Aetna to pay up.

In December, Aetna became the latest insurer to agree to a proposed settlement to pay physicians and patients $120 million because it used Ingenix databases that deflated payments for out-of-network physician services. The decision stems from settlement of a 2009 lawsuit against Aetna by the Texas Medical Association, the American Medical Association, and state medical societies in California, Connecticut, Florida, Georgia, New Jersey, New York, North Carolina, Tennessee, and Washington. They alleged Aetna used databases created by Ingenix, Inc., a subsidiary of UnitedHealthcare, to set usual, customary, and reasonable (UCR) rates for out-of-network services. They said Ingenix was inherently flawed and unable to establish proper UCR rates.

Real meaningful use.

Researchers at The University of Texas at Austin are helping practicing physicians and other health professionals use electronic health records to wean smokers off tobacco. That's important because UT's MD Anderson Cancer Center says patients are 30 times more likely to enroll in tobacco cessation counseling if a clinician refers them than if they merely receive information about services. Researchers developed the e-tobacco protocol to improve patient referrals to the state-funded Texas Tobacco Quitline, a free, confidential, and 24-hour, 7-day-a-week service. It offers three to five phone counseling sessions and two weeks of nicotine replacement therapy to those referred by a physician or other health professional.

A steep price.

Texas physicians fear that sharp funding cuts in state family planning services and changes in a state health program for women will threaten women's access to vital preventive services. They say the situation is a crisis and urge lawmakers to restore money to programs that provide low-income women with recommended screenings and birth control.

Zip it!

When it comes to enforcing HIPAA data security and privacy standards, the federal government means business. In fact, the government is conducting a national pilot program to audit 150 physicians and others that HIPAA covers as the first phase of a concerted effort to crack down on HIPAA violations.

The price of health.

Maintaining an adequate local public health infrastructure is increasingly difficult in the wake of budget cuts.

Precocious 2-year-olds. Texas Regional Extension Centers (RECs) did a lot in past two years.

Texas' four regional extension centers (RECs) turned two this year, and they have a great deal to celebrate. The centers have enrolled more than 5,900 Texas physicians and helped them select, install, and implement electronic health records (EHRs) and train their staff members to use them. They also helped many physicians achieve meaningful use of an EHR to earn Medicare or Medicaid bonus payments.

Drug shortage.

Calcium gluconate, neostigmine, propofol, epinephrine, furosemide, and a host of sterile injectables, as well as antibiotics and other medications, are among the drugs on an expansive list of shortages tracked by the U.S. Food and Drug Administration (FDA). A record 246 drugs were in short supply as of June, according to FDA. That figure has many Texas physicians worried about potential risks to patient safety and quality of care.

Good for patients, good for doctors.

The medical liability reforms the Texas Medical Association pushed through eight years ago are still paying off. Texas has more physicians, thereby increasing patients' access to care; liability insurance premiums have been drastically cut; and there are fewer lawsuits. But TMA leaders say physicians must remain vigilant and protect the noneconomic damage cap and other provisions won through tort reform.

ZPICs.

The Zone Program Integrity Contractors (ZPICs) program is a government effort to eliminate fraud, waste, and abuse in Medicare. ZPICs perform a range of medical review, data analysis, and Medicare audits. While the audits share many similarities with other Medicare audits, they do differ in one key aspect: potential Medicare fraud implications.

Healthy debate.

Physicians advocated passage of Texas legislation to decrease the burden of vaccine-preventable disease, bolster cancer prevention and research, protect Texans from cigarette smoke, and curb obesity. The Texas Medical Association and the Texas Public Health Coalition supported bills in this year's budget-conscious session that also would reduce health care costs and decrease the toll of disease.

Meaningful dollars.

Texas physician practices that have received payments from the Medicare or Medicaid electronic health record (EHR) incentive program say that those incentives will help cover the ongoing costs associated with the EHR system, such as maintenance of software and staff training.