March 7, 2021
1. State Lawmaker Pushes Opioid Informed Consent Bill Again; Engage

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. Texas Legislature: 84 Days Remain;
What Happens This Week?

5. Workers' Comp: Legislation Coming to Examine Guidelines
6. Texas' Mask Mandate and Medical Practices: What Does It Mean?

7. APRNs Continue Strong Independent Push; Now the Optometrists

8. Bundled Payments for Texas Employees? Austin Legislation

9. Health Provisions in Congress' Covid Bill; Medicare Sequester Absent

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 + Concerning Opioid Informed Consent: 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.

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 yesterday's Zoom 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. 2021 Texas Legislature: 85 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. Click here if you missed any of TOA's updates.

March 12: Important Deadline
March 12 is the deadline to file legislation in the Texas Legislature.

This Week: Committees Begin Meeting in Earnest
The Texas Legislature's appropriations committees began meeting in January to dig into the budget. And all committees held organizational meetings last week. But the "real work" in which committees will consider bills is set to begin this week.

The first week of committee hearings is light, and the only issue related to musculoskeletal care that will be heard in committee this week is HB 410, which would waive prior authorizations for bone density screenings.

Otherwise, all of the other musculoskeletal-related bills are still being worked on behind the scenes and will feature committee hearings in the future.

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. Workers' Comp: Legislation Coming to Examine Guidelines
A state representative from the Dallas area will file legislation this week that would give the commissioner of the Texas Department of Insurance - Division of Workers' Compensation (TDI-DWC) the ability to change treatment guidelines, return-to-work guidelines and any other guidelines by rule if the commissioner determines that it would be prudent.

The legislation is likely the beginning of a deep look at TDI-DWC's guidelines that will extend into the state's Sunset review of TDI-DWC, which will conclude in the 2023 Texas Legislature.
6. Texas' Mask Mandate and Medical Practices: What's Next?
Texas Governor Greg Abbott announced earlier this week that he will end his executive order related to the statewide mask mandate and limited capacity on March 10. (There are exceptions for areas of "high hospitalizations," and that would allow county judges to engage.)

Texas Medical Board & Masks
Click here to read the Texas Medical Association's summary, which indicates that the Texas Medical Board's safe-standard practices are no longer in place.

However, it is very important to note that the TMB continues to feature the CDC's guidelines related to operating medical offices during the pandemic on the TMB's FAQs on its website, and the CDC guidelines do refer to masks in medical offices. Click here to view the CDC guidelines.

Hospital Restrictions: Mostly Lifted
Most of the hospital capacity limits related to Covid-19 have been lifted. Click here to learn more from the Texas Hospital Association.
7. APRNs Continue Strong Push for Independence; Optometrists Push for Surgery
Mid-level providers are continuing a strong scope-of-practice expansion push in Austin.

APRNs & CRNAs: Independent Practice
Rep. Stephanie Klick, RN (R-Fort Worth), the chair of the House Public Health Committee, and Sen. Kelly Hancock (R-North Richland Hills), the chair of the Senate Business & Commerce Committee, introduced legislation that would give full practice authority to APRNs. HB 2029 and SB 915 would remove the requirement for physician supervision.

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.

Optometrists: Surgery Authority
Meanwhile, Rep. Klick and Sen. Hancock also filed legislation - HB 2340 and SB 993 - that would give optometrists the authority to perform surgery on the eye. Click here to view the ophthalmologists' response.

Due to weak physician lobbies in Oklahoma and other states, optometrists were able to gain the ability to perform surgery, and the optometrists use that capability in other states as an argument as to why it should happen in Texas.
8. Bundled Payments for State Employees? Legislation Filed in Austin
State Rep. Gary Gates (R-Fort Bend County) filed legislation (HB 571 and HB 1527 in Austin that would direct the state's employee plans - ERS and TRS - to create bundled payment programs for their members. The two health plans represent almost 2 million Texans.

Rep. Gates created the legislation after studying The Surgery Center of Oklahoma's model.

The legislation faces a number of hurdles:

  • Texas Medical Association's policy typically opposes bundled payments, especially in cases in which a facility or a single physician controls the entire payment bundle. Of course, Medicare's bundled payments require either a facility or a physician to direct the bundled payment.
  • ERS and TRS and the large health plans that serve as their third party administrators would have to accept the bundled payments, and nothing prevents ERS and TRS from creating bundled payment programs without a legislative mandate.

The legislation is expected to move through the Texas Legislature and receive a healthy debate. Stay tuned for updates from TOA.
9. Medicare Sequester Provisions Absent in Congress' $1.9 Trillion Covid Bill
The U.S. Senate passed its $1.9 trillion Covid-19 relief bill on Saturday, and it will now be kicked back to the House for final consideration.

Medicare Sequester
The moratorium on Medicare's 2 percent sequester is set to expire at the end of March, and the Senate did not address the sequester in the Covid-19 relief bill. The bill also failed to include funding for the Provider Relief Fund.

Watch for updates from AAOS on the Medicare sequester.

Health Provisions That Did Make the Senate Bill
The Senate bill would pay EMS agencies for treatment in place related to Covid-19. Ambulances are typically only paid if they transport a patient to a hospital. However, the Trump administration created the Emergency Triage, Treat and Transport (ET3) program for EMS, in which Medicare will pay for treatment in place and transport to alternative destinations.

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 Legislature: Personal Injury Lawsuit Negotiation
Last week's TOA e-mail newsletter told you about the stakeholder meeting to determine the fate of SB 207, which would change the way that surgeons are paid for their medical work related to personal injury lawsuits.

We are expecting a new draft of the legislation this week, and both sides are expected to give up something.

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