dallas medical journal november 2011

v o l u m e 9 7 • n u m b e r 1 1 • n o v e m b e r 2 0 1 1

Health Economics

Health Economics 2011 - From a Physician’s View

Physician Spotlight - Dan McCoy, MD

I n t h i s i s s u e :

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Rated A (Excellent) by A.M. Best Company

submit letters to the editor to [email protected]

About the Cover PhotoDan McCoy, MD, listens to a question while serving on the panel of the 26th Annual Conference of Professions on Oct. 14 at SMU’s Perkins School of Theology. The conference topic was “Professional Ethics and Social Networking: Like?”

207 President’s Page Another Nice Mess

214 Health Economics 2011 The view of Stuart Black, MD

218 Physician Spotlight Dan McCoy, MD

221 Membership Matters Why being a member of DCMS is important to C. Turner Lewis III, MD

223 Conference of Professions Photos

Dallas County Medical SocietyPO Box 4680, Dallas, TX 75208-0680Phone: 214-948-3622, FAX: 214-946-5805www.dallas-cms.orgEmail: [email protected]

DCMS Communications CommitteeRoger S. Khetan, MD ............................................. ChairRobert Beard, MD Gene Beisert, MDSuzanne Corrigan, MDSeemal R. Desai, MD Daniel Goodenberger, MD Gordon Green, MD Steven R. Hays, MDLudwig A. Michael, MDDavid Scott Miller, MD

DCMS Board of DirectorsShelton Hopkins, MD ...................................... PresidentRichard W. Snyder II, MD .........................President-ElectSteven R. Hays, MD .........................Secretary/TreasurerStephen Ozanne, MD ............. Immediate Past PresidentGarret Cynar, MD Sarah L. Helfand, MD Michael R. Hicks, MDJeffrey Janis, MD Rainer A. Khetan, MD Dan McCoy, MD Todd Pollock, MDCynthia Sherry, MD Jim Walton, DO

DCMS StaffMichael J. Darrouzet .................. Chief Executive OfficerLauren N. Cowling ............................... Managing EditorMary Katherine Allen ..........................Advertising Sales

Articles represent the opinions of the authors and do not necessarily reflect the official policy of the Dallas County Medical Society or the institution with which the author is affiliated. Advertisements do not imply sponsorship by or endorsement of DCMS. ©2011 DCMS

According to Tex. Gov’t. Code Ann. §305.027, all articles in Dallas Medical Journal that mention DCMS’ stance on state legislation are defined as “legislative advertising.” The law requires disclosure of the name and address of the person who contracts with the printer to publish legislative advertising in the DMJ: Michael J. Darrouzet, Executive Vice President/CEO, DCMS, PO Box 4680, Dal-las, TX 75208-0680.

Dallas Medical Journal(ISSN 0011-586X) is published monthly by the Dallas County Medical Society, 140 E. 12th St, Dallas, TX 75203.

Subscription rates$12 per year for members; $36, nonmembers; $50, overseas. Periodicals postage paid at Dallas, TX 75260.

PostmasterSend address changes to:Dallas Medical Journal, PO Box 4680 Dallas, TX 75208-0680.

v i s i t u s o n l i n e a t w w w . d a l l a s - c m s . o r g • N o v e m b e r 2 0 1 1 • 2 0 5

v o l u m e 9 7 • n u m b e r 1 1 • n o v e m b e r 2 0 1 1

MEMBER EVENTSPrice per ticket (person) average benefit:- Four (4) Networking Socials ($15 per person, per event) - DCMS Spring Celebration Picnic at the Dallas Arboretum (average family of 4)- Night Out with the Frisco Roughriders - Member Roundup ($45 per person/average family of 4) - Holiday Social at the Meyerson (average 2 tickets per person )

MEMBER DISCOUNTS- 4 Texas Rangers Game Tickets (average savings) - 2 Dallas Stars Game Tickets (average savings) - 2 Dallas Mavericks Game Tickets (average savings) - 2 FC Dallas Game Tickets (average savings)

PayMENT aDVOCaCy (specific claims)- Average Staff Time and Resources Saved (per claim) - Payment Maximization (coding consult) (estimated increase on simple claims) LegaL & ReguLatoRy SeRviceS:- Sample Policies and Procedures (Estimated 2 hours in legal fees) (example: Red Flag Rules)

COMMUNICaTION/ REfERRal TOOlS- DCMS DocBook, MDTM

- DCMS Directory- Dallas Medical Journal Annual Subscription

COMMUNITy SERVICE (through Project access Dallas)- Access to lab/diagnostic services (estimated per PAD patient visit)- Staff/administrative time (average, based on seeing 3–4 patients a year)

RESOURCES aVaIlaBlE THROUGH TMa- Accessing the Coding and Billing Hotline- Attending Billing and Coding Mini-Consultations- Contacting the TMA Knowledge Center for Research- Health System Reform Analysis and Summary

ad·vo·ca·cy n. The act of pleading or arguing in favor of something, such as a cause, idea or policy; active support advocacy for medicine. DCMS members stay apprised of pertinent legislation during legislative sessions.

sup·port v. to maintain by supplying with things necessary to existence services to support your practice. DCMS physicians can focus on patient care because DCMS staff provides resources for the business side of your practice.

serv·ice n. an act of helpful activity; help; aid: to do someone a service community service opportunities. DCMS provides members with opportunities to use their medical skills to improve the health of their communities.

net·work·ing n. a supportive system of sharing information and services among individuals and groups having a common interest peer networking. DCMS offers many opportunities to get to know and socialize with your colleagues.

in·for·ma·tion n. the act or fact of informing news and information. DCMS is your source for information about upcoming events, community health alerts, legislation affecting medicine, and much more.

con·nect v. to establish communication between; put in communication efficient communication tools. DCMS produces materials that members can use as efficient and effective referral tools.

benefits of dcms membershipmembership benefitsthe mission of the Dallas county Medical Society is to advocate for physicians and their patients, to promote a healthy community, and to enhance professionalism in the practice of medicine.

ben·e·fit n. something that is advantageous or good; an advantage

val·ue n. 1. relative worth, merit or importance 2. monetary or material worth, as in commerce or trade 3. estimated or assigned worth; valuation

DCMS/ TMa Dues for 2012 $843value of Member Benefits for 2012 $2,088

total vaLue of Membership PRiceLeSS

tangible benefitsSavings reflected below are estimates based on a member taking advantage of these events and programs.

$2,088

$60 $100

$50 $180

$50

$64 $60 $28 $28

$100 5%

$250

$50$38$36

$165$420

$30$224

$45$150

total (estimated) Member Benefits


President’s Page

When I look at the newspapers and listen to the radio, I’m reminded of a favorite comedy team from my childhood: Stan Laurel and Oliver Hardy. Whenever their harebrained antics would create a disaster, Oliver, often the cause of the problem, would say to Stan, “Well, Stanley, here’s another nice mess you’ve gotten me into!” Well, Stanley (or somebody) has done it again — in spades.

We have no clear picture of where the economy or the country is going, but we see inchoate seething in the Wall Street demonstrations. There clearly is anger at what has happened to the system, but who to blame? What to do? To answer those questions, one should be able to describe what has happened, but it is so complicated that many books, dissertations and theses still wait to be written in explanation. We always want to bring such things down to a scale we comprehend, like those models of the earth’s size, in relation to our galaxy’s size showing a pencil dot in comparison to a basketball, and then the basketball is the dot compared to another basketball, and then another…. You still don’t really understand, but you can better comprehend the enormity of space.

Another way to scale things to an understandable level is through anecdotes. Anecdotes can put a human face on issues, and they can be malleable enough to make a point. If you have lost your job, you have a story and a concrete idea of part of what has happened. If your employer has made record profits by manipulating currencies and has seen fit to give you a bonus, then you, too, have a story and understand part of what has happened. Of course, your satisfaction with the changes likely will be quite different. Both of these anecdotes are legitimate pieces of a big puzzle. Although those players feel helpless and vulnerable, other “puzzle pieces” have very focused goals. Many of those pieces are well-represented in Washington, D.C.

Anecdotally, if one’s re-election campaign receives large contributions from an entity that gains from minimally regulated financial dealings, one at least

will listen to its pitch to remain unregulated. And if that charming person who lobbies one in its interest is the same person on whom one depended for good information and solid service just a year or so ago, one may well be swayed by the blandishments. If that entity claims that not bringing foreign profits

home to the United States will keep a US worker out of a job, and that eliminating US taxes on that profit will result in her return to work, one may be convinced that that is a good idea. It would be in one’s best interest not to look at the record of what happened the last time a tax holiday on foreign profits was granted (2004): almost all the money went to stock buybacks1. And 90 percent of stock buybacks result in increases in total number of shares outstanding because buybacks usually are a mechanism for management to exercise stock options with little or no drop in share price2. That is, the corporations that were granted the tax holiday used the money to pay management bonuses, not to put workers back on the job. Jobs actually were lost and taxes for debt payment were lost. So, although one’s former aide or chief-of-staff-turned-lobbyist may be able to remind one of the good ol’ days and his prior hard work, the now-lobbyist cannot provide unbiased data showing that jobs were created by the prior foreign profit tax holiday. For the benefit of one’s election chances, it would be best not to look at the stats. Just listen to the theoretical benefits promulgated by one’s former chief of staff, and then vote the way one is told.

These are issues important to all Americans, but especially to those of us in the practice of medicine. We have seen an economy-related decrease in general medical consumption — hence, a drop in patient contacts and charges. More important is the threat to the entire social support system and medical payment system. We now are struggling with threats to Medicare payment levels, and with possible changes to age and income eligibility requirements. We also know that hospital readmissions correlate with social support structures more than with medical care3 (a cause of substantial consternation for hospital administrators threatened with future Medicare/Medicaid payment reductions for readmitted patients). Thus, a collapse of the social safety net would directly impact medical resource usage and quality.

Cuts to public spending to support a “No Tax” philosophy will guarantee a longer stagnation and will drive up medical costs even further. We should be pushing for an aggressive spending program with the stated and planned future institution of taxes spread widely across the population. Our economy and our medical system need it.

1. NPR Oct. 4, 2011, referencing Bloomberg Business Week article 2. The Dallas Morning News Oct. 2, 2011 3. Data from Parkland Health & Hospital System

Shelton Hopkins, MD

Another Nice Mess

T h e p r o f e s s i o n a l s b e h i n d t h ep r o f e s s i o n a l s f o r o v e r 1 9 y e a r s

www.doctorsreferralservice.com

20 Pain RelieversD.R.S. is a network of highly experienced independent businesses and professionals

offering medically related products and services specific to physicians. Members

are selected for their high standards and uncompromising service.

Accountant (CPA) / Tax ServicesPaula Allgood, CPA……Beaird Harris & Co, P.C.972.503.1040……[email protected]

Lori A. Eads, CPA……Bland, Garvey, Eads, Medlock + Deppe, P.C.972.231.2503……[email protected]

Design / Build Medical & Dental ContractorGrady Herzog……Structures & Interiors Inc.817.329.4241……[email protected]

Electronic Medical RecordsLeslie Warren……EMR Advisory Group972.898.5671……[email protected]

Employee BenefitsAmy Rickman……Lockton Dunning Benefits940.380.1245……[email protected]

Financing / BankingGary West……BB&T469.791.4502……[email protected]

Financial / Estate / Insurance PlanningMark A. Trewitt, CFP®, CLU, ChFC, AEPIntegrated Financial Solutions Group972.312.1337……[email protected]

Healthcare FurnishingsLisa Locke……bkm Total Office of Texas, LLC214.902.7215……[email protected]

Healthcare Interior DesignerLaura Ginsberg……Medical Space Design, Inc.972.566.6771……[email protected]

Linen / Laundry ServicesGary W. McDaniel……ImageFirst214.769.6677……[email protected]

Legal ServicesMichael H. Saks*……Wright, Ginsberg, Brusilow, PC972.788.1600……[email protected]

W. Darrell Armer*……Looper, Reed & McGraw, PC214.922.8923……[email protected]*Board Certified-Health Law by The Texas Board of Legal Specialization

Marketing / Public RelationsBarbara Steckler……Concepts in Medical Marketing972.490.7636……[email protected]

Medical Malpractice / Commercial InsuranceJames Patterson, CIC, AAI……Agapé Healthcare PartnersMetro 817.329.4200……[email protected]

OSHA ComplianceJessica James469.360.1367……[email protected]

Personnel RecruitmentJan Harris, CPC……J. Harris Co. Personnel Services Inc.214.369.9545……[email protected]

Practice Management / Billing / ConsultingDavid Loomis……The Health Group972.792.5700……[email protected]

Promotional Products / Wearables / Filing SystemsNance Lindstrom……Safeguard Business Systems& Promotional Products972.596.8282……[email protected]

Real Estate (Commercial)M.W. (Hugh) Resnick……Pizel & Assoc. Commercial Real Estate 972.404.0008……[email protected]

TelecommunicationsCharlie Hubbard, PMP……HUBCO Communications, Inc.469.293.3081……[email protected]

DCMS values your opinion.

We need your input to make your Dallas County Medical Society even better! We’re interested in your feedback regarding DCMS’ advocacy efforts, communication tools and pieces, and membership events and services.

Our survey only has 15 questions and should take no longer than 3 minutes to complete.

Questions?Contact Lauren Cowling, DCMS director of communications, at 214.413.1447or [email protected].


T h e p r o f e s s i o n a l s b e h i n d t h ep r o f e s s i o n a l s f o r o v e r 1 9 y e a r s

www.doctorsreferralservice.com

20 Pain RelieversD.R.S. is a network of highly experienced independent businesses and professionals

offering medically related products and services specific to physicians. Members

are selected for their high standards and uncompromising service.

Accountant (CPA) / Tax ServicesPaula Allgood, CPA……Beaird Harris & Co, P.C.972.503.1040……[email protected]

Lori A. Eads, CPA……Bland, Garvey, Eads, Medlock + Deppe, P.C.972.231.2503……[email protected]

Design / Build Medical & Dental ContractorGrady Herzog……Structures & Interiors Inc.817.329.4241……[email protected]

Electronic Medical RecordsLeslie Warren……EMR Advisory Group972.898.5671……[email protected]

Employee BenefitsAmy Rickman……Lockton Dunning Benefits940.380.1245……[email protected]

Financing / BankingGary West……BB&T469.791.4502……[email protected]

Financial / Estate / Insurance PlanningMark A. Trewitt, CFP®, CLU, ChFC, AEPIntegrated Financial Solutions Group972.312.1337……[email protected]

Healthcare FurnishingsLisa Locke……bkm Total Office of Texas, LLC214.902.7215……[email protected]

Healthcare Interior DesignerLaura Ginsberg……Medical Space Design, Inc.972.566.6771……[email protected]

Linen / Laundry ServicesGary W. McDaniel……ImageFirst214.769.6677……[email protected]

Legal ServicesMichael H. Saks*……Wright, Ginsberg, Brusilow, PC972.788.1600……[email protected]

W. Darrell Armer*……Looper, Reed & McGraw, PC214.922.8923……[email protected]*Board Certified-Health Law by The Texas Board of Legal Specialization

Marketing / Public RelationsBarbara Steckler……Concepts in Medical Marketing972.490.7636……[email protected]

Medical Malpractice / Commercial InsuranceJames Patterson, CIC, AAI……Agapé Healthcare PartnersMetro 817.329.4200……[email protected]

OSHA ComplianceJessica James469.360.1367……[email protected]

Personnel RecruitmentJan Harris, CPC……J. Harris Co. Personnel Services Inc.214.369.9545……[email protected]

Practice Management / Billing / ConsultingDavid Loomis……The Health Group972.792.5700……[email protected]

Promotional Products / Wearables / Filing SystemsNance Lindstrom……Safeguard Business Systems& Promotional Products972.596.8282……[email protected]

Real Estate (Commercial)M.W. (Hugh) Resnick……Pizel & Assoc. Commercial Real Estate 972.404.0008……[email protected]

TelecommunicationsCharlie Hubbard, PMP……HUBCO Communications, Inc.469.293.3081……[email protected]

Dallas Nephrology Associates Celebrate 40 Years of Excellence

Technology and society have changed dramatically over the last 40 years: eight U.S. presidents, the inventions of DVDs, microwave ovens, the Internet, GPS systems, and Smart Phones just to name a few. The same is true for one of the nation’s oldest and largest nephrology practice groups, Dallas Nephrology Associates (DNA). Through the years, DNA has grown into one of the largest single specialty nephrology practice groups in the United States and continues to be on the forefront of patient care.

Prior to 1971, patients needing dialysis treatment in Dallas had only two choices, Peritoneal Dialysis or Home Hemodialysis and only one place, Parkland Memorial Hospital, to receive treatments. Drs. Alan R. Hull and Ronald C. Prati had a vision to build and manage a dialysis treatment center outside of a hospital setting In June 1971, they opened the Southwestern Dialysis Center and started what later became the practice group of Dallas Nephrology Associates.

“Southwestern Dialysis Center was unique in that within the dialysis center we had our doctors’ offices, outpatient clinic, plus a conference room which was a totally new concept” stated Dr. Hull.

Substantial changes in dialysis technology have occurred over the last 40 years that have also positively impacted patient care and the physician’s care of those patients.

“The dialysis equipment provides smoother sessions, pharmaceuticals correct metabolic deficiencies, and we have fresher understandings of the value of providing a variety of treatment modalities instead of just thrice weekly dialysis,” says Dr. Tom Parker, one of the early members of the group who pioneered many scientific advances related to dialysis.

“Since DNA began 40 years ago, technology and medical improvements have made tremendous advancements,” said Dr. Ruben Velez, President and CEO of DNA. “Since our beginning, our practice has led the way—from starting the first private dialysis center in Dallas to the creation of one of the nation’s largest and most sophisticated out-patient transplant clinics at the Dallas Transplant Institute.”

Dallas Transplant Institute (DTI) is unique in that it is a stand-alone clinic in a private practice that provides care to post-transplant patients. DTI has a Medicare approved lab, radiology services and radio nuclear studies.

Dr. Hull recalls, “Shortly after the DTI opened in 1981, they were visited by one of the leading transplant surgeons at that time, who commented that they could not do this at their university center, but if they could, it would be designed exactly like this is.” DTI continues to provide care to transplant patients and offers a full complement of professionals including transplant physicians, nurses, physician assistants, advanced practice nurses, social workers and dietitians. DTI also has one of the largest pre-transplant departments evaluating living donors and potential

recipients for several of the major transplanting hospitals in Dallas. Patient referrals come from all over Texas, the United States and some international.

Today, DNA has approximately 70 physicians and currently operates 14 offices throughout the Dallas/Fort Worth metropolitan area. In addition to providing care for dialysis and transplant patients, DNA offers expert treatment for a variety of renal disorders including hypertension, diabetes, chronic kidney disease, and kidney stones. The group is also instrumental and proactive in education of primary care physicians in the early detection of kidney disease resulting in delaying or preventing progression to end stage renal disease. In addition, DNA is involved in teaching and training of young physicians in several major teaching programs in Dallas.

More sophisticated treatment of patients with kidney disease has resulted in patients being kept off of dialysis longer. These treatments are primarily advancements in pharmaceutical treatment of certain kidney disease and/or of the symptoms caused by kidney disease. Of course, early detection has been a main emphasis resulting in earlier treatment. Kidney disease affects 15-30 million people with more than 550,000 receiving some form of renal replacement therapy.

DNA physicians continue their 40-year trend of maintaining leadership positions in the nephrology community, locally, regional, and nationally including the American Society of Transplant Physicians, American Society of Nephrology, Renal Physicians Association, National Kidney Foundation, Inc, and Texas Transplant Society and the Texas Governor’s CKD Task Force. DNA physicians were founding members of the American Transplant Society and Texas Transplant Society.

“Our reputation across not only the Dallas/Fort Worth area, but across the country was not established overnight—but through four decades of leadership and excellence from all of our employees,” said Dr. Velez. “Our team of physicians and staff are continually called upon for advice and direction from other practice groups around the world.”

Dr. Velez emphasizes that as the industry continues to evolve, DNA will be there in the forefront. “We are never content with the status quo. We strive every day to lead the way in patient care and we truly look forward to the next 40 years.”

S P E C I A L A D V E R T I S I N G S E C T I O N

214-358-2300 www.dneph.com 1-877-6KIDNEY (1-877-654-3639)

1420 Viceroy Dr., Dallas 75235

DNA_DMJNov_090111A.indd 1 9/1/11 3:56 PM


Sunday, Dec. 4Starts at 2:30 p.m.

Meyerson Symphony Center2301 Flora St.

Dallas

1:30 p.m. – Cocktails and light hors d’oeuvres.

2:30 p.m. – Christmas Celebration

The DSO’s beloved holiday concert returns with an all-new show that is festive for the entire family. Join conductors Joshua Habermann and Lawrence Loh for “A World of Joy,” unforgettable entertainment featuring beloved carols and majestic pageantry from the Dallas

Symphony Chorus, the Christmas Celebration Children’s Choir, and the DSO!

RSVP Required! Limited seats available. Cost is $25/person.

Only ONE guest per DCMS member.

I will attend ___ SOLO or with ___ ONE GUEST

Spouse/Guest Name:___________________

Select one: ___1 ticket for $25 or ___2 tickets for $50

DCMS Member Name:__________________________________

Phone________________________________________________

E-mail_______________________________________________

Credit Card ___________________________________________

Card Type: VISA MC AMEX DISC

Exp. Date__________ Security Code_______________

FAX credit card payments to 214.946.5805 or mail checks payable to DCMS, PO Box 4680, Dallas, TX 75208.

Reservations must be received by Friday, Nov. 25.

Questions? Contact Cara at 214.413.1423 or [email protected]

Dallas Nephrology Associates Celebrate 40 Years of Excellence

Technology and society have changed dramatically over the last 40 years: eight U.S. presidents, the inventions of DVDs, microwave ovens, the Internet, GPS systems, and Smart Phones just to name a few. The same is true for one of the nation’s oldest and largest nephrology practice groups, Dallas Nephrology Associates (DNA). Through the years, DNA has grown into one of the largest single specialty nephrology practice groups in the United States and continues to be on the forefront of patient care.

Prior to 1971, patients needing dialysis treatment in Dallas had only two choices, Peritoneal Dialysis or Home Hemodialysis and only one place, Parkland Memorial Hospital, to receive treatments. Drs. Alan R. Hull and Ronald C. Prati had a vision to build and manage a dialysis treatment center outside of a hospital setting In June 1971, they opened the Southwestern Dialysis Center and started what later became the practice group of Dallas Nephrology Associates.

“Southwestern Dialysis Center was unique in that within the dialysis center we had our doctors’ offices, outpatient clinic, plus a conference room which was a totally new concept” stated Dr. Hull.

Substantial changes in dialysis technology have occurred over the last 40 years that have also positively impacted patient care and the physician’s care of those patients.

“The dialysis equipment provides smoother sessions, pharmaceuticals correct metabolic deficiencies, and we have fresher understandings of the value of providing a variety of treatment modalities instead of just thrice weekly dialysis,” says Dr. Tom Parker, one of the early members of the group who pioneered many scientific advances related to dialysis.

“Since DNA began 40 years ago, technology and medical improvements have made tremendous advancements,” said Dr. Ruben Velez, President and CEO of DNA. “Since our beginning, our practice has led the way—from starting the first private dialysis center in Dallas to the creation of one of the nation’s largest and most sophisticated out-patient transplant clinics at the Dallas Transplant Institute.”

Dallas Transplant Institute (DTI) is unique in that it is a stand-alone clinic in a private practice that provides care to post-transplant patients. DTI has a Medicare approved lab, radiology services and radio nuclear studies.

Dr. Hull recalls, “Shortly after the DTI opened in 1981, they were visited by one of the leading transplant surgeons at that time, who commented that they could not do this at their university center, but if they could, it would be designed exactly like this is.” DTI continues to provide care to transplant patients and offers a full complement of professionals including transplant physicians, nurses, physician assistants, advanced practice nurses, social workers and dietitians. DTI also has one of the largest pre-transplant departments evaluating living donors and potential

recipients for several of the major transplanting hospitals in Dallas. Patient referrals come from all over Texas, the United States and some international.

Today, DNA has approximately 70 physicians and currently operates 14 offices throughout the Dallas/Fort Worth metropolitan area. In addition to providing care for dialysis and transplant patients, DNA offers expert treatment for a variety of renal disorders including hypertension, diabetes, chronic kidney disease, and kidney stones. The group is also instrumental and proactive in education of primary care physicians in the early detection of kidney disease resulting in delaying or preventing progression to end stage renal disease. In addition, DNA is involved in teaching and training of young physicians in several major teaching programs in Dallas.

More sophisticated treatment of patients with kidney disease has resulted in patients being kept off of dialysis longer. These treatments are primarily advancements in pharmaceutical treatment of certain kidney disease and/or of the symptoms caused by kidney disease. Of course, early detection has been a main emphasis resulting in earlier treatment. Kidney disease affects 15-30 million people with more than 550,000 receiving some form of renal replacement therapy.

DNA physicians continue their 40-year trend of maintaining leadership positions in the nephrology community, locally, regional, and nationally including the American Society of Transplant Physicians, American Society of Nephrology, Renal Physicians Association, National Kidney Foundation, Inc, and Texas Transplant Society and the Texas Governor’s CKD Task Force. DNA physicians were founding members of the American Transplant Society and Texas Transplant Society.

“Our reputation across not only the Dallas/Fort Worth area, but across the country was not established overnight—but through four decades of leadership and excellence from all of our employees,” said Dr. Velez. “Our team of physicians and staff are continually called upon for advice and direction from other practice groups around the world.”

Dr. Velez emphasizes that as the industry continues to evolve, DNA will be there in the forefront. “We are never content with the status quo. We strive every day to lead the way in patient care and we truly look forward to the next 40 years.”

S P E C I A L A D V E R T I S I N G S E C T I O N

214-358-2300 www.dneph.com 1-877-6KIDNEY (1-877-654-3639)

1420 Viceroy Dr., Dallas 75235

DNA_DMJNov_090111A.indd 1 9/1/11 3:56 PM

DOES YOUR PRACTICE HAVE A HEALTHY FINANCIAL PROGNOSIS?You’ve got to manage the finances for both you

and your busy practice. Bank of Texas has special

services for both—plus someone dedicated to

your financial needs. And that means better health

for you, your practice and your patients.

Private Banking | Fiduciary Services | Investment Management

Wealth Advisory Services | Specialty Asset Management

Doug Dixon: 214.987.8806 | Bernie Blaschke: 214.706.0367

www.bankoftexas.com

Personal SolutionsResidential mortgage including 100% financingLife and disability insurance servicesInvestment managementEstate and retirement planningSpecialized healthcare deposit products

Practice SolutionsTerm financing for partnership buy-insEquipment financing and lines of creditReal estate financingHealthcare remittance automationDeposit solutions

©2011 Bank of Texas, a division of BOKF, NA. A subsidiary of BOK Financial Corporation. Member FDIC. Broker/Dealer Services and Securities offered by BOSC, Inc., an SEC registered investment adviser, an SEC registered municipal adviser, a registered broker/dealer, member FINRA/SIPC. SEC registration does not imply a certain level of skill or training. Insurance offered by BOSC Agency, Inc., an affiliated agency. Investments and insurance are not insured by FDIC, are not deposits or other obligations of, and are not guaranteed by, any bank or bank affiliate. Investments are subject to risks, including possible loss of principal amount invested.

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Most HIV positive persons had previous

visits to a medical facility where they

were not tested for HIV.

Routine HIV testing is an opportunity for earlier diagnosis and treatment.

Learn more at

www.testtexashiv.org

CDC. Missed Opportunities for Earlier Diagnosis of HIV Infection --- South Carolina, 1997—2005. MMWR 2006; 55(47);1269-1272

message no 5 dcms.indd 1 6/12/11 6:36:58 PM

Renew online or contact Cara Jaggers, director of membership, at 214.413.1423 or [email protected] for more information.

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2 1 4 • N o v e m b e r 2 0 1 1 • D a l l a s M e d i c a l J o u r n a l

by Stuart B. Black MD, FAAN

The birth of Health Economics, often referred to as Medical Economics, is associated with a 1963 article by Kenneth Arrow, PhD, an American economist and winner of the 1972 Nobel Memorial Prize in Economics. His article, “Uncertainty and the Welfare Economics of Medical Care,” was published in The American Economic Review. This classic publication essentially marked the creation of the discipline of Health Economics. As Arrow wrote in the second paragraph of his paper, “It should be noted that the subject is the medical-care industry, not health.” Thus, he stipulated that his discussion was focused on medical services and not on health care, per se. The article essentially started the discussion about healthcare markets. Since the 1960s, the topics of health economics and the availability of health care have been much researched. The response to a demand for affordable, quality health care led to the 2010 passage of the health system reform bill.

Although today’s healthcare system is considerably different than the one Arrow wrote about in 1963, the gradual development of highly specialized interrelated and costly services which are now funded by complex financial and insurance mechanisms have resulted in major economic legislative acts, the most recent of which is the Patient Protection and Affordable Care Act, which the president signed into law in March 2010. The PPACA is intended to improve the healthcare delivery system by emphasizing Value as a function of Quality divided by Cost.

One proposed model of care is the Accountable Care Organization. On March 31, the Centers for Medicare and Medicaid Services released the proposed rules and guidance for the Medicare Shared Savings Program and the development and implementation of Accountable Care Organizations. Less than a month later, CMS announced the Bundled Payments for Care

Improvement Initiative as a reimbursement model in which the fees of multiple providers are bundled into one comprehensive payment that covers all services involved in a patient’s care. Because a bundled payment system requires providers to bear more of the financial responsibility for outcomes, this type of reimbursement model requires an integrated delivery system. Many healthcare experts believe that ACOs are the most likely entity to manage bundled payments. The recent surge of literature about ACOs appears to demonstrate widespread belief that they could provide the collaborative and contractual relationships between physicians and hospitals that are necessary for patient care coordination.

As health economics influence healthcare markets, economic issues also result in changes in how physicians practice medicine. If the Medicare Shared Savings ACO rule were to define the structure for the future practice of medicine, ACO governance would require the type of leadership and management structure which would meet the demands for proposed clinical and administrative benchmarks. As a practical matter, hospital and physician collaboration would be the core of the ACO model. Conversely, the statutory framework for ACOs is limited to a narrow scope of providers that can apply; the Bundled Payments for Care Improvement Initiative is more flexible and allows applications from physicians, hospitals and other healthcare providers including rehabilitation facilities, home health agencies and skilled nursing facilities. As the proposed legislative regulations become integrated into practice reimbursements, physicians must be aware of the new complex management tools which include pay-for-performance formulas, evidence-based medicine guidelines, clinical algorithms, electronic health records, global budgets, shared

Health Economics 2011Health Economics 2011


savings, and a multitude of legislative changes regarding legal structures and antitrust protection. While the medical literature is capacious in regard to ACOs, it remains unclear whether organizations that integrate physicians and hospitals can provide better care coordination, fewer complications and cost savings. It also is unclear whether changes in value and quality will be passed along to patients and payers as lower prices. What is certain, however, is that changes are taking place in physician practice settings and organizational models which are migrating toward physicians who are seeking a more integrated structure with hospitals and hospital-owned provider networks.

Not long ago, solo practices or two-physician practices were the dominant model for patient care. This organizational structure began to decline as a result of economics of scale. Group practices became more popular for reasons including the ability to share expenses such as rent, office maintenance, staffing, medical supplies, and technology support. According to the Center for Studying Health System Change, between 1996–97 and 2004–05 the proportion of physicians in solo and two-physician practices decreased from 40.7 percent to 32.5 percent. Although a multispecialty practice model would best be able to support the care coordination, quality improvement and reporting activities required in the ACO structure, the multispecialty organizational design has declined as more physicians have gravitated toward single-specialty group practices. According the HSC, between 1998–99 and 2004–05 the proportion of multispecialty practices decreased from 30.9 percent to 27.5 percent. Physicians had incentives to aggregate into midsized single-specialty practices, including the ability to provide more comprehensive quality care. Single-specialty groups also could provide procedures and ancillary services such as CT and MRI imaging, sometimes at lower costs than other imaging facilities. These services also could provide opportunities for additional physician revenue. Single-specialty groups have been an excellent model for physicians who desire more management and control over their practices.

Whereas in the recent past, midsized single-specialty practices have exhibited the most growth, the current system carries uncertainty as new reimbursement structures are initiated and economic pressures become more complicated. Also, physician recruitment is being affected by larger healthcare organizations driving higher and higher compensation packages to young job-seeking physicians who have specific specialty training in areas of hospital need. These same young physicians may be balancing the commitment to meet an average $200,000 education debt while facing the uncertainties of the employment markets. For this reason, an increasing proportion of graduating

physicians are not accepting the traditional “partner track” positions in private medical groups; instead, they are opting to take salaried positions in hospital-owned provider networks. More physicians now join hospital-owned practices than any other type of practice.

As large US healthcare systems have begun responding to the implementation of healthcare reform and physicians are becoming more receptive to health-system sponsored employment, the trend fueled by the implementation of ACOs also appears to focus on physicians seeking economic stability. According to a 2009 survey by the Medical Group Management Association, 65 percent of established physicians were placed in hospital-owned practices, and 49 percent of physicians hired out of training joined a hospital-owned practice. This represents a nearly 75 percent increase in the number of active physicians employed by hospitals or hospital provider networks since 2000. Although certain specialists receive greater initial compensation by hospitals than they might in a private practice environment, different specialties, such as primary care, may receive a base compensation that is lower than their previous earnings but with incentives that could increase that compensation to their prior level or even higher. These incentive-driven compensation packages which link productivity and clinical behavior are the type of models seen in the March 31 ACO Medicare Shared Savings Program. Although hospital employment may offer physicians a guaranteed income and protection from mandated legislative reforms, it comes with much more performance management. In a hospital-owned provider network, a sustainable employment model must include governance by administrative practice leaders, well-delineated expectations of clinical and financial performance measures, an analysis of the physician’s quality measures, clinical documentation, regulatory compliance to monitor such things as patient satisfaction surveys, as well as policies and practices to measure a physician’s economic performance when compared to other physicians treating the same or similar disorders. If an ACO-like model dominates the hospital provider network, incentive bonuses and bundled payments may play an even greater role in physician reimbursements.

In an ACO, physicians will need to evaluate economic criteria even more carefully. To maximize the opportunity for shared savings, physicians in leadership positions likely will impose economic criteria on their peers. In the past this type of economic performance measure was called “economic credentialing,” which implies economic factors in the measurement of a physician’s qualifications. The hospital staff privileging process was an earlier example of utilizing economic criteria for credentialing. This practice of basing qualifications


primarily on economics led to much discussion and debate among physician organizations, medical societies, other healthcare providers, state medical associations, the insurance industry, attorneys, and, eventually, some state legislators. Most of the discourse revolved around utilization of hospital resources by staff physicians who owned or were affiliated with a competing facility. Obviously today, with thousands of physician-owned or joint-ventured surgical centers, imaging centers or other facilities, hospitals would not have adequate medical staff if those principles applied. The concept of hospital economic credentialing led to landmark lawsuits as well as to state laws prohibiting the use of economic factors in the hospital credentialing process.

The practice of economic profiling of physicians resurfaced as insurance companies developed the tiered provider network. The assignment of physicians into preferred or limited panels led to a model of “rating” them on cost efficiency. Although insurance companies argue that clinical quality indicators play a role in the rating of physicians, many experts and physicians believe that health plans select preferred panels on the basis of cost effectiveness as opposed to evidence-based standards, quality of care or overall competency. Two excellent studies published by the RAND Corp. indicated that the results of current cost profiling systems the insurance industry uses are misleading. One study was published in the March 18, 2010, issue of The New England Journal of Medicine; the other in the May 18, 2010, issue of Annals of Internal Medicine. Both papers concluded that the insurance tiering programs do not accurately measure a physician’s performance. Debate continues about the insurance industry’s use of economic credentialing, despite evidence that indicates the data used to rank physicians is imprecise and inaccurate.

Unlike hospitals or the insurance industry, in an ACO environment, where primary care physicians and specialists join together to implement performance measures, value will be defined by quality indicators as a function of the cost of services. For a successful organization, cost evaluation strategies and quality measurements are required. The March 31 Rules and Regulations regarding development and implementation of ACOs emphasize economic performance measures. Such measures must be considered when choosing and maintaining a physician panel for an ACO, or the viability of the organization will be compromised. A physician whose cost is “too expensive” relative to his/her peers in providing the same or similar services becomes a burden to all ACO members. One must remember that because ACOs are groups of providers that work together to manage and coordinate the care of beneficiaries, cost effectiveness and quality become an integral element in the overall care of patients.

That the Bundled Payments for Care Improvement Initiative reimbursement model was released less than a month after the “Rules” for ACOs probably was not coincidental. There recently has been much criticism that fee-for-service ties reimbursement directly to the volume of services provided instead of to the quality of service provided. The literature is filled with editorials about how fee-for-service is the cause for poor coordination of care and overutilization of expensive, “unnecessary” physician services. Whereas capitation in the HMO days provided a lump sum for the medical care of each individual, which then transferred the full insurance risk to the provider, bundled payments focus on a single payment for a defined group of services rather than a separate payment for each item or service. To administer this type of payment model clearly will require an integrated delivery system. ACOs have been suggested as an appropriate entity to manage bundled payments on behalf of its providers. Because ACOs are greatly focused on a collaborative and contractual relationship between physician providers and hospitals, bundled payments can transverse the boundaries of outpatient and inpatient care. The BPCII CMS program outlines four models for episodic care. The first three models are retrospective; the fourth model is prospective: Model 1: For inpatient stay in a general acute care

hospital Model 2: For inpatient stay and posthospital care,

ending 30 to 90 days after discharge

Model 3: From discharge as a hospital inpatient, ending no sooner than 30 days after discharge

Model 4: CMS would make a bundled payment to the hospital, which would pay physicians and other healthcare providers involved in the episode of care instead of the providers filing individual Medicare claims

For the first three models, applicants would set a target payment amount for a defined episode of care. That price would be negotiated at a discount of about 2 percent off the original Medicare FFS rate. Total payment then would be reconciled against the predetermined target price. For Models 2 and 3, any profit or shared savings beyond the target price would be paid to the participants. This would be synergistic with the ACO concept of better outcomes for less cost. Costs above targets would be paid back to CMS. Because Model 4 is prospective, an entity, such as a hospital or ACO, would be responsible for administering equitable reimbursements to all providers. Multiple potential operational and design issues would need to be addressed before bundled payments were implemented.


Historically, private insurance carriers largely follow the lead of CMS when it comes to physician reimbursements and the structure of documentation for services provided. Although the new rules and regulations regarding the design of ACOs and new reimbursement designs focused on integration of medical care with an emphasis on value, quality and cost, experts have expressed concern about the great potential for unintended consequences and fragmentation of care. As physicians gravitate toward healthcare system-sponsored employment with a guaranteed salary, they should recognize that in the template of an ACO-type marketplace, incentive-driven compensation linked to productivity and clinical behavior probably will be the income model of the future.

Although it is true that most people in the United States earn less income than physicians, few professions require postgraduate education, internships, residencies, and fellowships before entering the business marketplace at age 30 or older. In addition 85 percent of graduating medical students have an average of $200,000 in outstanding loans. Despite these facts, according to the Association of American Medical Colleges, some 40,000 students apply to medical school each year, with about 17,000 matriculating. In 2010, American medical schools graduated 16,838 students. Future decreases in income, coupled with the years of education and expense to become a physician, could challenge the compassionate and altruistic motivations of some of our best and well-rounded students who previously would choose medicine as a career. How this influences the projected AAMC physician shortage of 91,500 by 2020 also is a major concern.

In Arrow’s paper in 1963, he essentially created the discipline of Healthcare Economics. His paper is

still quoted because of its intellectual elegance and insight. That same tribute applies to the number of outstanding physicians who, throughout centuries, introduced science to the study of medicine and set the standards for modern medical care. Whatever the future design of medical care turns out to be, one thing is for certain: as Arrow clearly stated in his paper, healthcare economics is not the same as health care. The former is mainly related to economic research regarding health market failures and the role of public intervention to provide health care to citizens. The latter is related to the care that physicians have provided to patients for centuries.

The majority of us who have had the privilege of becoming physicians would agree that medicine is an intellectual and honorable profession. The opportunity of having the knowledge and professional skills to help others is extremely rewarding. When a physician thinks about how he or she became a physician, the memories usually focus more on getting into medical school and completing each step to become a physician, as opposed to learning about the business of medicine. However, today our profession’s quality of care not only is being questioned but is tied to value measured by monetary parameters. Our current delivery system is economically unsustainable; physicians must take the lead and direct the practice of medicine, integrating their own clinical judgment into the new statutory laws.

Stuart Black, MD, FAAN, is the chief of neurology at Baylor University Medical Center at Dallas and codirector of the Baylor Neuroscience Center.

Resident Roundtable

Lucy and Nicholas Piotrowski, MD Drs. Lam Chu and Elizabeth Ramirez

David Owen, MD, and Circle of Friends members Charles Curtice, Leilani Mojw and

Rebecca Harrell

Circle of Friends member John Peiser with Julio Alvarez and Mariangeli Arroyo, MD

DCMS member residents and their guests enjoyed a lively dinner discussion and presentation, “Starting a Medical Practice,” on Oct. 6 at the Aldredge House, led by a TMA practice consultant.


DCMS Physician SpotlightEnthusiast, M.D.

“Other than my parents, teachers were the role models I mostly looked up to, and my family doctor. I always grew up thinking I wanted to be a doctor.”

He grew up on the family’s cattle ranch in Bosque County, about 85 miles southwest of Dallas. His parents still have the ranch.

“My dad is 91 and still ranching,” Dr. McCoy says. “Mom, too. They’re both doing well.” After last summer’s drought, the McCoys cut back on the number of cattle and are converting the land into a wildlife management area. Dr. McCoy spends many weekends on the ranch, where they’ve cleared cedar trees and are making a better habitat for the deer, turkeys and other wildlife.

Dr. McCoy found numerous benefits to his small high school, where just a dozen students were in his class. They were fortunate that several college professors had retired to the small town and then taught high school.

“I was very blessed,” Dr. McCoy says. “I had a progressive curriculum in a small school.”

He attended a small college close to home, graduating summa cum laude from Tarleton State University with a bachelor’s degree in biology.

“I had an unbelievable time,” he recalls. “I was able to be involved in lots of activities. I was the newspaper editor. I was active in the journalism program, even though I was in the medical program.”

He had started writing for his high school paper at 15 or 16, and has been writing ever since — columns, blogs, articles.

After graduating first in his class from University of Texas Southwestern Medical School, he completed an internship in internal medicine at Baylor University Medical Center in Dallas and a residency in dermatology at UTMB Galveston.

He selected dermatology because he loved pattern recognition.

“I liked to walk into a patient room, put all the details in my head as quickly as I could, and render a treatment plan as fast as I could,” he says. He considered specializing in emergency medicine, noting that in his fourth year of med school, all his rotations were in emergency medicine. But he also enjoyed the surgical aspects of dermatology, and decided to go that route without even doing a rotation in it.

He returned to Dallas to join a dermatology group, and split his time between clinical work and administrative work. About 5 years ago, Dr. McCoy decided to do more clinical practice and business consulting. He joined Alan

Menter, MD, at Texas Dermatology Associates, P.A., an academic-based practice at Baylor University Medical Center. Drs. Menter and McCoy started the Baylor Dallas Dermatology Residency Program 3 years ago, for which Dr. McCoy volunteers as a faculty member and assistant program director. The two physicians also formed the Melanoma and Skin Tumor Clinic at Baylor University Medical Center, and Dr. McCoy is its medical director.

Dr. McCoy sees patients four days a week, including one day in Corsicana, where he practiced full time before moving to Dallas. On Fridays, he does consulting work with other healthcare organizations and businesses. Although much of the consulting centers on communication issues, all the work is related to health care.

“I do public speaking to groups; help companies with their marketing and turnaround work; and help with complex organizational issues, board strategy, direction, and discussion,” he says. “I’ve dabbled a little in compliance assistance regarding fraud and abuse. I’ve worked with a couple of companies on fairly complicated IT projects.”

Not surprisingly, Dr. McCoy says that if he weren’t a physician, he’d be in the business world. “I enjoy venture capital startups and business turnarounds.” THE ADVENTURER

He also enjoys adventures and excitedly talks about a few of his interests.

“I’m a big outdoors person,” he says. “People tell me I immerse myself in it. I love the whole experience of being outdoors and seeing how beautiful the world is.

“I love working on the ranch. I love to fly. I started as a student pilot when I was in college. I love going to the ocean and seeing things that only a handful of people get to see; it’s a huge rush.”

Dr. McCoy began scuba diving while in college and picked it up again when he turned 40. He has his dive master certification and does a little teaching. His last scuba trip was to the Galapagos in 2010, where his wife, Kristen, and children also dove (daughter Cathryn is 12 and son Will is 15). He and a group from Dive West had planned the trip for 3 years, scheduling it within the short timeframe when they could see hammerhead sharks and whale sharks. They dove 185 miles west of the islands.

“We scuba with a zip line and a GPS so we don’t get lost,” Dr. McCoy says.

In a town of 313 people, role models can be scarce.

Fortunately for Dan McCoy and his patients, his

hometown of Iredell had a family physician.

DCMS Physician SpotlightDan McCoy, MDby Tracy Casto, director of political affairs and advocacy


DCMS Physician SpotlightEnthusiast, M.D.

THE EPICUREIf not piloting a helicopter or airplane, or scuba diving

in the middle of nowhere, Dr. McCoy might be in his commercial-grade kitchen behind his house. He’ll either be making chocolates or blowing sugar sculptures.

“It’s the same kind of skill set,” he says. “I like to try new and exciting things that are fun to do and challenging.”

Twelve years ago, he decided he wanted to make chocolates.

“They were absolutely horrible,” he remembers. “They were ugly and didn’t taste good. But slowly over the years, I’ve become friends with now-famous chocolatiers all over the country, and I’ve been able to get a good education. After doing it for over a decade, my chocolates are pretty and they taste pretty good.”

THE SOCIAL MEDIA ENTHUSIASTA few years ago, Texas Dermatology Associates

decided to embrace social media. “We’d set on the idea of creating a video blog or project

related to our practice,” Dr. McCoy recalls. “We spent a little money and a little time, and we got our butt kicked. By the time we got it together, we were late and the wave had crashed over our head.

“Then a team I put together decided to embrace a bigger project. We cast our proposal way ahead of the wave. Most of the time when we deliver healthcare information, we decide what the patient wants to know and we provide that information. In the office, the patient is on the bed in a gown and we’re in a white coat, we see him for 7 minutes, and tell him what we want him to know. I thought there was a better way we could deliver what the patient needs to know.”

Dr. McCoy’s offices now include a TV studio and laboratory where he can experiment with social media. “We’ve come up with a robust and interesting way to deliver health care,” he says. “We put together the Web architecture to allow interactive patient/doctor discussions over the Internet. This is all in an effort to study, so that on the consulting side, we know what we’re talking about. We have a written blog and do video blogs. We began to produce and create a weekly live Webcast about current healthcare topics and public policy issues. We’re in the process of visiting with sponsors, contributors and colleagues to put that type of project forward.

“We’ve assembled the right team, but the question is, do we continue it as a lab project as part of our consulting business, or transition it into a not-for-profit 501(c)3 model? We want to take what we’ve acquired in knowledge and equipment, and donate it to not-for-profits to create these kind of projects.

“Most of us feel like the old information channels are dead. There’s great value in delivering the information, but there may not be much profit. We hope to be broadcasting live before the end of the year.”

THE WONKDr. McCoy has become a go-to guy for insight and

information about health system reform and the politics of health care. In addition to giving talks about melanoma and alopecia, Dr. McCoy just as easily educates his colleagues about the Medicare Meltdown and accountable care organizations. For decades he’s written articles about legislative issues for specialty society journals and given presentations to physician groups about the importance of physician involvement in the political process.

Winning a Burroughs Wellcome Company Leadership Award as a first-year resident resulted in more than the all-expense paid trips to two AMA meetings. When Dr. McCoy and another award winner met a TMA lobbyist during their Chicago trip, the political die was cast.

“My friend and I ran into Kim Ross in Chicago,” Dr. McCoy recalls. “Kim said, ‘I’m inviting you both down to Austin. We’ll put you up in rooms across from TMA and get you training in how to testify before a legislative committee.’ During the conference I got excited about it all.” Dr. McCoy had lunch with Kim, Alfred Gilchrist and David Marwitz (all TMA lobbyists at the time) at the Texas Chili Parlor. “Kim said they’d never had a resident on the TEXPAC board, and they made me chair of the Membership and Marketing Committee.”

Dr. McCoy since has been chosen chair of TEXPAC’s board of directors and of the Candidate Evaluation Committee.

Participation in the intensive, week-long AMA Campaign School also fanned his interest in politics, but not for his own political race. Although he’s run a few local political campaigns, he sees no “Elect McCoy” signs in his future.

“I used to be romantically interested in serving in the Legislature,” he says. “I believe that has great value, and I highly encourage it. I enjoy participating in the process, and we are blessed to have talented people to dedicate their time and money to this. But I don’t have the passion required to do that job. I have no political ambitions.”

Dr. McCoy’s enthusiasm in politics has spread to other areas of organized medicine. At TMA, he served as chair of the Council on Legislation and in May was elected to the Board of Trustees. He’s on the Task Force on Health System Reform and just completed service on the TMA Insurance Trust Advisory Committee.

Dr. McCoy is on the DCMS delegation to the TMA House of Delegates and the Texas delegation to the AMA House of Delegates. He has served on the DCMS board of directors. He is a past president of the Texas Dermatological Society and is chair of the society’s Legislative/Socioeconomics Committee.

THE FUTURENext on Dr. McCoy’s “want to do” list is to learn to play

the cello and to fly multiengine airplanes. At just 44, Dr. McCoy has time for many more

contributions to the practice of medicine and to his adventure log.

Dan McCoy, MD, safely pilots a helicopter to the ground after “attaining his“First Solo Flight” with in-structor Caleb Gidcumb”

Recovery Isn’t Simply a Goal, It’s Our Mission.

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Kindred offers services including aggressive, medically complex care, intensive care, short-term rehabilitation and compassionate long-term care for dementia or Alzheimer’s.

Doctors, case managers, social workers and family members don’t stop caring simply because their loved one or patient has changed location. Neither do we.

Come see how we care at continuethecare.com

Dedicated to Hope, Healing and Recovery


M E M B E R S H I P M A T T E R S

“A rolling stone gathers no moss.” “It takes a village to raise a child.” “It starts with one voice.” As I tried to think of a saying that would convey my sentiments, I turned to the facts and decided that, as the facts would unfold, the phrase that I so desperately was looking for would come to me. The purpose was to enlighten and encourage our DCMS members that even their smallest efforts or involvement could lead to significant results.

Physicians are faced with stressful issues today: (1) How will healthcare reform affect me? (2) Why do I have to work harder and longer, and see more patients to receive less compensation? (3) Why has such a historically honorable profession become so heavily scrutinized by our government? (4) I wanted to become a physician so I could help patients. Now I also have to be a businessman and a lobbyist? Who has time for all that?

This is exactly why DCMS members should become more involved. You will have more control, direction and input into the legislative and economic landscape of your practice by knowing what your medical society and the TMA can and does do for you with a little input from each member. We all have heard this before, and by now you are saying that it sounds great, but nothing ever really changes. Right? So, I’m going to tell you my story — a story of a previously apathetic physician who did not have time to become involved. This is about a pediatrician who believed he could not change anything by himself. This story is about how I came to realize that, although the process may take longer than I would like, some things can be changed.

Many of our members are familiar with the case I won against the Office of the Inspector General in 2007 with the help of the TMA, DCMS, attorneys, Fox4 News, the attorney general, Texas Medicine journal, and a host of other individuals. These challenging events spurred me to become involved at the local and state level with media relations; DCMS Legislative Affairs and Communications committees; DCMS Medicaid Forum; the TMA Select Committee for Medicaid, CHIP and the Uninsured;

and, ultimately, to be appointed by the Health and Human Services commissioner to the state’s Medicaid Regional Advisory Committee.

I found that being involved and aware was the best way to influence and possibly change what was broken or what was being wrongly proposed. But I kept asking myself, had anything really changed? I found myself contemplating this question while trying to assess my efforts.

In 2008 at the TMA House of Delegates, I proposed a resolution to “privatize” Medicaid, which was not well-received. I felt simply that privately held Medicaid HMOs would be able to deliver healthcare more efficiently. As of Oct. 1, the HHSC has ceased its centrally run PCCM program and turned it over to the privately held Medicaid HMOs!

During that delegation meeting, I also proposed that the TMA ensure that Medicaid would pay for after-hour services in an effort to decrease the overutilization of emergency rooms, increase access to care for patients, and decrease costs for the state. Now the HHSC is looking at financial incentives to increase the number of urgent care centers and after-hours services.

Since 2009, I have been invited to meetings of the Select Committee for Medicaid, CHIP and the Uninsured. Those meetings directly influenced me and provided contacts that directly led to two additional changes: the application process for Medicaid providers has been streamlined, and the TMA Council on Public Health contacted me in regard to a resolution I’d written on the prescribing of controlled substances for treatment of attention deficit disorder. State law allows for up to a 90-day supply to be written for C2 medications. Private insurers abide, but Medicaid will allow only a 30-day supply. This causes a great deal of hardship for parents and physicians, especially considering that 80 percent of Texas counties do not have a child and adolescent psychiatrist to prescribe for this condition. The TMA and its Council on Public Health are working with the HHSC to change its process to comply with state law.

By now you may be saying that all sounds

W h y B e i n g a M e m b e r i s I m p o r t a n t f o r C . T u r n e r L e w i s I I I , M D

Recovery Isn’t Simply a Goal, It’s Our Mission.

CONTINUE THE CARENATIONALLY, KINDRED CARES FOR PATIENTS IN:

LONG-TERM ACUTE CARE HOSPITALS • NURSING AND REHABILITATION CENTERS • INPATIENT REHABILITATION HOSPITALSTRANSITIONAL AND SUBACUTE CARE • ASSISTED LIVING • CONTRACT THERAPY SERVICES • HOME CARE • HOSPICE

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Kindred offers services including aggressive, medically complex care, intensive care, short-term rehabilitation and compassionate long-term care for dementia or Alzheimer’s.

Doctors, case managers, social workers and family members don’t stop caring simply because their loved one or patient has changed location. Neither do we.

Come see how we care at continuethecare.com

Dedicated to Hope, Healing and Recovery


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wonderful, but who has time to be involved? As I read the July issue of Texas Medicine, everything immediately became crystal clear. Some 3 years ago, I had introduced Resolutions 102 and 103 to the TMA Reference Committee on Financial and Organizational Affairs to ensure that physicians would have due process of law afforded to them under the US Constitution, which was not available when it came to the Texas Medical Board and the Office of Inspector General. Basically, a physician could have won his case in a state administrative court, but both of these above entities had Texas Administrative Code authority to decide whether to abide by the impartial court’s ruling!

It was with great pride that I read that Governor Perry had signed into law TMA-backed legislation that made important changes to the Texas Medical Board. As I read through these seven changes, the last one caught me by surprise. This new law “binds the TMB to the ruling of an administrative law judge in a proceeding supervised by the State Office of Administrative Hearings.” Later TMA President C. Bruce Malone, MD, said, “In time, I believe these reforms will go down in TMA history as comparable to the Patient Protection Act of 1997, and the liability reform and prompt pay bills of 2003.” The TMA immediate past president and newly elected vice speaker of the AMA House of Delegates, Susan Rudd Bailey, MD, introduced and encouraged the AMA House of Delegates to adopt unanimously “the lines of TMA’s 2011 legislative agenda aimed at ensuring due process for physicians undergoing state medical board investigation.” Then came the moment I never had anticipated. As I was reviewing my morning’s e-mails on Sept. 7, an Arizona newswire caught my attention: “Medical Board Abuse Curtailed by Law.” It noted the reforms that our new Texas law required of the Texas Medical Board as well as the following statement regarding our new law: “Legislation passed this year is the first in American history to broadly curtail overreaching by a medical board.”

Looking back over the last 5 years since my “awakening” and writing this article helped validate my efforts. It also reminded me of my appreciation for the contributions everyone at DCMS and TMA give on a daily basis. It has motivated me to encourage each member of our medical society to become involved, even if it is merely an idea of which you inform others who will take the charge because, after all, it takes only a pebble to cause an avalanche.

C. Turner Lewis III, MD, is a practicing pediatrician in Kaufman and has been a DCMS member since 1994.

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Mary Katherine Allen, business development manager, at [email protected]


Conference of ProfessionsThe 26th Annua l Confe rence o f P ro fess ions was he ld Oc t . 14 a t SMU. Phys i c i ans , a t to rneys and the c le rgy en joyed the confe rence speaker , Car r i e J ames , PhD, a research d i rec tor and pr inc ipa l inves t iga tor a t P ro jec t Ze ro a t the Harvard Graduate Schoo l o f Educa t ion . Her research spec ia l t i es inc lude soc ia l med ia and mora l and e th i ca l deve lopment , and she presented on the top ic , “ P ro fess iona l E th i cs and Soc ia l Ne twork ing : L ike? ”

Drs. Dee Whittlesey, Rick Snyder, Shelton Hopkins, Steve Hays, and Eugene Hunt gather before and listen to presentation at the 26th Annual Conference of Professions.

Robert Brown, MD, greets Barbara Baxter, MD.

Drs. Steve Hays and Alice Smith converse during a break. Carrie James presents to physicians, attorneys and clergy.

Babette Farkas, MD, speaks with conference speaker Carrie James. Dan McCoy, MD, answers an audience question.


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As a CareNow physician, you’ll enjoy your off hours as much as your offi ce hours. We offer convenient work schedules, no patient call, more than 20 centers in great locations across the Dallas-Fort Worth Metroplex, and great salaries and benefi ts.

TMAIT-endorsed Life Insurance coverage is issued by The Prudential Insurance Company of America, 751 Broad Street, Newark, NJ 07102. A Booklet-Certificate with complete plan information, including limitations and exclusions, will be provided. Contract Series: 83500.0185865-00002-00 Ed. 9/11 TMA-53554

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Term Life Plan

Preparation for life’s uncertainties As a medical professional, you know just how valuable—and fragile—life is. Through your membership in TMA, you can apply for life insurance that helps protect your family’s financial well-being, even if you’re no longer around to see to it yourself.

Reliable insurance protection, personalized serviceThe Texas Medical Association Insurance Trust (TMAIT) is able to offer TMA members quality life insurance, issued by The Prudential Insurance Company of America, at group rates lower than many individual plans.

But besides affordable rates, TMAIT Life also offers life insurance designed for medical professionals and their families. Apply online or call 1-800-880-8181 to learn more about TMAIT Life.

Designed for your lifestyleSome features of the Plan that can help you are:

• coverage amounts that meet your family’s needs: up to $2,000,000 in benefits (available in $10,000 increments)

• continued coverage at no cost while you are totally disabled if your disability begins prior to age 60 and continues for at least 9 months

• available coverage for your spouse and dependent children, if you are enrolled in the TMAIT Life Plan.

Watch your mail for more information on the Plan!

Apply online at:

www.tmait.org/lifeapply.or call 1-800-880-8181.

Take care of your family—even if you can’t be there.

Use your Smartphone to scan this barcode.It will take you directly to the TMAIT Life web page, where you can apply online, download a request form, or simply find out more about the Plan.

Currently, an estimated 5.4 million Americans have Alzheimer’s. This disease is cruel,

devastating and could cripple Medicare and impact every one of us. Think of all the

special moments that could be taken from you.

Now is the time to

Take action at alz.org or call 800.272.3900.Now is the time to

alz.org or call

©20

11 A

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’s A

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iatio

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Alzheimer's disease costs Americans

more than si180 billion annually.

But the real loss is impossible to measure.

Alzheimer’s is a cruel, devastating reality for an estimated 5.4 million Americans that have this disease. It could cripple Medicare and impact every one of us.

To find out about our free programs for patients and families or to schedule a complimentary education class for your staff, contact us at 1.800.272.3900 or visit alz.org/greaterdallas.

Join us.Walk to End Alzheimer’s Nov. 12 at Fair Park in Dallas Register at alz.org/walk

dallas medical journal november 2011

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