Stories written by Joey Berlin

CMS Finalizes Cut to Many Physician Payments, Adds Telehealth Codes in 2021 Fee Schedule - 12/04/2020

Medicare has finalized its 2021 physician fee schedule, resulting in payment cuts to many physicians due to the much-maligned budget neutrality requirements the Texas Medical Association has advocated against.


Arbitration Law Will be “Messy,” Bring Operational Concerns, Panelists Say - 12/02/2020

 The state’s new law allowing arbitration of payment disputes on certain out-of-network care carries concerns for physicians and uncertainty about what it will look like from an enforcement standpoint, a panel told the Texas Medical Association Winter Conference on Saturday morning.


Patient Privacy’s New Frontier: AMA Aims to Keep Apps Honest With Personal Health Data - 12/01/2020

In the evolving world of health information technology, some vendors that store and transmit health information – such as the tech minds behind certain mobile apps – are getting their hands on patient data without any HIPAA leash to rein in their use of it. Now, organized medicine is doing its part to preserve patients’ privacy when their health information finds its way outside of HIPAA-covered organizations.


Rewarding Results: Texas Medicare ACOs Perform Promisingly - 11/30/2020

For the Medicare Shared Savings Program (MSSP) and many of the accountable care organizations (ACOs) that participated in it, 2019 was billed as a transition year. But data released by the Centers for Medicare & Medicaid Services (CMS) in September show Texas ACOs fared quite well last year – and a number of Texas physicians and ACO officials say the savings generated are worth the gruntwork that MSSP requires.


The Power of Community: TMA Envisions Locally Focused ACO Model - 11/30/2020

TMA is developing a promising, locally focused version of the accountable care organization (ACO) model that could help cover uninsured and underinsured Texans who fall in the gap or “hole” in the state’s safety net: those who make too much money to qualify for Medicaid coverage as it’s now administered in Texas, but also don’t qualify for Medicare.


Priority: Primary Care - 11/30/2020

The Texas Medical Association and other corners of organized medicine know primary care is part of the bedrock of a sturdy health care system. So medicine – including the Texas Primary Care Consortium (TPCC), of which TMA is a member, and the Texas Academy of Family Physicians (TAFP) – is engaging policymakers to not only help the state’s primary care system survive the pandemic, but also enable it to thrive for the long haul.


Federal Agencies Adopt Rule Mandating Health Plan Price Transparency - 11/24/2020

A number of health plans will be required to be more transparent about coverage pricing starting in early 2021 after the recent adoption of a rule by three federal agencies.


AMA Advocates for 24/7 Prior Authorization Processing - 11/19/2020

AMA delegates passed new policy on Tuesday that advocates for insurers and benefit managers who require prior authorization to have staff available to process  those approvals 24 hours a day, year-round, “including holidays and weekends.”


CMS Increases Advanced APM Thresholds for 2021 - 11/13/2020

If you participated in Medicare’s Quality Payment Program (QPP) this year as a Qualifying Alternative Payment Model Participant (QP), you’ll need to keep an eye on your status for 2021.


Telemedicine Boot Camp: Physicians Get Trained for the Future of Remote Care - 11/12/2020

Thanks in large part to COVID-19, telemedicine has arrived. Where does it go from here? That was much of the focus of a Telehealth Virtual Bootcamp, an Aug. 29 presentation by the Telehealth Initiative that touched on technology, applications, and payment.


Allow Choice Between In-Person and Virtual Learning, TMA Tells School Leaders - 11/12/2020

Although face-to-face education is superior to virtual learning, the time isn’t right for school districts to “completely dismantle” remote schooling, the Texas Medical Association is telling state education leaders.


A Case for More Coverage: Studies Suggest Medicaid Expansion Would Fiscally Benefit Texas - 11/12/2020

Two recent studies suggest expanding Medicaid will not only save Texas money, but add to the Lone Star State’s coffers.


VA Waives State Scope Laws for Nonphysician Practitioners - 11/11/2020

The U.S. Department of Veterans Affairs (VA) is waiving state scope-of-practice laws in an interim rule that takes effect Thursday, effectively allowing VA nonphysician practitioners to practice across state lines at VA facilities without physician overs


TMB Emergency Rule Allows Chronic-Pain Telephone Refills - 11/09/2020

In response to the state’s continuing COVID-19 disaster declaration, the Texas Medical Board adopted a new emergency rule allowing for refills of prescriptions for chronic pain patients who recently saw their doctor via telemedicine.  


TMA Questions QPP Data Showing Most Clinicians Will Receive Medicare Bonus in 2021 - 11/05/2020

The Centers for Medicare & Medicaid Services (CMS) has released preliminary data for the 2019 Medicare Quality Payment Program (QPP), which shows more than 95% of participating clinicians earned an incentive payment that they’ll see next year. However, Texas Medical Association experts are skeptical of the preliminary data.


Champions of Medicine: TEXPAC-Endorsed Incumbents Head to November Elections - 10/30/2020

Each election, TEXPAC, the Texas Medical Association’s nonpartisan political arm, throws its support behind candidates who have demonstrated their support for a medicine-friendly agenda.


Mismatch Game: PMP Errors Could Harm Patient-Physician Relationship - 10/30/2020

Now that Texas prescribers must check a patient’s history in the state’s prescription monitoring program (PMP) before prescribing opioids, plus three other drug classes, the errors are becoming more apparent.  


Mixed Bag: Some Payers Capitalize on COVID Chaos; Others Help Make Care Easier - 10/30/2020

Physicians believe some payers are taking advantage of COVID chaos with their drug policies, but also see some plans taking steps to make care easier during the pandemic.


End-of-Life Challenge Takes a New Turn - 10/30/2020

TMA fights decision that could strip physicians of their ability to exercise their conscience.


CMS Announces Plans to Cover COVID-19 Vaccine - 10/29/2020

The Centers for Medicare & Medicaid Services (CMS) has released a rule to make COVID-19 vaccines available at no cost to Medicare, Medicaid, and CHIP patients.


Road to Recovery: COVID-19 Tests, Bends, and Breaks Texas Practices - 10/27/2020

Ricardo Garza, MD, was still walking the tightrope: standing, but unable to withstand another gust of wind. COVID-19 swept away about 35% of the San Antonio solo cardiologist’s practice revenue, and that was just what he could calculate as he waited for insurers to process straggling claims. But he had returned to in-office operations without any layoffs. While some practices are surviving – and trying their best to prepare for future threats – others weren’t so lucky. On-the-ground experiences align with the Texas Medical Association’s Practice Viability Survey in showing COVID-19 was, and still is, a disruptor unlike any other – challenging or torpedoing the viability of various practice types.


Preserving Do No Harm: Supreme Court Tosses Challenge to Medical Ethics Committee Law - 10/13/2020

Twenty years after it took effect, Texas’ medical ethics committee review law has withstood challenge after challenge. The Texas Supreme Court is on the verge of ending the latest high-profile attack on the law that ensures physicians can uphold their professional obligation to “do no harm.” In October 2019, the state’s high court declined to take up Kelly v. Houston Methodist Hospital, in which the mother of a deceased patient attempted to overturn a provision of the Texas Advance Directives Act. Justices’ action leaves intact an appeals court decision that preserves physicians’ ability to use their medical judgment in end-of-life cases.


TMA Balks at Proposed Medicare Payment Cut, More Changes to QPP During Pandemic - 10/12/2020

Physicians who renew their medical licenses after Sept. 1, 2020, are required to take one hour of CME that addresses human trafficking. TMA has now published its own CME course to educate physicians on how to identify, treat, and respond to people who are at risk or who have been trafficked.


TMA Opposes Bill Defining Clinical Psychologists as Physicians in Medicare - 09/28/2020

A broad swath of organized medicine, including the Texas Medical Association, is asking congressional leadership to oppose a bill that legally would consider clinical psychologists to be physicians within Medicare, saying it “inappropriately” expands psychologists’ scope of practice.


Docs Must Supervise Delegation to CRNAs, TMA Tells Attorney General - 09/21/2020

Texas Attorney General Ken Paxton should state that certified registered nurse anesthetists (CRNAs) require physician supervision when a physician delegates medical acts to them, the Texas Medical Association told the attorney general in response to a request for opinion.