February 24, 2021
1. State Lawmaker Pushes Opioid Informed Consent Bill Again; Engage

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

3. Resident Zoom Series: What's in Your Contract? Friday, March 5

4. Texas Legislature: 95 Days Remain
What to Expect for Orthopaedics

5. AAOS Criticizes the Removal of All MSK Services From Inpatient Only List
6. A Look at One Resident's Strategy for Returning to Texas to Practice

7. Texas AG Rules on CRNAs & Delegation; APRNs Seek Practice Bill

8. Today's Stakeholder Meeting in Austin: How Much Should Surgeons Be Paid?

9. Medicare DME Competitive Bidding in Doubt; Focus on Back/Knee Braces

10. TOA's Checklist: What You Missed + What to Expect

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. Amarillo Lawmaker Pushes Opioid Informed Consent Legislation Again; Contact Lawmakers
The 2019 Texas Legislature passed a number of new laws related to opioids, as evidenced by the graphic. However, one concept - a mandate for surgeons to provide an informed consent related to the harms of opioids - did not pass. Ultimately, the Senate decided that enough opioid bills passed.

Rep. Four Price (R-Amarillo) once again introduced the bill yesterday (HB 2117).

The legislation - click here to view the proposal - would require a physician to read 13 bullet points to a patient before prescribing an opioid. The legislation would also create a number of unknowns, including a physician's liability if he or she forgets to read the informed consent and document.

Reach out to Your State Lawmakers
Earlier this year, you were encouraged to reach out to your state lawmakers to educate them about opioids. Specifically, remind state lawmakers about the number of opioid bills that they passed in 2019 and the need to focus on the implementation of those new laws.

Click here to send a message to your state lawmakers about opioids today. Click here to view TOA's one-pager for lawmakers.
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 retreat this October 2-3 at the Horseshoe Bay Resort in Marble Falls.

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. TOA's Resident Zoom Series: What's in My Contract? Friday, March 5
A number of residents asked TOA to hold a Zoom with attorneys to discuss legal issues that residents will face in their future practices. As a result, TOA will hold a Zoom for residents to take a look at the future legal issues related to contracts, ancillary ownership, and much more on Friday, March 5 at 6 a.m. CST.

Click here for the details. RSVP by replying to this e-mail.

All orthopaedic surgeons are welcome to join; you do not have to be a resident.
4. 2021 Texas Legislature: 95 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.

The following items are on our radar screen:

Texas House Committee Assignments Are Here
The Speaker of the House, Dade Phelan (R-Beaumont) announced the House's committee assignments and chairs earlier this month. Ultimately, the chairs determine which bills will live or die in committee.

Some of the most important chairs related to health policy include:

  • Stephanie Klick, RN (R-Fort Worth) - Chair, House Public Health Committee. Rep. Klick, a nurse and one of the strongest scope of practice expansion advocates, chairs the committee with jurisdiction over physician licensing issues, opioid policy, and more.
  • Tom Oliverson, MD (R-Spring) - Chair, House Insurance Committee. Rep. Oliverson, an anesthesiologist, chairs the committee with jurisdiction over health insurance.
  • Dustin Burrows (R-Lubbock) - Chair, House Calendars Committee. The committee is a gatekeeper for all "contested" legislation moving through the House, and it determines which bills will see the light of day on the House floor.
  • Greg Bonnen, MD (R-Friendswood) - Chair, House Appropriations Committee. Due to the fact that the Texas Legislature's only task is to produce and fund a budget, the Appropriations Committee could be viewed as the most powerful committee in the House. Rep. Bonnen is a neurosurgeon.

Committees Are Now Meeting
The House Appropriations Committee and Senate Finance Committee have already been meeting to consider the state's budget.

Several committees are meeting this week to look at Texas' electrical grid.

Other committees will get a late start this year: Many will meet next week for an organizational meeting, and this will be followed by the consideration of actual bills during the second week of March.

The Texas Legislature is a maze of deadlines. Most bills will need to receive their initial committee hearing in either chamber by the end of March or the first week or April to have a chance of making it through the entire gauntlet of both chambers.

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. "CMS Inpatient Only Policy Threatens Patient Access to Appropriate Surgical Setting" - AAOS
AAOS's president recently penned an op-ed that criticizes CMS's decision to remove all orthopaedic services from Medicare's inpatient-only list.

Click here to read the op-ed.
6. A Look at a Resident's Strategy to Return to Texas for Practice: Midhat Patel, MD of Arizona
Dallas native Midhat Patel, MD is in the middle of his orthopaedic residency at the University of Arizona. However, he plans to return to Texas following his residency.

Dr. Patel created a strategy consisting of speaking at every TOA meeting (he won the top presentation prize two years in a row), participating in TOA's resident Zooms, and many other means to network with orthopaedic practices in Texas.

Click here to read TOA's interview with Dr. Patel about his strategy.
7. Attorney General Rules on CRNAs/Delegation; APRNs Introduce Bill
The Texas attorney general, Ken Paxton, issued an opinion on February 9 indicating that CRNAs do need to be supervised under the delegation of a physician for certain circumstances.

Click here to view the attorney general's opinion.

Both the anesthesiologists and CRNAs released statements on the opinion, and those tweets from the Texas Society of Anesthesiologists and Texas Association of Nurse Anesthetists can be found below.

As always, TOA does not offer legal advice, and this has been posted for informational purposes only.

APRN Independent Practice Legislation Includes CRNAs
Rep. Stephanie Klick, RN (R-Fort Worth), the chair of the House Public Health Committee, introduced legislation on Monday that would give full practice authority to APRNs. HB 2029 would remove the requirement for physician supervision.

California was the latest state to fold on the APRN independent practice issue.

In an interesting twist, HB 2029 is the first time that this legislation specifically called for the independent practice of CRNAs. Past attempts did not include CRNAs.
8. Today's Stakeholder Meeting Will Determine Surgeon Payments for Personal Injury Work
Stakeholders will meet in Austin today to discuss legislation that would tie surgeons' payments related to personal injury lawsuits to benchmarks that include Medicaid, Medicare, Workers' Comp, and commercial insurance contracts.

On one side, TOA, the Texas Hospital Association, the Texas Medical Association, chiropractors, and anesthesiologists will argue that government payer rates are not relevant and should not be considered.

On the other side, the trucking industry and Texans for Lawsuit Reform will push to give juries more information to consider when determining how much a surgeon should be paid for their medical work for a plaintiff in a wrongful injury case. For example, if an 18-wheeler hits an individual, the individual can sue for the medical services (as opposed to having to use his or her own personal insurance).

TOA Proposal
Click here to view an overview of the proposals from all of the stakeholders.

TOA proposed to allow the defense attorney to introduced the FAIR Health database. (Ultimately, it will still be up to the plaintiff's attorney to convince the jury as to what is an appropriate payment for the medical service.)

In addition, TOA asked lawmakers to eliminate some of the irrelevant discovery that is plaguing the system. Ultimately, defense attorneys should not be asking surgeons for unnecessary information to simply complete a fruitless exercise.

Why Is This Issue Important?
While the majority of the readers of this newsletter may not pursue personal injury work, many may inadvertently encounter these cases through trauma work.

The issue also has wider implications for the entire commercial insurance market. TOA argued in an amicus brief before the Texas Supreme Court earlier this year that government rates and commercial contract rates should not be considered by the court.
9. Medicare DME Competitive Bidding in Doubt; Only Back/Knee Braces Achieved Savings
Healthcare Dive recently speculated that Medicare's competitive bidding program for DME may be in doubt due to a lack of savings. However, it is interesting to note that only two aspects of the program - off-the-shelf back and knee braces - achieved savings.

Click here to read the story.
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