Action: Sept. 17, 2012

TMA Action Sept. 17, 2012            

                                                                                                                        News and Insights from Texas Medical Association 

 INSIDE: Feds May Audit Your Medicare Payments           

Medicare E&M Audits Coming
Hello, Novitas? Is That You?
New MAC Means New LCDs
TMA: Medicaid Fraud Rules Too Much
TMA Condemns Women's Health Rules
Letters: Congress Must Stop Medicare Cuts
PPACA Tops Fall Conference Agenda
St. David's Helps Repay Loans
DocbookMD Goes 4.0
Are You Registered?
Flu Vaccine on the Way
DSHS Issues Pertussis Alert
Academic Physicians: Reward Yourself
CMS Releases New EHR Rules
New Recognition Opportunity for Physicians
Sept. 30 Deadline for GETAC Applications
This Month in Texas Medicine


Medicare E&M Audits Coming

The Centers for Medicare & Medicaid Services (CMS) gave Region C recovery auditor contractor (RAC) Connolly, Inc. the green light to begin auditing Medicare coding for CPT 99215 (evaluation and management [E&M]of an established patient) in physician offices in Texas and several other states.

Texas Medical Association Payment Advocacy Director Genevieve Davis said the association is trying to get information from CMS about where and when the Texas audits will begin. She said TMA is concerned about the timing of the audits since Novitas Solutions will become the new Medicare carrier for Texas in November.

TMA also is concerned about the service to be audited. E&M audits are subjective and require a lot of information and review to determine if the service is coded correctly, she said. Another concern is that Connolly will be able to extrapolate its findings based on a statistical sample of claims, which is not always an accurate assessment of a physician's coding and documentation.

TMA Payment Advocacy says you have options if Connolly selects you for an audit.

Besides Texas, Connolly conducts audits for CMS in 16 other states and territories.

For more information about the recovery audit program, email

TMA Ready to Help  

TMA offers several online courses and publications to help you avoid trouble. They also offer continuing medical education (CME) credit. They include:  

  • "Avoiding RAC Audits," which teaches you how to conduct a self-audit, what to do with your findings, and how to obtain buy-in for corrective actions (enter coupon code:ACTION to receive a $25 registration fee);  
  • "Fraud and Abuse Compliance," a seminar that addresses what constitutes fraud and abuse and how to steer clear of it in your practice; and  
  • A new publication, Fraud and Abuse, which covers the basic ethical and legal tenets regarding health care fraud and abuse, and gives you a clear overview of how federal and state law enforcement can affect a practice. 

For a complete list of offerings, go to the TMA Education Center a convenient, one-stop access to CME when you need it.

TMA's Coding Hotline can answer your questions. Call (800) 880-1300, ext. 1414.  

TMA Practice Consulting advises you against waiting for a formal third-party or RAC audit. Be proactive. Find out if you or your practice is at risk for audit. TMA Practice Consulting has certified professional medical auditors and coders on staff to review physicians' documentation to determine whether the documentation guidelines are being followed, levels of service are correctly coded, and medical necessity is established. It also offers these services to help to make sure you code correctly and document what you've done:

  • Coding and documentation audits, comprehensive reviews of medical record documentation, identity opportunities for improvement, helping reduce your liability and risk of third-party audits;  
  • Coding and documentation training provides an in-depth understanding of the coding and documentation guidelines and criteria for appropriate charge capture; and  
  • Coding and documentation check-ups, abbreviated reviews of claims coding and medical record documentation, provide a glimpse into a physician's coding techniques.

Call TMA Practice Consulting at (800) 523-8776 for a proposal, or email

CMS also has resources for physicians. They include the Evaluation and Management Services Guide and Documentation Guidelines for Evaluation and Management Services. Physicians should be following these guidelines since auditors use when reviewing medical records. They're also the guidelines that EMR vendors should use when setting up physician templates. Physicians should make sure their EMR vendor does this.  

The Department of Health and Human Services (HHS) reports that between 2001 and 2010:  

  • Medicare payments for E&M services increased by 48 percent, from $22.7 billion to $33.5 billion.  
  • The number of E&M services billed by physicians increased by just 13 percent, from 346 million to 392 million.

Based on the percentage of services billed for each E&M code, HHS found that physicians increased their billing of higher level E&M codes and reduced their billing of lower level, less complex and less expensive E&M codes.  

CMS alleges that E&M services had the most improper payments of all Medicare Part B service types in 2008. This is likely one of the reasons E&M services are some of the most scrutinized and audited services. For some practices, E&M services may account for more than half of a physician's revenue; it is critical that you correctly code and document these services.  



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.    




New MAC Means New LCDs


Novitas Solutions will begin administrating all Part B Medicare claims filed in Texas Nov. 19 as it takes over from TrailBlazer Health Enterprises as the state's Medicare administrative contractor (MAC).  

Changes to current local coverage determinations (LCDs) may impact your practice. Novitas Solutions has added 25 new LCDs, while retiring 35 previously covered under TrailBlazer. It is important to note that all retired LCDs will continue to be effective for dates of service before the cutover to Novitas Solutions.  

A comprehensive crosswalk of current, retiring, and new LCDs is on the Novitas Solutions JH LCD Crosswalks web page. This site includes a breakdown of the outgoing TrailBlazer LCD numbers and their new, corresponding Novitas Solutions numbers.   


TMA's upcoming Medicare 2013 Seminar series will outline how these changes will impact physician practices.




TMA: Medicaid Fraud Rules Too Much

Proposed new Medicaid fraud and abuse rules give the state too much power and presume that physicians are crooks.  

That's the gist of a 35-page letter TMA sent the Texas Health and Human Services Commission (HHSC) to oppose its proposed new "program integrity" rules that cast every Medicaid billing error as a possible target for fraud-and-abuse prosecution.

"TMA strongly opposes the proposed rules because they expand [the Office of Inspector General's] authority, minimize the rights of physicians and other providers, and have a tenor that implies a presumption of wrongdoing," John Holcomb, MD, chair of TMA's Select Committee on Medicaid, CHIP and the Uninsured, wrote. Without due process protections and other important changes in the draft rules, he wrote, "the pervasive fear among physicians that they will be incorrectly accused of fraud, waste, or abuse, or denied meaningful recourse in a fraud investigation will continue to contribute to the decline in physician participation in Medicaid."     


Dr. Holcomb objected to the proposed rules repealing current language that not all actions resulting in overpayment to a provider are necessarily fraudulent. He asked that HHSC officials retain that language and reiterate in new rules that some overpayments are the result of mistakes, not fraud.

TMA opposes health care fraud and supports fair processes designed to prevent and detect actual fraud.  



TMA Condemns Women's Health Rules


Proposed rules for the state's Women's Health Program (WHP) would interfere with the patient-physician relationship and set a dangerous precedent "based upon the political agenda of the day," a representative of organized medicine warned the Texas Department of State Health Services (DSHS) earlier this month.  

If implemented, said Austin family physician Celia Neavel, MD, "the rules would interfere in the patient-physician relationship by restricting physicians' ability to provide candid and confidential information about elective abortions to any woman in the practice, even if the physician felt that this information was in the clinical interest of the patient or if the patient asked about the procedure." Dr. Neavel, who practices at People's Community Clinic in Austin, testified at the Sept. 4 hearing on behalf of TMA, the Texas Academy of Family Physicians, the American Congress of Obstetricians and Gynecologists, the Texas Association of Obstetricians and Gynecologists, and the Texas Pediatric Society.   


Adoption of the rules would force the clinic to resign from the program, she added.  

DSHS held the hearing to discuss how WHP will function without federal funding. The Texas Legislature approved a plan last year that would ban Planned Parenthood and other abortion affiliate programs from the federal Women's Health Program. That move led the Obama administration to cut off federal funding for WHP. Since then, the Texas Health and Human Services Commission (HHSC) proposed rules affecting the program that concern many Texas physicians. At the hearing, physicians spoke in favor of the program and opposed proposed rules that would not only forego 90 percent of federal funding for the program, but also bar physicians in it from discussing abortion with patients.

Janet Realini, MD, president of Healthy Futures Alliance, a coalition working to reduce teen and unplanned pregnancy, stressed that Texas is experiencing a "crisis in access to women's preventive care." She says further reduction of participating physicians in WHP "will only make things worse." (See "A Steep Price" in the July 2012 issue of Texas Medicine.)  

TMA sent a letter to DSHS in early August opposing the proposed rules. TMA President Michael E. Speer, MD, wrote that the rules would impose a "gag order" on physicians who participate in the Texas WHP. "If the state indeed wants doctors to participate in the program, this is a step in the opposite direction," Dr. Speer wrote.

Rep. Donna Howard (D-Austin), Rep. Sarah Davis (R-Houston), and Sen. Kirk Watson (D-Austin) attended the hearing and encouraged state officials to protect the patient-physician relationship and work in the best interest of Texas women.              






Letters: Congress Must Stop Medicare Cuts

TMA, the American Medical Association, and more than 100 state and specialty medical societies are urging Congress to nullify the 2-percent cut in Medicare payments to physicians called for under the Budget Control Act's sequestration provision and the 27-percent cut coming due to the flawed Sustainable Growth Rate (SGR) formula.  

In letters to congressional leaders, TMA and other groups said the combination of a sequestration cut and looming SGR payment cut "would not only impede improvements to our health care system, it could lead to serious access to care issues for Medicare patients as well as employment reductions in medical practices. Sequestration also will result in across-the-board cuts to a wide range of essential programs to ensure high quality and accessible patient care, and we believe that Congress should not abdicate its responsibility to deliberate and make policy decisions on what is important and needs to be funded."  

They added that the cuts "could not occur at a worse time. Medicare physician payments have been nearly frozen for a decade, while the cost of caring for patients has increased by more than 20 percent. Congress still has not revealed a clear plan for addressing the 27-percent cut in 2013 called for by the Medicare SGR formula. While these cuts alone will be devastating to physician practices and patient access to care, physicians are also facing present and future financial penalties if they do not successfully participate in multiple Medicare programs, including the e-prescribing program, the electronic health record meaningful use program, and the Physician Quality Reporting System, as well as the value-based modifier."    


The letters conclude by saying that Congress is responsible for ensuring that Medicare has sufficient funding to sustain adequate payment for medical services physicians provide to senior citizens and people with disabilities. "The status quo is unsustainable, and will do considerable harm to the Medicare program as well as the broader health care delivery system. We understand that our nation faces significant fiscal challenges; however, these cuts will undermine efforts to achieve broader, long-term reforms to the Medicare program."  

AMA, the American Hospital Association, and the American Nurses Association released a new report that found that as many as 766,000 health care and related jobs could be lost by 2021 as a result of the 2-percent sequester of Medicare spending mandated by the Budget Control Act of 2011.  




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.  



St. David's Helps Repay Loans


Physicians in Travis, Williamson, Hays, Bastrop, and Caldwell counties can apply for help paying off their medical school loans through the new St. David's Foundation Central Texas Loan Repayment Program. The Texas Higher Education Coordinating Board says the program is designed to recruit and retain qualified physicians, dentists, physician assistants, and nurse practitioners at eligible safety net sites located in those four counties.  

To qualify, eligible physicians must agree to provide four years of service at an approved practice site, with the understanding that they will be released from the agreement if grant funding is not continued after the first year of service. The loan repayment awards will be for the amount required to repay their student loans over four years up to $30,000 annually.     


Oct. 1 is the application deadline, but the coordinating board says that likely will be pushed back. Applications will be considered on a first-come-first-served basis after the priority deadline.  

Email Lesa Moller at the coordinating board if you need more information.  




DocbookMD Goes 4.0 

The first major update has been released for the physician-only mobile app DocbookMD. Version 4.0 brings a whole new look and feel to the app that is meant to make the user interface much simpler to navigate and to enhance the speed and ease in which you can communicate with your colleagues and care for your patients.  

Along with the new look comes a greater level of functionality. The 4.0 release features threaded messaging (for easy reference, all parts of a conversation are listed below the latest message), message forwarding, and a much faster physician directory download time, as well as many behind-the-scenes improvements to increase app speed and stability.   

Hospitals and physician groups now can also sort directory searches by name or specialty of physicians within their group, helping to build a sense of community and increasing in-network referrals, while also streamlining the efficiency and quality of patient care.  

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. It's your latest membership benefit from TMA.  

To learn more about DocbookMD and the new 4.0 update, visit the TMA website or             


TMLT Nest Egg Ad  



Are You Registered?

Make sure you're registered to vote in the November general election. There's a lot at stake. In addition, Texas physicians have a chance to add to the number of physicians in the Texas Legislature.  

Here's the 2012 election calendar:  

Last day to register to voteOct. 9
First day of early voting – Oct. 22
Last day to apply for ballot by mailOct. 30
Last day of early voting – Nov. 2
Election Day – Nov. 6   




Flu Vaccine on the Way

Manufacturers are shipping influenza vaccine for the 2012-13 seasonal influenza season, according to the Centers for Disease Control and Prevention (CDC).   

CDC reports little flu activity so far but recommends vaccinating patients as soon as the vaccine is available. It recommends an annual influenza vaccination for all individuals at least 6 months old. It recommends two doses of influenza vaccine for children aged 6 months through 8 years, depending on their vaccination history.

The annual vaccine is especially important for certain groups who are at higher risk of developing serious complications, including:   

  • People who have certain medical conditions including asthma, diabetes, and chronic lung disease;  
  • Pregnant women;  
  • People 65 years and older, and  
  • People who live with or care for others who are high risk of developing serious complications.  

An estimated 46 percent of people who were older than 6 months received vaccinations last year. Coverage during the 2011-12 season slightly increased compared with the previous season.

If you attend TMA's 2012 Fall Conference, make sure to stop at the influenza vaccine clinic, Saturday, Oct. 20, from 7:30-8:45 am at the AT&T Center in Austin. You can make sure you are protected against influenza so you can protect your patients. Register for an influenza shot ($25) or nasal-spray vaccine ($40) on the conference website.  



DSHS Issues Pertussis Alert

Six deaths and more than 1,000 cases of pertussis in Texas so far this year prompted the Texas Department of State Health Services (DSHS) to issue a health advisory urging immunization against the illness.  

DSHS urges physicians who suspect pertussis to report the case to their local health department as soon as possible. Patients who have pertussis should not return to work or school until they've had five days of antibiotic treatment.

Health officials said the six deaths so far this year are the most for a single year since 2005. Five of the deaths were among infants younger than 2 months, the age at which the first pertussis vaccination is recommended. The sixth death was of an unvaccinated older child with underlying medical conditions.    


TMA's Be Wise — ImmunizeSM program combines education and hands-on immunization clinics to increase statewide vaccination rates. Be Wise offers physicians current information and best practices on childhood and adolescent immunization and educational materials for patients to promote the importance, safety, and effectiveness of vaccines.  

Be Wise offers tools to help you implement or enhance existing vaccination practices.   

  • Use the Be Wise physician childhood and adolescent toolkits to put vaccination best practices in place in your office. The toolkits inform you and your staff how to use ImmTrac (Texas' immunization registry), join the Texas Vaccines for Children program , and talk to parents about conscientious objection.  
  • Take continuing medical education (CME) courses offered through Be Wise. Each year, programs about timely vaccination topics are available to physicians at TexMed, the association's annual meeting. Other CME programs are offered continually.  
  • Join the Be Wise Advocates Panel and help get the word out about the importance and safety of vaccinations by writing a letter to the editor or becoming a spokesperson on vaccinations.   


Academic Physicians: Reward Yourself

Have you been working hard teaching for the past three to five years? TMA thinks it’s time to reward yourself. If you are a physician who has taught medical students, residents, or fellows for at least the past three years and you were a TMA member during that time, TMA encourages you to apply for new awards created for doctors like you.   

The TMA Award for Excellence in Academic Medicine recognizes teaching physicians who are clinicians and have a record of TMA leadership, scholarly activity, mentoring, professional development, advocacy, and community service.  

"TMA is eager to recognize our physician leaders who are dedicated to caring for patients as well as preparing tomorrow' physician workforce," said David P. Wright, MD, chair of the TMA Council on Medical Education. "These awards express the value TMA places on the academic segment of the physician community and the role they play in transforming health care through teaching."   

Qualification for bronze- and silver-level awards is through self-nomination. Physicians may download and submit the application by Dec. 31. TMA is developing criteria for gold and platinum levels and will announce them in coming months.

Once TMA verifies your eligibility for a bronze or silver award, you will receive a framed certificate in the mail. In addition, you will receive recognition in Texas Medicine and a mention in the Handbook Report for the next TMA House of Delegates annual meeting. If you have questions, email Jennifer McHaney or call her at (800) 880-1300, ext. 1451, or (512) 370-1451.    







What Can Practice Production Numbers Tell You?

Consider these factors if your production isn't consistent.  

A practice management tip from
TMA Practice Consulting




CMS Releases New EHR Rules

The Centers for Medicare & Medicaid Services (CMS) recently released the final rule on Electronic Health Records (EHR) Meaningful Use Stage 2. Physicians can earn the maximum EHR incentives by meeting meaningful use for five consecutive years under the Medicare program. (Medicaid is a six-year program, and the years do not have to be consecutive.)  

TMA fought to make the new rule simpler and more physician friendly. Now that it is in place, we're here to help you get your bonus payments as easily as possible.  

According to the final rule, physicians who started the EHR incentive program in 2011 or 2012 must comply with Stage 2 criteria beginning in 2014. Physicians who begin Stage 2 in 2014 only have to report for 90 days that year (instead of the full year previously required) because CMS recognizes that EHR vendors will need to upgrade their systems to meet the requirements.

Each stage of meaningful use becomes more complex. The time frames for Stage 2 are tighter, and the standards are higher for the measures that were part of Stage 1. For example, in Stage 1, physicians had three days to get patients their clinical summaries; the new rules reduced that to one day. A new Stage 2 rule for physicians requires them to electronically communicate at least one time with 5 percent of their patients. During the comment period, TMA opposed this measure, which CMS originally set at 10 percent.

Stage 2 now has six menu (optional) objectives, of which physicians must select and meet three. Five of the menu measures are new. CMS prepared a summary that compares Stage 1 and Stage 2.

To help physicians, the Office of the National Coordinator for Health Information Technology established regional extension centers (RECs) to provide onsite health information technology (HIT) consulting in physician practices. The RECs receive grant funding to subsidize the consulting costs for primary care physicians. RECs can assist specialists but not at the subsidized rate.

For questions about eligibility and REC services, visit the REC Resource Center on the TMA website. For questions about meaningful use or other HIT issues, contact TMA's HIT Department by telephone at (800) 880-5720 or by email; or visit the TMA website.  


New Recognition Opportunity for Physicians

Texas physician practices are making great strides in patient care through preventive services and the use of health information technology. To recognize these practices, TMF Health Quality Institute, TMA, and Texas Osteopathic Medical Association have partnered to introduce the inaugural Texas Physician Practice Quality Improvement Award program.

The program is open to all Texas physician practices with one or more Texas-licensed physicians providing care to Medicare fee-for-service patients. Award criteria include adoption of health The program is open to all Texas physician practices with one or more Texas-licensed physicians providing care to Medicare fee-for-service patients. Award criteria include adoption of health information technology, use of population care management methods, participation in data-reporting initiatives and top performance on nationally recognized clinical outcomes measures.

Physician practices are encouraged to self-nominate by Sept. 30.



Sept. 30 Deadline for GETAC Applications

The Governor's EMS and Trauma Advisory Council (GETAC) is accepting applications through Sept. 30 for its standing committees.   

GETAC promotes, develops, and maintains a comprehensive EMS/Trauma System in Texas. The committees meet quarterly in Austin to find innovative techniques and systems for delivering emergency care in the state.  

Committee members serve three-year terms. If interested, download the application from the News/Features column of the DSHS Office of EMS/Trauma Systems Coordination website. Click on GETAC committee applications accepted until September 30.  

GETAC officials will announce new or reappointed committee members in November. New committee members will meet with the committee for the first time at the February GETAC meetings. If your appointment to a committee expires in 2012, you must reapply to be considered for reappointment to that committee.  

For information, email Nancy Rosas or call her at (512) 834-6700, ext. 2363.  



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.

Physician Health and Rehabilitation, Ext. 1342  

Healthy Physicians: Healthy Patients
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.