February 1, 2021
1. Future Practice Opportunities: February, February 5 Zoom

2. TOA's Circle of Champions for 2021: Thanks for Their Support

3. Texas Supreme Court's Workers' Comp Ruling Favors Orthopaedics

4. Texas Legislature: 119 Days Remain
What to Expect for Orthopaedics

5. TMA Abandons Resolution Related to Specialists' Use of Mid-Levels
6. Texas Supreme Court Rules Against TMA in Chiropractor Scope Case

7. "Why Tenet Health Is Expanding Its Surgery Center Footprint"

8. "The Customer Is Always Right?" A Look at Patient-Reported Outcomes

9.TOA Is Considering an In-Person Retreat in October for the Hill Country

10. TOA's Checklist: What You Missed + What to Expect
Zoom: Practice Opportunities for Orthopaedic Residents
Friday, February 5 | 6 a.m. - 7 a.m. CST | Click Here

TOA is now offering two free hours of online CME to fulfill the state's new opioid prescribing CME mandate. Click here to access it. Click here to view the newest CME requirements in Texas.

1. Future Practice Opportunities for Residents: Friday's Zoom; TOA's Resident Database
TOA will host a Zoom for residents this Friday, February 5 at 6 a.m. CST to examine future practice considerations.

Click here for more details. Residents must reply to this e-mail or Bobby@toa.org to receive the Zoom link.

Seeking New Orthopaedic Surgeons? Check out TOA's Resident Database
Residents are invited to submit their information to TOA's resident networking database, which includes information about residents' future career plans. It's an opportunity to connect residents and orthopaedic practices in Texas.

To access it, 100 percent of the orthopaedic surgeons in your practice must be TOA members. E-mail Edberg@toa.org to access the database.
2. TOA's Circle of Champions:
Thanks to Our Sponsors
This year will be different for TOA: We will continue to watch the pandemic's course to determine whether or not we can hold a smaller meeting in the fall.

In the meantime, TOA's reliance on sponsorship revenue to support TOA's important advocacy work does not change. As a result, TOA is grateful to our 2021 Circle of Champions, which gave their commitment to TOA's work (whether TOA is able to hold a conference or not in 2021).
3. Texas Supreme Court's Workers' Comp Ruling Favors Orthopaedic Surgeons
The Texas Supreme Court ruled on Friday in favor of a hospital in a Workers’ Comp case that has wide implications for all orthopaedic surgeons participating in the program. TOA submitted an amicus brief (click here to view it).

Click here to view the court's ruling.

In the case of Patient’s Medical v Facility Insurance Corporation, the Texas Supreme Court was asked to address a lower court’s ruling that had declared that in a Workers’ Compensation case related to a medical fee dispute that the burden of proof remained with the physician or facility, regardless of which party prevailed at the administrative level. Had this standard remained, carriers would have been incentivized to take more cases to the State Office of Administrative Hearings (SOAH) , and that would have made TDI-DWC’s relatively inexpensive administrative review merely a “speed bump” to force the case to SOAH.
Fortunately, this case was appealed to the Texas Supreme Court, and TOA’s amicus brief was an important part of the legal process. TOA supported Patient’s Medical’s position that the burden of proof is on the party seeking review of the decision. The Court agreed and found that “the burden of proof in a contested case hearing before SOAH is on the party seeking review of the Division’s initial MFDR (Medical Fee Dispute Resolution) decision. Accordingly, the court of appeals erred in holding that the burden always and necessarily remains on the provider.”
4. 2021 Texas Legislature: 119 Days Remain
What to Expect for Orthopaedics
The Texas Legislature contains dozens of issues that are of interest to orthopaedic surgeons, and TOA is attempting to make them easier to digest through a series of "issue focus" e-mails.

TOA hopes that all surgeons and practice administrators will consider the following:

House Committee Assignments Are Coming Soon, and They Mean Everything
The Speaker of the House, Dade Phelan (R-Beaumont), could announce committee assignments and chairs in the House as soon as this evening after the governor gives his "State of the State" speech, and those assignments will determine the course of legislation in 2021. The committee chairs will have the power to move and kill bills in the House.

TOA's Legislative Primer for State Lawmakers
Click here to view it. TOA shared a copy of this with every state lawmaker and their staff.

TOA's Bill Tracker
Click here to view TOA's bill tracker, which tracks all of the musculoskeletal-related bills.

TOA's Action Alerts
TOA will ask orthopaedic surgeons and practice administrators to e-mail their state lawmakers on a variety of issues.

Right now, we're asking TOA members to engage their state lawmakers on opioids. Specifically, TOA is asking the Legislature to fund the state's prescription monitoring program integration into your EHR and to hit "pause" on new opioid legislation.

Click here to contact your state lawmakers.

TOA's Issue Focus & Legislative Preview
TOA will continue sending "issue focus" e-mails to take a specific look at each issue.

Click here to view the past "issue focus" e-mails.
5. TMA Abandons Resolution Related to Specialists' Use of Mid-Levels
The Texas Medical Association's "Young Physicians Group" proposed a resolution for its House of Delegates that criticized specialists' use of mid-level providers for the initial screening of patients.

After a heated a number of specialists on one side and primary care physicians and psychiatrists on the other, the proponents abandoned the resolution.
6. Texas Supreme Court Rules Against TMA in Chiropractor Scope of Practice Case
The Texas Supreme Court ruled against the Texas Medical Association (TMA) in its court case against the chiropractors regarding the chiropractors' scope of practice as it relates to nerves.

Click here to view the decision.

What Was the Case?
To put it plainly, the TMA argued that chiropractors were acting outside of their scope of practice when performing VONT testing due to the fact that the nervous system (nerves) was not part of a chiropractor's scope of practice.

Meanwhile, the chiropractors argued that the nerves touch every part of the musculoskeletal system. Therefore, if the nerves were not part of their scope of practice, then the chiropractors do not have any scope of practice (that is what the chiropractors said).

Legislation regarding the definition of the "neuromusculoskeletal" system (as it relates to chiropractors) has been introduced in the 2021 Texas Legislature by Senator Charles Perry (R-Lubbock).
7. "Why Tenet Health Is Expanding Its Surgery Center Footprint"
Click here to read the article in D Magazine.

The following is an excerpt from the article:

Musculoskeletal interventions have become a growth industry as the United States ages. According to Science Daily, half of all adults have a musculoskeletal disease, and three of four people over the age of 65 do. Trauma, back pain, and arthritis are the most common issues. In 2016, Americans spent $380 billion on low back and neck pain and joint and limb pain, and other musculoskeletal disorders, or about two percent of the country’s total GDP.

According to Tenet data, surgery centers represented $2.2 billion in revenue in 2019, compared to $14.9 billion for its 65 hospitals. But the centers have a 41 percent profit margin, compared to a 10 percent margin for hospitals. Tenet said that ambulatory surgery centers grew 33 percent year over the year in 2019, and they expect 45 percent growth in 2021.
8. "The Customer Is Always Right? Patient-Reported Outcome Measures Have Fans and Detractors"
David Brigati, MD of Fort Worth (pictured at the podium at TOA's 2020 annual conference) was recently quoted in the Texas Medical Association's magazine about patient-reported outcomes. Austin orthopaedic surgeon Kevin Bozic, MD was also quoted.

Click here to read the article.
9. TOA Is Considering an In-Person Meeting for October 2021 in the Texas Hill Country
TOA won't be able to hold its traditional annual conference in Austin at the end of this week; TOA will meet at the AT&T Conference Center in Austin next April 22-23, 2022.

In the meantime, TOA is in talks with the Horseshoe Bay Resort in Marble Falls for TOA's 2021 "retreat" for the weekend of October 1, 2021.

TOA is continuing to monitor the course of the pandemic. If TOA does hold the meeting, it will be a scaled-back "retreat" that features fewer presentations and more networking.

TOA will provide an update in February.
10. TOA's Checklist: What You Missed + What's Coming up
What Did You Miss?
Click here to view all of TOA's e-mail updates from 2021.

Congress' End-of-Year Legislation: E/M Update, Surprise Billing & PPP
Congress passed legislation at the end of 2020 that:

  • Updated the E/M cuts.
  • Banned surprise billing for ERISA plans.
  • Created a new round of PPP.

Click here to view TOA's summary of the legislation, which includes an E/M calculator and a summary of the new ban on surprise billing for ERISA plans. The federal government will create rules to implement the new law.

New Stark Laws: December 2020
Click here to read the summary from the Dallas law firm of Weaver, Johnston, and Nelson.

New Federal Prior Authorization Rules: January 2021
The Trump Administration finalized rules that create new prior authorization requirements for a limited number of health plans that are under the federal government's jurisdiction. (While it only affects a limited number of plans, the rule is important for patients.)

Click here to view TOA's summary of the proposed rule. Click here to read about the health plans' angry reaction.

Federal Anti-Trust Exemption for Health Plans Repealed: January 2021
Click here to learn more from AAOS, which worked hard on this issue.

Scope of Practice at the Department of Veterans Affairs: January 2021
Click here to view the letter sent by AAOS and other federal stakeholders to address the Department's new scope of practice policy.

The VA updated its Nursing Handbook in 2016, which granted independent practice for APRNs (with the exception of CRNAs). In November 2020, the VA issued an Interim Final Rule, which is effective on the date it was published (Nov. 12, 2020), and it “confirms that its health care professionals may practice their health care profession consistent with the scope and requirements of their VA employment, notwithstanding any State license, registration, certification, or other requirements that unduly interfere with their practice.” The rule applies to all APRNS, including CRNAs. There was a 60-day comment period, which concluded January 12, 2021. There is no requirement for the VA to comment further or have a hearing.

Workers Comp Webinars: ODG & TDI-DWC
Click here to view TDI-DWC's upcoming webinars.

Effective March 31, 2021, ODG Legacy will sunset in favor of the new ODG by MCG website.  ODG will hold a webinar on February 4. Click here to learn more.
Texas Orthopaedic Association www.toa.org