The Centers for Medicare and Medicaid Services (CMS) released the final calendar year (CY) 2019 Physician Fee Schedule (PFS) rule on November 1, and CMS modified the controversial E/M proposal. CMS also released the hospital outpatient department (OPPS) and ambulatory surgery center (ASC) final payment policy rule for CY 2019 on November 2. Click here […]
Click here for the latest info for our upcoming 2019 Annual Conference. Sponsorship details are coming soon!
A discussion related to approving hip and knee replacement surgeries for Medicare payment in ASCs dominated last year’s hospital outpatient department (HOPD) and ambulatory surgery center (ASC) payment proposal for Medicare. (Ultimately, CMS simply removed TKA from the inpatient only list.) The 2019 proposal, which was released on July 25, 2018, only addressed the anesthesia […]
The Centers for Medicare and Medicaid Services (CMS) announced on January 9, 2018 that it is creating the voluntary Bundled Payments for Care Improvement Advanced (BPCI Advanced) demonstration that requires participants to take on financial risk. In addition, the program, which includes outpatient and inpatient episodes of care, would count as an Advanced APM for […]
Texas became the first legislature to pass a bill related to patient reported outcomes (PROs) for musculoskeletal care through SB 55, which was introduced by Senator Judith Zaffirini (D-Laredo) and Representative JD Sheffield, DO (R-Gatesville). Governor Greg Abbott signed the bill into law on June 15. SB 55 directs the two of the state’s employee […]
Both the Texas Orthopaedic Association (TOA) and American Academy of Orthopaedic Surgeons (AAOS) have addressed the opioid crisis at recent meetings. Austin orthopaedic surgeon David Ring, MD, PhD presented at TOA’s 2017 Annual Conference: “The Opioid Crisis: The Future Role of Orthopaedic Surgeons in Solving the Crisis.” Dr. Ring shared a pain relief video at […]
Texas Governor Greg Abbott signed HB 1076, which will update the state’s scoliosis screening standards to reflect the latest science. The measure was sponsored by Representative Tom Oliverson, MD (R-Spring) and Senator Don Huffines (R-Dallas). A groundbreaking 2013 study published in the New England Journal of Medicine affirmed that a back brace can slow the […]
The American Academy of Orthopaedic Surgeons (AAOS) is meeting with the American Board of Orthopaedic Surgery (ABOS) to discuss potential changes to the Maintenance of Certification (MOC) process. The California Orthopaedic Association (COA) recently completed a survey of 612 orthopaedic surgeons (84 Texas orthopaedic surgeons participated). The results will be presented to the ABOS leadership […]
The Texas House Select Committee on Opioids and Substance Abuse released its report on December 3, 2018. The committee is chaired by Rep. Four Price of Amarillo. An additional select committee, which is co-chaired by Senator Charles Schwertner, MD and Rep. JD Sheffield, DO, is expected to release a report on the state’s prescription monitoring […]
The Centers for Medicare and Medicaid Services (CMS) introduced the Price Procedure Lookup tool, which allows consumers to compare the prices of ambulatory surgery centers (ASCs) and hospital outpatient departments (HOPDs), on November 27. The tool was created in January 2017 by the 21st Century Cures Act. Click here to learn more from CMS.
John W. Hinchey, MD recently joined Ortho San Antonio and recently sat down with TOA to conduct a Q&A to discuss his thoughts on the future of orthopaedics in Texas. Dr. Hinchey received his undergraduate degree from Southern Methodist University. He later attended The University of Texas Health Science Center at San Antonio (UTHSCSA) for […]
The Texas Medicaid Vendor Drug Program has proposed a policy that would apply morphine equivalent dose (MED) limits per day and seven-day limits on opioids opioids that are used to treat acute pain in the state’s Medicaid managed care organizations (MCOs). The Texas Health and Human Services Commission (HHSC) is accepting comments until November 14, […]
The Texas Health and Human Services Commission (HHSC) has proposed new Medicaid rates for ambulatory surgery centers (ASCs). Click here to download the .zip file for the “Medicaid Biennial Calendar Fee Review” dated January 1, 2019. The proposal is a mixed bag for orthopaedic ASCs. TOA will join other stakeholders to provide comments. HHSC will hold […]
The Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) announced on October 12, 2018 that it will conduct a plan-based audit for neuromuscular testing. Click here to view details of the plan-based audit. The study will focus on the 10 providers who had the highest number of referrals for neuromuscular testing during the time period […]
By Mel Gunawardena, SYNERGEN Health Ensuring successful revenue cycle management comes down to how proficient health care organizations are at optimizing processes, utilization of staff and the latest technology. More health organizations are turning to advanced technology that can be integrated into their current billing software and delivers an immediate return on investment. Specifically, artificial […]
Henry B. Ellis, MD is a pediatric orthopaedic surgeon at the Texas Scottish Rite Hospital for Children’s Center for Excellence in Sports Medicine. Dr. Ellis is an El Paso native who received his medical degree from the University of Texas Science Center San Antonio, conducted his residency at UT Southwestern Medical Center, and completed fellowships […]
A special committee of the Texas Legislature chaired by State Senator Charles Schwertner, MD and State Representative JD Sheffield, DO will meeting on October 3, 2018 to review the state’s prescription monitoring program (PMP). Click here to view TOA’s position paper.
The Centers for Medicare and Medicaid Services (CMS) released proposed changes to the Conditions of Participation for ambulatory surgery centers (ASCs), hospitals, and other segments of the health care industry on Monday. CMS indicated that it has gathered feedback from stakeholders, and this proposal would address 55 percent of the issues. As a result, CMS […]
David Brigati, MD is a fellow in adult reconstructive surgery at the Dell Medical School at the University of Texas at Austin. Upon completion of his fellowship, Dr. Brigati hopes to go into practice in the Fort Worth area. Dr. Brigati, a Texas native, performed his orthopaedic residency at the Cleveland Clinic. He performed his […]
The Texas Department of State Health Services (DSHS) will dedicate the rest of 2019 and 2020 to re-writing its trauma and stroke rules. TOA is joining the Texas Medical Association and other stakeholders to make recommendations. DSHS has announced the following stakeholder meetings for the rest of 2019:
Three members of TOA’s Residency Council – Max Danilevch, MD (UTMB), Jacob Murphree, MD (Texas Tech) and Joey Romero, MD (UT Southwestern) joined the Texas Orthopaedic Association for its annual trip to meet with the Texas Congressional Delegation on Capitol Hill in June 2018. The three orthopaedic surgeons … click here to view the entire article.
By Joseph Mathews How much is just enough? This is an ongoing conversation for practices regarding staffing as we face lower profit margins, increasing overhead and patient populations that demand both quick processes and high levels of customer service. However, this conversation and the decisions that follow can become less tedious and stressful if practices […]
The Centers for Medicare and Medicaid Services (CMS) released the calendar year 2019 payment rule for the Medicare Physician Fee Schedule (PFS) and Quality Payment Program for MACRA on July 13, 2018. Comments are due on September 10, 2018. TOA’s members are invited to review TOA’s analysis of the proposal, which can be found in […]
Integrated Practice Units and the Perioperative Surgical Home: What’s on the Horizon? Q&A with Karl Koenig, MD Karl Koenig, MD, MS is the Medical Director for the Musculoskeletal Institute at UT Health Austin. He specializes in treatment of hip and knee arthritis including both primary and revision surgery. Dr. Koenig has a special interest in […]
The Texas Department of Insurance – Division of Workers’ Compensation adopted a rule on March 29, 2018 that will require compounded drugs to be preauthorized beginning on July 1, 2018. Click here to learn more.
By Joseph Mathews While the patient experience should begin with a seemingly uncomplicated call to schedule an appointment, the patient journey is often marred by hard-to-understand greetings and instructions, abandoned calls, being sent to voicemail, or sitting on hold for long wait times while listening to a barrage of promotions about the organization. These are […]
The Texas Medical Board (TMB) approved a rule on June 15, 2018 that will recognize the out-of-state licenses for team physicians when they travel with their teams to Texas. Texas joins over 35 states that have passed similar measures. State Senators Charles Schwertner, MD and Don Huffines and State Representative Bobby Guerra worked with TOA […]
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Every year, over a dozen Texas orthopaedics go to Washington, DC to participate in the American Academy of Orthopaedic Surgeons’ National Orthopaedic Leadership Council (NOLC) to educate the Texas Congressional Delegation about musculoskeletal issues that affect Texans. On June 7, 2018, Texas orthopaedic surgeons will discuss two Medicare issues that are specific to Texas – […]
Andrew Palafox, MD of the Texas Orthopaedic Association and David Halsey, MD of the American Association of Orthopaedic Surgeons submitted a letter to the Texas Medical Board in support of its proposed rule that would recognize the out-of-state licenses of team physicians when they travel with their teams to Texas for athletic competitions. The move […]
Col. Christopher J. Roach, MD, FAAOS – the chair of the Department of Orthopaedics at the San Antonio Military Medical Center – presented on the Center for the Intrepid (CFI) at the Texas Orthopaedic Association’s 2018 Annual Conference. Click here to view Dr. Roach’s PowerPoint presentation from the conference. The following is a Q&A that […]
Rep. Bobby Guerra (D-McAllen) and Sen. Don Huffines (R-Dallas) pushed legislation in the 2017 Texas Legislature that would direct the Texas Medical Board (TMB) to recognize the out-of-state physician licenses for team physicians when they travel to Texas to provide support for their teams while in Texas. The legislation died due to un-related matters. TOA […]
Don Buford, MD, Director, Dallas PRP and Stem Cell Institute is a board-certified orthopaedic surgeon who has been practicing in the Dallas area for 18 years. He grew up in Los Angeles and attended Stanford University. While at Stanford, he was a member of the baseball team and had a double major in economics and pre-med. […]
San Antonio orthopaedic surgeon Adam Bruggeman, MD – the Texas Orthopaedic Association’s second vice president – testified before the Texas Senate Committee on Health and Human Services’ hearing on opioid and substance abuse. The Texas Legislature will continue examining the opioid issue in the months leading up to the 2019 Texas Legislature. TOA is educating […]
Muve Healthcare opened a joint replacement-focused ambulatory surgery center (ASC) in Lakeway outside of Austin in 2017. TOA recently conducted a Q&A with Marshall Maran of Muve to learn more about the concept. TOA: Prior to your entrance into the Texas market, what has the ASC volume for lower extremity joint replacements been like in […]
The Texas Department of State Health Services (DSHS) announced on March 9, 2018 new spinal screening standards for the 2018-19 school year. The changes come as a result of HB 1076 in the Texas Legislature. Sponsored by Rep. Tom Oliverson, MD and Sen. Don Huffines, HB 1076 reflects the latest science regarding scoliosis treatment. Click […]
BPCI Advanced – Medicare’s new physician-led bundled payment program that was announced in January 2018 – will not allow orthopaedic surgeons located in Texas’ five Comprehensive Center for Joint Replacement (CJR) to lead their own bundles for lower extremity joint replacements in the new BPCI Advanced program. Due to the upcoming March 12, 2018 application […]
The U.S. House and U.S. Senate approved a funding resolution on February 9 that includes several Medicare provisions that affect musculoskeletal care: Physician-owned Hospitals: No Relief. An effort by Texas lawmakers to allow physician-owned hospitals located in areas affected by the recent hurricane to expand by 50 percent was not included in the bill. However, […]
The Centers for Medicare and Medicaid Services (CMS) proposed the latest physician-led bundled payment model – BPCI Advanced – in January 2018. March 12, 2018 is the deadline to apply. Click here to learn more from TOA. Publicly available data gathered by Archway Health on lower extremity joint replacement surgeries for 2015 Medicare payments demonstrate […]
The Centers for Medicare and Medicaid Services (CMS) removed total knee arthroplasty from Medicare’s inpatient-only (IPO) list for the 2018 final rule. However, this does not mean that Medicare will pay for TKA in ambulatory surgery centers (ASCs). The American Association of Orthopaedic Surgeons (AAOS) produced the following FAQs to answer questions. Click here to […]
Greetings, Thank you for your interest in the newest CMS model – Bundled Payments for Care Improvement Advanced (BPCI Advanced). We are excited about the enthusiastic response to our model announcement on January 9, 2018. We continue to receive a high volume of inquiries in the BPCI Advanced inbox and will address most of the […]
Per the Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC): On November 20, 2017, The Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) solicited and received constructive input from workers’ compensation system participants on the proposed Lumbar Spine Magnetic Resonance Imaging (MRI) Plan-Based Audit (Plan-Based Audit). TDI-DWC appreciates the input provided by system […]
The Texas Department of Insurance – Division of Workers’ Compensation (TDI-DWC) announced that it is accepting comments regarding potential changes to the rules related to Commission on Accreditation of Rehabilitation Facilities (CARF)-accredited programs. The Workers’ Compensation Research and Evaluation Group recently published a report entitled “Outcome Comparisons of Return to Work Rehabilitation Programs by Accreditation […]
The Texas Medical Board (TMB) released a proposed rule in November 2017 to identify physicians who have failed to properly register as a pain clinic. Unfortunately, as written, the proposed rule could unintentionally include orthopaedic surgeons in the pain clinic registration, despite the fact that orthopaedic surgeons are not operating as pain clinics. TOA will […]
Texas HHSC has proposed new Medicaid rates for musculoskeletal services (effective January 1, 2018). Click here to view the proposed rates. The Texas Orthopaedic Association and Texas Medical Association submitted a response to Texas HHSC. Click here to view the response.
Congressman Kenny Marchant (R-Coppell) joined three other colleagues to introduce “The Medicare Care Coordination Improvement Act of 2017.” H.R. 4206 was introduced to address certain aspects of the Stark Law and physician self-referral laws that are preventing MACRA’s alternative payment models (APMs) from performing. The updates to the Stark Law are needed for Congress to […]
The Centers for Medicare and Medicaid Services (CMS) released the final rule for the Quality Payment Program’s second year on November 2, 2017. Click here for an extensive overview of the rule. Click here for an executive summary of the rule: Among the highlights: From 90 Days to a Full Year Physicians will be […]
The Centers for Medicare and Medicaid Services (CMS) released the CY 2018 final payment rule for the Medicare Physician Fee Schedule on November 2, 2017. The following is a summary of the final rule. TOA’s summary of the CY 2018 proposed rule, which was released this summer, can be found following this summary. Appropriate Use […]
The Texas Medical Disclosure Panel (TMDP) announced earlier this fall that it will be updating its patient notification form of required risks and hazards related to the nervous system. The TMDP is asking for recommendations by December 1, 2017. Please provide your suggestions to TOA (Bobby@toa.org). Click here to view the current disclosure of risks and hazards […]
The Centers for Medicare and Medicaid Services (CMS) released the CY 2018 final payment rule for hospital outpatient department (OPPS) and ambulatory surgery center (ASC) on November 1, 2017. TOA’s highlights of the CY 2018 proposed rule, which was released in the summer of 2017, can be found below this summary. Many of the summer […]
Speaker Joe Straus of the Texas House of Representatives announced the Select Committee on Opioids and Substance Abuse, which will examine the use of opioids in Texas. The committee members include: Rep. Four Price, Chair Rep. Joe Moody, Vice Chair Rep. Carol Alvarado Rep. Garnet Coleman Rep. Jay Dean Rep. Ina Minjarez Rep. Andy Murr […]
The Texas Orthopaedic Association responded to the Texas Department of Insurance, Division of Workers’ Compensation’s request for comments on a proposal to expand telemedicine services throughout the Texas workers’ comp program. Click here to view the letter.
The Division of Workers’ Compensation is accepting comments on an informal working draft of new 28 Texas Administrative Code §133.30 relating to Telemedicine Services. This change would allow health care providers to bill and be reimbursed for telemedicine services regardless of where the injured employees are when they receive telemedicine services. Click here to read the […]
Click here for the latest info for our upcoming 2018 Annual Conference. Sponsorship details can be found in our 2018 Sponsor Prospectus.
CMS announced a request for information regarding the future direction of the CMS Innovation Center. The Texas Orthopaedic Association will be providing comments regarding solutions for enhancing muculoskeletal in the Medicare program. Per CMS: In partnership with clinicians, patients, entrepreneurs, state officials, and others, the Centers for Medicare & Medicaid Services (CMS) plays a leading […]
State and federal regulatory bodies have relaxed some rules to help physicians and facilities respond to patients during Hurricane Harvey relief efforts. The following is an overview of some of the measures. This is provided for informational purposes only and does not serve as legal advice. Texas Department of Insurance The Texas Department of Insurance […]
The American Association of Orthopaedic Surgeons (AAOS) submitted stakeholder comments to the Centers for Medicare and Medicaid Services (CMS) on its CY 2018 Updates to the Quality Payment Program for physician payments. Click here to view the letter. The comments focus on the Merit-based Incentive Payment System (MIPS) and Alternative Payment Model (APM) payment mechanisms […]
The Texas Department of Insurance – Division of Workers’ Compensation (TDI-DWC) released an informal work draft on Friday to amend a rule related to the Designated Doctor program. Comments are due on September 1, 2017. An open records request found that the Designated Doctor program has experienced a 67-percent decrease in the number of physicians participating […]
Tuesday’s proposal by the Centers for Medicare and Medicaid Services (CMS) would scale back the Comprehensive Center for Joint Replacement (CJR) mandatory bundles for lower extremity joint replacement and would eliminate the mandatory episode payment models (EPMs) for surgical hip/femur fracture episodes of care (SHFFT). CMS stated: Many providers are currently engaged in voluntary initiatives […]
Congress passed an omnibus appropriations bill in 2015 that led to cuts for computed radiography (CR) x-rays by 7 percent in 2018 and 10 percent in 2023. This was supposed to serve as an incentive for practices to upgrade to digital radiography (DR). However, CR is still digital, which makes it capable of interfacing with […]
Richie Edeen, MD is the fifth generation of his family to grow up in the area of Vail, Colorado. After high school, he attended the University of Colorado, where he worked as a student athletic trainer. From there, he moved to Austin, TX, where he worked as an athletic trainer for the University of Texas […]
Alphabetical List Article/Post Link Alderete, Joseph Learn about Joseph Alderete, MD Brigati, David Learn about David Brigati, MD Budord, Don Learn about Don Buford, MD Danilevich, Max Article with Max Danilevich Edeen, Richie Learn about Richie Edeen, MD Ellis, Henry Learn about Henry B. Ellis, MD Haynes, David Learn about David Haynes, MD • Video with David […]
The Texas Orthopaedic Association submitted comments to the Texas Department of State Health Services’ call for stakeholder comments on updating the state’s scoliosis screenings standards in Texas schools. TOA recommended that DSHS follow the 2015 recommendations made by the American Academy of Orthopaedic Surgeons and Scoliosis Research Society that call for females to be screened […]
Click to view AAOS’s July 2017 quality update.
The Centers for Medicare and Medicaid Services (CMS) released a proposed rule on Tuesday for implementing Medicare’s new physician payment program. Congress passed the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which creates two avenues for physicians to be paid under the Medicare program – MIPS (Merit-based Incentive Payment System) and APMs (Alternative […]
Bone and joint disorders are the leading cause of disability in the U.S., disabling a significant part of the American workforce. Orthopaedic surgeons help millions of patients get back to work every year. With patient-centered practices, voluntary and streamlined payment models, physician led delivery and renewed patient-physician relationships, they can keep the promise of ensuring […]
A new white paper published by FAIR Health relies on its claims database to examine the opioid crisis in select cities, including several Texas cities. The study examines opioid-related diagnoses. Regarding Texas, the study found that 66 percent of the claim lines occurred in San Antonio, and an additional 23 percent occurred in Dallas. Houston […]
FAIR Health recently created an analysis of concussions based on over 20 billion privately-billed medical and dental claims. (click on graphic for full screen)
David Teuscher, MD, a past president of the Texas Orthopaedic Association and American Academy of Orthopaedic Surgeons, was sworn in as the Regional Administrator for Intergovernmental and External Affairs for the U.S. Department of Health and Human Services’ Region 6 on May 22. Region 6 covers Texas, Arkansas, Louisiana, Oklahoma, New Mexico, and 68 American […]
The Centers for Medicare and Medicaid Services (CMS) asked for comments regarding POHs in the proposed rule for inpatient hospital payments for 2018. CMS’s comments stated: “We are seeking public comments on the appropriate role of physician-owned hospitals in the delivery system. We are also seeking public comments on how the current scope and restrictions […]
Jungle Disk, the #1 data security suite for small businesses, provides backup, network security and email archiving solutions to protect critical data, such as patient information and electronic medical records, from system failure, human error and cyberattacks. Headquartered in San Antonio, TX, the Jungle Disk team now serves over 25,000 customers across the globe. We […]
Texas Ambassadors, I’m writing to ask you to help support a fellow Texan, AAOS Ambassador, and orthopaedic surgeon, Dr. David Teuscher. Congressman Brian Babin (TX-36) is circulating the attached letter of support for Dr. Teuscher for a senior-level post at the Department of Health and Human Services (HHS). AAOS has also written a letter of […]
TOA will dedicate the Saturday, May 6 portion of the 2017 Annual Conference in Dallas to “The Business of Orthopaedics.” One of the presentations will examine key financial benchmarks in Texas orthopaedic practices and highlight some of the financial strengths and weaknesses facing orthopaedic practices in Texas. TOA is seeking volunteers to participate in this […]
Texas Lieutenant Governor Dan Patrick named the Senate committees for the 85th Texas Legislature, and Charles Schwertner, MD (R-Georgetown) – an orthopaedic surgeon – will continue to lead the Senate Health and Human Services Committee. Two other physicians serve in the Texas Senate: Dawn Buckingham, MD (R-Austin) – an ophthalmologist – and Donna Campbell, MD […]
State Senator Charles Schwertner, MD (R-Georgetown), the chair of the Senate Health and Human Services Committee, is expected to offer an amendment to the Texas Sunset Commission’s report on the Texas Medical Board that would direct the Board to license out-of-state team physicians when they travel with their teams to Texas. The Texas Orthopaedic Association […]