Action Current Issue - full text

 TMA Action Dec. 1, 2015   News and Insights from Texas Medical Association


INSIDE: TMA Says Future Medicare Reimbursement Are Wasteful, Costly

TMA Says Future Medicare Requirements Are Wasteful, Costly
TMA Wants Meaningful Use Hardship Exception
Workers' Comp Fee Conversion Factor Up 1.1 Percent in 2016
TXACP Accepting Applications for 2016 Preceptorship Program
HHSC Transformation Public Hearings Set
Physicians: Reenroll in Medicaid by March 24, 2016
Medicaid Attestation Portal Closed Nov. 21–Dec. 14
Young Texans Win AMA Posts

TMF Offers Help Navigating Medicare Requirements
Enter TMA Journalism Awards Competition
Group Reaches ACO Pact With TMA PracticeEdge, BCBSTX
DSHS Asks Doctors to Report Cronobacter sakazakii in Infants
Need TMAF Grant Support? Deadline Approaching
Physicians Benevolent Fund Helps Physicians, Families

TMA Says Future Medicare Requirements Are Wasteful, Costly

The Texas Medical Association is "very concerned that many of the compliance, documentation, and reporting requirements that will be implemented in the future Medicare system are wasteful, costly, and do little or nothing to improve care quality or increase efficiency," TMA President Tom Garcia, MD, told the Centers for Medicare & Medicaid Services (CMS).

The strong comments came in response to a CMS request for information regarding implementation of the Merit-Based Incentive Payment System (MIPS), promotion of alternative payment models, and incentive payments for participation in eligible alternative payment models. CMS published the proposal for implementation in the Federal Register on Oct. 1. 

"The requirements and incentives may even have the counterproductive effect of reducing access to good ambulatory care for some or all Medicare beneficiaries. If the goal is to reduce total medical cost, it is counterproductive to try to achieve that by increasing the total cost of medical practice. If the goal is better use of ambulatory care by patients, it is counterproductive to penalize the physicians who provide it," Dr. Garcia wrote

In developing rules to implement MIPS, TMA urges CMS to consider these principles: 

  • They must be administratively efficient, keeping new documentation and reporting requirements to an absolute minimum. When possible and relevant, documentation should be drawn from existing sources such as claims data or Medicare enrollment records.
  • Physicians should be held accountable only for those aspects of cost and quality that they can reasonably influence or control.
  • Physician choice of payment model should be preserved. No physician should be forced or coerced into accepting a payment model that is unacceptably risky for small practices, which are likely to have a small and unrepresentative patient mix.
  • All quality and meaningful use measures should be revised to exclude the effects of patient care preferences or choices and patient inability or unwillingness to adhere to medical orders or advice.
  • All cost or utilization measures should be revised so that they do not cause adverse impact on physicians who treat patients from any socioeconomic, racial, or cultural group which may have diverse preferences for medical treatment. 

For a full list of TMA's recommendations, read the letter 

TMA Wants Meaningful Use Hardship Exception

TMA President Tom Garcia, MD, told U.S. Rep. Tom Price, MD (R-GA), in a letter that TMA supports his HR 3940, the Meaningful Use Hardship Relief Act of 2015. The bill authorizes a meaningful use significant hardship exception for the 2015 reporting period due to the delay in timely publication of the Stage 2 meaningful use rule. Support for HR 3940 is part of TMA's advocacy efforts to put the meaning back in meaningful use.

Congressman Price, an orthopedic surgeon, chairs the House Budget Committee.

"Since inception of the meaningful use program, TMA has studied rules, developed resources, educated physicians, listened to complaints, advocated for improvements, and tracked results," Dr. Garcia wrote in a letter also sent to the entire Texas delegation in Congress. He added that "the Centers for Medicare & Medicaid Services has disregarded stakeholders frequently," citing the late release of the 2015-17 modification rule as "a prime example of this disregard." 

"Physician practices and the health care industry cannot be expected to turn on a dime, especially when regulatory changes are rolled out during a required reporting period," the letter states.

TMA is calling on Congress to enact legislation that provides positive incentives for physicians to acquire and maintain health information technology. Until electronic health record (EHR) systems truly add value to medical care, TMA wants Congress to reform the program and eliminate federal mandates that compel physicians to engage in unnecessary activities and reporting. 

On a side note, physician and rapper Zubin Damania, MD, known as ZDoggMD, released a video that starkly presents physician attitudes toward EHRs. Take a moment to enjoy his perspective. The video was created in collaboration with EHR vendor athenahealth. Dr. Damania was the keynote speaker at TMA's 2014 annual meeting.

If you have questions about EHRs and meaningful use, contact TMA's Health Information Technology Department by email or by calling (800) 880-5720. 

Workers' Comp Fee Conversion Factor Up 1.1 Percent in 2016

The Texas Department of Insurance (TDI) has posted the annual change to the Medical Fee Guideline conversion factors affecting workers' compensation system participants. Fee guidelines adopted by TDI's Division of Workers' Compensation (DWC) for non-network services and approved out-of-network services are based on the most current reimbursement methodologies, models, and values or weights used by the federal Centers for Medicare & Medicaid Services.

At TMA's urging, DWC established a conversion factor and an annual update, based on the Medicare Economic Index (MEI) to provide predictability and reflect changes in medical service delivery costs to system participants. MEI is a weighted average of price changes for goods and services used to deliver physician services. The MEI for 2016 reflects an increase of 1.1 percent.

More information on 2016 Medical Fee Guideline conversion factors and a table containing conversion factors from 2008 through 2016 is available on the TDI website 

TXACP Accepting Applications for 2016 Preceptorship Program

The Texas Chapter of the American College of Physicians (TXACP) is now accepting applications from Texas medical students and physicians for the summer 2016 General Internal Medicine Statewide Preceptorship Program (GIMSPP). 

Since 1992, GIMSPP has placed first- and second-year medical students with internists across the state for four-week preceptorships during summer break. Students get the opportunity to observe the daily routine of their preceptor, experiencing the variety of an internal medicine practice. Preceptors also share their expertise and knowledge, while helping shape the next generation of medicine.  

Previously, the Texas Higher Education Coordinating Board financed the program, but the Texas Legislature cut funding for it in 2011. TMA helped lead the fight to restore funding during the 2015 legislative session.

Curated by the nonprofit TXACP, GIMSPP's renewed financial support for 2016 and beyond allows for stipends for participating students. Student preceptorships are available on a first-come, first-served basis, and students should apply early. Only students currently enrolled in a Texas medical school are eligible to participate. 

For more information on the program or to download the application for participation, visit the TXACP website.   

     Action TMLT Ad 10.15

HHSC Transformation Public Hearings Set

The Texas Health and Human Services Commission (HHSC) has scheduled public hearings in Austin on Dec. 2 and in Amarillo on Dec. 10, and has created an online survey to take public comment regarding the transformation of the state's health and human services system.

The HHSC transformation is an opportunity to restructure the Texas health and human services system to make it more functional, efficient, effective, and responsive for the agency's clients and stakeholders. The public, including physicians, has an opportunity to comment on medical and social services, regulatory services, public health, protective services, and state-operated facilities. The Austin public hearing will be webcast, and other public hearings will be scheduled in other parts of the state during December and January.

Details on the December public hearings are available on the HHS Transformation website.


Physicians: Reenroll in Medicaid by March 24, 2016

The Affordable Care Act requires all Medicaid health professionals to reenroll in the program at least once every five years (some professionals must reenroll more frequently). Physicians are next on the list and must reenroll by March 24, 2016. However, if you initially enrolled or reenrolled on or after Jan. 1, 2013, you will be required to reenroll by the date indicated on your enrollment letter.

The Texas Health and Human Services Commission and the Texas Medicaid and Healthcare Partnership (TMHP) have improved the electronic enrollment portal to make it easier for doctors to complete the reenrollment process. (Physicians newly enrolling in Medicaid can also use the portal.) The enhancements apply to applications submitted through the TMHP website on or after April 26, 2015.

The improved electronic application process allows you to:

  • Upload supporting documentation;
  • Sign the enrollment agreement electronically (e-sign);
  • Receive guidance as you work on the application and see more accurate error messages to avoid mistakes;
  • Receive instruction on how to upload documents and submit the application using an e-signature; and 
  • Expedite processing of your application by reducing the need for printing and mailing documents. 

For physicians currently enrolled in Medicaid, the portal will pre-populate the application with demographic data pulled from the physician’s current account.

To be considered fully reenrolled by the March 24, 2016, deadline, physicians must receive verification from TMHP that the application has been approved before that date. It currently takes about 32 days for applications to be processed. Thus, physicians should reenroll early to avoid gaps in enrollment. The reenrollment requirement also applies to physician assistants and advanced practice registered nurses.

To use the online application, you must have a TMHP user account and a user name (portal user ID). Refer to the TMHP Website Security Provider Training Manual for instructions on activating a TMHP user account. For more information about Medicaid provider reenrollment, visit the TMHP provider reenrollment page.

Action, Dec. 1, 2015

Medicaid Attestation Portal Closed Nov. 21–Dec. 14

The Texas Health and Human Services Commission (HHSC) will take the electronic health record (EHR) attestation system offline from Nov. 21 through Dec. 14, 2015, to make the meaningful use Stage 2 system modifications. 

Physicians who are attesting to adopt, implement, or upgrade a certified EHR will still be able to attest during this period. Physicians will also be able to view existing attestations and upload documentation as necessary. But physicians who are attesting to the modified version of Stage 2 meaningful use will not be able to enter their attestations at that time. The portal will reopen on Dec. 15, 2015, to accept meaningful use attestations for program year 2015 under the new requirements of the modified Stage 2 final rule.

HHSC has extended the attestation deadline for the 2015 Medicaid EHR incentive program to April 30, 2016. Participants must complete their attestation by this date and have "payment pending" or "in review" status to receive an incentive payment for the 2015 program year.

If you have questions about EHRs and meaningful use, contact TMA's Health Information Technology Department by email or by calling (800) 880-5720. 


Young Texans Win AMA Posts

Congratulations to the Texas medical students and residents who continued the tradition of strong Texas leadership in the American Medical Association. Winning elections during the November meeting of the AMA House of Delegates were:  

  • John Corker, MD, a resident at The University of Texas Southwestern, Dallas; and Laura Faye Gephart, MD, a fellow at Baylor Scott & White, Temple, were elected sectional delegates for the AMA Resident and Fellow Section (RFS). The RFS also voted to endorse Dr. Gephart as one of two candidates for the resident position on the AMA Council on Medical Service. The election will be in June.
  • Jared Bell, from the Paul L. Foster School of Medicine in El Paso, is the new Region 3 delegate for the AMA Medical Student Section (MSS). Jerome Jeervarajan of UT Southwestern Medical School is the alternate delegate.
  • Megan Swonke, from The University of Texas Medical Branch at Galveston, and Milan Raythatha, from Texas A&M Medical School, Round Rock, are the very first MSS Region 3 liaisons to the AMA Foundation. They will be responsible for increasing students' participation in the foundation's fundraising and community service activities.

  TMAIT Action Ad 6.15     

TMF Offers Help Navigating Medicare Requirements

Physicians looking for free help navigating the Centers for Medicare & Medicaid Services (CMS) requirements for the Physician Quality Reporting System (PQRS), meaningful use, and value-based payment modifier programs can benefit from three networks from the TMF Quality Innovation Network Quality Improvement Organization (QIN-QIO).  

The three networks help physicians save time, improve patient care, and reduce costs associated with meeting these requirements. The networks, focused on immunizations, behavioral health, and value-based improvements, are free and designed to help physicians benefit from — and not be penalized by — CMS mandates.  

The Immunizations Network aims to boost vaccination rates for Medicare beneficiaries. The program strives to improve referrals for tracking and reporting immunizations via certified electronic health records and evaluates opportunities to enhance payment by reviewing practice workflow processes.  

The Behavioral Health Network offers free resources and training to help increase screening rates for depression and alcohol use disorder in Medicare beneficiaries receiving care at primary care practices. Additional goals include reducing the 30-day readmission rate and increasing follow-up care for patients discharged from inpatient psychiatric facilities.

The Value-Based Improvement and Outcomes Network helps physicians understand the requirements of CMS' PQRS and value-based payment modifier program. Participants are provided with education and free consulting services designed to help them meet the goals of CMS' hospital and physician value-based payment and quality reporting programs.

For more information on participating in any of these networks, visit the TMF QIN-QIO website, or download and complete the network participation agreement. Once complete, this can be emailed to your TMF QIN-QIO quality improvement consultant or faxed to (512) 334-1775, Attention: Participation Agreement. Please note if you wish to provide an electronic signature, you will need to download and save the document to your computer before completing it.  

Enter TMA Journalism Awards Competition

Do you write a medical column for your local newspaper? Or do you host a health-focused radio show or a segment on the local TV news? If so, enter your work in the TMA Anson Jones, MD, Awards contest.

TMA has honored award-winning Texas journalists with the Anson Jones, MD, Awards for excellent medical news reporting for more than 55 years. The Physician Excellence in Reporting category is just for you: It recognizes physician- and medical-student reporters who regularly contribute to general-interest media aimed at a Texas public audience.

Enter today. Any story published or broadcast in 2015 is eligible. TMA will accept entries until Jan. 10, 2016. You also can nominate a colleague who is an outstanding medical journalist. 

Visit the Anson Jones webpage for more details. If you have questions, email or call Tammy Wishard, TMA outreach coordinator, at (800) 880-1300, ext. 1470, or (512) 370-1470. 

Group Reaches ACO Pact With TMA PracticeEdge, BCBSTX

TMA PracticeEdge signed an agreement to provide accountable care organization (ACO) services to UPSA ACO, LLC (UPSA), a group of San Antonio physicians, in conjunction with a Blue Cross and Blue Shield of Texas (BCBSTX) value-based agreement beginning Jan. 1, 2016. 

The two agreements will provide UPSA with shared savings opportunities while managing the population health of 5,400 BCBSTX members. The deal includes the TMA PracticeEdge turnkey solution for ACO services, such as population health management tools, local care coordination resources, and a state-of-the-art information technology solution. 

"The independent physicians who compose the UPSA organization have been serving the health care needs of their community for decades," said Lou Goodman, chief executive officer of TMA PracticeEdge. "By transitioning to a value-based care model, UPSA will be positioned to remain a health care leader in San Antonio for years to come."

Created by TMA, TMA PracticeEdge is a physician services organization providing solutions to strengthen the independent private practice of medicine in Texas. Its programs bring physicians the technology, expertise, and resources needed to take advantage of newly emerging health care payment models.

"High-quality patient care and population health management, delivered by independent primary care physicians, is the future of health care in this country," said Lloyd Van Winkle, MD, president of UPSA. "We are pleased to have the opportunity to work with BCBSTX in a value-based care model and have the specialized services of TMA PracticeEdge in support of our value-based care initiatives," added Dr. Van Winkle, who also serves on the board of the American Academy of Family Physicians.

"We are extremely pleased to work with UPSA in a value-care based model," said Bert Marshall, president of BCBSTX. "We are committed to supporting independent physicians in providing high-quality care to patients and look forward to sharing savings with physicians working to manage population health, improve quality, and lower health care costs." 

UPSA has 48 physicians from 32 different independent primary care practices working together to manage the care for more than 5,400 patients covered by BCBSTX. "UPSA is always very interested in adding new physicians committed to delivering high-quality patient care and from independent practices in value-based models," said Dr. Van Winkle.

Learn more about TMA PracticeEdge online, email, or call (888) 900-0334. 

DSHS Asks Doctors to Report Cronobacter sakazakii in Infants

The Texas Department of State Health Services (DSHS) wants physicians and laboratories to promptly report infections with Cronobacter sakazakii (formerly Enterobacter sakazakii) in infants younger than 12 months to their respective local health department or DSHS

DSHS says it has received reports of two cases of Cronobacter infection. The department says it's not clear if the two cases are related to a common source. Both infants had consumed powdered infant formula, but it is not known whether either of them was exposed to Cronobacter through powdered infant formula. The investigation is ongoing into whether these two infants shared exposures. 

Infants with Cronobacter infection typically present with symptoms and signs of bacteremia or meningitis. DSHS says diagnostic evaluation and treatment should be guided by the clinical presentation.

Additional information about Cronobacter is available online

 PC Action Ad Oct 13

Need TMAF Grant Support? Deadline Approaching

The TMA Foundation (TMAF) is accepting applications for its 2015-16 Medical Community Grants and Medical Student Leadership Grants programs through Dec. 31, 2015. 

County medical societies and alliance and medical student chapters may apply for a grant to support their health improvement initiative focused on any of TMA's public health priorities, including tobacco use; obesity/metabolic syndrome; mental health and substance use disorders; violence, victimization, and unintentional injuries; vaccine-preventable diseases (immunizations); unplanned pregnancy; and environmental health (or hazards). Find out more, and download the application on the TMAF website

This fall, TMAF awarded more than $26,000 to five local health improvement programs:  

  • "Drive Thru, Prevent the Flu" by Lamar Delta County Medical Society; 
  • "Mind, Exercise, Nutrition, Do It!" by McLennan County Medical Society; 
  • "Project Access" by Tarrant County Medical Society; 
  • "Health Fair 2015" by Parker County Medical Society; and 
  • "Lubbock Impact Immunization Night" by Texas Tech University Health Sciences Center TMA Medical Student Chapter. 

Two grant programs support these initiatives. To learn more about these funded programs or to make a tax-deductible gift, visit the TMAF webpage or call (800) 880-1300, ext. 1466, or (512) 370-1466.  

Physicians Benevolent Fund Helps Physicians, Families

When Texas physicians and their families have needed support because of poverty, infirmity, disability, accident, or other adversity, the TMA Physicians Benevolent Fund (PBF) has stepped in to help for the past 53 years. 

"I don't know what I would have done without your help. Your generosity is a blessing. Thank you," said one grateful PBF recipient.

Some PBF recipients are elderly and not practicing medicine, some are disabled or ill, and some are widowed and raising families. With your help, PBF will continue to take care of the Family of Medicine. Each month, recipients receive help with their rent or mortgage, utilities, health insurance, medical bills, clothing, and food. 

PBF has given more than $3.7 million in assistance payments to more than 740 physicians and their families since the fund began in 1961 with a $2,500 donation from the late May Owen, MD, a Fort Worth pathologist and past president of TMA.

PBF thrives because of the generosity of TMA members willing to share with less fortunate colleagues and families. Contributions are tax-deductible and may be in the form of honoraria or memorials.

Contribute online, or send a check to Physicians Benevolent Fund, Texas Medical Association, 401 W. 15th St., Austin, TX 78701-1680.

If you are a physician in need or know of a physician or a physician's family in need, please contact PBF today. For more information on contributions or benefits, email Chris Johnson at TMA or call her at (800) 880-1300, ext. 1602, or (512) 370-1602. 


 This Just In ...

Want the latest and hottest news from TMA in a hurry? Then log on to  Blogged Arteries.  

Deadlines for Doctors

TMA's Deadlines for Doctors alerts you and your staff to upcoming state and federal compliance timelines and offers information on key health policy issues that impact your practice.      

Jan. 1, 2016
EHR Incentive Program's First Day of the 2016 Reporting Period 

 TMA Education Center 

The TMA Education Center offers convenient, one-stop access to the continuing medical education Texas physicians need. TMA's practice management, cancer, and physician health courses are now easier than ever to find online.  


Medicare Now and Tomorrow
Nov. 3-Dec. 3

Live Webinar

Chronic Care Management  
Dec. 9  

On-Demand Webinar 
New Initiatives for Texas Medicaid Providers


Texas Health Steps programs — Free CME! 
Use coupon code THSEDU for free registration. 

Electronic Medical Records Implementation: Successful Strategies from the Front Lines  

Overcoming Barriers to Medical Home Implementation

Conferences and Events

2015 TMA Advocacy Retreat
Dec. 4-5
Omni Barton Creek Resort in Austin

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