Action: July 5, 2011

TMA Action July 5, 2011
News and Insights from Texas Medical Association


INSIDE: 2011 TMA Legislative Report Card

2011 TMA Legislative Report Card
Medicine Wins; CMS Drops Lab Signing Rule
Deficit Cuts Must Include Medicare Reform
Aetna to Drop Doctors from Aexcel Network
AMA: Bad Claims Payment Increasing
Buyer Beware in EHR Vendor Contracting

Physicians Can Report EHR, Vendor Issues
100,000 Helmets and Counting
Apply Now for TMA Foundation Grants
TMA Seminars Explain ACOs
Do You Twitter? Follow TMA
This Month in Texas Medicine  

2011 TMA Legislative Report Card 

A Message from TMA President C. Bruce Malone, MD

Our top priority as the 2011 legislative session convened was to protect the patient-physician relationship in every aspect of the health care system. With an enormous budget deficit and special interest groups from hospitals to midlevel practitioners lining up to take on medicine, it felt like everyone wanted a piece of our profession. Many of our adversaries wanted control of physicians, our practices, and our patients. Others wanted to weaken the Texas Medical Board (TMB), jeopardizing Texas' hard-fought liability reforms and Texans' access to care. Some believed physicians were the cost drivers and needed restraint.

However, when the session ended, physicians crossed the finish line with the reins still in hand. Even better, lawmakers took major steps to protect and strengthen the patient-physician relationship from future outside interference.

Working with the legislature, we were able to minimize the Medicaid cuts to office-based physicians so that our hard-working doctors can continue to see the neediest Texas patients and continue their important work of improving the health of all Texans.

Here is a short list of TMA accomplishments:

  • Fought off severe cuts to physicians' Medicaid payments.  
    Result: Physicians won't be forced to stop seeing Medicaid patients.

  • Protected the patient-physician relationship against corporate interference.
    Result: Patients' health care needs come before a corporation's bottom line.

  • Defended clinical autonomy of physicians employed by rural hospitals, 501(a)s, and future health care collaboratives.
    Result: Physicians and their patients have ultimate control of health care decision-making.

  • Won Texas Medical Board reforms.
    Result: The improved TMB disciplinary process is much fairer for physicians without  endangering Texas' medical liability reforms. The anonymous complaint was eliminated.

  • No scope-of-practice expansions.
    Result: Midlevel practitioners and allied health professionals must stay within a scope of practice safely permitted by their education, training, and skills. The doctor is the trusted leader of the health care team.

  • Safeguarded the public health system.
    Result: Cuts to tobacco cessation and chronic disease prevention programs were mitigated.

  • Improved immunization requirements.
    Result: College students are protected from contracting meningococcal meningitis. ew vaccination policies ensure health workers won't spread infectious diseases to their patients.




  Click here  to read the entire report card.

Medicine Wins; CMS Drops Lab Signing Rule

Admitting it did not fully understand the impact of what it was requiring, the Centers for Medicare & Medicaid Services (CMS) now says it will drop a proposed rule [PDF] that the ordering physician or nonphysician practitioner (NPP) must sign requisitions for all clinical diagnostic laboratory tests paid under the clinical laboratory fee schedule.

CMS said it made the decision "based on continued and new concerns noted by stakeholders regarding the practical effect of the finalized policy on beneficiaries, physicians, and NPPs. Even in cases where the physician or NPP sees the patient in his/her offices for an appointment and recommends that clinical diagnostic laboratory testing be performed, we now better understand that, typically, the information is transcribed from the medical record onto a paper requisition by office staff after the physician or NPP and the patient have concluded their interaction. In practice, we can see how requiring the physician or NPP to sign the paper requisition could, in some cases, be very inconvenient and disruptive to the physician, NPP, the beneficiary, and other patients."

Earlier this year, TMA, numerous specialty societies, hospitals, and several members of Congress, including U.S. Rep. Michael Burgess, MD (R-Texas), asked CMS to delay the rule until next year. Representative Burgess was among a bipartisan group of House and Senate members who wrote CMS requesting the delay because of the "the myriad potential harmful consequences of this policy on Medicare beneficiaries' timely access to laboratory testing."

Representative Burgess said he is glad CMS "made the right decision in pulling this provision back so that we can put patient care first. The new enforcement was unnecessary and went beyond delaying care, Medicare beneficiaries could end up spending a lot of their time contacting providers to get required signatures, and providers could see their payments delayed or worse, possibly denied for a new administration hurdle. Creating more bureaucracy in a system that can sometimes already be hard to navigate only creates more problems. Patients, physicians, hospitals, nursing homes, and laboratories could not afford to have this change implemented, and all supported this effort."


Deficit Cuts Must Include Medicare Reform

In a June 27 letter [PDF], TMA, the American Medical Association, and 110 other state and national medical societies told President Obama and congressional leaders that any plan to reduce the federal budget deficit must include reforming the Medicare physician payment system.

"Bypassing this issue or passing another short-term fix simply drives up the cost of a long-term solution," the physicians wrote. "Had Congress acted as recently as 2005, the ten-year cost of preventing future cuts would have been $48 billion. Today, it is estimated that averting currently scheduled cuts would cost nearly $300 billion over the next ten years. If Congress continues to follow the past practice of employing budget gimmicks to push cuts into the future, the cost will exceed $500 billion in only a few short years."

Unless Congress acts, payments to physicians are scheduled to drop 29.5 percent on Jan. 1. "There is unanimous agreement that cuts of this magnitude would result in serious disruptions for the nation's elderly and disabled populations and cannot be allowed to occur," the letter warns.

The groups added that Congress "should ensure that the necessary funding is provided, in a credible and fiscally responsible manner, to ensure beneficiaries' continued access to physicians. An agreement on the debt ceiling legislation provides the best – and perhaps only – opportunity to ensure stability in Medicare payments, ensure continued beneficiary access to care, and address the SGR (Sustainable Growth Rate) deficit in a fiscally responsible manner."




Aetna to Drop Doctors from Aexcel Network

Aetna is notifying physicians in 12 specialties in Austin, Dallas, El Paso, Houston, and San Antonio whether they have been selected to participate in its Aexcel network or if they are being terminated from Aexcel on Jan. 1, 2012. Aetna will post physicians' updated status on its online provider directory Sept. 2.

Specialties affected are:  

  • Cardiothoracic, general, plastic, and vascular surgery;  
  • Cardiology;  
  • Gastroenterology;  
  • Neurology;  
  • Neurosurgery;  
  • Obstetrics/gynecology;  
  • Orthopedics;  
  • Otolaryngology; and  
  • Urology.   

TMA encourages physicians to appeal the Aetna ranking if they believe it does not comply with a state law (House Bill 1888) that TMA persuaded the legislature to pass in 2009. That law requires health plans to conform to nationally recognized standards and guidelines when ranking or tiering physicians. TMA has developed a Physician Ranking Toolkit to help physicians with the appeals process.   

Physicians appealing the Aetna ranking should act quickly, as appeals must be requested in writing within 30 calendar days of receiving the letter from Aetna. In addition, physicians also should request patient-specific claims data to review the accuracy of the data Aetna is using and consider sending all correspondence via certified mail. Current Aexcel program information can be found through Aetna's secure provider website NaviNet.

TMA is tracking this issue. If you appeal, e-mail a copy to Liz Jero in TMA's Payment Advocacy Department or send it to her by fax at  (512) 370-1632. Also, please notify her of the result of the appeal or any issues that occur.  

HB 1888 requires health plans to give physicians: 

  • Notice of the standards and measures they use before any evaluation period;
  • An opportunity to dispute the ranking before publication;
  • A minimum of 45 days written notice of the proposed rating, ranking, or tiering, including all methodologies and information used;
  • A fair reconsideration process (if timely requested); and
  • A written communication of the outcome of the proceeding before publishing the ranking or tiering.  

AMA: Bad Claims Payment Increasing

It's not your imagination. Most health insurers are getting worse at correctly paying physicians' claims, the American Medical Association says in its fourth annual National Health Insurer Report Card [PDF]. AMA reports that the overall rate of inaccurate claim payments has increased since 2010 among major commercial health insurers, wasting billions of dollars and frustrating patients and physicians.

AMA says its findings show that commercial health insurers have an average claims-processing error rate of 19.3 percent, a 2-percent increase over 2010. "The increase in overall inaccuracy represents an extra 3.6 million in erroneous claims payments compared to last year, and added an estimated $1.5 billion in unnecessary administrative costs to the health system," an AMA news release  said. AMA estimates eliminating claims-payment errors would save $17 billion. 

The news release says UnitedHealthcare was the only insurer to improve claims-processing accuracy. "UnitedHealthcare came out on top of seven leading commercial health insurers with an accuracy rating of 90.23 percent. Anthem Blue Cross Blue Shield scored the worst of those measured with an accuracy rating of 61.05 percent," the AMA said.

The report's key findings were mixed:  

  • Physicians received no payment from insurers on nearly 23 percent of their claims.
  • Denial rates dropped dramatically since last year at Aetna, Anthem Blue Cross Blue Shield, Health Care Service Corporation, and UnitedHealthcare.
  • Although it had the lowest denial rate, CIGNA had the highest rate of claims requiring prior authorization.
  • CIGNA and Humana cut their median claims response time in half during the last four years.   

Buyer Beware in EHR Vendor Contracting

Electronic health record (EHR) contracts are typically written in a manner favorable to the vendor. A solid contract is critical to a successful long-term relationship and helps ensure that your EHR lives up to its advertised potential.

To help physicians navigate the EHR contract, TMA has developed eight key considerations in EHR Buyer Beware: Issues to Consider When Contracting with EHR Vendors [PDF]. The white paper is not an exhaustive list of considerations. TMA advises you to have your area regional extension center (REC) or an attorney carefully review your final contract before signing.

Texas has seen a record number of EHR purchases in 2011. Incentives are available to eligible physicians who "meaningfully use" a certified EHR – up to $44,000 under Medicare or up to $63,750 under Medicaid. 

Recognizing the challenges associated with implementing or upgrading EHRs, the federal government established RECs to give physicians access to technical consultants and on-site help. REC consultants can help you evaluate EHRs, negotiate a contract, and select an EHR system to fit your practice's needs and budget, all for only $300 per primary care physician. REC pricing for specialists varies. Contact your area REC for more information. Even if you already have an EHR system in place, you likely will face challenges in reaching "meaningful use." Visit TMA's REC Resource Center for more information.

If you have questions about the white paper, federal incentives, or REC services, contact the TMA Health Information Technology helpline at (800) 880-5720 or  




Physicians Can Report EHR, Vendor Issues

Have you had issues with your electronic health record (EHR) or the vendor? Are you concerned your patients' safety may be affected? The EHR Support Center is designed to collect data related to EHR products and to document potential or identified patient safety and usability issues.

The Texas A&M Health Science Center Rural and Community Health Institute has partnered with the PDR Network  to give physician an opportunity to report EHR-related patient safety events. Both are accredited patient safety organizations that seek to improve the quality and safety of health care. Data are entered into a protected database and used for research to find weak points in health care delivery.

EHR issues that you may want to report include problems with product applications, vendor-related difficulties, or contractual issues that resulted in a less-than-optimal or undesired outcome. The tool also enables physicians to report features of EHRs that they feel are best practices. Collection of the data will help improve patient safety and quality as physicians adopt, implement, and use EHRs.


100,000 Helmets and Counting

TMA's Hard Hats for Little Heads program reached a major milestone in May. Thanks to TMA physicians, medical students, and TMA Alliance members, TMA has given away more than 100,000 bicycle helmets to children across the state.

During the past five years, TMA increased the number of helmets given by more than 200 percent, from 8,390 in 2006 to 17,792 in 2010. Already in 2011, more than 8,000 helmets have been given at 70 events.

Hard Hats for Little Heads, created in 1994, encourages children to exercise safety by wearing a properly fitted helmet every time they bike, skate, skateboard, or ride a scooter. The TMA Foundation provides funding, thanks to top donors – Blue Cross and Blue Shield of Texas, Prudential, and an anonymous foundation – and gifts from physicians and their families.

To find out how you can give helmets in your community and help TMA reach 200,000 helmets, email the TMA Outreach Coordinator or call (800) 880-1300, ext. 1470, or (512) 370-1470.


Apply Now for TMA Foundation Grants

TMA, county medical societies, and alliance and medical student chapters may apply to the TMA Foundation (TMAF) to support their health outreach efforts. This year, applicants are encouraged to include tobacco cessation efforts in their applications to complement TMA's new Tobacco Cessation Initiative.  

TMA, county medical society, or county alliance chapters may apply for matching grants of up to$7,500 per project at 2011-2012 TMAF Medical Community Grant RFP.

TMA medical student chapters may apply for matching grants of up to$3,000 per project at 2011-2012 TMAF Medical Student Community Leadership Grant RFP.

Proposals must be submitted by Aug. 1. The TMAF Board of Trustees will act on the proposals at its Oct. 21 meeting.

For more information on this funding opportunity or to receive a printed version of the application, e-mail Sean Dunhamor call him at (800) 880-1300, ext. 1664, or (512) 370-1664.

What Can Practice Production Numbers Tell You?

Consider these factors if your production isn't consistent.

A practice management tip from
TMA Practice Consulting


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.


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 Month in Texas Medicine

The July issue of Texas Medicine details TMA's effort to reform the Texas Medical Board, reports on the board's crackdown on pill mills, and explains why a new medical school admissions test may be on the horizon. It also tells you why the Cancer Prevention and Research Institute of Texas is a lifesaver, and how Texas colleges are training high-tech workers for your office. You'll also find a wrap-up of TexMed 2011.


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


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
7/19      McAllen
7/20      Houston
8/3        San Antonio  

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

What Health Reform & "Accountable" Care Mean to Physicians
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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