Oversight of Practice Management Services

TMA's practice management services are overseen by the Council on Practice Management Services, formed by the House of Delegates in May 2006. Having had two meetings, the council already has proven to be a key governing body in unifying development and delivery of these services for physicians and their office staffs. The council evaluates the success of current service offerings, provides input on projects that are in development, and presents concepts for new services it feels members will find valuable in the management of their practices. The council's current focus is to provide guidance on endorsement of practice management service companies, information and education activities, coding and reimbursement services, health information technologies, and consulting services.

Vendor Endorsements - The council's charge within the endorsement process is to ensure that all formally endorsed vendors, both current and future, are those whose operations and offerings benefit TMA and its physician members and support the goals and principles of TMA 2010. For this purpose, the council has established informal guidelines to aid in the screening process. In addition, the council will implement an application fee from companies requesting endorsement to compensate TMA, in part, for the time and effort it takes to perform due diligence on companies being considered for endorsement.

In October the council reviewed and approved evaluation materials for Innovative Health Resources, a company founded in 1999 and headquartered in Austin that specializes in streamlining credentialing and contracting processes for physicians. The endorsement agreement was approved by the Board of Trustees in October 2006, and became effective Jan. 1, 2007. Innovative is one of two credentialing services endorsed by TMA .

Additionally, the council is evaluating endorsement of companies that provide human resource services to small group practices, services to maximize the recovery of unpaid claims, and online resources for up to date clinical information.

TMA Knowledge Center
The TMA Knowledge Center compiles and distributes TMA's most commonly requested information and quick tools such as form letters - many related to practice management. Information on leadership development events and programs, practice consulting services, or general practice management concerns comprise 50 percent of total responses completed by knowledge center specialists .

Web Site
To further increase awareness of practice management resources and services, the practice management section of the TMA Web site is being revamped and made more robust in terms of its offerings. The updates will allow physicians and their staffs access to information and tools that are easier to find, timely, and relevant.

Seminars
In 2006, TMA offered 62 live seminars reaching more than 3,500 individuals (32 percent representing physicians and 68 percent non-physicians). Seminars are co-sponsored with local county medical societies which provide staffing and promotional assistance. The most successful programs are those dealing with regulatory compliance, legal, and reimbursement issues. Non-physician attendees include primarily (1) office managers/administrators, (2) coding personnel, (3) billing/collection staff, and (4) secretaries and certified medical assistants. Revenue generated by the seminars is used to support many of TMA's regulatory initiatives, such as the Coding Hotline, the Hassle Factor and Mini Consults programs, as well as free member publications such as Straight Talk About Fraud and Abuse and The Texas Medical Records Handbook.

TMA's practice management seminar and education schedule for 2007 was approved by the council and includes the following:

TexMed Track - A day-long series of lectures on practice management topics. Council member Sidney Ontai, MD, MBA, serves as chair of this session.

Prompt Pay - Part of TMA's core curriculum, this series includes discussion of Texas prompt pay laws, tips for dealing with insurance carrier hassles, and review of the new CMS-1500 claim form.

The Verdict is In (TMLT discount program) - This is an encore performance of a seminar based on TMLT closed-claim case studies. An audience response system allows physicians to rate performance of defendants and anticipate the outcomes of liability suits.

Designated Doctor and Impairment Rating - This two-day conference was developed to meet mandatory training requirements for physicians who conduct impairment ratings or serve as designated doctors in the Texas workers' compensation system. It is TMA's top revenue producer and the most expensive program to produce with nine speakers.

Medical Records - Offered annually, this program addresses management, release, and retention of medical records. Based on evaluations, the content will include more information on minors, responding to subpoenas, and technology.

HIT/EMR Selection - The council will work with the health information technology committee and staff to determine appropriate topics, speakers, and locations for this series.

Economic Survival - The term "economic survival" was identified throughout the latest TMA physician survey and will serve as the "theme" for a full-day program with speakers on expense analysis, cash-flow management, marketing, pay for performance, dealing with carrier hassles, and contracting.

Prescription Errors (TMLT) - This program will address medication tracking, patient education, documentation, drug interactions, evidence-based medicine, liability associated with medical trials, and e-prescribing.

Workers' Compensation - This series is a blend of payment policy, practical coding, reimbursement, and administrative advice, regulatory compliance, and marketing as they relate to workers' compensation.

Policies and Procedures - TMA successfully conducted this seminar several years ago in conjunction with the release of its Policy and Procedure Manual. This one or two-day program centers around key procedure areas related to management of the medical practice. Participants receive a copy of the policy and procedure publication which can be customized for their practice.

Medicare - This annual series is held in collaboration with Trailblazer Health Enterprises and includes an ICD and CPT coding update and Medicare policy changes. The 2007 series will include a discussion of Medicare Advantage Plans and the new quality standards.

Residency Programs - Each year TMA receives numerous requests from residency programs to present educational seminars on starting a medical practice. Most residency programs do not contain in-depth practice management courses in their curriculum. In 2000, TMA Physician Services developed a seminar entitled, "A Resident's Guide to Starting a Medical Practice," which is offered to residency programs across Texas. The seminar's goal was to provide residents with an introduction to the business side of a medical practice. Each year, the number of requests from residency programs continues to increase and program directors confirm that physician attendees greatly benefit from the program content.

Distance Learning
Several new publications are scheduled for release in 2007. There also will be an emphasis on Web-based courses in response to increasing demand.

Publications - In addition to publications written to address a specific topic, materials from a seminar are often turned into enduring materials so that physicians not able to attend a seminar on care can access the information and obtain CME. The following publications are slated for release in 2007:

The Texas Prompt Pay Handbook - This publication is a resource for Texas physicians on Senate Bill 418, more commonly known as the Texas prompt pay law. A $40,000 grant from TMLT enables us to mail this publication, free of charge, to approximately 12,000 to 15,000 physicians. In addition, the publication will be distributed to all newly licensed physicians in the state along with TMA membership information. Physicians may receive three hours of AMA PRA Category 1 Credit after submitting a $25 processing fee. Target completion date was January.

Transitions:  Legal Considerations in Selling or Closing a Medical Practice - This is an update of a highly requested publication which covers legal and administrative details that physicians must consider when buying, selling, merging, or retiring from practice. This publication will be priced between $29 and $49, depending upon production costs. Target completion date was February.

Non-Physician Practitioners - This will be an update of a previous TMA publication. The book addresses the legal and billing aspects of hiring and supervising physician assistants, nurse practitioners, advanced practice nurses and clinical nurse specialists. It includes scope of practice considerations, supervision issues, and billing, coding, and reimbursement concerns. TMLT will provide a grant for production costs and offer a 3 percent professional liability discount to physicians who complete the course. TMA will sell the publication for $45. Target completion date: May.

Policy and Procedure Manual - Currently under revision, the Policy and Procedure Manual is a top-seller and is used by TMA consultants as part of practice set ups and audits. In addition to updates, sections on human resources and health care technology will be added. It will continue to sell for $250. Target completion date: August.

Electronic Medical Record Implementation Guide - This publication was funded by a grant from the Physicians' Foundation for Health System Excellence and will be mailed free of charge to all TMA members in active practice and to nonmembers upon request. CME completers will be eligible for a TMLT premium discount of 3 percent. Target release date: April.

Negotiating Your First Employment Contract - This monograph will cover legal and financial perspectives of negotiating an employment contract. The guide will be provided free of charge during the resident seminars and during resident orientations. Target release date: June.

Internet CME - TMA offers a select listing of CME courses online. However, few are related to practice management. This is a new program in development. TMA is developing courses and setting up infrastructure on its Web site so that it can host its own programs. Demand for courses and pricing also must be determined prior to launch.

In order to capitalize on the increasing demand for online educational activities, TMA began to produce Web-based CME courses . At the end of 2006, TMA published four courses on its Web site : Outstanding Patient Service, Are You Ready for an EMR, Which EMR is Right for Your Practice, and Technology: Legal Issues and Vendor Contracting.

In 2007, TMA will produce additional Web-based courses. The following topics are planned for both Learn at Lunch Sessions and Web-based courses:

Consulting Services - TMA's consulting staff are developing a new services for members, including Web site design, conflict resolution, and health information technology selection services. TMA's most commonly requested consulting services are new practice set-ups, operations assessments, and billing and coding compliance audits.

Health Information Technology
TMA's Ad Hoc Committee on Health Information Technology has focused its efforts in four areas:

• Activities for in-office support;
• National and State HIT Policy, including policy for Health Information Exchange (HIE);
• HIE/data warehouse feasibility study; and
• Development of regional health information organizations (RHIOs).

The department of Health Information Technology operates with funding provided in a grant from the Physicians' Foundation for Health Systems' Excellence, with the goals of promoting technology as a tool that can improve quality of care and patient safety. TMA's HIT activities are discussed in a separate report to the house.

Summary
TMA's Council on Practice Management Services will greatly enhance TMA's ability to provide a full range of services to support the viability of medical practice in Texas.

TMA House of Delegates: TexMed 2007