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 Volume 17, No 38                       

 Nov. 23, 2015            


TMA Says Future Medicare Requirements Are Wasteful, Costly

TMA 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 alternative payment models. “The requirements and incentives may even have the counterproductive effect of reducing access to good ambulatory care for some or all Medicare beneficiaries,” Dr. Garcia’s letter said. “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.”

Lawsuit Threatens Texas Docs Who Care for New Mexico Patients

When it comes to health care, eastern New Mexico is really part of Texas. That’s the message physicians and advocacy groups in both states are sending to the New Mexico Supreme Court. Pending there is a malpractice lawsuit — Montaño v. Frezza — in which a lower court has ruled that New Mexico law governs, and our Texas’ medical liability reforms don’t. The case involves a patient from New Mexico who was treated in Texas. In court filings and news stories, TMA, the Texas Alliance for Patient Access (TAPA), the New Mexico Medical Society, and others argue that upholding the lower court ruling “will likely diminish access to care for thousands of Eastern New Mexicans, at a time when the area is already medically underserved.” For example: 

  • More than 27 percent of New Mexico residents live in the 13 counties that border Texas. However, those counties account for only 14 percent of the state’s specialty physicians.

  • Two of the 13 counties have among the greatest shortage of primary care physicians in New Mexico. Nine of the 13 counties need general surgeons, and four have a shortage of obstetrician-gynecologists.

  • Sambaiah Kankanala, MD, an internist in Hobbs, N.M., told the TAPA annual meeting that his town has just four primary care physicians for a population of more than 30,000.

  • New Mexico’s only Level 1 trauma center is in Albuquerque. More than one-third of New Mexico’s critically injured trauma patients are treated in Texas.

Feds to Set Network Adequacy Standards for ACA Exchange Plans

CMS says it plans to set minimum network adequacy standards for Affordable Care Act plans sold on insurance exchanges. There’s more good news in this than that CMS will adopt some of Texas’ consumer protections for out-of-network services. According to news reports, the CMS proposal is a departure from model legislation drafted by the National Association of Insurance Commissioners (NAIC), which was to be ratified last weekend, and which prohibits physicians from billing patients in certain circumstances. As we wrote NAIC in our most recent comment letter in what has become a long and frustrating process, “Now is the time for [CMS] and the Center for Consumer Information and Insurance Oversight to move forward and impose time and distance requirements upon insurers, as they had proposed, while leaving more stringent state standards in place.”

San Antonio Group Signs ACO Pact With TMA PracticeEdge

UPSA ACO, LLC, a group of 48 San Antonio physicians, is TMA PracticeEdge’s newest client for accountable care services. The contract comes 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 IT solution. “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. TMA PracticeEdge is a physician services organization TMA created to strengthen the independent private practice of medicine in Texas. Its programs bring physicians the technology, expertise, and resources needed to take advantage of emerging health care payment models. For information, visit www.TMAPracticeEdge.com, email info@tmapracticeedge.com, or call (888) 900-0334. 

Bill Would Grant Meaningful Use Exemptions for 2015

Sometimes the bureaucrats at CMS really outdo themselves. Like when they finally passed a new rule for the meaningful use program too late for physicians to have 90 days left in the year to comply with the rule. TMA is backing HR 3940 by U.S. Rep. Tom Price, MD (R-Ga.), which authorizes a meaningful use significant hardship exception for the 2015 reporting period due to the delay publishing the rule. “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,” Dr. Garcia wrote in a letter to Congressman Price and the Texas delegation in Congress.

EVPGram Takes Turkey Break

Despite the troubles in our world, we all have so much to be thankful for. All of us at TMA wish you and yours a very Happy Thanksgiving. EVPGram will take a short break. We’ll be back Dec. 7.

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