Action: Jan. 4, 2011

TMA Action Jan. 4, 2011
News and Insights from Texas Medical Association


INSIDE: EHR Incentive Registration Begins   


EHR Incentive Registration Begins
Texas HIEs Seek Physician Commitments
TMA Challenges Chiropractors' Rules Again
Medicare Money Overdue, TMA, AMA Say
Primary Care Bonuses Kick In
CMS Delays Lab Signature Rule
Renew Your Dues Today
BCBS Posts BlueCompare Information

Flu Vaccine Recalled
Tell Us Your Story
State Revises Foster Care Drug Rules
Donations to TMAF Improve Health
Come to Winter Conference Jan. 28-29
This Month in Texas Medicine
Do You Twitter? Follow TMA

EHR Incentive Registration Begins

Starting in 2011, significant incentives are available for physicians who "meaningfully use" an electronic health record (EHR). You must register to participate. To enroll, visit the Centers for Medicare & Medicaid Services (CMS) registration and attestation web page. 

Have your tax identification and National Provider Identifier numbers handy when registering and be prepared to select one of the two available programs, Medicare or Medicaid. The Medicare incentives are up to $44,000 over five years. Medicaid incentives are up to $63,750 over six years but require a threshold of 30 percent Medicaid encounters (20 percent for pediatricians).   


"With the start of registration, these landmark programs get under way, and patients, providers, and the nation can begin to enjoy the benefits of widespread adoption of electronic health records," said CMS Administrator Donald Berwick, MD.

For physicians planning to participate in the Medicaid EHR incentive program, in addition to the CMS registration, there also are Texas Medicaid enrollment requirements. Texas Medicaid will host a webinar demonstration of the enrollment process. The webinar will be on Thursday, Feb. 3, at 1 pm and 6:30 pm. For details and to register, click here. 

Regional extension centers (RECs) provide federally subsidized consulting to help physicians select and implement an EHR system and to meet federal "meaningful use" requirements for EHR incentive eligibility. Primary care physicians and specialists who can attest to providing primary care services are eligible for the consulting services, which cost $300 per year (valued at $5,000). For more information, visit TMA's Texas Regional Extension Center Resource Center.  

For answers to questions on these programs or other health information technology (HIT) issues, contact TMA's HIT experts by calling (800) 880-5720 or by e-mailing


Texas HIEs Seek Physician Commitments

Health Information exchanges (HIEs) around the state that are applying for federal grant funds are seeking commitments from local physicians. The number of physician commitments received affects the amount of funding for which the HIE is eligible and becomes part of the funding formula. For each physician committed to a particular HIE, that HIE gets $300. Physicians may participate in more than one HIE, but for funding purposes, physicians can only sign commitment to one.  

In basic terms, an HIE is a way to use technology to make patients' health information available anywhere, anytime.

Before committing to participate in a local HIE, physicians need to ask questions. The following questions have been compiled from physician health information technology experts:

  • What privacy and security mechanisms does the HIE feature? Physicians should learn what policies and procedures HIEs have developed on how they'll obtain patient consent for use of the data. If a patient chooses to exclude some data from being shared, the physician should ensure the HIEs disclose that fact.  
  • Does the HIE cover patient populations, encompass referral networks, and include the hospitals and physicians you work with? Physicians should make certain the HIEs they participate in connect with the local hospitals, labs, radiology services, and other facilities. Taking part in an HIE with limited connections could result in a physician making decisions based on partial information.  
  • Will the HIE be financially viable in the future? It's not simple to move from one HIE to another. Physicians should ensure the HIE they participate in has a thorough business plan with strategies for long-term success and staying power. If the HIE has been in existence for a while, physicians should ask their colleagues about the exchange's track record and functionality.  
  • Is there a fee to participate? Many HIEs will be free to use initially, but physicians should ask whether potential future fees have been addressed.  
  • Who is on the HIE board of directors? HIE governance should be representative of health care stakeholders in the community.  
  • What are the system requirements to connect to the HIE?  
  • Does the HIE use a centralized model or a decentralized model? Physicians participating in exchanges that use a centralized model obtain a patient's permission to have their records and information stored in a database. Physicians and other health care professionals can query the database for patient information and share it with others. A decentralized model allows for organizational control of data in which the physician stores patient information while permitting authorized personnel and entities access.
  • What opportunities are there for physicians to provide feedback on HIE operations? Physicians should inquire about their ability to attend HIE meetings and to weigh in on the system's functionality.  
  • What information will be shared via the HIE? Some HIEs will share only lab data, while others will allow access to discharge summaries, notes, test results, and more.

The February issue of Texas Medicine will feature an in-depth report on HIEs in Texas. For answers to questions on HIEs or other health information technology (HIT) issues, contact TMA's HIT Department by calling (800) 880-5720 or by e-mailing

TMA Challenges Chiropractors' Rules Again

Chiropractors are trying to get around a court ruling and expand their scope of authority beyond what they are trained to do, TMA charges in a letter to Glenn Parker, executive director of the Texas State Board of Chiropractic Examiners.

Last year, an Austin state district judge ruled that a chiropractic license does not authorize chiropractors to perform manipulations under anesthesia (MUA) and needle electromyography (EMG) procedures. TMA sued in 2006 to block the chiropractic board's rules because, the association said, MUA and needle EMG constitute the clinical and legal practice of medicine.

Since then, the chiropractic board has proposed new rules governing chiropractors' treatment of their patients.

In TMA's letter, President Susan Rudd Bailey, MD, addresses section 75.17 of the rules and says the proposals are "a bad faith effort … to circumvent the court's final judgment …"  She added that "as if to completely disregard the prior litigation and court's ultimate ruling, the board is attempting to expand by rule the scope of chiropractic. This expansion is not permitted by the legislature, the courts, or the attorney general."

The letter does not mince words. For example, regarding the chiropractic board's proposal on "subluxation complex," the letter reminds Mr. Parker that "it is the state legislature, and not a limited number of members of the Board of Chiropractic Examiners, that has been given the right and duty to define the practice of chiropractic in the state of Texas. The health and welfare of Texans is at risk when these few men and women try to impermissibly expand the scope of chiropractic, a piece at a time, at their board meetings. TMA, therefore, strongly recommends removing this amendment from the proposed rules."

Dr. Bailey's letter concludes that the proposed rules permit chiropractors "to diagnose and determine if a patient, with virtually any disease, condition, or abnormality of the body, may benefit from chiropractic care. A chiropractor is not permitted to diagnose virtually any condition, disease, or abnormality of the body, and make the determination of whether a person with various conditions, diseases, or abnormalities may safely undergo chiropractic treatment. A medical professional should be involved immediately whenever a chiropractor notes an 'unusual finding' that does not involve the biomechanics of the spine and musculoskeletal system. This is a public health issue."


Medicare Money Overdue, TMA, AMA Say

TMA has joined the American Medical Association and state and specialty societies across the country in a letter [PDF]asking Health and Human Services Secretary Kathleen Sebelius to pay physicians overdue Medicare fees. We're calling on the Centers for Medicare & Medicaid Services to use the $200 million Congress allocated to provide physicians long-overdue Medicare payments they should have received earlier this year.

TMA joined in a second letter asking Secretary Sebelius to revise Medicare's e-prescribing penalties. That policy, which would penalize physicians in 2012 if they don't e-prescribe in the first six months of 2011, will hurt efforts to implement widespread health information technology adoption among physician practices and cause them to take on needless financial and administrative burdens.

"After weathering a year filled with uncertainties from continuous threats of cuts to Medicare payments, many physicians are not in a position to rely on IOUs from the government," said AMA President Cecil Wilson, MD.

e-MDs Ad  


Primary Care Bonuses Kick In

Medicare has begun paying primary care physicians a 10-percent bonus for providing primary care services. The Primary Care Incentive Program [PDF] is part of the Affordable Care Act, otherwise known as health system reform,  that Congress passed last year.

 Paid quarterly, the payments equal 10 percent of the payment amount for primary care services under Medicare Part B. Primary care physicians (physicians enrolled in Medicare with a primary specialty of: family medicine, internal medicine, geriatrics, or pediatrics) and nonphysician practitioners (practitioners enrolled in Medicare as physician assistants, nurse practitioners, or clinical nurse specialists) who furnish primary care services involving the following service codes from Jan. 1, 2011, through Dec. 31, 2015, are eligible for the payments:  

  • 99201–99215,   
  • 99304–99340, and  
  • 99341–99350.   
 The Centers for Medicare & Medicaid Services (CMS) says physicians should remember these key points: 
  • Primary care services must account for at least 60 percent of the allowed charges under Part B for the provider in a prior period.
  • If a group or practice bills for a primary care service, the primary care professional service must be rendered by one of the eligible providers and be reflected by the rendering National Provider Identifier (NPI) for the claim detail.
  • CMS will extract eligible providers by rendering NPIs and provide contractors with the information at the beginning of each year. These two files will be issued to Medicare contractors:
    • PCIP Eligibility File – Lists qualifying NPIs. Medicare contractors will post this file on their websites by the end of January of each year. The incentive will be calculated on the amount paid for each quarter for the codes billed by the Provider Transaction Access Numbers  associated with each qualifying NPI listed on the file.
    • Physician/Specialty File – Lists physician/nonphysician practitioner information by NPI.

In addition to the bonuses, Medicare began reimbursing physicians for an annual checkup or wellness visit [PDF] for beneficiaries. This also is part of the health system reform bill.

Finally, the Affordable Care Act waives copayments [PDF] for most preventive services. Medicare will pay 100 percent of the cost of these services.

CMS Delays Lab Signature Rule

The Centers for Medicare & Medicaid Services (CMS) says it is delaying until April enforcement of a requirement that a physician or qualified nonphysician practitioner (NPP) sign requisitions for clinical diagnostic laboratory tests paid for under the 2011 clinical laboratory fee schedule.

"Although many physicians, NPPs, and clinical diagnostic laboratories may be aware of and are able to comply with this policy, CMS is concerned that some … are not aware of or do not understand this policy," a CMS statement said. "As such, CMS will focus in the first calendar quarter of 2011 on developing educational and outreach materials to educate those affected by this policy. As they become available, we will post this information on our website and use the other channels we have to communicate with providers to ensure this information is widely distributed. Once our first quarter of 2011 educational campaign is fully under way, CMS will expect requisitions to be signed."

Twenty-nine health care organizations representing hospitals, labs, and lab technicians oppose the requirement. They called it "redundant and burdensome" in a letter to CMS. They said they will try to get it repealed.


Renew Your Dues Today

Please don't wait any longer to renew your membership. We are facing the biggest challenges ever seen in our health care system. And the uncertainty is threatening to upset your practice and the care of your patients as you know it.

With the upcoming legislative session right around the corner, you should know that no organizations are better equipped to fight for and serve you in these difficult times than are TMA and your county medical society.

Installment options are available. For more information, call the TMA Knowledge Center at (800) 880-7955 or e-mail TMA Knowledge Center.


BCBS Posts BlueCompare Information

Blue Cross and Blue Shield of Texas has posted online the presentation from the Dec. 22 webinar [PDF] about its BlueCompare program. It was the only webinar the company conducted on the program, which rates some 18,000 Texas physicians in 14 specialties.

TMA's Payment Advocacy Department staff and an ad hoc committee of physicians are developing a toolkit to guide physicians on how to appeal their ranking. It will be published on the TMA website.

The specialties reviewed are:  

  • Allergy-immunology,  
  • Cardiovascular disease-noninterventional,  
  • Cardiovascular disease-interventional,  
  • Endocrinology,  
  • Family practice,  
  • Geriatric medicine,  
  • Internal medicine,  
  • Nephrology,  
  • Neurology,  
  • Obstetrics and gynecology,  
  • Pediatrics,  
  • Pediatric allergy-immunology, and  
  • Pediatric pulmonary disease.  
  • Pulmonary disease.




Flu Vaccine Recalled

Cracked vials prompted the U.S. Food and Drug Administration to recall one lot of the 2010-11 Novartis Fluvirin vaccine. The lot involved is 111812P1.

The Texas Department of State Health Services says the lot was not shipped to any Texas providers via the Texas Vaccines for Children program, but some may have received it through private purchases. However, this vaccine could possibly have been received through private purchases. Novartis recommends contacting the distributor if you received the vaccine.


Tell Us Your Story

The patient-physician relationship is medicine's secret weapon. We need to make it not so secret. Every physician has a story. What's yours?

On the TMA website, we've posted a very short video from Fort Worth pediatrician Gary Floyd, MD. He tells a story only a physician can tell: what it means to be someone's doctor, the trusting relationship between physician and patient. Every Texas physician has a story like this. We want to share these stories ... with lawmakers and the public. The power in these stories will help them understand the problems in medicine today and how we hope to solve them.

So, what's your story? Why did you go to medical school in the first place? Do you remember that patient encounter that brought it all home to you? The patient you think of when times are tough? Tell your story to a video camera. We don't care if it's your cell phone, a flip camera, or a full-featured video recorder. Just "get it down on film" and send it our way. TMA has set up a special YouTube channel where you can upload your story. Just follow the simple directions on the TMA website.


State Revises Foster Care Drug Rules

With help from TMA and the psychiatric, pediatric, and family practice specialty societies, the state updated parameters for use of psychotropic drugs for foster children [PDF]. TMA and the societies helped develop the original parameters and also provided input on the latest version.

The new parameters include updated references and medications introduced since the last revision, as well as more detailed information about indications for usage, warnings, and precautions; age-specific dosage ranges; and metabolic monitoring where indicated. They are resources for physicians and clinicians who care for foster children diagnosed with mental health disorders such as attention-deficit hyperactivity disorder, disruptive behavioral disorders, major depressive disorder, bipolar disorder, and anxiety disorder.

TMA, the Texas Department of Family and Protective Services (DFPS), The University of Texas at Austin College of Pharmacy, the Federation of Texas Psychiatry, the Texas Pediatric Society, and the Texas Academy of Family Physicians developed the guidelines in 2005 after complaints that some clinicians relied too much on psychotropic medications to treat children in foster care. They were updated in 2007 and again this year.

"The goal then, as it is now, was to support the safe, effective, and appropriate administration of these psychotropic medications," DFPS says in a letter to the foster care network. The letter adds that the parameters "resulted in a significant decrease in utilization of psychotropic medications among foster children in Texas, and the guidelines have been influential in the development of several other states' monitoring efforts."


Donations to TMAF Improve Health

Thousands of Texans will be safer and healthier in 2011 thanks to physicians, their families, and institutions that have donated to the TMA Foundation (TMAF). Their generosity is reflected in more than $230,000 in grants to TMA's award- winning Hard Hats for Little Heads and Be Wise — Immunize  programs, as well as the Minority Scholarship Program, the Ernest and Sarah Butler Awards in Excellence in Science Teaching,and the Physician Oncology Education Program. 

Top institutional gifts from Blue Cross and Blue Shield of Texas, H-E-B, and Prudential and a grant from an anonymous foundation are the key to ensuring that these flagship programs continue to help Texans take preventive steps and greater responsibility for their health.

There are many ways to get involved with these TMAF-supported programs. TMA and TMA Alliance members can bring a Hard Hats or Be Wise event to their community. Most of these programs include free physician and patient educational materials.

For more information about these programs and how to support them, visit the TMAF webpage or call TMAF at (800) 880-1300, ext. 1664, or (512) 370-1664.  



Come to Winter Conference Jan. 28-29

Uncertainty regarding the effects of health system reform has many physicians caught in a holding pattern. Pending regulations have prompted unprecedented interest by hospitals and large groups to employ physicians. Medicaid expansions and budget shortfalls have state legislators scrambling for new health care delivery and funding options. Compounding the ambiguity, Congress has yet to correct an unredeemable Medicare payment formula that has many doubting the long-term viability of their medical practices.

Join your colleagues at TMA's 2011 Winter Conference Jan. 28-29 at the AT&T Conference Center in Austin to discuss these important issues. Here's the schedule:

Friday, Jan. 28

8 am-10 pm
TMA business meetings

1-3 pm or 3-5 pm
Legislative testimony training workshop (preregistration required)

Saturday, Jan. 29

6 am-5 pm
TMA business meetings

7:30-8:30 am
Networking breakfast

8:30-11:30 am
General Session: Policy, Politics, and Practicum

11:45 am-5 pm
County Medical Society Leadership Forum (preregistration required)

You may register online for the conference meetings and events.

Book your room at the AT&T Conference Center online. Use code TXMEDA0111 to receive a $179 discounted room rate. This offer expires Jan. 6 or whenever the TMA room block sells out. You also may call (877) 744-8822 to make your reservation.

For more information, call the TMA Knowledge Center at (800) 880-7955, or e-mail TMA Knowledge Center.  


This Month in Texas Medicine

The January issue of Texas Medicine  tells you what TMA learned in its 2010 survey of physicians and interviews several doctors to put faces on all the numbers. It also reports on the budget dilemma lawmakers face this year, how you can use technology in your practice to improve your bottom line, and why the state attorney general is suing six obstetrician-gynecologists in Grapevine. And, you'll learn why AMA is talking about taking a new direction.  


Texas Medicine RSS Feed

Don't want to wait for Texas Medicine to land in your mailbox? You can access it as an RSS feed, the same way you get the TMA Practice E-Tips RSS feed.  


E-Tips RSS Feed

TMA Practice E-Tips, a valuable source of hands-on, use-it-now advice on coding, billing, payment, HIPAA compliance, office policies and procedures, and practice marketing, is available as an RSS feed on the TMA website. Once there, you can download an RSS reader, such as Feedreader, Sharpreader, Sage, or NetNewsWire Lite. You also can subscribe to the RSS feeds for TMA news releases and for Blogged Arteries, the feed for Action


Do You Twitter? Follow TMA

As part of its work to explore new communications technologies, TMA regularly publishes on Twitter, the hot, 140-character "micro-blogging" service.

If you Twitter, follow TMA to get practice management tips, news bits, and political chatter – and we'll follow you, too. If you don't know what we're talking about, click here to check it out.


What Can Practice Production Numbers Tell You?

Consider these factors if your production isn't consistent.

A practice management tip from
TMA Practice Consulting


This Just In ...

Want the latest and hottest news from TMA in a hurry? Then log on to Blogged Arteries. You can hear the latest Podcast TMA episodes and read the most recent news from Action and Texas Medicine

TMA Seminars

Practice Management, Ext. 1421

Recorded Web Seminars

Avoiding RAC Audits
Communication Skills: Why Bother?
Evaluating Your Medicare Options
Medical Records-Consent for Treatment of Minors
Patient-Physician Relationship
Patient Satisfaction
Professional Courtesy: Waiving Copays, and Charity Care Requirements
 Revenue Cycle Management  

Physician Health and Rehabilitation, Ext. 1342

PHR Training Session
2/18      Frisco  

PHR Retreat: Disruptive Behavior, Dual Diagnosis, and Relapse Prevention
2-18-19 Frisco  

Family Systems: The Impact of Marriage and Family on Physicians
4/2       Tyler
4/16      Galveston
9/10      Amarillo
10/20    El Paso

About Action

Action, the TMA newsletter, is e-mailed twice a month to bring you timely news and information that affects your practice.

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If you have any technical difficulties in reading or receiving this message, please notify our managing editor, Shari Henson. Please send any other comments or suggestions you may have about the newsletter to Larry BeSaw, Action editor.