Action: June 15, 2011


TMA Action June 15, 2011
News and Insights from Texas Medical Association

INSIDE: Last Call to Avoid Medicare Penalty

  Last Call to Avoid Medicare Penalty
RxEvent Improves Patient Safety
CMS to Sell Medicare Data
TMA Announces Member Benefit for PQRS
Seminars to Teach Death Registration
Practice Management Webinars: A Good Deal
TMA Seminars Explain ACOs

The Death of Private in Private Practice
TMB Needs Physicians to Review Cases
Be a TMAF Star
POEP, TSU Cancer Meeting Rescheduled for July 29
This Month in Texas Medicine
Do You Twitter? Follow TMA

Last Call to Avoid Medicare Penalty

Physicians who have not e-prescribed at least 10 times by June 30 may be penalized (1 percent Medicare Part B) for the 2012 calendar year. The Centers for Medicare & Medicaid Services (CMS) estimates 209,000 physicians and other providers will be penalized.

The penalty increases to 1.5 percent in 2013 for physicians who do not submit 25 e-prescriptions by Dec. 31. Submitting 25 e-prescriptions by Dec. 31 may also qualify you for a 1 percent bonus. (See TMA's 2011 e-prescribing white paper [PDF]).

Have You Not Started E-Prescribing?
Perhaps you're planning on e-prescribing when you purchase an electronic health record (EHR) system, but with only 15 days left until the June 30 deadline, it won't be implemented soon enough!

Other e-prescribing options are available.  Follow these steps:  

  1. Select an e-prescribing system. Many Texas physicians are going with standalone systems such as Dr. First by Rcopia and RxNT, priced around $50 per month per physician. A free vendor-sponsored, ad-supported e-prescribing system also is available through the National ePrescribing Patient Safety Initiative. All of these systems meet CMS qualification standards.  
  2. Select your hardware.  To install or access a standalone e-prescribing system, you need a computer with an Internet connection.  
  3. Send 10 e-prescriptions. The June 30 deadline requires you to send 10 new e-prescriptions for 10 of your Medicare patients. (See TMA's 2011 e-prescribing white paper [PDF]).  
  4. Report G-code G8553 to Medicare. There is no separate application for the Medicare e-prescribing program; simply report G8553 on your Medicare claim and submit the G-code again with every office visit during which an e-prescription is sent.

10 E-Prescriptions in a Crunch
If you're in a rush to beat the June 30 deadline, you're not alone. Here is what you need to know about Medicare's e-prescribing program:  

  1. CMS counts a successful e-prescription as an "event" as soon as a physician sends an e-prescription to a pharmacy.
  2. The event counts even if a pharmacy is not capable of accepting e-prescriptions or rejects the e-prescription. (Standalone e-prescribing systems automatically convert to fax if a pharmacy is not capable of receiving e-prescriptions.)  
  3. Whether a patient picks up his or her prescription is not relevant to a successful event.  
  4. A successful event can include over-the-counter prescriptions for vitamins, stool softeners, and Tylenol 3 or other noncontrolled pain relievers.  

Looking for On-Site Help With E-Prescribing?
If you are a primary care physician, you may qualify for assistance through a federal grant for technical consulting services for only $300. Specialists interested in receiving services should contact their regional extension center (REC) for pricing information. The Texas RECs provide consulting help with programs like e-prescribing, selecting and implementing EHRs, and reaching meaningful use to earn federal EHR incentives of $44,000 to $63,750 under Medicare and Medicaid. Visit the TMA REC Resource Center for more information.

Program Exemptions
TMA urged CMS to revise the current e-prescribing penalties, and CMS announced in May proposed changes to the 2011 e-prescribing program by adding possible exemptions for the 2012 penalty. TMA will comment on the proposed rule, again urging CMS to adopt the additional exemptions. The final ruling on additional exemptions is expected by September. Existing program exemptions can be reported now by using a G-code on Medicare claims, including:

  • G8642: Physician's practice is in a rural area without high-speed Internet access; and  
  • G8643: Physician's practice is in an area without sufficient available pharmacies for electronic prescribing.  

If you have additional questions about program e-prescribing or program exemptions, email or call the TMA HIT helpline at (800) 880-5720.


RxEvent Improves Patient Safety

Physicians can now report adverse drug events through, a new online service the PDR Network  and its partners launched June 14. The service is available to all prescribers via integration into electronic health records (EHRs) and other online services.

Adverse drug event reports submitted to will be sent to the manufacturer and/or the U.S. Food and Drug Administration (FDA) and will also be held by the patient safety organization PDR Secure, a  PDR news release said. Information from PDR Secure "will be used to better understand adverse events and to develop education materials that will increase patient safety and benefit physicians and other clinicians in their use of drugs," the release said.

PDR Network Chief Executive Officer Edward Fotsch, MD, said RxEvent is designed "to improve the convenience of adverse event reporting for physicians, the cost-efficiency for manufacturers, and the quality of information ultimately reported to the FDA." He said studies indicate that health care professionals report as few as one in 10 adverse drug events, largely due to the time-consuming and inefficient processes involved in reporting adverse drug events.



CMS to Sell Medicare Data

Organizations that meet certain qualifications would have access to Medicare data to generate public reports on physicians, hospitals, and other health care professionals under the Availability of Medicare Data for Performance Measurement [PDF] rule the Centers for Medicare & Medicaid Services (CMS) proposed in early June. It is required by the 2010 health system reform bill.

CMS said in a news release it would sell standardized extracts of Medicare claims data from Parts A, B, and D to "qualified entities that have the capacity to process the data accurately and safely." The data could be used only to evaluate provider and supplier performance and generate public reports detailing those results. CMS has not yet specified what groups it is talking about, but officials said they would evaluate an organization's eligibility based on:

  • Organizational and governance capabilities;
  • Addition of claims data from other sources; and
  • Data privacy and security. 

Under the proposal, the organizations would share the reports confidentially with physicians before they are released in an attempt to prevent mistakes. Meanwhile, CMS says publicly released reports would include aggregated information only; individual patient and beneficiary information would not be available.

"We believe the sharing of Medicare data with qualified entities through this program and the resulting reports produced by qualified entities would be an important driver of improving quality and reducing costs in Medicare, as well as for the health care system in general," a CMS statement in the proposed rule said. "Additionally, we believe this program would increase the transparency of provider and supplier performance, while ensuring beneficiary privacy."

CMS will accept comments on the proposal until Aug. 8. Instructions for commenting are in the proposed rule.  

TMA Announces Member Benefit for PQRS

 TMA presents PQRIwizard, a simple and cost-effective online tool that eligible physicians can use to collect and report quality measure data under the Physician Quality Reporting System (PQRS), an initiative created by the Centers for Medicare & Medicaid Services (CMS) in 2007.  

In 2011, reporting for PQRS (formerly PQRI) will earn physicians 1 percent of their total allowed charges for Medicare Physician Fee Schedule services. Physicians who do not report data to PQRS will see a 1.5-percent cut in their payments in 2015. That penalty increases to 2 percent in 2016 and subsequent years. 

PQRIwizard guides you through four easy steps: (1) select your measures, (2) register, (3) enter chart data from 30 Medicare Part B patients, and (4) review and submit. You will answer a series of questions for each patient. PQRIwizard will let you know when your report is complete and ready to submit to CMS.  

The tool's Progress Monitor tracks data so that you have continuous feedback on patients. It provides an alert when all submission criteria have been met and data are ready for you to review and submit. The system calculates measures and provides a printable report of measure results in real time.  

After CMS reviews and accepts your data, you will receive an incentive payment equal to 1 percent of your total Medicare Part B Physician Fee Schedule charges for all covered services provided during the reporting period. In other words, the incentive covers all payments received from Medicare fee-for-service, not just those that are applied to the services reported.

The TMA discounted fee for PQRIwizard is $250. The tool enables you to participate in the PQRS program without modifying your billing process. On average, 2009 bonus payments for satisfactory reporters in PQRS were $1,956 per eligible professional.  

Interested? Then access the PQRIwizard and begin enrolling for your 2011 incentive. For more information, contact the TMA Knowledge Center at (800) 880-7955 or by email




Seminars to Teach Death Registration

Registering deaths electronically – required by state law – is one of the topics to be covered in seminars the Texas Public Health Association and the Texas Department of State Health Services (DSHS) Vital Statistics Unit will conduct in five cities next month. The seminars will be in Waco, July 11; Abilene, July 13; Nacogdoches, July 15; Galveston, July 18; and Laredo, July 20.

Physicians may earn 1.5 hours of continuing medical education credit by attending the seminar.

Doctors who do not use the Texas Electronic Registrar (TER) Death Registration system to register patient deaths are subject to a $500 fine by the Texas Medical Board. DSHS officials say registering deaths electronically is faster and less susceptible to fraud than is paper registration.

Click on the seminars link above to register. For information about registration, contact Terri Pali at (512) 336-2520, or email    


Practice Management Webinars: A Good Deal

Have an hour, and need to earn some continuing medical education (CME)? Have an hour, and need to train staff about a specific topic?

TMA offers a range of one-hour, on-demand webinars to fulfill your licensure CME requirement and to improve your professional skills and those of your staff. These Texas-specific programs delve into what today's medical practices need to know about medical records, patient relations, legal considerations, and more.

Find the full list in the Distance Learning course catalog on the TMA website. Many of the webinars offer ethics CME, and most count toward a Texas Medical Liability Trust (TMLT) insurance discount. TMLT insureds who watch any combination of three webinars can earn a 3-percent discount on their premiums, up to $1,000.

You pay only one fee per webinar, and your entire staff can watch it. You may start and stop the program at your convenience, continue where you left off, and review supporting materials as often as you like.

TMA will continue to add topics throughout the year. Check out the course catalog, and register for a webinar today. If you need help or have a practice management topic to suggest, contact the TMA Knowledge Center by telephone at (800) 880-7955 or by email.  


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.  



The Death of Private in Private Practice

A comprehensive report from The Physicians Foundation offers private practice physicians a new tool for understanding how federal health system reform may impact their practice of medicine. The report examines the provisions of the Affordable Care Act (ACA) and how they will directly impact private practice physicians, both immediately and over the coming months.

The report, A Roadmap for Physicians to Health Care Reform [PDF], gives physicians an in-depth perspective on the societal and economic issues that influence current health reform efforts, as well as insight into Congress and the possibility that it may alter the reform legislation. It also focuses on the major legislative changes that are significant to the daily practice of medicine, such as changes in payment systems, quality reporting, shared savings programs, workforce and rural initiatives, and select aspects of the changes reshaping the private health insurance market.

Among the report's findings:

  • Physicians will assume greater responsibility for the health of populations, not individuals.
  • Significant numbers of physicians may feel compelled to relinquish private practice autonomy in favor of networks or group formations.
  • Physicians will increasingly lose the "private" in private practice, and
  • Physicians could become a link for risk-bearing arrangements, thereby assuming significant shared financial risks and quasi-insurance roles.

"Physicians bring an essential perspective on how the health care system can and should support optimal patient care. Therefore, it is vital that this community understand which aspects of health reform will be most meaningful over time due to their impact on the practice of medicine," said Louis J. Goodman, PhD, president of The Physicians Foundation and TMA's executive vice president/chief executive officer. "We believe that no matter what actions Congress takes to amend the ACA, the most direct provisions affecting physicians will endure in some form. The Physicians Foundation commissioned this roadmap in order to educate physicians on these core elements, as well as to promote broader understanding of how private practice physicians will be impacted."

The Physicians Foundation is a nonprofit organization that seeks to advance the work of practicing physicians and improve the quality of health care for all Americans.

TMB Needs Physicians to Review Cases

The Texas Medical Board (TMB) is looking for physicians to serve on its expert physician panels to review standard-of-care cases. TMB pays reviewers $100 per hour. TMB says it can add five experts in most specialties to its roster. Spine surgeons and pediatric subspecialties are especially needed.

TMB says it wants active, licensed, board-certified physicians "who truly represent the best of the medical profession," who have no history of license restriction or peer discipline, and who have an "acceptable" malpractice complaint history. Malpractice limits will be evaluated on an individual basis, a TMB spokesperson said. Experience in peer review is preferred.

Email TMB Medical Director Linda Gage-White, MD, PhD for an application if you are interested.


 Be a TMAF Star 

You can help the Texas Medical Association Foundation (TMAF) win a $10,000 matching grant! Make a difference in the health of all Texans and double your impact by donating to TMAF's 2011 Star Campaign.

For the fifth year, the John P. McGovern Foundation of Houston, a longtime supporter of the foundation's work, has pledged a matching gift of $10,000 to the Star Campaign. Help ensure that TMAF wins this generous match by donating now on the foundation's secure website.


 POEP, TSU Cancer Conference Rescheduled for July 29

POEP, TSU Cancer Conference Rescheduled for July 29

Breast cancer, human papillomavirus infection and vaccine, prostate cancer, and pain management will be among the topics discussed at the 2011 Texas State Cancer Advocacy Movement for Colleges and Outreach 3rd Annual Cancer Symposium, July 29, at Seton Medical Center Williamson, Round Rock.

The conference, which will run from 8 am to 2 pm, is a joint project of TMA's Physician Oncology Education Program (POEP) and Texas State University (TSU). Click here [PDF] to view the flyer.

Physicians may earn up to 5 hours of continuing medical education credits by attending the conference. Registration fees are $75 for physicians and $50 for physician assistants and nurses. Seton employees and affiliates will receive a discounted registration fee.

To register, e-mail Leslie Jones at POEP or call her at (800) 880-1300, ext. 1671, or (512) 370-1671.   

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 June issue of  Texas Medicine  helps young physicians choose between their own practice and working for someone else. It also details efforts in Congress to pass Texas-style tort reform, reports on a TMA program that helps physicians get paid, and explains how hiring a billing company can improve collections. You'll also learn about a new way of teaching at The University of Texas Medical Branch and read about how to talk to teenagers about sensitive subjects.  


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.


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

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