Action: Sept. 5, 2012

TMA Action Sept. 5, 2012  
News and Insights from Texas Medical Association


INSIDE: Be By Your Phone Oct. 25

It's Official: ICD-10 Starts in 2014
Hello, Novitas? Is That You?
Chiropractic Neurology Rules Scrapped
PPACA Tops Fall Conference Agenda
United Takes Over State Health Plan
DocbookMD Enhances Care
Don't Leave $5,000 on the Table!
Hear All About It!
Apply for a Be Wise — Immunize Grant 

Fight Pertussis With Needles
TMA Helps Protect Your Practice
Have We Heard From You?
Shot Summit in Houston
POEP Stands Against Colon Cancer
Workers' Comp Rules Change
This Month in Texas Medicine

It's Official: ICD-10 Starts in 2014

Federal officials' decision to go ahead with the ICD-10 coding system does not improve patient care and only helps bureaucrats, Texas Medical Association President Michael E. Speer, MD, said after the Centers for Medicare & Medicaid Services (CMS) announced the new system would take effect Oct. 1, 2014. The ICD-10 announcement was contained in a news release about a CMS rule establishing a unique health plan identifier system officials say will save physicians time and money.  

But Dr. Speer says the ICD-10 system "is a huge burden that deeply affects every practice. Instead of working with 13,500 diagnostic codes, we now will need to learn and use more than 70,000 different codes." It's also expensive, he said, costing solo physicians as much as $83,000 each and group practices of up to 10 doctors as much as $250,000.  

"The timing of the transition could not be worse, as many physicians already are spending significant time and resources implementing electronic health records in their practices, meeting meaningful use regulations, adapting to a host of new Medicare and Medicaid policies, and hurdling other administrative burdens created by the new health law," Dr. Speer said.   

Because of objections from TMA and others, federal officials delayed ICD-10 adoption from October 2013 to October 2014.

TMA now offers an easy-to-use electronic ICD-9 to ICD-10 GEMs mapping software to help practices with the transition. The downloadable tool will help you quickly and easily identify which ICD-10 codes replace the ICD-9 codes your practice uses now. It allows you to:  

  • Search by code, code description, or key words;
  • Create and save a "favorites" list of commonly used codes; and
  • Develop and print quick reference lists.    

TMA will hold seminars to help physicians and their staff prepare for the transition. Future issues of Action and Texas Medicine will have more information when it becomes available.

TMA Practice Consulting is available for customized and private on-site training programs, as well. Call (800) 523-8776.


Hello, Novitas? Is That You?

TMA will hold a tele-town hall meeting at 8 pm CDT on Oct. 25 as part of its ongoing efforts to help physicians prepare for the Nov. 19 switch from TrailBlazer Health Enterprises to Novitas Solutions for processing Medicare claims. Novitas representatives will join TMA physician and staff experts to give you a quick overview of what the transition means to you and to field your questions.

TMA will call you at your home phone number. If you would prefer TMA to call you at another number or if you would like to include your office administrator or another staff member, contact the TMA Knowledge Center by phone at (800) 880-7955 or by email.  

TMA's Novitas Resource Center tells you what you need to do right now, provides links to the Novitas transition website, gives you a heads-up on training events such as the upcoming webinar in mid-October, and lists the Novitas toll-free phone number established to answer your questions. That number is (855) 252-8782.  

While Texas physicians switch to Novitas on Nov. 19, hospitals and skilled nursing facilities will switch Oct. 29. Novitas will also handle Medicare claims in Arkansas, Colorado, Louisiana, Mississippi, New Mexico, and Oklahoma.   


Chiropractic Neurology Rules Scrapped

TMA Victory Icon

TMA's ongoing patient safety efforts paid off again Aug. 16 when the Texas Board of Chiropractic Examiners (TBCE) voted against adopting rules to recognize a specialty it called "chiropractic neurology" after hearing opposition from organized medicine and legislators.

TMA President Michael E. Speer, MD, had warned the board that its proposal could deceive and harm patients.

"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," he wrote in a formal letter to Yvette Yarbrough, executive director of the board. "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."

In addition, Reps. Charles Schwertner, MD (R-Georgetown), and John Zerwas, MD (R-Simonton), and Sens. Bob Deuell, MD (R-Greenville), and Jane Nelson (R-Flower Mound) wrote letters asking TBCE to withdraw inappropriate scope-expansion rules and obtain proper stakeholder input when proposing rules in the future. 



PPACA Tops Fall Conference Agenda 

Health care economist Thomas Miller will discuss the impact of the Supreme Court's ruling on the Patient Protection and Affordable Care Act (PPACA) on physicians and patients at TMA's 2012 Fall Conference, Oct. 19-20, at the AT&T Conference Center in Austin.

Mr. Miller is a former senior health economist for the Joint Economic Committee of Congress and has been at the forefront of health care policy on the national level.   

Also on tap is a panel discussion featuring legislators and candidates for election in November. Invited to participate are:  

  • Greg Bonnen, MD, Republican nominee, Texas House District 24;  
  • Rep. Michael Burgess, MD, U.S. House District 26;  
  • Donna Campbell, MD, Republican nominee, Texas Senate District 25;  
  • Sen. Bob Deuell, MD, Texas Senate District 2;  
  • Rep. Susan King, Texas House District 71;  
  • Rep. Charles Schwertner, MD, Republican nominee, Texas Senate District 5;  
  • J.D. Sheffield, DO, Republican nominee, Texas House District 59;  
  • Rep. Mark Shelton, MD, Republican nominee, Texas Senate District 10; and
  • Rep. John Zerwas, MD, Texas House District 28.   
 And, the conference's Legislative Training Session can teach you how to be a persuasive and effective communicator in the debate over new state and federal laws that affect you and your patients. Two training sessions will be conducted on Friday: 1:30-3 pm and 3-4:30 pm. Space is limited, so register today.

Finally, the conference will feature a flu shot clinic in the Grand Ballroom Foyer of the AT&T Center from 7:30 to 8:45 am on Oct. 20. The shots are $25. The nasal-spray vaccine is $40. Register for the conference and a flu vaccine though the TMA registration page.

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

For more information, contact the TMA Knowledge Center by telephone at (800) 880-7955 or by email.  


United Takes Over State Health Plan

UnitedHealthcare now administers the state health plan covering state employees and retirees. United replaced Blue Cross and Blue Shield on Sept. 1.  

The prescription drug plan is still administered by Caremark.

Information on the transition is on the TMA website.   



DocbookMD Enhances Care

A new mobile app, DocbookMD, addresses the many issues surrounding the convenience, speed, and legality of physician-to-physician communication. It's your latest membership benefit from TMA.

Developed by Austin husband and wife physicians Tim Gueramy, MD, and Tracey Haas, DO, DocbookMD eliminates the red tape and overcomplicated systems that govern your communication with other physicians. By letting you send and receive other vital patient information instantly via your smartphone or tablet, DocbookMD helps you enhance patient care, make your practice more efficient, gain and give referrals, and avoid mistakes.  

"DocbookMD allows you to look up another doctor at the point of care. You can then either call the physician or send a text message with room numbers, medical record numbers, and even pictures of wounds and x-rays. And all of this is sent securely and in a way that meets HIPAA requirements," Dr. Gueramy said.   

With DocbookMD, a regional network of physician colleagues is at your fingertips for consultation and referrals – all at the point of care and in the blink of an eye.  



Don't Leave $5,000 on the Table! 

Physicians planning to participate in the Medicare Electronic Health Record (EHR) Incentive Program must begin their 90 days of meaningful use by Oct. 1 or they will forfeit $5,000 of the maximum $44,000 bonus. Physicians who begin the program in 2013 will be eligible for only $39,000 over the next four years.   

Physicians in the 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 in 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. CMS released the final stage 2 rules Aug. 23. Unfortunately, the government did not accept many of the recommendations TMA made. TMA staff is examining the rules and will continue to guide Texas physicians on what they need to do to continue receiving EHR incentive funds. 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.   

A recent government accountability office (GAO) report indicated that physicians were twice as likely to receive their incentive payments when they used the REC program. Visit the TMA REC Resource Center to find the REC serving your geographic region.  

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



Hear All About It!

Read, hear, and see how TMA and TMA Alliance members collaborate with business and community groups to help Texans achieve great health in the TMA Foundation's 2011 Annual Report (try out the QR codes featured in the report, too).  

"Medicine + Business + Community = A Prescription for Great Health" celebrates how medicine's visible and trusted leadership is "improving the health of all Texans."  

You also can support the efforts of your colleagues by making a tax-deductible gift to TMA's philanthropic foundation.  


Apply for a Be Wise — Immunize Grant

TMA's Be Wise — Immunize program is accepting grant applications until Oct. 1 for local vaccination programs. Grants of $500 to $1,500 are available to county medical societies (CMSs), TMA Alliance chapters, medical student chapters, and TMA member-physician practices and clinics. Grants can fund new or expanded shot clinics or coalition activity to immunize underserved and uninsured children, adolescents, and/or adults.

In March, local-impact grants were awarded for projects by the McLennan CMS, the Medina Healthcare System, the Taylor-Jones-Haskell-Callahan CMS Alliance, and the Texas Tech University Health Sciences Center medical student chapter.  

TMA launched the Be Wise — Immunize program in 2004 to increase the state's immunization rates. Since then, the program has provided more than 214,000 shots to Texas children and adolescents. If you have questions, email Tammy Wishard, TMA's outreach coordinator, or call her at (800) 880-1300, ext. 1470, or (512) 370-1470.

Be Wise — Immunize is a joint initiative led by TMA physicians and the TMA Alliance. Funding for Be Wise —Immunize is provided by the TMA Foundation thanks to generous support from HEB, TMF Health Quality Institute, and gifts from physicians and their families.

Be Wise — Immunize is a service mark of the Texas Medical Association.  

TMLT Nest Egg Ad



Fight Pertussis With Needles


Central Texas has seen a recent surge in cases of pertussis, with multiple outbreaks confirmed in communities north of Austin to Waco. This uptick follows a wider trend in pertussis outbreaks across the country.

In fact, the Centers for Disease Control and Prevention (CDC) reports nearly 18,000 reported pertussis cases in the United States since January, almost double the number of cases seen this time last year. Many of these infections have been among immunized children whose immunity has waned.  

TMA's Committee on Maternal and Perinatal Health reminds physicians that we can protect ourselves, children, and especially infants by using the current vaccine schedule to update pertussis immunity.   

Pregnant women can and should be immunized to prevent their infants from getting pertussis. Deaths from pertussis occur usually in infants in their first few months, before protection from their immunizations is established.  

To protect infants from pertussis, the CDC's Advisory Committee on Immunization Practices (ACIP) recommends the Tdap vaccine for infants, pregnant women who have not previously received it, and all infant household contacts or care providers, a practice known as cocooning. Here are the ACIP's most recent pertussis immunization recommendations.  

For more information on pertussis, including current insurance reimbursement policies for Tdap vaccination, visit the Pertussis page on the TMA website. It includes a link to the TMA Be Wise — ImmunizeSM program, which provides vaccine resources for patients and physicians, including the handout Facts About Pertussis.

Be Wise — Immunize is a service mark of the Texas Medical Association.  


 TMA Helps Protect Your Practice


Is your practice at risk for allegations of harassment and discrimination? Are you paying your hourly employees correctly? Do you know how to properly counsel or terminate employees? Are you prepared to meet staff training regulations under the new Texas privacy law?  

If you don't know the answers to these questions, your practice may be in big trouble down the road. Learn to safeguard your practice by developing sound practice policies. TMA's new half-day seminar, "Policies and Procedures: Is Your Practice Protected?," will show you how.

The seminar will help you:  

  • Learn why you need policies and procedures,  
  • Identify specific risk areas where your practice may be vulnerable in human resources,  
  • Determine what your medical practice must do to stay compliant, and
  • Implement practical and proactive policies to reduce your liability.    

Led by attorney Regina Williams, the seminar will teach you how to protect your practice.

Seminar attendees receive $100 off the normal price of $250 for TMA's Policies & Procedures — A Guide for Medical Practices.

For more information, click on the link above or call (877) 880-1335.


Have We Heard From You?


Have you participated in TMA's 2012 survey yet? So far, TMA has awarded 16 continuing medical education certificates of $50 to physicians who respond to the survey.

Each month, we randomly draw five winners among physicians who have answered that month's survey. Even better, physicians who answer every survey this year are eligible for a drawing for one of five Apple iPads.  

Your responses will help TMA develop and deliver timely information to keep medical practices strong and serving patients. Physicians who wish to respond but have not received an invitation should contact the TMA Knowledge Center to be sure TMA has the correct email address. 


Shot Summit in Houston

"Immunization in Texas" is the focus of the Texas Immunization Summit 2012, Sept. 27-28, at the Westin Galleria Hotel in Houston. Physicians, nurses, public health officials, legislators, and other policymakers will gather to promote immunizations and to continue the work to raise immunization rates in the state.  

Among the topics are:   

  • Ways to Effectively Communicate the Immunization Message;
  • Implementation of the Meningitis Law;  
  • Health System Reform and Immunizations, and  
  • Vaccine Refusals and the Impact of Exemptions on Disease Rates.    

Several TMA members will speak at the conference: Jason Terk, MD, chair of the TMA Council on Science and Public Health; Erica Swegler, MD, chair, and Julie Boom, MD, a member of the Committee on Infectious Diseases; and C. Mary Healy, MD, consultant to the Committee on Maternal and Perinatal Health.  

TMA has designated the conference for up to 14.25 AMA PRA Category 1 Credits™.

For more information, email Jennifer Adair or call (281) 400-3689.  

What Can Practice Production Numbers Tell You?

Consider these factors if your production isn't consistent.  

A practice management tip from
TMA Practice Consulting


POEP Stands Against Colon Cancer

What stands between patients with colorectal cancer and early death? It could be you.

Sadly, colorectal cancer is caught early only 40 percent of the time. But when it is caught early, almost 90 percent of patients survive five years or more. Screening is crucial, and the TMA Physician Oncology Education Program (POEP) can help you do this important job better.  

POEP's on-demand webinar, "Issues and Answers in Colorectal Cancer Screening," brings you the latest information on this topic, including how to: 

  • Assess risk for colorectal cancer,
  • Choose the appropriate evidence-based screening practices, and  
  • Address common barriers to colorectal cancer screening.   

And, you can earn 1 AMA PRA Category 1 Credit™, including ethics. Register now. The cost is $25.

To learn about other POEP training for primary care physicians, visit the POEP website and click on CME.  


Workers' Comp Rules Change

New recertification rules for designated doctors in the state workers' compensation system took effect Sept. 1. The new rules include changes to the testing and training requirements for current designated doctors.  

The Texas Department of Insurance Division of Workers' Compensation (TDI-DWC) advises all designated doctors to immediately check their TXCOMP profile to determine when their designated doctor credential expires.  

Designated doctor rules, new applications, training dates, and testing vendor information are available on the TDI website or by calling Designated Doctor Outreach and Oversight at (512) 804-4766.   

TDI-DWC will conduct Workers' Compensation Compliance Conferences in Austin and Houston. Each conference will feature an optional preconference session entitled "Basic Workers' Compensation" geared toward individuals who are new to the Texas workers' compensation system. The second day will include 20 breakout sessions organized in three tracks for employers and insurance carriers, designated doctors and other health care professionals, and exhibitors offering workers' compensation-related products and services.  


This Month in Texas Medicine

The September issue of Texas Medicine is a special one, following the Supreme Court's decision to uphold the Patient Protection and Affordable Care Act. It outlines TMA's reaction to the ruling, why the state Medicaid program needs to be different, not just bigger, and what TMA plans to work for in Congress and the Texas Legislature in the year ahead. You'll also learn how the health system reform law affects your practice operations. The issue also explains the vital role poison control centers play and introduces you to a Houston oncologist who was acquitted of fraud charges brought by insurance companies. Finally, the issue also contains the third 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  

Recorded Web Seminars

Avoiding RAC Audits
Avoiding the Courthouse: 10 Practice Pitfalls

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

About Action   

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

To change the email address where you receive Action, go to Member Log-In on the TMA website, then click on "Update Your TMA Demographic Information (including newsletter subscriptions and preferences)."

To unsubscribe from Action, email TMA's Communication Division at

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.