AAOS’s Information CMS’s Toolkit Texas EMS Alliance – How Are EMS Agencies Preparing? Texas Hospital Association – How Are Texas Hospitals Responding? Texas Medical Association – Toolkit Congressional Packages Click here to view a summary of the three packages passed by Congress. Centers for Medicare and Medicaid Services CMS Announces Quality Reporting Relief Provider Enrollment Relief Click […]
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The 2019 Texas Legislature followed the lead of the New York Legislature by addressing surprise bills through an arbitration process that takes patients out of the middle by giving physicians an opportunity to challenge out-of-network payments made by commercial health insurance plans through an arbitration process. The New York system has worked. Click here to learn […]
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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 […]
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 […]
Note: This has been printed for informational purposes only. TOA does not offer legal advice. Please consult your attorney. OIG Guidance and Anti-Kickback Considerations in Response to COVID-19 April 4, 2020 In our most recent COVID-19 guidance which can be found here, we outlined the blanket Stark Law waivers recently issued by the Centers for […]
Phase One: [enacted March 6th, 2020] – The package appropriates $8.3 billion in emergency funding to give the federal government the initial tools to respond to the coronavirus outbreak. The law provides fiscal year 2020 supplemental funding for the Food and Drug Administration, the Centers for Disease Control and Prevention, the National Institutes of Health, […]
The Centers for Medicare and Medicaid Services (CMS) announced temporary regulatory waivers and new rules for hospitals and ASCs to respond to COVID-19. Physician-Owned Hospitals “Physician-owned hospitals can temporarily increase the number of their licensed beds, operating rooms, and procedure rooms. For example, a physician-owned hospital may temporarily convert observation beds to inpatient beds to […]
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Note: Weaver Johnston Nelson sent this e-mail on March 22, 2020. TOA has published it for informational purposes only; it does not constitute legal advice. Elective Procedures and Surgeries March 25, 2020 On March 22, 2020, Governor Abbott signed Executive Order GA-09, which directs facilities and licensed healthcare professionals to postpone through April 21, 2020 […]
What Health Organizations Need to Know About the CARES Act’s Tax and Loan Provisions By Mel Gunawardena, Managing Partner, SYNERGEN Health As the pandemic continues to develop and negatively impact the U.S. and global economy, health practices in Texas and across the nation are being forced to plan for financial challenges. As different state, county […]
Click here (or on the graphic above) for Texas Workers’ Compensation Program Opportunities for Orthopaedic Surgeons. DWC Offers On-Demand Learning We realize health care providers can’t afford to be away from their busy clinics for training. DWC now offers free live lunchtime webinars and pre-recorded webinars, available on-demand when it’s convenient for you. Learn about […]
Prior Authorization Process for Certain Durable Medical Equipment Prosthetics, Orthotics and Supplies (DMEPOS) Items: Inclusion of Lower Limb Prosthetics (LLPs) in Prior Authorization Wednesday, March 11th, 2020 2:00-3:00 PM Eastern Time Conference Call Only The CPI will host a Special Open Door Forum to invite suppliers, physicians, and other Medicare practitioners or interested parties to […]
TOA disclaimer: The following article has been provided for informational purposes only. It does not constitute legal or accounting advice. You should consult your attorney and accountant. By Susan Scherbel, Bellview Associates It is hard to think of a profession that has faced more challenges than medicine. For the past decade, physicians have been hammered […]
Author: Mel Gunawardena, Managing Partner, SYNERGEN Health In November 2019, two new rules that require pricing information to be made public were finalized by executive order and announced by the Trump administration. The rules – Calendar Year 2020 Outpatient Prospective Payment System & Ambulatory Surgical Center Price Transparency Requirements for Hospitals to Make Standard Charges […]
TOA recently sat down with Ross DeRogatis of Matrix Orthopedics to look at Medicare’s Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding program, which will affect back and knee braces. Ross is the President/Owner of Matrix Orthopedics, an exclusive Donjoy distributor. He has been in the DME space for over 10 years and […]
Clark Race, MD is board certified in Orthopedic Surgery by the American Board of Orthopaedic Surgery and has been in private practice in the Austin area since 1983. Dr. Race recently created Expert Witness Doctors to provide medicolegal services, which include depositions, trial testimony, medical record reviews, IMEs, peer reviews, disability evaluations, designated doctor exams, […]
The Centers for Medicare and Medicaid Services (CMS) released its final payment rule for the calendar year (CY) 2020 Physician Fee Schedule (PFS) payment policy on Friday, November 1. CMS finalized most of the orthopaedic-related proposals that were published in this summer’s proposed rule. Therefore, this summary will simply touch on a few of the […]
The Centers for Medicare and Medicaid Services (CMS) released its final payment rule for the calendar year (CY) 2020 hospital outpatient (OPPS)/ASC payment policy on Friday, November 1. CMS finalized most of the orthopaedic-related proposals that were published in this summer’s proposed rule. Click here to review TOA’s summary of the proposed rule. Click here […]
TOA recently sat down with Field Scovell, MD of the Carrell Clinic in Frisco and Shane Miller, MD of Texas Scottish Rite Hospital for Children in Frisco to take a look at the evolution of football injuries and their treatment. The following is TOA’s conversation. TOA: Have you and your colleagues changed the way that […]
The White House Office of Management and Budget (OMB) is reviewing a three-year extension of the Comprehensive Center for Joint Replacement (CJR) model. CJR, which focuses on hip and knee replacement bundles, debuted in 2016. It is scheduled to end in 2020. Sixty-seven geographic areas, including five Texas regions, were included in the initial mandate. […]
The Texas Medical Board (TMB) issued preliminary guidance related to Texas’ new limit on opioid prescriptions that will go into effect on September 1, 2019. The 10-day limit on opioid prescriptions was created by HB 2174 in the 2019 Texas Legislature. Click here to view the initial guidance: HB 2174 Initial Guidance – TMB
The Texas Orthopaedic Association (TOA) supported legislative efforts in the 2019 Texas Legislature to require continuing medical education (CME) for prescribing opioids. TOA was pleased that lawmakers worked with TOA on the issue. Instead of passing an omnibus bill related to opioids, the 2019 Texas Legislature took a “shotgun approach” to opioids by passing a […]
TOA recently sat down with Henry Ellis, MD of Texas Scottish Rite Hospital for Children in Frisco and Christian Balldin, MD of The San Antonio Orthopaedic Group to take a look at youth baseball injuries. TOA: Why do you think that have witnessed an epidemic of arm injuries in baseball recently? On one end, people […]
The Centers for Medicare and Medicaid Services (CMS) released its proposed payment policy for the Medicare hospital outpatient prospective payment system (OPPS) and ambulatory surgical center (ASC) payment system for calendar year (CY) 2020 on July 29, 2019. Keep in mind that the American Association of Orthopaedic Surgeons (AAOS) is currently digging through the proposed […]
The Centers for Medicare and Medicaid Services (CMS) released its proposal for the calendar year (CY) 2020 Physician Fee Schedule (PFS) on July 29, 2019. The American Association of Orthopaedic Surgeons (AAOS) will provide a lengthy summary of the proposal and a response in the near future. In the meantime, TOA has provided a summary […]
Carl Nunziato, MD is an orthopaedic resident at the University of Texas at Austin Dell Medical School. A California native, Dr. Nunziato completed medical school at the University of Vermont and received an undergraduate degree from Yale. Dr. Nunziato is a Lieutenant in the United States Navy Reserves. TOA asked Dr. Nunziato to testify before the Texas Legislature […]
The prescription monitoring program (PMP) is an important tool for physicians and pharmacists to deter some forms of “doctor shopping” for the illegal or inappropriate use of prescription drugs. TOA worked with lawmakers in the 2019 Texas Legislature to: Secure funding for the Texas State Board of Pharmacy (TSPB) to acquire licenses so that the […]
The Texas Orthopaedic Association (TOA) strongly supports the prior authorization and utilization review proposals that were added to SB 1742 in the 2019 Texas Legislature. SB 1742 is now waiting for Governor Abbott’s consideration. Click here to learn more.
The Texas Orthopaedic Association (TOA) recently offered its support for HB 3284, which passed out of the 2019 Texas Legislature. The bill, which is authored by Rep. JD Sheffield, DO and Sen. Jane Nelson, would delay the state’s prescription monitoring program (PMP) mandate by several months to ensure that physicians’ electronic health record (EHR) programs […]
Over a dozen Texas orthopaedic surgeons will visit Capitol Hill on June 6 to discuss issues related to out-of-network balance billing, hospital monopolies, and antitrust regulations related to commercial health insurance plans. The orthopaedic surgeons will discuss initiatives that can lower health care costs for patients. The Texas Orthopaedic Association (TOA) will sponsor four orthopaedic […]
TOA recently sat down with Austin orthopaedic surgeon Austin Hill, MD, MPH of the Dell Medical School at the University of Texas to discuss the orthopaedic trauma department’s experience with scooter injuries in Austin. TOA: What were your thoughts when the scooters first went live and you first started seeing injuries? Austin Hill: The first […]
The San Antonio Orthopaedic Group (TSAOG) recently opened its WorkSmart Industrial Rehab Clinic, which focuses on physical and behavioral rehabilitation of injured workers. TOA recently conducted a Q&A with Chris Kean, the chief operating officer of TSAOG, to learn more about the clinic. TOA: What is the “WorkSmart Industrial Rehab Clinic”? Chris Kean: WorkSmart Industrial […]
The Texas Orthopaedic Association (TOA) is supporting HB 2088, which would direct the Texas State Board of Pharmacy (TSBP) to maintain and publish a list of drop-off locations for unused drugs. The legislation by Rep. Jay Dean (R-Longview) was heard in the House Public Health Committee on April 10, 2019.
The Texas House Committee on Pensions, Investments & Financial Services will consider HB 2367 by Rep. Greg Bonnen, MD in a committee hearing on April 18. The bill would prohibit health plans from bidding on the state’s contracts if the plans participate in the practice of dropping a physician from a plan for notifying a […]
The Texas Orthopaedic Association (TOA) testified in support of SB 2316 in both the House and Senate as a bill that would enhance the state’s prescription monitoring program (PMP). Offered by Senator Chuy Hinojosa and Representative Senfronia Thompson, SB 2316 would create an advisory committee of physicians, pharmacists, and electronic health record companies to provide […]
The Texas Orthopaedic Association will speak in support of Rep. Bobby Guerra’s legislation – HB 2299 – which would protect out-of-state team physicians when they travel with their teams to Texas. The bill would direct the Texas Medical Board to recognize the out-of-state licenses for those physicians while they are assisting their teams for competitions […]
State Rep. Mary Gonzalez (D-El Paso) introduced HB 3468, which would allow multiple ASCs to operate within a single ASC on different days. Medicare recently approved the “timeshare ASC” model. However, Medicare indicated that state legislatures must approve the concept at the state level.
Kevin L. Kirk, DO is a board-certified orthopedic surgeon specializing in disorders of the foot, ankle and lower leg. Although he treats all general orthopedic conditions, he has a special interest in foot and ankle joint replacement, arthroscopy, reconstruction and trauma surgery. Dr. Kirk received his Doctor of Osteopathic Medicine from the Philadelphia College of […]
Texas lawmakers recently introduced several bills that would address the health plans’ unnecessary delays that are resulting in delays for patients. The Texas Orthopaedic Association strongly supports the bills that have been introduced by Sen. Dawn Buckingham, MD, Rep. Greg Bonnen, MD, Rep. Julie Johnson, and Rep. Sarah Davis. Make the prior authorization process easier […]
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TOA issued support for HB 1005 by State Rep. Nicole Collier, which would direct Workers’ Compensation carriers to reimburse physicians for medical causation narrative reports. Bobby Hillert, TOA’s executive director, stated: “The medical causation report is an important tool that helps injured workers receive the care that they need. It is critical to have qualified […]
The Texas Orthopaedic Association (TOA) is encouraging Texas lawmakers rely on the Legislature’s supplemental funding package to fund the Texas State Board of Pharmacy’s request to acquire physician licenses to access the prescription monitoring program (PMP) database. The September 1, 2019 mandate for physicians to check the PMP is seven months away, and it is […]
Texas House Speaker Dennis Bonnen announced the committee assignments for the 86th Texas Legislature today. Click here to view the assignments.
The Texas Legislature created a joint committee of the two bodies following the 2017 Legislature to address the future of the state’s September 1, 2019 mandate for physicians to check the state’s prescription monitoring program (PMP) before prescribing certain drugs. The committee, which is co-chaired by Senator Charles Schwertner, MD (R-Georgetown) and Representative JD Sheffield, […]
The Texas Orthopaedic Association (TOA) submitted feedback on December 17, 2018 that expresses concern regarding the Centers for Medicare and Medicaid Services (CMS) proposal to add back and knee braces to Medicare’s new round of competitive bidding. TOA expressed concern that this could limit the number of physicians who would be able to provide these […]
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 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 […]
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.
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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 […]