Stories written by Phil West

Mandatory Medicare Specialty Pilot Reveals Texas Participants - 04/02/2026

Just over 1,100 Texas physicians are on the initial participant list for a 2027 program addressing heart failure and low back pain in patients. The program will use the Merit-Based Incentive Payment System’s Value Pathways performance measures, drawing TMA’s attention.

Prior Auth Challenges Physician Effort to Save Patient’s Foot - 03/31/2026

After a peer-to-peer review maintained the determination to deny a San Antonio vascular surgeon’s request for prior authorization, she put the patient’s best interests first and intervened without guarantee of payment. The physician is currently appealing to recoup full payment.

New Types of Medicare Cuts Impact Physician Payment - 03/23/2026

The 2026 Medicare physician fee schedule included a small increase, including a one-time positive payment adjustment, but also included two cuts that could offset those gains. Organized medicine is continuing a dialogue over the changes.

Future of HHSC, DSHS to Be Determined by Sunset Review - 03/18/2026

Every 12 years, each state agency is subject to a sunset review process culminating with the Texas Legislature authorizing its continuation. TMA is providing initial input on two entities instrumental to the state’s health infrastructure.

WISeR Online Prior Auth Process for Original Medicare Shows Promise - 03/16/2026

To educate physicians on the progress of Medicare’s new prior authorization pilot, TMA has been in contact with Cohere Health, the technology vendor selected by the Centers for Medicare & Medicaid Services to manage the program in Texas in partnership with Novitas.

New Medicare Pilot Promotes Technology to Treat Certain Chronic Conditions - 03/16/2026

The program targets high blood pressure, diabetes, musculoskeletal pain, and depression, and encourages the use of wearable devices, including ones patients already have. Physicians have until April 1 to apply for inclusion in July’s initial launch.

Keep AI in Health Care Physician-Centered, TMA Cautions Feds - 03/05/2026

As the federal government looks to encourage more widespread adoption of artificial intelligence (AI) in clinical care, TMA highlights ongoing concerns about interoperability, reliability, and keeping patient data secure.

Advocacy, Passion Motivates Medical Student Scholarship Winners - 03/04/2026

The Harris County Medical Alliance Scholarship has awarded close to half a million dollars in its history. This year, 16 medical students at three Houston schools are receiving scholarships.

PBM Consolidation Concerns Medicine for Impacts on Drug Costs, Access - 03/03/2026

Low competition in the pharmacy benefit manager (PBM) market may drive higher costs with savings not fully passed to consumers. Medicine is vigilant as state and federal legislators have started addressing the entities’ evolving role.

Getting Credit: How Mandated CME is Changing for Texas Physicians - 02/27/2026

New state laws and revamped requirements comprise the most significant changes to CME since 2019.

NPI Requirements Changing for Off-Campus Outpatient Hospital Departments - 02/26/2026

Starting in 2028, each off-campus outpatient hospital department will need its own National Provider Identifier (NPI) separate from the main hospital’s. Payments to hospitals could be impacted by the policy change, which in turn could affect hospital-employed physicians and practice owners partnering with hospitals.

Majority of Nurse Practitioners Satisfied with Physician-Led Health Care - 02/25/2026

In an American Medical Association study involving hundreds of nurse practitioners and physician assistants, nearly all found discussing complex cases with physicians to be a benefit.

Network Adequacy Enforcement Paused for State-Regulated PPOs and EPOs - 02/23/2026

A dispute between the Texas Department of Insurance and Texas Association of Health Plans has reopened rulemaking connected to a 2023 network adequacy law. TMA, which supported that law’s passage, will weigh in on the process.

Quality Measures Transformation Catches Medicine’s Attention - 02/18/2026

TMA does not yet have official policy on the recent initiative aiming to streamline quality measures, but that could change come April. Recently rolled-out examples reflect reform-minded efforts and underscore why medicine must weigh in now.

CME E-Tracking Mandate Begins Sept. 1 - 02/18/2026

Following state legislation, TMB has previewed an arrangement with vendor CE Broker for physicians to log CME. Experienced users suggest documentation tips and timely logging.

Medicare Advantage Plan Audits Resume, with Possibility of Health Plan Recoupment - 02/13/2026

While health plans are responsible for overpayments, physicians may be impacted in turn. Clinicians can review their contracts with health plans for any policies regarding recoupment and what it deems an overpayment.

Medicare Modifier 25 Documentation Under Microscope Following Federal Report - 02/04/2026

A recent federal audit focused on Medicare payments for eye injections revealed overwhelmingly high improper payment rates for evaluation and management services billed with modifier 25 usage. TMA provides information on how to help physicians avoid denials.

TMB Adopts Rules for Two New Physician License Categories Amid Visa Impediments for IMGs - 02/02/2026

International medical graduates (IMGs) and unmatched physician graduates now have rules on how to apply for new license classes created via 2025 legislation aimed at expanding the state’s physician workforce. However, a state halt on certain work visas could also impede the law’s progress.

Federal, State Impediments to H-1B Visas Threaten Texas Physician Workforce - 02/02/2026

A 2025 presidential order requiring a new $100,000 fee for H-1B work visa applicants, followed by a Jan. 27 freeze on new petitions by Gov. Greg Abbott, could squeeze the pipeline of international medical graduates helping to meet the state's health care needs.

Questions About Your TMA Membership? TexMed Has a Member Services Booth for That - 02/02/2026

TexMed 2026 attendees have an on-site destination for information on all TMA membership has to offer, from the Knowledge Center and CME courses, to practice management support and resources for physicians in different practice settings and career phases.

Physicians Now Required to Provide Medicaid Enrollment Info to New Mothers - 01/28/2026

House Bill 3940 was one in a series of bills addressing Medicaid concerns and gives health care professionals tools to inform parents about covering their newborn children. The law also requires a key state agency to share that information with health care facilities.

Medicare Judicial Dispute Threshold Increases in 2026 - 01/28/2026

Physicians who take initial steps to dispute Medicare or Medicare Advantage decisions, upon receiving unfavorable reviews, can opt for two quasi-judicial pathways to resolve the case. However, the amount in controversy in the underlying dispute must meet a minimum amount, which has risen 11% over the past four years.

Rural Ambulance Grant Program Provides $84 Million for Texas Counties - 01/21/2026

More than 40 counties have applied for funding for rural-serving ambulances as of this writing. The funding, made possible by a 2025 bill, could assist the state’s largest county as it faces replacing a four-year EMS partner.

One Insurance Company Holds Majority Share of Texas Market, Per AMA Study - 01/14/2026

Increasing insurance consolidation negatively impacts both physicians and patients, according to the American Medical Association, making advocacy crucial.

Mixed Bag: Federal Changes May Narrow Certain Medicaid Eligibility Provisions, Boost Others - 01/12/2026

Changes on the horizon include a shortened timetable for giving new Medicaid applicants retroactive coverage, more frequent eligibility checks, and an expansion of the populations eligible for home and community-based services. Texas will also need to reconcile an issue concerning CHIP waiting periods and benefit caps.