Government Regulatory Madness: ICD-10 Transition

ICD-10 Transition is just one example of Government Regulatory Madness

Also looming over physicians’ heads is the transition of our diagnosis coding from ICD-9 (13,000 codes) to ICD-10 (68,000 codes) or face payment disruption in government and commercial payments.

ICD-9 to ICD-10 transition

Some of these codes are quite absurd  — but, the real issue is how is this ICD-10 transition making us better physicians and increasing access to care? The transition will be costly in upgrading systems and substantial physician and staff training. In February, 2014 the AMA published a report updating cost data for physicians to comply with ICD-10. The study updates costs from an earlier study done in 2008. The report showed new cost estimates for the ICD-10 transition that range from $56,639 to $226,105 for small practices; $213,364 to $824,735 for medium-sized practices; and about $2 million to more than $8 million for large practices. The new estimates include the costs associated with purchasing new software in order to accommodate the new codes.  Needless to say, these costs can be debilitating to a practice to the point of placing practice viability in danger. In addition, the focus on implementation of this ill-thought out mandate also places what should be most paramount — the patient physician relationship — in peril.

On April 1, 2014, President Obama signed into law the Protecting Access to Medicare Act of 2014.  The primary focus of the law is to provide a temporary patch to the Sustainable Growth Rate (SGR) for physician payment.  However, Section 212 of the new law establishes a delay for the implementation of ICD-10.  The language states that the Secretary of Health and Human Services (HHS) may not adopt the ICD-10 code sets prior to October 1, 2015 rather than the previous effective date of October 1, 2014.

The AMA spoke out against the proposed legislation before it was passed due to its opposition to a temporary fix for the SGR. Dr. Hoven, AMA President, stated, “The AMA and other physician organizations strongly agree that while a delay in ICD-10 implementation provides welcomed temporary relief, it does not offset the continued harm caused by keeping the SGR formula on life support and further delaying badly needed Medicare physician payment reforms. The AMA remains committed to relieving physicians of the crushing administrative burdens and practice disruptions that are anticipated during the scheduled transition to ICD-10.”

Physicians cannot leave our patients’ destiny and that of medicine in the hands of those who have neither a license to practice nor the education to deliver medical care. Physicians may not be able to reform our health care system overnight, but we must prevent the health care system from destroying medicine. Remember that our patients look to physicians as trusted leaders for health care solutions, not to the government.  


Dr. Russell Kridel is a Houston-based Facial Plastic Surgeon in private practice in the Texas Medical Center.

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Russell Kridel MD hosts Ted Poe reception

Russell Kridel MD hosts Ted Poe reception to support re-election campaign

Dr. Russell Kridel with Congressman Ted Poe

Congressman Ted Poe with Dr. Russell Kridel

Dr. and Mrs. Kridel recently held a reception to support the re-election campaign for Congressman Ted Poe. The campaign event was well attended by members of the medical community.  Several physicians in attendance shared their own experiences with red tape getting in the way of delivering quality care to their patients.  Congressman Poe also shared remarks including his interest standing up against regulations that are over-burdensome to physicians and detract from patient care.

“Ted is a US Congressmen with common sense.  He believes in the free enterprise system without overregulation.  He has also been a great champion of medicine and his efforts will go a long way to preserve the patient-physician relationship,” said Dr. Kridel.

Congressman Poe, Dr. Kridel, medical students and physicians at reception

Dr. Kridel, Congressman Poe, medical students and physicians at reception

Russ has worked with US Congressman Ted Poe and several key US Congressmen from Texas as they introduced bills to help resolve the SGR and ICD-10 crises and reduce over-burdensome rules that hamper the practice of medicine.

During his tenure as President of the Harris County Medical Society (HCMS) and as current Past-President, Dr. Kridel has worked with physicians across all disciplines to address critical issues affecting their ability to maintain practice viability while preserving the highest standards of patient care.

Russ is a facial plastic and reconstructive surgeon in Houston and has long been an active member of the AMA, TMA and HCMS. He is the immediate past president of the Harris County Medical Society and is currently a Member of the AMA House of Delegates and Chair of the AMA Council on Science and Public Health.

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Russell Kridel MD Meeting With Congressmen in DC

Russell Kridel MD meeting with Congressmen in DC at NAC Conference

Dr. Russell Kridel in DC to meet with members of Congress

Russ Kridel, MD goes up to capital hill to meet with members of Congress

Dr. Russ Kridel is in our national’s capital at the National Advocacy Conference (NAC) to take part in discussions that will help maintain the patient-physician relationship and improve the health of the nation.

Russ is meeting with members of Congress, political insiders and other industry experts on current efforts being made in health system reform refinement and implementation.

This year’s NAC conference is just weeks before Congress’ March 31 deadline to pass a bipartisan SGR (Sustainable Growth Rate) repeal bill that has been in the works for a year. A 24% payment cut is scheduled to take place April 1.

Dr. Kridel and other conference participants will personally call on members of Congress to co-sponsor the bill (H.R. 4015/S. 2000) and vote for repeal before the deadline.

Russ is a facial plastic and reconstructive surgeon in Houston and has long been an active member of the AMA. He is currently a Member of the AMA House of Delegates and Chair of the AMA Council on Science and Public Health.


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Electronic Health Records

Electronic Health Records transition can be a burden to physicians

In addition to payment cuts, our government is now penalizing us more frequently for not buying into their new plans. In order to comply with Medicare “Meaningful Use” requirements, we have to purchase expensive electronic health records (EHR) systems.


These EHRs often are not “physician friendly” and require a large investment in time and money for data input, as well as physician and staff training. This is in addition to physicians being required to meet each of the three stages of meaningful use criteria to avoid penalties. Beginning in 2015, non-compliant physicians will receive payment penalties of 1 percent and additional 1 percent decreases each  subsequent year until the total fine equals 5 percent. Medicare physicians who do not participate in the Physician Quality Reporting System (PQRS) will receive a 1.5 percent penalty on all traditional Medicare fee-for-service payments (Part B) in 2015, which increases to a 2 percent penalty in 2016. Similar penalties are already in effect if we are not e-prescribing.

All physicians were required to convert from Version 4010 to Version 5010 of the HIPAADollars electronic claims standard or face payment disruption from Medicare and commercial payments. Beginning in September 2012, we also had to put into place the Texas House Bill 300 regulation, governing patient privacy, which is more stringent than federal HIPAA requirements. These compliance mandates and payer administrative burdens have required us to hire more staff, pay for numerous Electronic Health Records (EHR) and billing software upgrades, and in some cases completely overhaul how our office operates, all based on the supposition of increased efficiency.

To read Russ Kridel’s Electronic Health Records editorial.

— Russell Kridel, MD

Russell Kridel, MD is a leading facial plastic surgeon in private practice in Houston, TX.  Dr. Kridel founded Facial Plastic Surgery Associates in 1981.


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Physicians Leading Future Change in Healthcare: HCMS Newsletter President’s Page by Dr. Russell Kridel

Physicians Leading Future Change in Healthcare

Thank you for the great honor in allowing me to serve you and the Harris County Medical Society (HCMS) this year. We have had many challenges but have faced them squarely. Rather than meekly accepting the intrusive and over-reaching mandates and regulations foisted on physicians, our patients and medicine, your county society has been actively in the forefront speaking out, anticipating and working on leading future change and sharing the perspectives that only practicing physicians experience.

Physicians Helping Patients

As the country’s largest county society (We are larger than 37 state medical associations.), the HCMS has played a huge role in the dialogue of health care system reform on all levels and in a myriad of venues. In January, the physician leadership of the Harris County Medical Society (HCMS) undergoes its yearly team renewal. HCMS members should feel privileged to know they have elected a strong and energized cohort of physicians, bolstered by an incredible hardworking and insightful staff, poised to continue and expand upon past accomplishments and inroads and ready to continue our necessary role to preserve the patient physician relationship, practice viability, and a scientific, compassionate, and patient-based approach to health care delivery.

By the time this newsletter goes to press, Congress may have decided the fate of the Medicare Sustainable Growth Rate (SGR) payment system to physicians that was never sustainable, never a growth rate and always unfairly discriminatory against physicians. How physicians have been able to keep their doors open to Medicare patients for so long while under a 13-year price freeze when practice expenses have skyrocketed is only answerable by the altruism and personal commitment that doctors have for their patients. We are so fortunate that U.S. Congressman Kevin Brady from Houston has listened to our plight and the deleterious effect on patient access that might ensue. Congressman Brady has met with HCMS over four times in this last year, and, in his role on Ways and Means, he is trying to bring sense to future legislation. With the Congressman, we met with the Houston Chronicle Editorial Board and two editorials were published supporting this vital issue.SGR

The problem going forward with Congressional compromise and wheeler/dealer arrangements in replacing the SGR is simply that future reimbursements may be based on compliance requirements and so-called quality measures that have unproven clinical relevance and may be more costly than helpful. It is laudable that when Congress passed the Medicare Act (Title XVIII) in the 1960s, the original language specifically said: “Nothing in this title shall be construed to authorize any Federal officer or employee to exercise any supervision or control over the practice of medicine or the manner in which medical services are provided, or over the selection, tenure, or compensation of any officer or employee.” It is distressing to see the absolute disregard of that principle as Congress and the Executive Branch take every opportunity to interpose themselves between the patient and the doctor. Those who have neither a license to practice medicine nor the education to deliver medical care seem to take pleasure in the erosion of physician autonomy and medical decisions, which should be based on the individual needs of the patient rather than on a bureaucratic practice or cost parameter.

Physicians Fighting Government Red Tape

This past year, as an HCMS priority, we have been fighting the burgeoning regulatory burdens and red tape that contract the time physicians can spend with patients. We have spent substantial time educating our U.S. Congressmen and Texas Legislators about the accumulation of compliance issues that are overwhelming physicians’ offices. They all seem receptive, but Representatives Brady and Poe have particularly embraced our causes. The opening of health insurance marketplaces and all the new rules and regulations under the Affordable Care Act (ACA) have increased our challenges. Physicians are right in the center of the paths of multiple, colliding fronts in the form of more federal and state regulatory requirements. U.S. physicians commit about 20 percent of their time to administrative tasks. Wouldn’t that time be better spent delivering health care?

We have made progress in Texas. This legislative session, we successfully advocated for six bills that will reduce Texas physicians’ regulatory burden. Physicians now can renew their controlled substances registration at the same time that they are renewing their medical license through the Texas Medical Board. Other bills passed that will create uniform prior authorization forms for medications and medical services, allow patients to sign in to physician offices simply by swiping a driver’s license, and will greatly simplify compliance with the state’s medical privacy law.

To assist you in meeting the regulatory and compliance burdens, HCMS created an incentive/penalty calculator, identified vendors to assist with “meaningful use” certification and IT support, submitted comments on delaying “meaningful use” Stage 2, and worked with Greater Houston HealthConnect. We also began working closely with TMA to develop a service organization to assist physicians with compliance and non-clinical office functions. At a national level, we continued collaborating with AMA on developing payment policy, administrative simplification and a national e-preauthorization for medical services and medications.

We physicians are now being mandated to take on patient risk in our practices, as if each of us individually were an insurance company, making our reimbursements dependent on patient outcomes. Somehow someone neglected to understand that we as physicians don’t create disease. We are not responsible for the body’s systems that fail and shut down. We are valiantly doing our best to decrease ill health and the suffering and pain that often accompany illness. We cannot be financially or morally responsible for patient outcomes when we are being crippled by mandates on how to deliver care from those who hold the purse strings but no license or by patient non-compliance. This year, in order to highlight the role that patients can play in their own health, HCMS started a Personal Responsibility Committee. It is estimated that more than half of all our U.S. sugar sweetened beverages and obesityhealth care expenditures are for self-induced medical problems that could be prevented if individuals took better care of themselves and their families. Obesity alone has taken on epidemic proportions, with the U.S. spending hundreds of billions a year to treat diabetes, obesity and overweight problems. And, yet, there are little if any Congressional legislative initiatives that incentivize patients to practice healthy lifestyles. Our Committee developed a brochure, soon to be distributed, to increase patients’ awareness of how sugar-sweetened drinks not only add to the waistline but also increase their risk of diseases. HCMS has received grant funding from the Texas Medical Association Foundation to assist with the Shut Out Sugar campaign. Go to or for more information.

view ahead

As your new officers, committee and council members take the wheel of this great organization we cannot view the future of medicine and the role we have to play by looking through the rear view mirror of yesterday. The view ahead belongs to those who face the fact of change and move forward to shape it. And change is here, often obstructing our progress forward and causing many detours, which frustrates physicians as we try to provide the best care for our patients and advance science. We used to be solely in the driver’s seat, helping our patients arrive at healthy destinations. But now, the person paying for the gas is no longer the patient, having been replaced by the government and third-party payers; they used to be just back seat drivers, annoyingly telling us where to make our turns. But more recently, they’ve made passengers of physicians; and they are behind the wheel. Unfortunately for patients and physicians alike, they don’t have a license and haven’t even had drivers’ education. Your new leaders will be working harder than ever to put you back in the driver’s seat to lead the health care car safely in the right direction.

—  Russell Kridel, MD

Dr. Russell Kridel is a facial plastic surgeon in Houston.

See all of the exciting community and physician resources available at the Harris County Medical Society.

Read the full text of Dr. Russell Kridel’s President’s Page in the December 15, 2013 issue of the HCMS Physician’s Newsletter.


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Physician leaders as artists ignite change

Physician Leaders as Artists

Great Physician Leaders and Artists

Physician Leaders and Artists

We know of the classic art museums in the world, famed not because of their structure, but because of the diverse unique works on their walls.  The greatness of these institutions expands only as do their collections.  Unlike the fleeting end of a relay race, the artwork survives centuries, for all to view, praised or damned.  And, so should our physician leaders see their mandate to put their own brush marks on the canvas; not everyone will like our art, but our effort and thoughts will be reflected.

Artists are a suffering brood, usually impoverished and unknown, but always innovative and gutsy, and generally not afraid to offend or delight.  Out of their adversity and needy realities spring their creativity and social commentary.  Recognition, if at all, may come decades after death, so the driving force must be an inner turmoil or exuberant expression.  There must be a passion, a vision of an image to place upon that canvas.  If we have no passion, no desires or goals, we should let others take our place at the easel, because the oils don’t belie mediocrity.

Physician leaders take an active hand as artists

Physician leaders take an active hand

Just like artists, physician leaders need to have a fired passion for their organization and need to be allowed to be different, to be proactive agents of change, lest their organizations stagnate.  Leaders also need an experienced basis in adversity to temper naïve and youthful illusions of reality.  Often an electorate shies away from the innovator, away from the squeaky wheel, when indeed that is what membership may need the most.  We are living too much in a time of acceptance when perhaps we should be back in time, like the sixties, daring to be controversial, not afraid to make others uncomfortable if we disagree.  Growth does not take place unless we challenge the mind, our beliefs, and ourselves.  We must increase the debate, not make it less.

— Russell Kridel, MD

Russell Kridel, MD is in private practice in Houston, TX

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Personal Responsibility in Healthcare

Role of personal responsibility in healthcare costs:

Personal responsibility in healthcare costs

Personal Responsibility is an important element of addressing rising health care costs. Obesity alone has taken on epidemic proportions, with the United States spending $174 billion a year to treat diabetes, and at least $147 billion on health problems related to overweight and obesity. Tobacco still costs this nation more than $150 billion a year. 
According to the Centers for Disease Control and Prevention (CDC), nearly 75 percent of Americans report they do not always take their medications as directed; one in three never fill their prescriptions; and proper adherence approaches only 50 to 65 percent in patients with chronic conditions, such as diabetes and hypertension.

An article in the New England Journal of Medicine (NEJM) reported that poor medication adherence contributes significantly to medication-related hospital admissions in the United States, at an estimated cost of at least $100 billion annually.

Lifestyle behaviors are difficult to change, and solutions to effect behavioral modification have been largely unsuccessful to date, despite huge community efforts and even legislation. Some patients have developed a sense of entitlement of care, taking no responsibility for abusing their health but expecting every conceivable means of treatment be used to cure them, no matter the expense. They, in turn, blame the health care delivery system for its high costs. This is unfortunate, since there likely would be more than enough money in our health care system to help patients with illnesses that could not be prevented if the rest of our population practiced healthy living. Other patients would like to change but need to be taught what to do. Others face economic and cultural obstacles that prevent wellness, which we must address.

Physicians can help patients help themselves.  But, we also need the government’s support to help us do that.

Click here to read Russ Kridel’s full editorial

For more information about Russ Kridel check out his bio or his full cv

Russell Kridel, MD is in private practice in Houston, TX


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Russell Kridel MD given Bluebonnet Award for contributions to dietetics

Russell Kridel MD given Bluebonnet Award by Houston Academy of Nutrition and Dietetics

Dr. Russell Kridel given Bluebonnet Award

Academy of Nutrition & Dietetics presents Dr. Russell Kridel Bluebonnet Award

The Bluebonnet Award of the Houston and Texas Academy of Nutrition and Dietetics is intended to recognize an individual who is not a dietitian, but who has contributed significantly to the advancement of nutrition and dietetics in Texas.

Dr. Russell Kridel is a passionate advocate of the importance of nutrition and diet in our community.  As the President of the Harris County Medical Society for 2013, one of his primary goals during this year is to help target the obesity epidemic in our community.

Russ Kridel is passionate advocate of diet and nutrition

HCMS President, Russ Kridel, MD is passionate advocate of diet and nutrition

He created the HCMS Personal Responsibility Committee dedicated to helping address the obesity epidemic. The committee provides physicians from all specialties with additional tools to communicate with their patients about the importance of diet and nutrition to prevent obesity, diabetes and other diseases, with specific emphasis on sugar sweetened beverages. Through Dr. Kridel’s leadership, the committee developed a brochure called “Shut Out Sugar” for physicians and other health providers to hand out to patients.  The brochure clearly outlines simple and easy steps people can take to reduce consumption of sugar-sweetened beverages to improve their health.

He also participates in key roles at the state and national level on health care issues that positively promote the role of diet and nutrition in the ever-changing landscape of health care.

Russell Kridel MD is Chair of the AMA Council on Science and Public Health

Dr. Kridel is Chair of the AMA Council on Science and Public Health

Dr. Kridel is in his sixth year and the current Chair of the American Medical Association (AMA) Council on Science and Public Health (CSAPH). CSAPH provides information and recommendations on medical, scientific, and public health issues.  Reports during Dr. Kridel’s tenure on the CSAPH, have covered such issues as: sugar sweetened beverages, obesity and bottled water safety.

Dr. Russell Kridel is past president of TMA Foundation

Russ Kridel, MD is past president of TMA Foundation

As the immediate Past President of the TMA Foundation, Dr. Kridel also raised funds for initiatives that enable physicians and their families to give back to their community and improve the health of all Texans. The foundation supports TMA’s health improvement programs that address the association’s public health priorities.

Dr. Kridel will be presented with the Bluebonnet Award at the annual Houston Academy of Nutrition and Dietetics member’s dinner in May, 2014.  He will also be placed into consideration for the statewide designation.

Dr. Russell Kridel is a Houston-based Facial Plastic Surgeon in private practice in the Texas Medical Center.


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Russell Kridel MD Chair of AMA Council on Science and Public Health Attended Interim Meeting of the AMA House of Delegates

Russell Kridel MD Chair of AMA Council on Science and Public Health attended the 2013 Interim Meeting of the AMA House of Delegates held at the Gaylord Convention Center in National Harbor, MD.

Always an activist for excellence in health care delivery, Dr. Kridel believes better health care for patients comes, in part, from physician’s dedication to developing medical advancements at all levels — from research to patient care.  He also believes physicians should play a leadership position in health care reform.

Elected by surgeons from his own specialty, as well as, physicians across all disciplines, to numerous leadership positions, Dr. Kridel is a member of the AMA House of Delegates (the principal policy-making body of the American Medical Association) and is currently the Chair of AMA Council on Science and Public Health.

The AMA Council on Science and Public Health (CSAPH) provides information and recommendations on medical, scientific, and public health issues. Summaries and recommendations of all CSAPH reports are available to the public.  In addition, Dr. Kridel’s blog,, provides answers to patient questions about health care issues from the CSAPH reports.

Russell Kridel MD Chair of AMA Council on Science and Public Health

Dr. Russell Kridel and Dr. Ben Carson at AMA Interim Meeting

During the AMA Interim meeting, Dr. Russell Kridel had the opportunity to speak with Dr. Ben Carson, Director of Pediatric Neurosurgery at Johns Hopkins University.  Dr. Carson has recently been in the media limelight following his rousing speech at the National Prayer Meeting Breakfast in February, which touched upon several critical national issues, including the importance of doctors having a voice in the health care debate.  His speech can be viewed here in two parts:  Part 1 and Part 2.

Dr. Kridel commitment to his profession and to the highest standards of health care is also evidenced by his current position as President of the Harris County Medical Society.  In this role, he has written numerous editorials on topics such as, physicians as trusted leaders, sustainable growth rate (SGR), personal responsibility, Affordable Care Act (ACA), accountable care organizations (ACO) and government regulation of the medical profession.


Dr. Russell Kridel is a Houston-based Facial Plastic Surgeon in private practice in the Texas Medical Center.

Read his most recent editorial — President’s Page in the November 1, 2013 issue of the HCMS Physician’s Newsletter.

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TEXPAC gives physicians a voice in health care policy: HCMS Newsletter President’s Page


Book is relevant to health care changes

Relevant commentary to the changes in health care

In the late 90’s, Spencer Johnson wrote the classic business fable—Who Moved My Cheese?—which forced businesspeople everywhere to think about change and how to deal with it. In recent years, no industry has experienced more change than health care. How are physicians to respond when the tried and true paths we’ve followed for years are blocked? Do we sit at the barricades complaining and motionless? Or, do we dare to be brave and explore and find ways around the detours, recognizing that our actions alone will be the biggest determinate of our potential success?

In his book, Johnson tells us that:

  • Change happens – whether we like it or not
  • We must let go of the old ways and adapt to change quickly
  • We must change ourselves in order to keep pace with the new reality
  • We should learn to enjoy changing and the advantageous position in which it puts us

Certainly, we must be more flexible and open to change. But Spencer Johnson’s view is too passive if we believe that some of the changes in our health care system should not be adopted. The problem is that we have allowed others to rearrange the maze without our leadership so that we have had to adapt to survive. We have failed as a profession to stop special interest groups—the government, hospitals, big Pharma, the device and supply industries, insurance companies, and politicians—from defining health care and practicing medicine without a license. Because we have abrogated that responsibility, others have taken control, and we have had to be subservient to their rules. So, we must not only find out how to live within these rules in the short term, but more importantly we must take back control of the system that cannot function without physicians. We can no longer be passive and wait for “the cheese” to appear magically at the whim and control of others.

With the introduction of EHRs, PQRS, the PPACA, and other rules and regulations that will not improve patient care and may destroy practice viability, health care as we knew it 10 years ago has changed dramatically, whether we like it or not. And, so the Texas Medical Association (TMA) and Harris County Medical Society (HCMS) have spent hours and many resources providing information on how to survive the maze. But that energy struggling with how to respond to these mandates is just a first step.

Doctors need to speak out about health care injustice

Physicians need to speak out about health care injustice

We need to do much more. We need to speak out when we see a threat to quality patient care and physician practices. And the first step is political advocacy. One of the great things about our system of government is that if we don’t like a law, we have the opportunity to change it. To change a law we must convince the Legislature to pass one that fixes our problem, and so we must educate not only patients but also our lawmakers. And we must continue to be proactive in designing legislation for the lawmakers as we did with the prompt pay legislation, liability reform, and physicians as leaders of the health care team laws we were successful in having adopted. Political advocacy is a two stage process, involving policy and politics. In the first stage, we develop policy through the TMA and American Medical Association (AMA) House of Delegates. Then HCMS, TMA and AMA lobbyists work to get that policy passed into law – and they do a great job of it. Your dues dollars go to support those efforts.

In the second stage, TEXPAC, which is the political arm of the TMA, works to get medicine-friendly candidates, who will support our policy, elected to office. These efforts are supported only by TEXPAC dues, not by HCMS/TMA membership dues.

We can develop all the policy we want, but if we don’t have friends in the Legislature to turn policy into bills and then pass them into law, we have wasted our time and your HCMS/TMA dues dollars. Remember, your HCMS and TMA dues dollars cover only HALF of the process.

I understand that for many physicians, politics is a dirty, unsavory process that they would just like to ignore. Well, my friends, we cannot ignore it because the political system is the root cause of the change that is affecting us. Here is where we must wake up to reality and change.

Currently, HCMS participation in TEXPAC is a paltry 13 percent. Statewide participation is only about 15 percent. With the money raised through membership, TEXPAC barely has enough money to adequately fund the physician candidates for public office and the other medicine-friendly candidates at the state level. Unfortunately, TEXPAC does not raise enough money to be a major factor in congressional and U.S. Senate races. This must change if physicians are going to play a significant role in improving the health care system of this state and this nation. We have a very strong team of lobbyists in Texas who represent us and do great work in Austin and in Washington. During this past legislative session, we were able to successfully cut red tape and paperwork hassles, stop the theft of physician services, stop unwarranted scope expansions, strengthen Texas’ physician workforce, and protect 2003 liability reforms, among other things. These are all very important accomplishments. However, in Austin we have been unable to fix our horribly broken Medicaid system, protect funding for critical health care services from the roller coaster that is the state budget, and keep the Legislature from inserting itself between us and our patients. In Washington, we have been working for more than 10 years to fix the flawed SGR formula, and the problems that are built into the Affordable Care Act (ACA) have all been mentioned earlier.

One of the reasons we can’t get the Texas Legislature and Congress to address the critical, system-wide issues is that our voice just isn’t loud enough. The reason for that is that we fall seriously short in supporting the political part of advocacy. The insurance, hospital and legal professions all out raise us when it comes to political contributions. Here’s an example of why that is important.

We recently discovered that patients who buy health insurance through the newly opened ACA Marketplaces have a 90-day grace period in which to pay their premiums. If health care is delivered to the patient who later does not pay the premium, the insurance company is responsible to pay for all charges during the first 30 days, but for the next 60 days, the health care provider will have delivered the care but will not be paid anything! How did this happen? Well, originally, the health plans were supposed to be responsible for all 90 days, but they were able to call on their friends in Congress and lobby the Administration to change the rule. We couldn’t stop this because our voice just isn’t loud enough. Now we may find ourselves not getting paid for a lot of marketplace patients.

TEXPAC support is important

It is important to support TEXPAC

Are you content with running around the maze in health care that others change daily without your input, so that most of your time is spent trying to navigate the changes that take you away from time with patients and increase your overhead? Are you content to let others determine the bigger issues? If not, then we need a louder voice. We need to field a strong lobby team and elect medicine friendly candidates to public office. I ask that as you fill out your 2014 HCMS/TMA dues statements this year, check the box for TEXPAC membership. The entry level is only $125 a year, and the benefits you will see by having more medicine-friendly legislators in Austin and Washington will far outweigh that contribution.

— Russell Kridel, MD

Dr. Russell Kridel is a Houston-based Facial Plastic Surgeon in private practice in the Texas Medical Center.

See all of the exciting community and physician resources available at the Harris County Medical Society.

Read this President’s Page in the November 1, 2013 issue of the HCMS Physician’s Newsletter.

Posted in Government Regulation of the Medical Profession, HCMS President Editorials, Physicians Under Attack, Stopping Regulatory Madness | Tagged , , , , | Leave a comment