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.

Part of the team.

Physicians play a pivotal role in assessing students' fitness for athletics and other extracurricular activities and in helping Texas schools adopt effective health policies. Whether they're on the sidelines at sports events, attending school health advisory council meetings, or examining patients in clinic, physicians can dramatically affect student health and well-being. Texas Medical Association policy on physician examinations for young athletes takes into account that these exams provide an entry point into health care for young Texans who may not have regular access to a primary care physician. The policy outlines TMA's support of student involvement in sports and other physical activities and eliminating barriers that prevent students from participating. TMA supports changes in the Texas Education Code to require that only licensed physicians or appropriately supervised physician assistants or advanced practice nurses licensed in Texas conduct athletic preparticipation physical examinations for school-age children.

Scope whac-a-mole.

TMA doesn't always oppose scope-of-practice expansion by nonphysicians. It believes it's appropriate when it improves patient care and nonphysicians are properly trained, when a physician heads the health care team, and when there is proper Texas Medical Board oversight.

Lifesaving shots.

Unfortunately, low rates of influenza immunization among health care workers contribute to some influenza outbreaks in hospitals and long-term care facilities. The Texas Medical Association believes the hospital should be a place where people go to get better, not a place where they should worry about contracting a vaccine-preventable disease. TMA policy strongly endorses immunizing all physicians with the recommended vaccines available for preventable, communicable diseases.