March 16, 2021
1. PMP Funding for Your EHR Is in the Works; Contact Your Lawmakers

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

3. Replay of Resident Legal Zoom Available: What's in Your Contract?

4. Medical Billing Tax Moves; 73 Days Remain in the 2021 Texas Legislature

5. TOA Is Coming to San Antonio on Monday, April 5; Surgeons Are Invited
6. Physician/Hospital Groups Can't Support Latest Personal Injury Bill

7. Athletic Trainers Introduce Bill to Clarify Their Scope and Training

8. Texas House Committee Addresses Cash Prices Through Hospital Bill

9. Medicare Sequester "Fix" Might Be Coming Soon

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. PMP Funding for Your EHR Is in the Works; Contact Your State Lawmakers
TOA and other physician groups have been working with lawmakers to fund the Appriss software license for your EHR to access the state's prescription monitoring program (PMP) in the Texas Legislature's budget. (TOA and other groups were successful in 2019.)

Click here to view the letter sent by TOA to ask lawmakers to fund the request.

Rep. Donna Howard (D-Austin) will be submitting a request for the Texas House Committee on Appropriations to fund the physician EHR software through a budget "rider." TOA is also working with lawmakers to create a permanent funding mechanism for the Appriss software through the attorney general's opioid settlement fund that was created by the lawsuit against opioid manufacturers.

Two Concerning Opioid Bills Remain: Contact Your State Lawmakers
Rep. Four Price (R-Amarillo) introduced two bills related to opioids:

  • HB 2117 would create an informed consent mandate related to the prescription of opioids that would require a physician to read 13 bullet points to a patient before prescribing an opioid.
  • HB 4408 would give a pharmacist the ability to give an opioid antagonist to a patient if the pharmacist determines that a patient may be at risk for an opioid overdose.

The informed consent mandate legislation ultimately died in the 2019 Texas Legislation after the Senate decided that enough bills related to opioids passed.

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.

Prescription Monitoring Program (PMP) Funding
TOA is working with other physician specialty groups to create funding in the Texas budget to pay for physician licenses to acquire the Appriss Health software to integrate the PMP into your EHR.

TOA's hope is that the Legislature will use the opioid settlement money secured by the attorney general to fund the software. Click here to view TOA's letter to the Senate.
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. Replay of TOA's Resident Zoom Available: What's in Your Contract?
Thanks to Dallas attorneys Ashley Johnston and Josh Weaver of Weaver Johnston Nelson for the Zoom earlier this month on what residents should expect regarding their future contracts.

Click here to view the replay. Click here to view the background documents.

If you have questions, e-mail Josh Weaver and Ashley Johnston.
4. Medical Billing Tax Moves; 85 Days Remain in the 2021 Texas Legislature
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. Click here if you missed any of TOA's updates.

March 12: Important Deadline
March 12 marks the 60-day mark of the Texas Legislature, and it is the deadline to file legislation in the Texas Legislature. TOA members received TOA's bill tracker over the weekend.

Medical Billing Tax Begins to Move
HB 1445 by Rep. Tom Oliverson, MD (R-Spring), an anesthesiologist, would end the state's tax on outsourced billing, and the bill received a committee hearing on Monday.

Click here to learn more about the issue.

Scope of Practice Issues Could Be up Next
TOA will provide an update over the weekend, and we expect major scope of practice expansion proposals to be considered by committees next week. Stay tuned.

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. TOA Is Coming to San Antonio on Monday, April 5; Surgeons Are Invited
TOA's executive director will provide a one-hour talk on the latest public policy issues affecting orthopaedic surgeons at the San Antonio Orthopaedic Society's dinner on Monday, April 5 in San Antonio.

TOA will provide a one-hour CME ethics credit.

If you're a member of the San Antonio Orthopaedic Society, look for details.
6. Bill Related to Physician/Hospital Payments in Personal Injury Cases: More Work Needed
SB 207, which would address "outlier payments" made to physicians and hospitals for their work related to personal injury cases, now features a new draft. However, physician and hospital groups indicated that they cannot support the latest iteration (click here to view it).

Additional Evidence for Judges & Juries to Consider
SB 207 was presented to stakeholders as an opportunity to give judges and juries more information to determine the appropriate payment made to a physician or hospital for medical services for plaintiffs in wrongful injury cases.

As proposed, SB 207 would have given judges and juries access to a physician's contracts, Medicare, Medicaid, and Workers' Comp rates. TOA and the other the other groups countered with giving judges and juries the ability to examine the FAIR Health database.

While SB 207's latest draft does not specifically reference Medicare, Medicaid, and contract rates, as written, it could give the judge and jury the ability to access those benchmarks.

Unnecessary Discovery
TOA and the other physician and hospital groups asked that SB 207 clarify that the defense may not make unnecessary discovery attempts, such as asking a physician to disclose his or her contract rates.

Ultimately, SB 207's latest draft did not address the unnecessary discoveries. In fact, the latest draft actually created a new concern for the physician and hospital groups: The ability of the defense to use individuals who do not have expertise in the medical field to submit counter affidavits to counter a physician's fee.

TOA and the other physician and hospital groups will continue working with the stakeholders to find a solution that works all sides of the issue.
7. Athletic Trainers Introduce Bill to Clarify Their Scope and Training
Rep. Geanie Morrison introduced HB 3254, which would clarify the athletic trainers' scope of practice and update their educational standards.

Click here to view the one-pager created by the Texas State Athletic Trainers' Association.

Do Athletic Trainers Have a Scope of Practice Issue?
A nurse reported an athletic trainer in to regulators at the Texas Department of Licensing and Regulation (TDLR) for helping members of the San Antonio Fire Department with their training. The nurse argued that the athletic trainer was not providing care in an "athletic competition," and the fire department was outside of an athletic trainer's scope of practice. The athletic trainer argued that he was working under a physician's supervision and delegation.

TDLR ruled in the athletic trainer's favor.

For the most part, a physician may delegate and supervise many different tasks to individuals. There are some limited exceptions, and those can be debated.

Athletic Trainer Education and Training
The bill also addresses the industry standards, and more details can be found by viewing the legislation and the one-pager.

TOA will do a deeper dive into this issue in a future e-mail update.
8. Texas House Committee Looks at Cash Prices Offered by Hospitals
A number of bills related to hospital pricing transparency (more on that to come in a TOA "issue focus" e-mail), and one of the first bills will actually receive an early committee hearing this week.

HB 1490 by Rep. Jay Dean (R-Longview) would require hospitals to post on a website the cash price of services regularly provided in the hospital.

Bills that receive hearings early in the process, such as March, typically have a better passage rate. And several key leaders have shown an appetite for other hospital pricing transparency bills to complement the Trump administration's hospital pricing transparency rule. However, this bill will also face some opposition.

TOA will take a deeper look at the pricing transparency issues related to hospitals, an all-payer database for physicians and much more in a future "issue focus" e-mail.
9. Medicare Sequester "Fix" Might Be Coming Soon in Washington
TOA's last e-mail told you about the $1.9 trillion Covid-19 relief bill and the notable absence of an additional moratorium on Medicare's 2 percent sequester, which is set to expire at the end of March.

Congress is expected to begin taking a look at the sequester this week to avert its return on April 1. The news related to the sequester is fluid.
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.

Texas Congressman Files Physician-Owned Hospital Legislation
Congressman Michael Burgess, MD of the Dallas area once again filed legislation that would allow physician-owned hospitals to expand. Click here to listen to AAOS's podcast with Congressman Burgess.

TOA and AAOS strongly support the legislation. However, neither the President nor Congressional leadership will support the issue.

March 31: Medicare Sequester Moratorium
The moratorium on the Medicare sequester cuts of 2 percent will end. Watch e-mails from AAOS on how to engage.
Texas Orthopaedic Association