Stories written by Emma Freer

Senate Committee Weighs Medicare Physician Payment Reform - 04/22/2024

Following a months-long, full-court press by the Texas Medical Association and others in organized medicine, Congress recently considered bolstering Medicare physician payment to ensure vulnerable patients’ access to care for chronic conditions during a Senate Finance Committee hearing on April 11.

Feds Extend Marketplace Special Enrollment Amid Medicaid Unwinding - 04/19/2024

Texas patients who have been disenrolled from Medicaid in the wake of the COVID-19 public health emergency now have more time to find alternative coverage on the federal marketplace. The extension could mitigate a coverage cliff about which the Texas Medical Association has long raised concerns.

Practice Viability Consequences of Cyberattack Weighed by House Subcommittee - 04/19/2024

The Feb. 21 cyberattack on Change Healthcare – and its consequences for physician practice viability, industry consolidation, and patient access to care – were the subject of the first of several anticipated congressional hearings on the topic. UnitedHealth Group – notably absent from the hearing – faces mounting pressure to account for the attack.

New Federal Rules Limit Short-Term Insurance Plans, Enhance Protections - 04/17/2024

Following advocacy by the Texas Medical Association, the U.S. departments of Health and Human Services, Labor, and the Treasury recently issued final rules that strengthen consumer protections related to short term, limited duration insurance.

TMA Spotlights Access Threats Posed by No Surprises Act to House Committee - 04/17/2024

Following a recent congressional field hearing on emergency care in rural and underserved communities, the Texas Medical Association emphasized in written comments how federal regulators’ flawed implementation of the No Surprises Act has exacerbated access challenges.

CMS Finalizes 2025 Medicare Advantage Payment Rates - 04/16/2024

Despite a 0.16% reduction in base pay rate, Medicare Advantage plans are projected to see a 3.7% growth in revenue in 2025 thanks to a rising average patient risk score.

CMS to Test Prior Auth Requirements for Certain ASC Procedures - 04/10/2024

Texas physicians soon may encounter new Medicare prior authorization requirements for certain services that double as cosmetic procedures when provided at an ambulatory surgical center.

CMS to Debut Primary Care Payment Model - 04/10/2024

In an effort to address financial barriers to accountable care organizations’ provision of primary care services, Medicare will test a new value-based payment model for approximately 130 starting in 2025 and running through 2029.

Seeking Balance: TMA Opposes Feds' Implementation of the No Surprises Act - 04/09/2024

The Texas Medical Association supported the patient protections in the federal No Surprises Act but also knew from the beginning that the law's payment arbitration provisions were flawed and could give insurers an advantage.

TMA Moment in Time: SGR Repeal - 04/09/2024

The historic victory has roots in TMA advocacy and may provide a playbook for future Medicare reform.

RICO Settlements: TMA's Leadership Against Payer Abuses Resulted in Relief, Reform - 04/09/2024

Back in 2001, the Texas Medical Association and the other plaintiffs alleged the nation’s major health plans had conspired to delay and reduce payments to clinicians and hospitals; the resulting lawsuits, brought under the federal Racketeer Influenced and Corrupt Organizations Act (RICO), represented a watershed moment in TMA history.

The Trust Model: For Decades, TMA's Insurance Trusts Have Put Physicians First - 04/09/2024

For decades, TMA’s private insurance and medical liability insurance trusts have put physicians first.

TMA Moment in Time: Texas' First PPO Rules - 04/09/2024

TMA fought to ensure fair regulation of PPOs, which now dominate the health plan market.

Mental Relief: Physicians Welcome State Behavioral Health Funding - 04/04/2024

Heeding advocacy by the Texas Medical Association, the Texas Legislature allocated during the 2023 regular session $9.4 billion for behavioral health services in the 2024-25 state budget; Texas physicians welcome this 32% year-over-year increase but say more is needed.

Medicare Advantage – and Disadvantage: Program Enrollment Grows Amid Physician Concerns - 04/03/2024

Despite its growing popularity among Medicare patients, Medicare Advantage is divisive among physicians.

Lifelong Leadership: TMA Debuts Development Program for Physicians at Every Career Stage - 04/01/2024

The Texas Medical Association's new Lifelong Leadership Program is a self-paced, 18-month program free to any TMA member physician; along with the Leadership College and the Leadership Summit, the program responds to members' requests for more career development opportunities.

Straight Shooter: Incoming TMA President Ray Callas, MD, Aims for Practice Protections, Membership Gains - 04/01/2024

Incoming Texas Medical Association President Ray Callas, MD, an anesthesiologist from Beaumont, cites as his top priorities preventing scope-of-practice creep, defending physician autonomy, and bolstering the TMA's membership.

MedPAC Backs Medicare Physician Payment Increase – Again - 03/26/2024

Echoing advocacy by the Texas Medical Association and others in organized medicine, the Medicare Payment Advisory Commission recently reupped its recommendation that Congress increase Medicare physician payment by tying such payment to inflation, among other factors.

Congress Mitigates 2024 Medicare Physician Pay Cut - 03/21/2024

Congress recently passed legislation halving the 3.4% Medicare physician pay cut that took effect on Jan. 1, 2024, following a months-long, high-pressure advocacy campaign by the Texas Medical Association, the American Medical Association, and others in organized medicine. But TMA and its allies continue to push for additional reform given that any cut threatens physicians’ practice viability and vulnerable patients’ access to care.

TDI Proposed Rules for State Network Adequacy Law Raise Strong Concerns - 03/20/2024

After securing network adequacy reform during the 2023 regular state legislative session, the Texas Medical Association has shifted its focus to ensuring the Texas Department of Insurance’s network adequacy rules conform to the plain language and intent of the law.

Cyberattack Prompts CMS to Extend 2023 MIPS Flexibilities - 03/19/2024

The Centers for Medicare & Medicaid Services recently announced two flexibilities related to Medicare’s Merit-Based Incentive Payment System 2023 performance year, citing the recent cyberattack on Change Healthcare and heeding advocacy by organized medicine.

Closing the Loop: Payers Address Social Drivers of Health - 03/15/2024

Houston family physician Lindsay Botsford, MD, received a call in late February from a Medicare patient with shingles. She prescribed an antiviral medication to treat the infection – and then the real work began.

Power Data: Texas' Claims Database Will Help Clarify Care Costs - 03/15/2024

Texas is building an all-payer claims database, which will provide a clearer view of opaque health care costs.

Medicare Sunsets Beleaguered Appropriate Use Criteria Program - 03/14/2024

After longstanding opposition from the Texas Medical Association and others, the Centers for Medicare & Medicaid Services finally nixed the appropriate use criteria program for advanced diagnostic services as part of the 2024 Medicare physician fee schedule.

Feds’ Response to Cyberattack Aids Physicians, But Further Measures Needed - 03/14/2024

Eligible physician practices and others impacted by the recent cyberattack on Change Healthcare now may apply for accelerated and advanced payments for certain Medicare and Medicaid claims.