Compliance Can Be a Dirty Word

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Commentary — January 2016

Tex Med. 2016;112(1):13-14.

By Tom Garcia, MD

I received a message recently from a member physician in response to a Texas Medical Association email about free services we have arranged to help physicians comply with the latest Medicare requirements.

"TMA should tell CMS [the Centers for Medicare & Medicaid Services] that the profession is not going to put up with any more new rules and regulations," he wrote. "TMA leadership has failed to save the profession and save patient care."

That first sentiment is quite consistent with what I have heard from your colleagues across Texas — and across much of the nation — during my first six months as your president.

Physicians are angry about the encroachment of outside forces on our practices — and depressed about the consequences. We all feel this loss of control is bad for us, for our practices, for our profession, and for our patients. We want someone to publicly stand up and fight for us. And we want someone to help us deal with the mess so we can stay in private practice.

The barrage of rules, regulations, and requirements flying at us from our government is maddening. ICD-10, meaningful use, value-based payment, HIPAA, and the Affordable Care Act all seem to have been developed either by someone who has never stepped foot inside a physician's office or by someone who's been there and has intentionally created something designed to fail. 

Medicaid and the commercial insurance companies aren't far behind in the volume of paperwork, hassles, and absurd bureaucratic bungling that interfere with our ethical duty to care for our patients.

I want you to know that TMA has fought, is fighting, and will continue to fight these intrusions. We work directly with our elected officials, file formal comments and complaints with state and federal regulators, and call public attention to the repeated insults to our profession. We have made progress. Some recent examples: 

  • We won two yearlong delays to the start of the ICD-10 coding system;
  • We fought for 14 years and won permanent repeal of Medicare's Sustainable Growth Rate formula;
  • We won passage of a tough new law reining in overzealous Medicaid fraud and abuse investigators; and
  • We won elimination of the state controlled substances registration permit. 

TMA helped form the Coalition of State Medical Societies to provide a new voice for physicians on Capitol Hill. Our most recent visit to Washington focused on winning relief from the bounty-hunting Medicare Recovery Audit Program contractors, eliminating federal mandates like the poorly named "meaningful use" program, and preventing maintenance of certification from becoming a nationwide condition for physicians to receive or keep a state license or to participate in Medicare or Medicaid.

But all of that advocacy, enhanced when doctors contact their lawmakers or contribute to TEXPAC, is only part of the battle. Sometimes, those rules and regulations take effect despite our best efforts.

When that happens, TMA makes certain we have what physicians need to cope with the latest regulatory assault. We created TMA PracticeEdge to provide the products and services physicians need to maintain their independence.

We certainly don't endorse those infringements on our profession. But we would be derelict in our responsibility to you, our members, if we didn't offer this badly needed help. The consequences to you — in terms of lost income, possible fines, or even imprisonment — are too great for TMA to let you founder on your own. 

This issue of Texas Medicine includes an article on what physicians need to do now to ensure their practices' policies and procedures put them in compliance with all those state and federal laws. The article is full of good practical advice to keep you out of trouble.

The Merriam-Webster Dictionary defines "comply" to mean "to do what you have been asked or ordered to do … to conform, obey, or adapt." As physicians, we want to conform to the rigors of science. We want to obey the directive to put our patients first. We are angered and depressed when we are forced to comply with regulations devised by people who've never spent an hour in anatomy lab, never spent a 30-hour shift in the ICU, never spent a moment in our white coats.

Angry physicians demand action. Depressed physicians need help. TMA is here to provide both.

Tom Garcia, MD, is TMA president. 

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