Action: Dec. 4, 2012

TMA Action Dec. 4, 2012  
News and Insights from Texas Medical Association  


INSIDE: SGR Zombie Must Die 

Tell Congress to Kill the SGR Zombie
Update Your Staff's HIPAA Training
Blues Ranking Letters on the Way
2013 Medicare Enrollment Ends Dec. 31
Renew Dues Now to Write Off the Expense
E-Tips Helps Your Practice Run Right
Physician-Reporters: Get Your Due

Legislative News Delivered to Your Inbox
TMA Winter Conference Feb. 1-2 in Austin
Meaningful Use Means No eRx Penalty
New CME Course Examines Drug Overdoses
Holiday Solution: TMAF's Holiday Tribute
This Month in Texas Medicine

Tell Congress to Kill the SGR Zombie

We need your help to convince Congress to stop the "zombie Medicare financing" it uses to pay physicians. Every year for the past 12, cuts driven by the defective Sustainable Growth Rate (SGR) formula have come back from the dead … but in even worse shape. The SGR crisis is not dead nor does it lie dormant. It's very much alive.

Year after year of payment uncertainty is forcing doctors out of Medicare, making it more difficult for seniors, Texans with disabilities, and military families to get the care they need. In fact, the number of Texas physicians accepting all new Medicare patients dropped from 78 percent in 2000 to only 58 percent in 2012. This statistic is frightening. The crisis can only get worse as millions of baby boomers become of Medicare age.  

Please call Washington today (Tuesday, Dec. 4) at 7 am and every Tuesday thereafter until Congress stops the payment cut and agrees to fix the defective SGR. Join your colleagues to convince Congress to stop this year's 27.5-percent cut. Get commitments from Sens. John Cornyn and Kay Bailey Hutchison and your representative to fix the 12-year-old problem.  

For talking points and congressional phone numbers, go to the Medicare Meltdown Action Center.  

Update Your Staff's HIPAA Training

A new state law that took effect in September has more stringent regulations for protected health information (PHI) than its federal counterparts, the Health Insurance Portability and Accountability Act (HIPAA) and the Health Information Technology for Economic and Clinical Health (HITECH) Act. Among other things, it has new requirements for notices to patients regarding electronic disclosure of PHI. And practices that wrongfully disclose a patient's PHI face increased civil penalties.

The law (House Bill 300) also requires employee training on state and federal laws regarding PHI. TMA will soon launch a new webinar series that satisfies these training requirements. Held at noon CST, these programs offer training tailored to each employee's scope of employment (as required by HB 300).The webinar dates and subjects are:  

  • Dec. 11: Complying With HIPAA & Texas Privacy Laws – a must for compliance officers and a good overview for the entire staff;  
  • Dec. 12: HIPAA for Non-Clinical Staff – tailored for reception and medical records personnel; and  
  • Dec. 15: HIPAA for Clinical Staff – focuses on physicians, nurses, billing and coding staff, and others involved in clinical care.   

Registration for each webinar is $59, or you may purchase all three as a bundle for $129. For this low fee, practices can train everyone on the staff.  

HB 300 Action Plan  

  • Update your policies and procedures to incorporate changes resulting from HB 300. This includes providing the newly required notice to an individual for whom your practice creates or receives PHI.  
  • Develop and implement an employee training plan. New employees must receive training on state and federal laws concerning PHI for privacy/security compliance within 60 days of hire. Existing employees must complete PHI training at least once every two years. Training must relate to your practice and the employee's duties. In other words, one size does not fit all.  
  • Document, document, document! To meet the training requirement, employees are required to sign, electronically or in writing, a statement verifying attendance at the training program. Your practice is required to keep the signed statement on file.  

Visit TMA's HIPAA Resource Center for more information and resources on HB 300, including downloadable forms needed for compliance.  


Blues Ranking Letters on the Way

Beginning mid-February, physicians may begin checking their mailboxes for letters from Blue Cross and Blue Shield of Texas (BCBSTX) containing doctors' latest ratings in the plan's BlueCompare quality and cost-efficiency assessment program. BCBSTX says it will publish those ratings, displayed as ribbons, in its web-based "Provider Finder" tool as of June 1.

The plan also will send information outlining a new "Physician Quality Measurement" (PQM) online ranking program set to launch some time later in 2013.The PQM initiative is part of a national effort by the Blue Cross and Blue Shield Association (BCBSA) to improve transparency for consumers when they shop for a doctor.  

Under the new program, each state's plan will rate physicians based on its choice among a pool of 20 set quality measures that BCBSA indicates will come from nationally endorsed quality measures of common conditions like asthma, back pain, diabetes, depression, and heart disease. BCBSTX says it will use the same measures for the new PQM as those used for BlueCompare, and the new program is meant to "enhance" the BlueCompare ratings by displaying the details of a doctor's measurement results for each quality metric.  

Patients searching online for a physician will see a physician's performance rating for each quality measure displayed as a star next to his or her name, in addition to a score comparing the doctor with local peer groups. Patients also can view an online description of the quality measures used to rate a physician.  

"Today's consumers are always looking for more information about physicians and quality health care," said Allan J. Chernov, MD, BCBSTX medical director for health care quality and policy. The PQM program supports patients' "healthcare decision-making, and promotes the collaboration of physicians, patients, health plans and employers in continuously improving the quality of care."  

TMA Director of Payment Advocacy Genevieve Davis said the association is working with BCBSTX to make sure the plan's program complies with a 2009 state law governing physician ranking and tiering programs. TMA won legislation that gives physicians the right to appeal their ranking or classification before a health insurance company publishes it or to opt out of a program completely. Plans also must involve actively practicing physicians in developing quality standards used.  

For physicians who choose to participate in a rating program, TMA wants to make sure they can truly review their quality data before Blue Cross posts it for all to see. On the other hand, messages indicating to patients that a physician has opted out should not be disparaging, Ms. Davis says.  

You can find information on physician rankings on the Physician Ranking page of the TMA website. The page includes "Basic Steps for Reviewing and Disputing Physician Rankings & Tierings," a two-page guide on how to appeal your ranking.  

2013 Medicare Enrollment Ends Dec. 31

Physicians have until Dec. 31 to enroll in the Medicare program for 2013.

You have three options:  

  1. Sign a participation (PAR) agreement and accept Medicare's allowed charges as payment in full for all Medicare covered services for your Medicare patients.  
  2. Elect nonparticipation (non-PAR), which allows you to make assignment decisions on a case-by-case basis and to bill patients up to the Medicare limiting charge for unassigned claims.  
  3. Opt out and become a private contracting physician, agreeing to bill patients directly and forego any payments from Medicare to your patients or yourself. To become a private contractor, PAR physicians must give 30 days' notice before the first day of the quarter the contract takes effect. For non-PAR physicians, the opt-out effective date is the date the affidavit is signed, provided it is filed within 10 days after the physician signs his or her first private contract with a Medicare beneficiary.  

Novitas Solutions, which replaced TrailBlazer Health Enterprises as the Medicare contractor for Texas on Nov. 19, has several resources on its website. They include an overview of Medicare assignment, participation, and the opt-out process. A separate page on the Novitas website offers more detailed information on the opt-out process. The page also includes a sample affidavit a physician must file if he or she decides to opt out.  

TMLT Nest Egg Ad  

Renew Dues Now to Write Off the Expense

If you would like to pay your TMA and county medical society dues by the end of the year, please act now. TMA estimates that 82 percent of your membership dues may be deductible as ordinary and necessary business expenses.

Renew online today, take the expense in 2012, and see what a difference TMA membership can make to you and your practice. Rest assured, TMA is committed to finding the solutions outlined in TMA's Healthy Vision 2020 that practices need to remain viable and strong and ensure patients have access to high-quality care.

The TMA Knowledge Center can answer your renewal questions by telephone at (800) 880-7955 or by email.  

E-Tips Helps Your Practice Run Right

TMA publishes TMA Practice E-Tips, a popular free e-newsletter twice a month to offer four brief, practical tips for managing a medical practice in Texas. Each issue gives you hands-on, use-it-now advice on coding, billing, payment, HIPAA compliance, office policies and procedures, practice marketing, and much more, along with useful links for more information.

Get E-Tips three ways: 

  1. Email delivery. Have TMA Practice E-Tips delivered to your inbox by subscribing today. (Log in and click on Subscriptions on the left. It's easy. And while you're there, you can sign up your office staff to receive E-Tips, too.)
  2. Read the feed. Check out the latest issue.
  3. Online. Read the latest issue of TMA Practice E-Tips online.

Physician-Reporters: Get Your Due

Do you write a medical column for your local newspaper or host a radio health show or a weekly medical segment on the local TV news? If so, enter your work in the TMA Anson Jones, MD, Awards program. 

TMA will accept entries until Jan. 15.

For more than 50 years, TMA has honored award-winning Texas journalists with the Anson Jones, MD, Awards for excellent medical news reporting. TMA opened the competition to physician-reporters in 2007 with the Physician Excellence in Reporting category.  

Visit the Anson Jones webpage for contest rules and an entry form. If you have questions, email or call Tammy Wishard, TMA outreach coordinator, at (800) 880-1300 ext. 1470, or (512) 370-1470.   




Legislative News Delivered to Your Inbox

The next session of the Texas Legislature promises to be action-packed, and you don't want to miss the action under the Capitol dome. You won't miss a thing if you sign up for the TMA Legislative News Hotline.

The electronic newsletter reports the legislature's latest actions on bills affecting you, your practice, and your patients. It's delivered daily before noon starting Jan. 2. A weekly recap, delivered each Friday, also is available.  

This year, the hotline also will bring you weekly video updates from TMA lobbyists, health care experts, and even state legislators. Don't miss out. Subscribe today.  

TMA Winter Conference Feb. 1-2 in Austin

 Save the date for the 2013 TMA Winter Conference Feb 1-2 at the AT&T Conference Center in Austin.  

The Texas Legislature will be in full swing, and TMA will continue to shape Healthy Vision 2020, the association's advocacy playbook for the future of Texas medicine.    

Book your hotel reservation by Jan. 11 to get the discounted rate.  

Watch your email and the Winter Conference website for more information.  


Meaningful Use Means No eRx Penalty

The Centers for Medicare & Medicaid Services' (CMS') 2013 physician fee schedule final rule says physicians who achieve meaningful use between Jan. 1, 2011, and June 30, 2012, and who attest to meaningful use by Jan. 31, 2013, will not suffer the 1.5-percent Medicare e-prescribing penalty on Jan. 1.

Physicians who intend to participate in the electronic health record (EHR) incentive program are eligible for an e-prescribing hardship exemption as long as they register for the EHR incentive program by Jan. 31, 2013, and provide their EHR certification number (available by visiting the Certified Health IT Product List site). If you have already registered for the program, you can go back and add in the EHR certification number.  

Physicians do not need to take any other action for these exemptions. As Action reported in November, CMS did reopen the e-prescribing portal for physicians needing to claim a hardship exemption, and it will remain open until Jan. 31, 2013.  

If you need help with e-prescribing, turn to the Texas regional extension centers (RECs). RECs provide support to physicians to help with e-prescribing, EHR selection, workflow analysis, staff training, EHR incentives, and much more. Visit TMA's Texas REC Resource Center for more information.  

For more information about the e-prescribing program, call TMA's Department of Health Information Technology calling (800) 880-5720 or email HIT 

What Can Practice Production Numbers Tell You?

Consider these factors if your production isn't consistent.  

A practice management tip from
TMA Practice Consulting

New CME Course Examines Drug Overdoses

Prescriptive drug abuse is at epidemic levels in the United States, and opioids are the drug patients use most often in unintentional deadly overdoses. How can physicians help stop these preventable deaths?  

The Texas Pain Society, in collaboration with TMA's Physician Oncology Education Program, shares effective strategies in a new home-study course, Pain Medicine: Accidental Lethal Overdoses. Physicians can learn the principles of chronic opioid therapy, including appraising a patient's risk for substance abuse, avoiding dangerous drug combinations, and assessing therapeutic benefit.   

This 13-page course costs $35 and offers continuing medical education credit, including 1.5 hours of ethics. You can download the course file through the TMA Education Center or request a hard copy in the mail by emailing Laura Wells or calling her at (800) 880-1300, ext. 1673, or (512) 370-1673.   

Holiday Solution: TMAF's Holiday Tribute

With the holidays here, you may be reviewing your gift and charitable giving budgets. The TMA Foundation (TMAF) has a solution to help make both go farther: TMAF's Holiday Tribute program. Make a donation to TMAF in someone's name, and that person will receive a beautiful holiday card acknowledging your generous gift in his or her honor.

Instead of worrying about a gift, make a gift to thank or remember a friend, family member, or colleague. You'll be supporting TMA's award-winning initiatives and creating a "Healthy Now and Healthy Future" for Texans of all ages. 

Visit the TMAF webpage to donate online or call (800) 880-1300, ext. 1664, or (512) 370-1664. Place your order by Dec. 15 to ensure your card arrives before the 25th.  

This Month in Texas Medicine

The December issue of Texas Medicine tells you why TMA is concerned about new state antifraud rules that presume a physician is guilty. You'll also learn about TMA's plan to push an anti-red tape bill in the next legislative session and what the government expects of you in its electronic health record rules. Finally, you'll find out what the "Choosing Wisely" program is all about.  

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.

Physician Health and Rehabilitation, Ext. 1342  

Interventions for Health: PHR Training Session and 20th Annual Retreat
2-22/23 Horseshoe Bay  

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