Action: May 18, 2011

TMA Action May 18, 2011
News and Insights from Texas Medical Association

INSIDE: Dr. Malone Takes Over; Dr. Speer Up Next|

Dr. Malone Takes Over; Dr. Speer Up Next
Remember Eight, at Eight, on the Eighth
TMB to Resume Death Registration Fines
June 15 is 5010 Testing Day
New Medicaid Information Cards Ready
Answer United Claims Questions by May 25
You Can Lead the House of Medicine

Legislature Tunes Up for Big Finale; Encore Possible

TMA Seminars Explain ACOs
Counting Down to June E-Prescribe Penalty
TUS Meeting in Las Vegas Next Month
This Month in Texas Medicine
Do You Twitter? Follow TMA

Dr. Malone Takes Over; Dr. Speer Up Next

C. Bruce Malone, MD, of Austin, became TMA's 146th president in an installation ceremony at TexMed 2011 in Houston on May 14. 

"In this time of disruptive change, we cannot just say 'no,'" Dr. Malone, an orthopedic surgeon, said in his installation address. "We have to help create a reorganized medical marketplace that creates value for the consumer and gives us a right to practice in the public system while having the option to privately contract with patients who want more."Shortly before Dr. Malone's installation, the TMA House of Delegates named Michael E. Speer, MD, of Houston, president-elect. Dr. Speer will be sworn in at TexMed 2012 next May in Dallas.

Dr. Speer, a neonatal-perinatal medicine specialist, has a long history of service to TMA. He was a member of the TMA Board of Trustees from 2004 to 2010 and board chair from 2009 to 2010. He was chair of the board's Committee on Physician Performance and chair of the TMA Council on Scientific Affairs. He also was the TMA representative to the TMF Health Quality Institute and this past year held the position of vice chair of TMA's Ad Hoc Committee on Accountable Care Organizations. 






As part of Dr. Speer's neonatology practice, he works as the deputy chief of pediatrics at The Methodist Hospital, chief of the newborn and premature service at St. Luke's Episcopal Hospital, and professor of pediatrics and ethics at Baylor College of Medicine, where he graduated.

Dr. Speer thanked the TMA House of Delegates and the members of the Harris County Medical Society."Because of my broad practical experience in medicine and proven leadership experience, I know the issues that we are facing. I live with these same issues. More importantly, I have the ideas and the determination to carry TMA through these challenging times so that we can emerge stronger and better than before," he said.

In other house elections:  
  • House Speaker Stephen Brotherton, MD, Fort Worth; Vice Speaker Clifford Moy, MD, Austin; and Secretary/Treasurer Art L. Klawitter, MD, Needville, all won reelection.  
  • The delegates reelected Carlos J. Cardenas, MD, Edinburg; and Austin I. King, MD, Abilene; and elected Dan McCoy, MD, Dallas, to the TMA Board of Trustees.  
  • Board members chose A. Tomas Garcia III, MD, as the new board chair. Dr. Cardenas is the new vice chair; Dr. McCoy is the new board secretary; and Don R. Read, MD, Dallas, and Lewis Foxhall, MD, Houston, are the at-large members of the board's Executive Committee.  

In balloting for an open spot on the Texas Delegation to the American Medical Association, the house chose Jay Shah, MD, of San Antonio, to be the newest alternate delegate.  

Remember Eight, at Eight, on the Eighth

Want to learn how the 2011 legislative session affects you and your patients? Then remember these three numbers: 8, 8, and 8. On June 8 at 8 pm, you can learn what actions legislators took on medicine's top eight issues.

TMA President C. Bruce Malone, MD, will call you at your home telephone number and invite you to stay on the line for TMA's Tele-2011 Legislative Victory Update. For the next 45 minutes, Dr. Malone and TMA's lobby team will discuss these eight issues:  

  1. 2012-13 state budget;  
  2. Employment protections;  
  3. Texas Medical Board reform;  
  4. Scope of practice expansions;  
  5. Health system reform;  
  6. Workforce;  
  7. Public health; and  
  8. Health insurance reform.  

You may ask questions after each topic and use your phone to participate in a survey. And, the best part, you will earn 1 AMA PRA Category 1 Credit™ for your time (providing you stay on the line for the entire program).

If you prefer that we call you on your cell or office telephone, please contact the TMA Knowledge Center by telephone at (800) 880-7955 or by e-mail  by Friday, June 3, and let us know. We hope to talk to you on June 8.

You also can learn more about the 2011 legislative session on TMA's website.

TMB to Resume Death Registration Fines

On June 1, the Texas Medical Board (TMB) will resume disciplining physicians who do not use the Texas Electronic Registrar (TER) Death Registration system to register patient deaths, TMB Executive Director Mari Robinson, JD, told the TMA Patient-Physician Advocacy Committee at TexMed 2011. The fine is $500.

Last November, TMB refunded money to more than 100 physicians who had already been fined and suspended pending cases because of physicians' complaints about the registration system. TMB said the delay in disciplining physicians would last until the 2011 session of the Texas Legislature ends this month.

If you haven't registered and aren't using the system, now is a good time to do so. Here's what TMB said in the January TMB Bulletin: "It's important to note that electronic death certification is here to stay. The health department adopted this system because it is faster for all parties involved, and it's less susceptible to fraud than paper."


June 15 is 5010 Testing Day

The Centers for Medicare & Medicaid Services (CMS) will conduct a National 5010 Testing Day June 15 to help physicians prepare for the switch from ICD-9 to ICD-10 coding standards. Physicians who do not switch to ICD-10 by 2013 will not be paid for treating patients. To use the new coding system in electronic transactions, physicians must convert to HIPAA Version 5010 software standards by Jan. 1, 2012. 

CMS urges Texas physicians to contact TrailBlazer Health Enterprises, the Medicare carrier for Texas, now to gain a better understanding of testing protocols and the transition to Version 5010. It said TrailBlazer will soon provide information on transactions to be tested. Check the TrailBlazer website

Embracing the standard by fully integrating it into work systems and work flow – rather than merely complying with it – will put practices on the right track. Here's why:  

  • Version 5010 corrects many of the flaws of the current 4010 version. Since Version 4010's launch in 2003, software developers have tweaked and patched it to its limits. Version 5010 incorporates hundreds of changes the medical industry has asked for.
  • You can begin to realize the administrative simplification and subsequent savings that HIPAA promised. For example, authorizations will be streamlined, saving time and hassle on the phone for you and your staff.
  • Version 5010 is a vital component for true standardization and interoperability, smoothing the way for widespread use of electronic health records.
  • It will facilitate reporting of clinical data for quality performance measures, which are poised to become a driving factor for payment of claims and performance bonuses.

By now you should be talking to your vendors and taking other steps to prepare for the conversion to Version 5010 and to ICD-10.

TMA can help you ease the way to ICD-10 adoption with boot camps and webinars that examine all angles of the task ahead. Register now. Also, go to the TMA coding page to find more information, including links to free webinars that Blue Cross and Blue Shield of Texas held in April.




New Medicaid Information Cards Ready

New bilingual general information cards for the Children's Health Insurance Program/Children's Medicaid may be ordered online on the CHIP/Children's Medicaid website. There is no charge.

The new cards feature an updated income guideline chart with income limits based on 2011 federal poverty guidelines. They are the only CHIP/Children's Medicaid outreach materials that include the 2011 income guideline chart. The Health and Human Services Commission says it  plans to print updated CHIP/Children's Medicaid general rack brochures with the new income guideline chart this summer. Until then, the cards are the best option for sharing the most current income guideline information with families.

Physicians may view or update subscriptions, passwords, or email addresses at any time on the User Profile Page. Enter your email address and password (if you selected one).

If you have any problems with the subscription service, email support[at]govdelivery[dot]com for assistance.   


Answer United Claims Questions by May 25

Did you file a claim for the UnitedHealth Group settlement and then receive a postcard from the settlement claims administrator asking for more information? If so, you need to be certain any questions regarding your claim are resolved by May 25 to receive payment.

The AMA Practice Management Center offers an  updated step-by-step resource [PDF] to help you complete your claim once you have received your requested data report from the settlement claims administrator. Visit the  AMA website  to access this resource and additional information regarding the UnitedHealth Group UCR settlement.

If you requested a data report from the settlement claims administrator in anticipation of filing a claim and believe you never received the data report, you should immediately contact the settlement claims administrator by telephone at (800) 443-1073, by fax at (516) 222-0271, or by email at unitedhealthcare[at]berdonclaimsllc[dot]com.


You Can Lead the House of Medicine

Who will lead medicine into the future? Will it be you?

If you are 40 or younger or in the first eight years of practice, the Texas Medical Association Leadership College (TMALC) can put you on the path to becoming a leader in TMA and organized medicine. The leadership college now is accepting applications for the TMALC Class of 2012. There is no tuition. This is a free TMA member benefit. June 15 is the deadline to apply.

Now more than ever, TMA needs young new leaders to continue our vision to "Improve the Health of All Texans." Now in its second year, TMALC is an intensive leadership program designed to identify, orient, and train young TMA members for future leadership positions at the county and state levels. Its mission is to ensure strong and sustainable leadership and to promote the role of physicians as trusted leaders in their local communities.

The 2012 class will be limited to 20 to 30 physicians. The program combines the elements of organizational education, skills training, mentoring, and guided experiences that cover the three "Ps" of leadership: philosophy, principles, and practice. 

Class of 2010-11 scholars already are putting their training to work. The majority of class members have been placed in TMA leadership positions, and all have been placed in positions with their county society and/or Texas specialty society.

To learn more about TMALC and the application process for 2011-12, visit the TMA website  or request an emailed application by contacting the TMA Knowledge Center by telephone at (800) 880-7955 or (512) 370-1550 or by e-mail.  The new class starts in Austin, Oct. 20-23, and concludes at TexMed in Dallas, May 18-19, 2012.   



TMA Seminars Explain ACOs

If you are thinking about joining an accountable care organization (ACO) or if you don't know what an ACO is, TMA has the answers you need in a series of seminars across Texas this summer. The series, What Health Reform & "Accountable" Care Mean to Physicians, will address whether ACOs are an opportunity or challenge, understanding and negotiating employment contracts, new payment models, and health information technology.

Loosely defined, an ACO is a collaboration of health care providers who accept responsibility for the costs, quality, and effectiveness of care delivered to a defined patient population. The Centers for Medicare & Medicaid Services will launch the ACO model as a voluntary program no later than January 2012. And although ACO regulations have not been finalized, many hospitals and physicians are rushing to form collaborations – worried they'll be locked out of the market as ACOs expand beyond Medicare. TMA will conduct a free webinar update when the rules are finalized.

You may earn 3 hours of continuing medical education credit by attending one of the seminars. Physicians who are insured with the Texas Medical Liability Trust and complete this course will earn a 3-percent discount (not to exceed $1,000), which will be applied to their next eligible policy period.  

TMA does not endorse participation in an ACO or any other postreform program. Physicians are encouraged to be wary, to be informed, and to take the time to learn about these systems, understand their differences, and what they can mean to their practice and their patients.


Counting Down to June E-Prescribe Penalty

Texas physicians have until June 30 to e-prescribe to avoid penalties in 2012 (1 percent of Medicare Part B claims). If you are not already e-prescribing in your office, act immediately to avoid this penalty. If you are not already using an electronic health record (EHR) system with e-prescribing capabilities, you can install a standalone e-prescribing system and still meet the approaching deadline. Physicians can even use a free e-prescribing service to avoid the penalty.  

Physicians must report e-prescribing via claims using G-code G8553 on at least 10 unique Medicare encounters by June 30 to prevent the penalty. Report at least 25 times by Dec. 31 to qualify for a 1-percent bonus of Medicare Part B claims and prevent the penalty in 2013.  Follow the instructions in TMA’s 2011 E-Prescribing informational paper [PDF], e-mail or call the TMA HIT helpline for more information at (800) 880-5720.If you need help with e-prescribing, turn to the Texas regional extension centers (RECs). RECs provide support to primary care physicians to help with e-prescribing, EHR selection, workflow analysis, staff training, EHR incentives, and much more. At a cost of $300 per eligible physician, you can get a consultant on site at any location in Texas. Visit TMA's Texas REC Resource Center for more information.

The Centers for Medicare & Medicaid Services (CMS) has offered the e-prescribing incentive since 2009 to encourage the use of e-prescribing to improve the efficiency and safety of health care. E-prescribing is a way to prevent medication errors that arise due to difficulties in reading or understanding handwritten prescriptions.    






If you plan to apply for the Medicare EHR incentive in 2011, note that you can't receive the e-prescribing incentive in the same payment year. Physicians enrolled in the federal Medicare EHR incentive program can still be penalized in 2012 if they do not report 10 e-prescriptions via claims using G-code G8553. Physicians applying for the Medicaid EHR incentive are still eligible for e-prescribing incentive payments.  

How can physicians e-prescribe for free?
The National ePrescribing Patient Safety Initiative (NEPSI) allows physicians to e-prescribe on any computer with an Internet connection for free. The product does not offer technical support, and it is vendor-sponsored with advertisements. NEPSI offers a qualified system and will allow eligible physicians to earn an e-prescribing incentive and avoid the 2012 penalty. 

What systems does TMA recommend?
TMA does not have an endorsed e-prescribing product. Surescripts, the nation's largest e-prescribing network, maintains a list of certified standalone e-prescribing products . Physicians should expect to pay around $50 per month for a standalone e-prescribing service.  

What type of encounter will count as an event?  
A physician must generate at least one electronic prescription using a qualified system during a patient visit from a set of defined services. Multiple prescriptions to the same patient constitute only one event. 


TUS Meeting in Las Vegas Next Month

The Texas Urological Society Annual Meeting will be held June 9-11 at the Venetian Hotel in Las Vegas.

Jim Rohack, MD, immediate past president of the American Medical Association, will discuss why physicians should support AMA even if they feel AMA does not support them. Other presentations will cover pelvic pain, prostatitis, penile reconstructive surgery, and how and why urologists should collaborate with medical oncology.

You may make hotel reservations online or by calling (888) 283-6423 or (702) 414-4100. May 20 is the deadline to make a reservation.

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 Month in Texas Medicine

The May issue of Texas Medicine describes state officials' desperate attempts to control the burgeoning Medicaid budget, tells you how TMA helped rescue three physicians dealing with overzealous state regulators, and outlines physicians' attempts to reduce teen pregnancy. You'll also learn about a new quality improvement project and find out what TMA did for you and your patients last year.


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 are TMA-member physicians saying on Twitter each day about health care, politics, science, and more? You don’t need a Twitter account to be part of the conversation. The TMA Member Physicians Daily comes out around 10 am each day. You can subscribe via e-mail or RSS feed. TMA’s own Twitter feeds reach more than 20,000 unique individuals online each week.


 Legislature Tunes Up for Big Finale; Encore Possible

TMA Vice President for Advocacy Darren Whitehurst likes to say that the end of a legislative session is like the final crescendo of a great orchestra – either the musicians come together and make beautiful music or the whole thing falls apart.  

Judging by where the 82nd Texas Legislature stands with just two weeks remaining in its session, the end could sound less like an orchestra and more like a train wreck. Virtually none of the major issues have been finalized. The budget for 2012-13 is unfinished. Redistricting bills have not been completed; in fact, no congressional map has even been proposed. And a plethora of issues of importance to organized medicine – such as a statewide smoking ban and bills to move Medicaid toward quality-based payments and to create health care collaboratives similar to accountable care organizations – were still in limbo.

Instead of focusing on the major issues, TMA officials say lawmakers spent considerable time squabbling over requiring women to get sonograms before abortions or outlawing so-called sanctuary cities – issues that tend to fray legislative nerves and distract lawmakers from the bigger issues.






In fact, the sonogram bill, a measure to allow some rural hospitals to directly employ physicians, and a measure allowing international medical graduates (IMGs) in graduate medical education (GME) programs to apply for licensure in Texas after two years of residency training appear to be about the only issues affecting organized medicine that have been finalized so far in this session.

Still, as Political Prognosis was prepared, lawmakers had 13 days left to wrap up their work. The question is can they produce a budget – the only bill they are constitutionally required to pass – in that time? If not, they will certainly be back in special session sometime before the end of the state fiscal year on Sept. 1.

Finalizing a Budget
TMA officials say success or failure of this legislative session rides on the legislature's ability to craft a final budget. Both the House and Senate have passed their budget bills, but the two are some $12 billion apart, which means a final budget compromise must be worked out by a House-Senate conference committee.

The Senate bill includes some $176.5 billion in spending, compared with $164.5 billion in the House bill. Most of the difference in those budgets can be found in the articles involving health care and education. TMA has thrown its support behind the Senate's budget bill, which spares Medicaid from much steeper cuts found in the House bill. The Senate bill maintains current Medicaid physician payment rates. The House bill, by comparison, cuts Medicaid fees by 10 percent. Earlier this week, the conference committee announced it had agreed to the Senate's plan for Medicaid and most other health programs. Education spending, however, remained unresolved.

The Senate bill includes more formula funding for both undergraduate and GME and saves primary care GME programs administered by the Texas Higher Education Coordinating Board. The House bill zeroes out those programs. The Senate bill also retains one of two physician education loan repayment programs that would be eliminated under the House bill and provides more funding than the House bill for mental health programs.

A little relief came May 17 when Texas Comptroller Susan Combs said she was increasing her revenue estimate for the next two years by $1.2 billion. She cited expected stronger performance of sales and oil production taxes.

But time is running out to get the budget done partially because the Senate was stymied in passing its bill for days because sponsors couldn't get the 21 votes needed to suspend Senate rules to bring it up. Finally in early May, Senate leaders used a parliamentary maneuver that required only a majority vote and passed the bill 19-12.

TMA lobbyists say the budget conference committee likely will have to craft its compromise by the middle of this week to meet legislative deadlines to print and distribute the budget bills for legislators to review before a final vote. If the committee can't meet that deadline, lawmakers will have to come back in special session sometime later this year to pass a budget.

Meanwhile, both chambers have numerous bills that are critical to balancing the state budget, including the so-called fiscal matters bill that identifies various cost savings throughout the budget; Senate Bill 23, which would provide about $426 million in various savings in Medicaid, including expanding Medicaid managed care to the Lower Rio Grande Valley, and public education bills that would produce a number of cost-saving measures, such as increasing class size.

If lawmakers fail to finalize those measures, Comptroller Combs may not be able to certify the budget as balanced, as required by the Texas Constitution. That again could result in lawmakers having to come back into special session.

Medical Board Reform
A package of TMA-backed bills to provide more fairness in the Texas Medical Board’s (TMB's) disciplinary process was moving forward and appeared poised to pass, possibly as early as this week. SBs 190, 191, and 227 by Sen. Jane Nelson (R-Flower Mound) include reforms that would do away with anonymous complaints; require disclosure of complaints filed by insurance companies, pharmaceutical companies, or their agents; extend the amount of time a physician has to respond to notice of a complaint; give the board flexibility to deal with minor infractions with nonpunitive remedial action plans rather than fines or public disciplinary actions; and bind the TMB to findings of fact and conclusions of law issued by an administrative law judge from the State Office of Administrative Hearings.

Those measures have passed the Senate and were pending on the House Local and Uncontested Calendar Committee, which – if they can be placed on the House's calendar without delay – likely means they would pass without further amendment and go straight to the governor to be signed into law.

Another TMB reform bill originally opposed by TMA – House Bill 1013 – passed the House but appears to be stalled in the Senate. A number of the bad provisions in the original legislation have been removed, but TMA leaders are still concerned with some of the details in the bill. If the bill weakens the ability of TMB to remove bad physicians from practice, it would likely weaken the 2003 medical liability reforms by driving more complaints back into civil district court.

The Employment Compromise
One bill that has passed is a measure by Sen. Robert Duncan (R-Lubbock) to allow some rural hospitals to directly employ physicians. The final bill was a compromise between TMA, the Texas Organization of Rural & Community Hospitals, and others. It limits the ability to employ physicians to hospitals in counties of less than 50,000, critical access hospitals, and sole community providers. The bill contains strong language supported by TMA to protect the employed physician's clinical autonomy from intrusion by hospital administrators.

Gov. Rick Perry signed the bill May 12.

Meanwhile, another bill by Sen. Duncan, which would give physicians employed by 501(a)/not-for-profit corporations similar rights as under the rural bill, passed the Senate and also was pending on the House local calendar. That bill would protect physicians' independent medical judgment within these organizations and give TMB flexibility in disciplining 501(a) corporations for violations. Currently, TMB can only grant or revoke a 501(a) corporation's certification to operate in Texas.

Still in Play
A slew of health care bills still are working their way through the process. While a standalone statewide smoking ban bill likely is dead, TMA is working to pass another measure to which it can add a variation of that ban, likely with some exceptions needed to gain the necessary legislative votes.

Also, two major bills that would impact Medicaid and private health insurance were working their way toward passage. SB 7 by Senator Nelson would move Medicaid away from a fee-for-service payment system and toward quality-based payments. SB 8, also by Senator Nelson, would authorize creation of health care collaboratives in both Medicaid and private insurance. Those collaboratives would be modeled largely after so-called accountable care organizations through which physicians, hospitals, and other health care providers can partner to provide care to a defined group of patients.

TMA supports those measures in their current form, but officials say they are still working with Attorney General Greg Abbott to ensure that these collaboratives do not violate antitrust laws and that there are safe harbors in place for physicians who participate in them. Further, TMA supports the idea that the governance of the collaboratives include equal physician participation to ensure that both clinical and financial decisions of the organization focus on patient care issues as well as economic issues.  TMA also wants to ensure that dominant hospital-led competitors do not drive physicians who don't participate in the collaboratives out of the marketplace.

One significant bit of good news is that most bills that sought to expand allied health practitioners' scope of practice seem to be going nowhere. TMA is keeping an eye out for any attempts to tack scope-related amendments onto other bills.

Texas Medicine Senior Editor Ortolon prepared this special supplement to Action.   


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

Medical Records & Documentation in a Post-Reform World
6/16      Austin
6/23      Fort Worth 
7/19      McAllen
7/20      Houston
8/3        San Antonio  

Special Group and Hospital Programs
7/12      McKinney
7/13      Abilene
7/27        Lufkin
8/4       Amarillo   

What Health Reform & "Accountable" Care Mean to Physicians
6/7      Austin
6/8      Lubbock
6/21    Abilene
6/22    Amarillo
6/28    Fort Worth
6/29    Dallas
6/30    Houston
7/12    San Antonio
7/13    McAllen

Recorded Web Seminars

Avoiding RAC Audits
Communication Skills: Why Bother?
Evaluating Your Medicare Options
Prepared for ICD-10?
Meaningful Use
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

Family Systems: The Impact of Marriage and Family on Physicians
9/10         Amarillo
10/20       El Paso

Challenging Behaviors, Recovery, and Physician Health Programs
9/16-17   San Antonio

About Action

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Last Updated On

January 27, 2016