thyroid problem, you do not put up a fight about taking a thyroid pill. The same goes when our brain chemistry needs a little help.  We also need to reach out to one another, to check in and see if our colleagues are really doing okay and if they need any help or support.  It’s okay to not be okay, but we need to recognize this and seek out the help we so desperately need, and to help our colleagues obtain the help that they need.

We also need to work from an advocacy standpoint so that physicians can seek the help that they need without the fear of needing to report their illness.  All other aspects of medicine and healthcare are taken care of in a private manner between a physician and a patient.  Why should mental health be any different?  Until this changes, no number of wellness programs, resilience building, etc., will be able to fix the problem.  

I encourage everyone to seek help when needed and to reach out to our colleagues, partners, and friends.  We have worked tirelessly to get to the point we can practice medicine, and those around you want you to stay here.

1John Matheson, “Physician Suicide.”  American College of Emergency Physicians. Accessed August 3, 2022.,times%20more%20often%20than%20females

Mental Health Resources

National Suicide Prevention Lifeline
1-800-273-TALK (8255)
Available 24/7

Crisis Text Line
Text TALK to 741-741
Available 24/7

Physician Support Line
1 (888) 409-0141
Open seven days a week,
7:00am – 12:00am CST
Psychiatrists helping their U.S. physician colleagues and medical students navigate the many intersections of our personal and professional lives. Free and confidential. No appointment necessary.

Emotional PPE Project
The Project connects healthcare workers in need with licensed mental health professionals who can help.

Join Cook Children’s for Ask the Doc Webinar on Pregnancy Care

Join Cook Children’s Medical Center on November 1, 2022, 5:30 PM – 6:30 PM CT, for their upcoming Ask a Doc webinar: “Do No Harm: The Ethics, Myths & Business of Caring for Pregnant People.”

The event, which is led by the Texas Department of State Health Services – Oral Health Improvement Program and the Children’s Oral Health Coalition, is focused on education, combatting barriers to healthcare, and coordinating services.

A number of topics will be covered, including:

  • Explaining ethical dilemmas related to delaying treatment
  • Discussing the myths dentist have about treating pregnant people
  • Recognizing why timely treatment is good for business
  • Identifying and manage potential medical and dental risk

You can find out more about the event or register here.

Physicians Urge Texans to Safely Return Unused Prescription Medication

Saturday is National Prescription Drug Take Back Day

Have unused, unneeded prescription drugs at home? Turn them in now, physicians say.

Texas doctors recommend people with unused or expired prescription drugs at home dispose of them safely this weekend, so they are not accidently consumed.

As the state grapples with a sharp increase in opioid overdose deaths, the U.S. Drug Enforcement Administration is organizing its biannual prescription drug Take Back Day on Saturday, Oct. 29. Prescription drugs can be returned anonymously at pop up locations across the state. Syringes or illegal drugs cannot be taken.

Returning unused medication is an important step to prevent misuse of prescription medication, especially opioids.

“The overwhelming majority of people who suffer from opioid addiction got started by getting opioids from friends and family,” said C.M. Schade, MD, a Texas Medical Association (TMA) physician leader and past president of the Texas Pain Society (TPS). “Their opioid addiction was not caused by taking opioids that were prescribed to them.”

According to the 2020 National Survey on Drug Use and Health, more than 9 million people aged 12 and above misused prescription pain relievers like hydrocodone, oxycodone, morphine, and prescription fentanyl.

Dr. Schade warns that consuming medication not meant for you can be life threatening. “Taking opioids that are not prescribed to you is especially dangerous because in the opioid-naïve patient it causes breathing problems that can cause brain damage and even death.”

Dr. Schade also said giving your prescription medication to others is both illegal and harmful. “You will be intentionally or unintentionally enabling dysfunctional behavior, which is not only unhealthy but oftentimes leads to addiction and/or death.”

While Dr. Schade noted illegal drugs – especially those laced with fentanyl – are largely to blame for the opioid epidemic, safely disposing of prescription medication is one way to prevent an overdose from occurring.

“The drug take-back program, while important, only removes one source of drugs that people who are addicted can use to get a drug to satisfy their addiction,” he said. “What is needed is a comprehensive program to engage these people in the health care system so that they will get medical care such as counseling and medication-assisted treatment.”

TMA and TPS physicians have been raising awareness about the dangers of street drugs. Dr. Schade testified before the Texas House Committee on Public Health last month and offered lawmakers several recommendations to curb deaths from illegal opioids including making naloxone – a medicine that reverses overdose – available over the counter without a prescription.