Action: Aug. 1, 2012

TMA Action Aug. 1, 2012                                                                                                                                                                

 News and Insights from Texas Medical Association

 INSIDE: TMA: No Chiropractic Neurology                                      

Bill Would Stop Medicare Cuts
Prepare for New Medicare Payer
Dr. Janek to Head HHSC
TMLT Declares Dividend Again
TMA: No Chiropractic Neurology
Attest Meaningful Use Annually
TMA, AMA Explain Insurer Data
Fall Conference in October
This Month in Texas Medicine                                                       



Bill Would Stop Medicare Cuts

U.S. Rep. Michael C. Burgess, MD (R-Texas), filed legislation to extend Medicare physician payment rates for one year. He said HR 6142, the Assuring Medicare Stability and Access for Seniors Act of 2012, would ensure continued access for Medicare beneficiaries and TRICARE recipients.

"In order to guarantee a substantive, long-term plan, guaranteeing proper services for Medicare beneficiaries, doctors need to first be provided with payment certainty for 2013," he said. He added that "by providing one more year of stability we make a critical, initial step towards ridding ourselves of this problematic and inadequate payment system. Allowing for a one-year extension now will prove early to our seniors, physicians, and health care providers that they are at the forefront of our minds and our legislative agenda, and we will not leave them uncertain about how the upcoming 'fiscal cliff' will impact their care," said Dr. Burgess, vice chair of the House Energy and Commerce Committee's Subcommittee on Health and chair of the Congressional Health Care Caucus. Unless Congress acts by the end of the year, the Centers for Medicare & Medicaid Services will cut 2013 Medicare payments to physicians by 27 percent on Jan. 1 because of the Sustainable Growth Rate (SGR) formula. For the last decade, Congress has stepped in to avert scheduled fee reductions.

"Despite Congress' continual enactment of last-minute legislation to prevent these cuts from going into effect over the last few years, 11th-hour legislative maneuvers should no longer take the place of a stable and secure solution," said Dr. Burgess. "I have never seen so much progress made on this issue than this year, but Congress must have more time to work with stakeholders on crafting a permanent replacement [to the SGR]. While this legislation will provide a one-year extension, Congress must continue to work towards a permanent fix that will solve the issue once and for all, and this bill provides that time."


Prepare for New Medicare Payer

Novitas will become the new Medicare carrier for Texas on Nov. 19, taking over from TrailBlazer Health Enterprises to administer Medicare claims for Texas and the six other states in Medicare Jurisdiction H (JH).

 Here are some things you ought to do now to ease into the switch:  

  • If your practice is enrolled with TrailBlazer for electronic funds transfer (EFT), you should have received a letter from Novitas in late July requesting a CMS-588 EFT authorization agreement. Read this letter carefully for how to complete and return the agreement so you won't experience a delay or interruption of your Medicare payments starting Nov. 19.
  • Bone up on Novitas' Local Coverage Determination (LCD) policies for JH, which are on the transition website. Be sure to study the TrailBlazer JH LCD Crosswalk, as well.
  • Join the JH Transition Segment 5 email list to receive news and updates. Use other transition website resources, such as FAQs and a teleconference/webinar schedule for Texas Part B physicians.   

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


Dr. Janek to Head HHSC

Former state Sen. Kyle Janek, MD, will become executive commissioner of the Texas Health and Human Services Commission on Sept. 1. Gov. Rick Perry appointed Dr. Janek and announced that Chris Traylor, of Austin, will be chief deputy commissioner.     

"Texas, like the rest of the country, is headed into a period of the most significant changes in health care in our history," Governor Perry said. "This new leadership team, with Kyle and Chris at the helm, combines unparalleled experience and expertise to ensure Texans continue to have access to the health care they need while implementing fiscal policies that are mindful it's taxpayer money they are spending."

Dr. Janek is a board-certified anesthesiologist and director of anesthesia services at Lakeway Regional Medical Center near Austin. He served in the Texas House of Representatives and Senate from 1995 to 2008. He replaces Tom Suehs, who is retiring.

Mr. Traylor has been commissioner of the Texas Department of Aging and Disability Services since 2010. 


TMLT Nest Egg Ad


TMLT Declares Dividend Again

Physicians who hold policies from the Texas Medical Liability Trust (TMLT) will save about $20 million in premiums in 2013, thanks to the TMLT Board of Governors' approval of a 15-percent dividend for policyholders who renew in 2013. TMLT says this is the eighth time it has declared a dividend, saving policyholders approximately $226 million since 2005.

"The 15-percent dividend is just one of many reasons why Texas physicians should choose TMLT. We provide products, customer service, and flexibility that set us apart. Unlike our out-of-state competitors, TMLT is uniquely rooted in the Lone Star State and committed to Texas physicians," said TMLT President and Chief Executive Officer Charles R. Ott Jr.     

Texas physicians interested in applying for TMLT coverage or learning more about how this dividend will benefit them can email or call the sales department at (800) 580-8658, ext. 8603. Current policyholders will receive detailed information about the dividend before their policy renews.

TMLT benefits include:

  • $100 million in 2012 dedicated to the Trust Rewards program, a nest egg that rewards TMLT policyholders for their loyalty and commitment to quality medicine;
  • Medefense coverage for administrative actions;
  • Cyber liability for privacy-related claims; and
  • About $539 million in savings from eight consecutive years of rate reductions.

The largest medical liability insurance provider in Texas, TMLT serves more than 15,500 TMA  member physicians. TMLT was created and is endorsed by TMA.

TMA: No Chiropractic Neurology

A state chiropractic board proposal to recognize a specialty it calls "chiropractic neurology" could deceive and harm patients, TMA warns in a letter to the board. 

"TMA is very concerned that not only will patients be deceived and misled, but many could also suffer injury and harm, for example by delayed diagnosis," TMA President Michael E. Speer, MD, said in a formal letter to Yvette Yarbrough, executive director of the Texas Board of Chiropractic Examiners. "A patient suffering headaches, syncope, or seizures could have a serious neurological disease, but that patient could easily find himself or herself in a 'chiropractic neurologist's' office. The patient could easily be deceived into believing that this chiropractor could diagnose or treat his or her medical condition, including a brain tumor, aneurism, or stroke. This proposed rule is not in harmony with the Texas Chiropractic Act, the Healing Art Identification Act, or the Health Professions Council Statute." 

He noted that some chiropractors are "already pushing the envelope" in their advertisements by burying the designations required under Texas law, thus confusing patients about whether the chiropractor is a physician.  

 Dr. Speer added that the state Chiropractic Act "makes no reference to neurology. Neurology does not involve the biomechanics of the spine and musculoskeletal system. Neurology is clearly beyond the scope of chiropractic in Texas, and this proposed rule is a brazen effort by the board to circumvent Texas statutory law to expand chiropractors' scope."  

Meanwhile, in TMA's lawsuit against the Texas State Board of Marriage and Family Therapists (TSBMFT), both sides filed cross motions for summary judgment, which the court will hear in the coming months. TMA's suit contends the board exceeded its statutory authority when it adopted rules defining "professional therapeutic services" to include a "diagnostic assessment" and authorizing marriage and family therapists to base their services on an "assessment, evaluation, or diagnosis." TMA believes the board's rule unlawfully authorizes marriage and family therapists to diagnose mental diseases and disorders even though therapists have no medical training, and the cause of many mental diseases and disorders is medical and only a physician can treat it.

TSBMFT, joined by the Texas Association of Marriage and Family Therapists, claims the board's rules authorizing marriage and family therapists to diagnose "are reasonable and consistent with the statutory scope of practice." They contend that therapists "have been exercising the authority to diagnose in this state for at least 18 years with no known complaints.” According to the board, "Law, public policy, and common sense all dictate that MFTs should be allowed to continue doing so."   





Attest Meaningful Use Annually

Physicians participating in the Medicare Electronic Health Record (EHR) Incentive Program must attest every year of the five-year program to continue receiving meaningful use incentive payments. Attestation is the process by which a physician proves to the Centers for Medicare & Medicaid Services that he or she meaningfully uses an EHR.    

 For example, if a physician attested in the 2011 payment year but does not attest for 2012, he or she forfeits the 2012 payment and cannot make it up the next year. The physician can attest again in 2013 and receive the third payment-year incentive.

Physicians attesting for payment years 2011, 2012, and 2013 must meet stage 1 meaningful use criteria. The more-advanced stage 2 meaningful use will be required of participants beginning in 2014; the final rules for stage 2 should be available later this summer. Stage 3 meaningful use rules are not yet proposed and likely won't be introduced until 2013. TMA will apprise you of the rules as they become available. 

Physicians participating in the Medicaid EHR Incentive Program can skip years during the attestation process. The six-year Medicaid EHR Incentive Program pays out until 2021. Physicians can attest now and then skip a couple of years before having to attest for their second year of the program. The caveat in waiting too long is that physicians would have to comply with the more-advanced stages of meaningful use. 

The EHR incentive program is complex in requiring physicians to meet varied and more difficult stages as they progress through the multiyear program. To help, the Office of the National Coordinator for Health Information Technology (HIT) established regional extension centers (RECs) to provide onsite HIT consulting in physician practices. The RECs received grant funding to subsidize the consulting costs for primary care physicians. RECs can assist specialists but not at the subsidized rate. For details on eligibility and REC services, visit the REC Resource Center on the TMA website.  

For questions regarding attestation or other HIT needs, contact TMA's Department of Health Information Technology at (800) 880-5720 or by email.


TMA, AMA Explain Insurer Data

TMA is among more than 60 organizations supporting an American Medical Association effort to help physicians better use health insurer-provided data reports as tools to enhance the quality and value of patient care.

To help create data reports that physicians can easily understand and use, AMA created the  Guidelines for Reporting Physician Data  with input from public and private health insurers, state and specialty medical societies, health standard organizations, and employer and consumer coalitions. The new guidelines offer a roadmap for improving the usefulness of physician data reports by encouraging greater format standardization, process transparency, and level of detail. 

 Among the organizations that support the use of AMA's Guidelines for Reporting Physician Data include CIGNA, Midwest Business Group on Health, the National Committee on Quality Assurance, and UnitedHealth Group.

"Almost every public and private health insurer presents physicians with practice profile reports to support data-driven decision-making," said AMA President Jeremy A. Lazarus, MD. "This feedback has been ineffective since the complex reports vary from plan to plan and are difficult to read and interpret. The organizations who have pledged to use the AMA guidelines recognize that providing physicians with ineffective or inaccurate practice data represents a missed opportunity. Encouraging industry-wide standardization of practice data reports will help physicians double-check the information and use accurate data as a tool to identify opportunities for practice improvement." 


What Can Practice Production Numbers Tell You?

 Consider these factors if your production isn't consistent.

 A practice management tip from
 TMA Practice Consulting 



Fall Conference in October

Join your colleagues and industry experts at TMA's 2012 Fall Conference at the AT&T Conference Center in Austin, Oct. 19-20, for another great opportunity to get involved in organized medicine.

Registration opens Aug. 10. Book your hotel room through the conference website by Sept. 27 to get the special TMA room rate.   

TMA councils, boards, and committees will meet during the conference.


This Month in Texas Medicine

The August issue of Texas Medicine tells you why physicians and many state licensing boards are worried about the Federal Trade Commission's decision to involve itself in scope-of-practice issues, explains the new state law requiring health care workers to be vaccinated, and gives you valuable practice management advice on how to avoid legal trouble in human resources issues. You'll also learn why TMA backs hospitals in their claims against Aetna and find out about new residency accreditation standards. The issue also contains the second chapter of Healthy Vision 2020, TMA's prescription for a healthy Texas.

Check out our digital edition.


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



TMA Education Center

The TMA Education Center offers convenient, one-stop access to the continuing medical education Texas physicians need. TMA's practice management, cancer, and physician health courses are now easier than ever to find online. The seminars listed below are among the CME opportunities found in the TMA Education Center.

Practice Management, Ext. 1421


Fraud and Abuse  
9/5       San Antonio 
9/6       Austin 
9/12     Houston 
9/13     Fort Worth 
9/19     Sugar Land 
9/20     Dallas 
9/27     Houston 
10/4     McAllen

Recorded Web Seminars  

Avoiding RAC Audits 
Avoiding the Courthouse: 10 Practice Pitfalls 

Communication Skills: Why Bother? 
HIPAA and the HITECH Act      
10 Ways to Turn Satisfied Patients Into Loyal Patients 
Write, Click, or Paste ... The Changing World of Documentation      

Physician Health and Rehabilitation, Ext. 1342

Healing the Healer 
9/14-15 Fort Worth   

Healthy Physicians: Healthy Patients 
9/8    Austin 
9/29  Dallas  

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