TMA Young Physicians Memo

Spring 2014

Should Texas Medical Licensing Laws Include Testing Limits

Both the November and December issues of TMA’s It's Academic newsletter invited readers to take an informal poll on whether TMA should support limits on passage attempts for national tests such as the United States Medical Licensing Examination (USMLE). Texas law sets the limit at three attempts per test and at seven years for completion of the testing series, with some exceptions.

Bills routinely surface each legislative session to increase or even completely waive these limits to accommodate an individual physician’s testing record. TMA’s Council on Medical Education has been considering whether to draft TMA policy on testing limits. About 1.3 percent of newsletter subscribers participated in the poll. 

Results From Informal Poll on Testing Limits, to Date (49 responses)

The overwhelming majority expressed support for limits:   

  • 69 percent favored limits on testing passage attempts; 
  • 47 percent supported a passage attempt limit of three per test;
  • 69 percent favored a time limit for completion of a testing series;
  • 47 percent supported a limit of seven years for completion of a full testing series (e.g., USMLE); 
  • 78 percent did not support lower testing requirements if a physician makes a commitment to practice in an underserved community; and
  • 58 percent supported lower testing requirements if a physician has had an unrestricted license in another state and is in good standing for at least five years.    

The Council on Medical Education plans to submit a policy proposal to the TMA House of Delegates at TexMed in May. 

A related story, “Testing the Limits: TMA Evaluates New Policy on Medical Licensing Tests,” in the February 2014 issue of Texas Medicine touches on various aspects of medical education and residency training in addition to state medical licensing laws. Texas medical schools and residency programs have specific testing requirements for their medical students, residency program candidates, and residents. 

Most Texas medical schools won’t promote students from the second to third year if they have not passed Step 1 of the USMLE, and won’t graduate them until they pass Step 2, Christian T. Cable, MD, explains in the article. And, most graduate medical education programs won’t advance students to a higher level of residency needed for board certification until they pass Step 3. 

Dr. Cable is a member of TMA's Council on Medical Education and director of the hematology/oncology fellowship at Baylor Scott & White Health. 

The article notes that changing medical license testing limits without taking into consideration the medical school graduate’s potential ability to enter residency training could create a gap between state rules and medical school policies. Such a gap could harm a candidate’s potential for being admitted into a residency program. 

The article includes the perspective of a San Antonio physician who graduated from a medical school outside the United States. The physician drew attention to the possibility that international medical graduates may have more difficulty in gaining admission to a residency program. Those who are delayed a year or more in entering residency training could reasonably be expected to have greater difficulty in completing a full testing series within a seven-year limit, the story states. 

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DPS Announces Interim CSR Renewal Solution

On Jan. 1, renewal of controlled substances registration (CSR) permits issued by the Texas Department of Public Safety (DPS) should have become part of physicians' biennial online medical license renewal with the Texas Medical Board (TMB). TMA advocated passage of House Bill 1803 by Rep. Bill Callegari (R-Katy) and Sen. Joan Huffman (R-Houston) to ease the administrative hassle and red tape on physicians when they renew their CSR permits, and to avoid interruptions in patient care and in physicians' practices due to inadvertent expirations.

Under the law, permits valid on Jan. 1 would automatically extend to the date of the physician's next state medical license renewal. At that time, the CSR permit would be valid for two years for a $50 fee. 

TMB reports that it had completed the work necessary to implement HB 1803 by Jan. 1, including developing data-sharing capabilities that allow information to flow electronically to DPS for processing. DPS wasn't prepared, however, by Jan. 1 to allow for the two-year permit and to synchronize the expiration of the permit with the physician's license renewal date. 

In the past, physicians have had problems when DPS didn't process renewals before the CSR permit's expiration. A physician's ability to prescribe certain medications hinges on possession of a valid CSR, which is necessary to obtain a permit from the Drug Enforcement Administration. Just as critical, a physician whose CSR permit lapses faces (at least) temporary suspension of hospital privileges, as maintaining current certifications is a requirement to retain medical staff privileges in Texas.   

To address concerns among physicians and to ensure DPS is ready to begin processing CSR renewals, TMA has been meeting with department officials and TMB representatives. DPS told TMA in February that it will take at least six weeks to implement necessary changes to its processing system and to verify test data. 

DPS officials say they'll begin synchronizing the CSR expiration date with the TMB expiration date "in the near future." To ensure physicians don't experience any disruption in their controlled substances prescribing authority or place medical staff privileges at risk, DPS has posted the following information on its Controlled Substances Search and Verification System website:   

  • CSRs that currently expire in February 2014 or March 2014 will automatically be renewed by DPS with a temporary one-year expiration date. The renewal will be completed before expiration without the renewal application and associated fee. No action is required by the physician. The information on the Controlled Substances Search and Verification System will be updated. 
  • Programming changes are under way at DPS to implement the statutory requirement to synchronize the CSR expiration date with the TMB expiration date. 
  • Upon completion of the synchronization, the information on the Controlled Substances Search and Verification System will be updated, and new CSR certificates will be mailed to each affected practitioner.    

 Visit the DPS Regulatory Services Division webpage for updates and additional information as it becomes available.  

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Get Down to Buisness at YPS Meeting

Join us for the next Young Physician Section meeting at TexMed 2014 in Fort Worth on Friday May 2, noon-1:30 pm. The meeting will include discussion on pertinent resolutions, Executive Council elections, and an educational presentation. Lunch will be provided for all who pre-register. Conference attendance is free for all TMA members. 

Elections for the YPS Executive Council will be held during the meeting. Positions available include:   

  • Chair-elect
  • American Medical Association delegates (four), one-year term
  • TMA delegates (four), two-year term
  • TMA alternate delegates (two), two-year term   

To apply, submit a letter of intent and CV to your section coordinator at by April 15. 

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O'Malley Scholarship Winner Announced

Congratulations to Elizabeth West of Alto High School, the 2014 recipient of the Michael O’Malley, MD, Memorial Scholarship. Elizabeth aspires to become a pediatric ophthalmologist. A personal experience following her younger brother’s birth showed her the tremendous value and impact a physician can have in shaping a family and a person’s life. 

Rural Texas high school seniors who excel in science receive $1,000 to use to pursue an education in the field of medicine. The Young Physician Section Rural Scholarship transformed into a memorial scholarship for the late Michael O’Malley, MD, in 2007. Dr. O’Malley, a recipient of a similar scholarship himself, was an internal medicine physician in Galveston and past chair of the TMA Young Physician Section. This year marks the 20th anniversary of the scholarship.

To ensure the continued work of this scholarship, make a donation by calling the TMA Knowledge Center at (800) 880-7955 or sending an email.

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CMS Pauses Recovery Audit Program

The Centers for Medicare & Medicaid Services (CMS) announced in late February that it will pause additional documentation requests by recovery audit contractors (RACs) until new RAC contracts are finalized. The pause in requests began Feb. 21, the last day a recovery auditor could send postpayment additional documentation requests (ADRs).

Take note of the following important dates:    

  • Feb. 28 was the last day a Medicare administrative contractor (MAC) could send prepayment ADRs for the Recovery Auditor Prepayment Review Demonstration. 
  • June 1 is the last day a recovery auditor may send improper payment files to the MACs for adjustment.  

"It is important that CMS transition down the current contracts so that the recovery auditors can complete all outstanding claim reviews and other processes by the end date of the current contracts. In addition, a pause in operations will allow CMS to continue to refine and improve the Medicare Recovery Audit Program," CMS said in an online notice. "CMS has proven it is committed to constantly improving the program and listening to feedback from providers and other stakeholders." 

CMS says it will "continue to review and refine the [Medicare Recovery Audit Program] process as necessary." 

The agency will continue to update its Recovery Audit Program website with more information on new contracts as information is available. Physicians should email for additional information.  

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Are You Ready for ICD-10?

The Oct. 1 compliance date to transition to ICD-10 will be here before you know it. A January report from the Medical Group Management Association (MGMA) suggests physicians, payers, and electronic health record (EHR) vendors are all well behind the curve in preparing for implementation.

The report shows fewer than 10 percent of responding practices had made significant progress when rating their overall readiness for ICD-10 implementation. Only 8.2 percent had begun or completed testing with their EHR vendor, and nearly 60 percent of respondents stated they hadn't heard from their major health plans as of December regarding when ICD-10 testing would begin.

On top of that, a new AMA-commissioned cost study says the costs for physician practices to implement the federally mandated transition to the ICD-10 code set are three times earlier estimates.  

Using the new report as ammunition, AMA "strongly urged" U.S. Health and Human Services Secretary Kathleen Sebelius to "reconsider the mandate." CMS administrator Marilynn Tavenner publicly rejected that request in a speech to the Healthcare Information and Management Systems Society in late February. 

The study, conducted by Nachimson Advisors, compared current estimates of ICD-10 conversion with Nachimson's 2008 report. For a typical small practice, the costs increased from $83,290 in 2008 to a range of $56,639 to $226,105 in 2014. Costs for a typical large practice jumped from $2.7 million in 2008 to a range of $2 million to $8 million this year. 

The Centers for Medicare & Medicaid Services (CMS) mandated the ICD-10 diagnosis code set for use by physician practices, other practitioners, clearinghouses, and health plans. With ICD-10 containing more than five times the number of codes as ICD-9 and incorporating a completely different structure, the new code set will require extensive changes for medical groups.

On Feb. 19, the federal government agreed to conduct limited end-to-end testing on ICD-10 for a small sample group of health professionals selected to represent "a broad cross-section of provider types, claims types, and submitter types."

"End-to-end testing includes the submission of test claims to [the Centers for Medicare & Medicaid Services] with ICD-10 codes and the provider's receipt of a Remittance Advice (RA) that explains the adjudication of the claims," CMS said in a memo to health professionals. Testing will occur July 21-25. 

American Medical Association President Ardis Dee Hoven, MD, says that while the decision to conduct end-to-end testing pleases AMA, the association "continues to urge CMS to reconsider the ICD-10 mandate during a time when physicians are struggling to keep up with many other costly, federal mandates."

At the AMA House of Delegates meeting in June, TMA delegates directed AMA to support federal legislation to "stop the implementation of ICD-10 and remain with ICD-9 until ICD-11 can be properly evaluated." Although TMA opposes the transition to ICD-10, the association has many tools and resources to help you get ready for the new coding system, should CMS persist in its current trajectory.  

  • TMA's newest statewide seminar series, ICD-10 Documentation and Auditing: Success Is in the Details, delves into how to use the new ICD-10-CM code book and its guidelines and how to audit physician documentation in day-to-day practice. If you can't attend in-person, register for TMA’s March 18 interactive webinar.
  • ICD-10 Now! How and Why, an on-demand webinar from TMA, offers a detailed look at everything you need to know and do to prepare for ICD-10. Another TMA on-demand webinar, ICD-10 Starts With Physicians, targets physicians, office managers, and coders. It highlights the ICD-10 transition process, code structure, and the impact of ICD-10 on a practice. Register for the webinars online
  • Be sure to bookmark TMA's ICD-10 resource page for news, tools, education, updates, and the ICD-10 Readiness Questionnaire for Vendors from the American Health Information Management Association. 
  • The TMA Knowledge Center alert service will also keep practices up to date with the newest articles and latest developments on ICD-10 and other health care topics. TMA Knowledge Center staff have created custom searches on ICD-10 and many other topics set to run weekly. The search can be emailed directly to you or accessed via RSS feed. TMA Knowledge Center alerts provide citations and abstracts along with some full-text access. Fill out the online form to sign up.   

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TexMed 2014 Registration Is Open

Register today for TMA's free annual conference, and join thousands of fellow Texas physicians, as TexMed 2014 descends on Fort Worth May 2-3 for a weekend of continuing medical education (CME) events, networking, policymaking, and all-around fun. TexMed is TMA's largest event of the year, offering more than 80 hours of free CME, an extensive gathering of exhibitors to help with every aspect of your practice, and, of course, this year's keynote speaker, Zubin Damania, MD ― perhaps better known for his alter ego and street persona, ZDogg, MD.

Practicing medicine today involves a dizzying array of regulations, standards, electronic health records, and payment plans that interfere with physicians' ability to develop a positive, productive medical culture. In his TexMed General Session presentation, Redefining the Culture of Medicine, Dr. Damania will delve into the ethical challenges of delivering excellent care in our dysfunctional health care system and will propose ways to revitalize it. In his new clinic, Dr. Damania seeks to break down the barriers, bringing together physicians and frontline health care professionals to mend the system and put autonomy back into health care.

Be sure to connect with Dr. Damania at before attending TexMed 2014. And check out ZDogg's personal invitation for you to go to Fort Worth.

For a full schedule of events, CME, exhibitors, lodging information, and fun things to do in and around Fort Worth, visit the TexMed 2014 webpage, and be sure to register today to reserve your spot so that you can enjoy this free benefit of your TMA membership.  

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 Stay Connected

Keep up with important news and connect with colleagues across the state through the YPS Facebook page.

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