Action: Feb. 15, 2013

TMA Action

Feb. 15, 2013          News and Insights from Texas Medical Association     

  INSIDE: TMA Wants a Better Medicaid System  

TMA: Expand Coverage and Reform Medicaid
TMA Wants HIT Safety Czar
Feb. 28 Is Medicare EHR Attesting Deadline
Flu Vaccine Supplies Increase
Flu Webinar on Feb. 19
TMA Webinar Explains HIPAA Security Rules
DSHS Website Promotes Healthy Babies
Who Has Time to Read 5,000 Medical Journals?
TMA Offers New Member Benefits
This Month in Texas Medicine
Political Prognosis: TMA Takes on Budget, Medicaid, Scope, End of Life

TMA: Expand Coverage and Reform Medicaid

Political leaders in Washington and Austin must immediately develop a bipartisan solution to reform the state's Medicaid program and expand coverage of poor, childless adults, the Texas Medical Association Board of Trustees says in a resolution the board adopted at its meeting Feb. 1 during the TMA Winter Conference.

"The Texas Medicaid system is broken," said TMA President-Elect Stephen Brotherton, MD. "As a result, it is morally unconscionable for national-state public policy gridlock to deny proper medical care for over 1 million of our state's low-income families and Texans with disabilities.

"We need to reform it to attract physicians back to the program," he said. "The current system offers the promise of coverage without adequate funding to ensure access to care. It is fraught with exasperating, unyielding red tape.

"Additionally, we need to make sure Medicaid payments cover the real cost of health care. If we don't address these two critical reforms, our state's Medicaid physician participation crisis (only 3 out of 10 Texas physicians now accept all new patients) will worsen."

Instead, Dr. Brotherton and TMA leaders called on state leaders and lawmakers to "look beyond the federal government expansion solution and design a solution that works for Texas and for Texans."

TMA officials emphasized that the association is seeking expansion of coverage for poor, childless adults that is not traditional Medicaid. The state, they say, has the ability to work with the Centers for Medicare & Medicaid Services on a proposal that: 

  • Has patient copays and deductibles,
  • Allows the state to develop a benefit package that makes sense for this patient population, and
  • Allows the state to drop out of the program if conditions change.  

"Texas physicians share both the taxpayer concerns of our state leaders as well as the very realistic medical care concerns of our state's uninsured population," Dr. Brotherton said.

TMA calls on Texans to use their ingenuity to "devise a comprehensive solution that:

  1. Draws down all available federal dollars to expand access to health care for poor Texans;
  2. Gives Texas the flexibility to change the plan as our needs and circumstances change;
  3. Clears away Medicaid's financial, administrative, and regulatory hurdles that are driving up costs and driving Texas physicians away from the program; and
  4. Relieves local Texas taxpayers from the unfair and unnecessary burden of paying the entire cost of caring for their uninsured neighbors."


TMA Wants HIT Safety Czar

Federal officials should appoint a "highly visible HIT Safety Czar" to help protect patients from adverse events caused by electronic health record (EHR) systems functioning improperly, TMA says in a letter to the director of the Office of the National Coordinator for Health Information Technology.

The czar would "oversee, coordinate, and market health IT patient safety across the multiple organizations, programs, developers, and end users," TMA wrote in comments on the U.S. Health and Human Services Department's HIT Patient Safety Action and Surveillance Plan. The plan is designed to prevent errors caused by EHRs.

TMA's letter, signed by Joseph Schneider, MD, head of the association's Health Information Technology Committee, says "significant patient safety risks exist now and new ones will emerge in the next one to two years as many EHR and other HIT vendors merge or go out of business. Therefore it is imperative to set mandatory deadlines and have a robust reporting and learning system in place now, not later. We are extremely concerned that the proposed plan lacks the specificity necessary for success."

It added that TMA also is "concerned that the document contains fundamental weaknesses that will cripple the effectiveness of the programs, such as reliance on voluntary reporting and funding."

Feb. 28 Is Medicare EHR Attesting Deadline

Physicians participating in the Medicare electronic health record (EHR) incentive program have until Feb. 28 to complete their meaningful use attestation. TMA recommends you attest as soon as possible to avoid any potential glitches that could delay or, worse, prevent payment. Physicians participating in the Medicaid EHR incentive program have until March 16 to attest.

 The Centers for Medicaid & Medicare Services (CMS) published some helpful resources for physicians:

TMA's EHR Incentive Program Resource Center provides a compilation of resources to help physicians.

TMA recognizes the complexities of compliance with the EHR incentive program and recommends physicians contact their local regional extension center (REC), established by the Office of the National Coordinator for Health Information Technology to help specifically with program compliance. The RECs are able to help all physicians, but may be able to discount services for primary care physicians. Details about the REC program are available on the TMA website in the Texas REC Resource Center.

For more information, call the TMA Health Information Technology Department at (800) 880-5720 or email HIT.  


TMLT Nest Egg Ad  

Flu Vaccine Supplies Increase

Sanofi Pasteur has made additional influenza vaccine available for children and adults. This includes Fluzone in 0.25 mL prefilled syringes for children aged 6 through 35 months, as well as Fluzone in 0.5 mL vials for patients 3 years and older.

This means several products are now available for physicians to use with children and adults, including Afluria by CSL Biotherapies for patients 9 years and older, FluMist by MedImmune for patients 2 years and older, Fluvirin by Novartis for those 4 years and older, and Fluzone by Sanofi Pasteur for patients 6 months and older.

Several products licensed for use in adults only are also still available. This includes FluLaval by ID Biomedical Corp. for patients 18 years and older, Fluzone High-Dose by Sanofi Pasteur for those 65 years and older, and Fluzone Intradermal by Sanofi for people aged 18 through 64 years.

The National Influenza Vaccine Summit compiled a list of flu vaccines available from distributors. The updated Centers for Disease Control and Prevention (CDC) website includes the latest recommendation on vaccinating pregnant women with Tdap during each pregnancy. The CDC also has directions on how to display vaccination schedules on your office website.

TMA's Be Wise — ImmunizeSM program offers you more information on vaccinations.

Be Wise works with physicians, medical students, and TMA Alliance members to improve vaccination rates in Texas through education and hands-on immunization clinics. The program can help you implement or enhance vaccination practices in your office with vaccination toolkits and continuing medical education courses; educate patients about vaccines in your office, in the media, or at public gatherings such as parent-teacher associations and civic organizations; host a low-cost/free vaccination clinic after hours or on the weekend; understand health care worker vaccination requirements and promote vaccinations among your employees; and keep up with the latest vaccine news.

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 H-E-B and TMF Health Quality Institute, and gifts from physicians and their families. Be Wise —Immunize is a service mark of the Texas Medical Association.  

Flu Webinar on Feb. 19

Current Texas surveillance data during the 2012-13 influenza season, plus general disease, virology, and prevention and control measures, will be discussed during a free Department of State Health Services (DSHS) webinar from noon to 1:15 pm CST on Tuesday, Feb. 19

The webinar presenters will be Texas Influenza Surveillance Coordinator Lesley Brannan and Carol M. Davis, epidemiologist and leader of the DSHS Respiratory Invasive Disease Team.  

Once you register for the webinar, DSHS will email you the telephone number to call and other information you need to join.

TMA Webinar Explains HIPPA Security Rules

Developing and using procedures in your practice to prevent, detect, contain, and correct security violations is the subject of an upcoming live TMA webinar. Complying With HIPAA Security, from noon to 1 pm CST on Wednesday, Feb. 20, offers 1 hour of continuing medical education credit in ethics.  

The webinar highlights include:

  • What is HIPAA Security?
  • Enforcement and penalties, and
  • What's different in Texas?

Webinar presenters will be Alan Atwood, TMA's associate vice president of technology and the association's HIPPA compliance officer, and Dallas health care attorney Jeffery P. Drummond. Mr. Drummond is a frequent speaker on medical record privacy and security issues and HIPAA. 



DSHS Website Promotes Healthy Babies

TMA's Maternal and Perinatal Health Committee recommends physicians log on to the new Someday Starts Now website established by the Department of State Health Services as part of its Healthy Texas Babies initiative to reduce infant mortality in Texas.

 The committee reviewed the site during its meeting at the TMA Winter Conference earlier this month. The site includes information and resources for physicians, including birth and life plan templates, posters, patient worksheets and FAQs, and training videos.

The Healthy Texas Babies initiative includes:

  • Evidence-based interventions led by local coalitions in communities statewide;
  • Communications campaigns to raise public awareness;
  • Efforts to address disparities in infant mortality among different ethnic groups; and
  • Provider education and support for clinical decision making.  

Who Has Time to Read 5,000 Medical Journals?

Let the TMA Knowledge Center alert service keep you up-to-date with the newest articles and latest developments in medicine and the business of medicine.

TMA Knowledge Center staff create custom searches set to run each week. The results of these searches are emailed directly to you or accessed via RSS feed. TMA Knowledge Center alerts provide citations and abstracts along with some full-text access.

It's a free member benefit! Sign up today!

Questions? Call the TMA Knowledge Center at (800) 880-7955 or 512-370-1550 or email TMA Knowledge Center.

TMA Offers New Member Benefits

Your TMA membership gives you access to exclusive discounts on a variety of products and services. Don't miss out on the latest member benefits. 

Akaro Graphics specializes in turnkey medical marketing solutions and can design, host, and maintain your website and email accounts for a no-hassle, discounted rate. Call (512) 300-4044 or email Akaro Graphics for more information.

SmartScrubs offers TMA members 15% off the cost for high-quality, professional S.C.R.U.B.S. and lab coats. Act now and receive free TMA logo embroidery through March 1.

Visit TMA's Group Discount Programs page for more great deals on items you use every day, and consult the TMA Endorsed Services page for services that have been vetted specifically for your medical practice. When contacting vendors, be sure to mention your TMA membership to receive discounted rates and the best service.   


What Can Practice Production Numbers Tell You?

Consider these factors if your production isn't consistent.  

A practice management tip from
TMA Practice Consulting




This Month in Texas Medicine

The February issue of Texas Medicine advises physicians on things they need to consider when deciding whether to join a practice or go solo. It also explains how TMA Practice Consulting can help with practice set-up, outlines the Public Health Coalition's priorities for the 2013 legislative session, and delves into changes in the workers' compensation drug formulary. 

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.  

Political Prognosis: TMA Takes on Budget, Medicaid, Scope, End of Life

The 2013 Texas Legislature kicked off Jan. 8 with a rosier budget picture than last session, which could be good news for TMA's goals of restoring many of the harsh cuts enacted in 2011. Fewer bills filed so far this session also could mean more air time for health care issues. 

That includes Medicaid, expected to remain a focus for lawmakers. As such, making headlines was the TMA Board of Trustees' decision at TMA's Winter Conference to support a bipartisan, federal-state solution to reform the state's Medicaid program and expand coverage to poor, childless adults.

Meanwhile, just one month into session, TMA already reached landmark agreements on bills addressing certain scope-of-practice and end-of-life issues. A number of insurance-related bills have medicine on alert.

Key committee appointments of House and Senate members of the house of medicine could play a big role in moving medicine's efforts forward.

On the Senate side: Sen. Bob Deuell, MD (R-Greenville), kept his spots as vice chair of the Senate Health and Human Services and State Affairs committees and as a member of the Senate Finance Committee; rookie Sen. Charles Schwertner, MD (R-Georgetown), won a seat on Health and Human Services; and new Sen. Donna Campbell, MD (R-New Braunfels), was appointed to the Senate Education Committee.

In the House: TMA Alliance member Rep. Susan King (R-Abilene), Rep. John Zerwas, MD (R-Simonton), and new Rep. Greg Bonnen, MD (R-Friendswood), have seats on the Appropriations Committee. Representative King and new Rep. J.D. Sheffield, DO (R-Gatesville), are on the Public Health Committee. Dr. Zerwas also is on the Human Services Committee, and Dr. Bonnen is on the Insurance Committee.

Let the Budget Battle Begin
In early February, Senate and House members began tackling their respective budgets, albeit conservatively.

Both chambers unveiled budgets of about $90 billion in state funds. That's well above last session's $80 billion budget, but still below the $101.4 billion that Comptroller Susan Combs projected was available for the 2014-15 biennium. The state's Rainy Day Fund has about $12 billion on hand that lawmakers appear reluctant to touch right away.

Both draft budgets, Senate Bill 1 and House Bill 1, take into account the $4.5 billion needed to make the Medicaid program whole from last session.

The Senate Finance Committee began hearings on SB 1, and physician leaders urged lawmakers to fund medical education and graduate medical education programs; mental and public health; and family planning and women's health services.

TMA officials already see signs of improvement on medical education funding. The initial Senate budget puts $33.4 million into the Texas Physician Education Loan Repayment Program – way up from the $5.6 million from last session and higher than the $20 million in funding when the program first started. Lawmakers are looking to use the new money to add 200 physicians to the program over the biennium.

TMA physicians also asked senators to reverse the 20-percent payment cut for physicians who treat patients dually eligible for Medicare and Medicaid.

In a partial win, the Texas Health and Human Services Commission reinstated payment of the $147 Medicare Part B deductible for these patients in January. It's up to the legislature to restore the 20-percent Medicare copayment that Medicaid used to cover for poor patients.

Medicaid Front and Center
Medicaid already is the subject of several bills that aim to save money by expanding Medicaid managed care, adding quality-based payment initiatives, and fighting fraud.

On the latter, Senate Bill 8 would essentially codify controversial state regulations that physicians believe could allow authorities to charge them with fraud for simple billing errors. TMA officials are working to ensure due process protections are included in that bill.

Despite Gov. Rick Perry's staunch opposition to expanding the state's Medicaid program as prescribed by the Patient Protection and Affordable Care Act, some lawmakers entertain the idea of finding a state-based solution that would allow Texas to get some of the extra federal dollars available.

Nor do physicians want the state to miss out on money that could go a long way toward helping their patients – so long as it fixes the broken program to win back the doctors needed to take care of those patients.

That's the gist of a recent policy statement that seeks expansion of coverage for poor, childless adults that is not traditional Medicaid.

How far those conversations go in the legislature remains to be seen.

Landmark Agreements on Scope, End of Life
There is no question, meanwhile, that TMA and nurse practitioners broke ground on a bill that protects diagnosing and prescribing as the practice of medicine, while allowing doctors to delegate their prescribing authority to advanced practice registered nurses (APRNs) and physician assistants (PA) as part of a physician-supervised care team. TMA officials say Senate Bill 406 will help establish a more flexible and collaborative practice model that improves on current site-based restrictions and expands access to care.

Months of discussions among TMA, the Texas Academy of Family Physicians, APRNs, and PAs led to the filing of the bill by Sen. Jane Nelson (R-Flower Mound) and Rep. Lois Kolkhorst (R-Brenham). The Senate Health and Human Services Committee unanimously approved the legislation, which heads to the full Senate.

Still, TMA officials anticipate other legislation aiming to expand the scope of practice of other allied health professionals. House Bill 624, introduced by Rep. Bill Zedler (R-Arlington), for example, requires health plans to pay podiatrists, optometrists, and others the same rate as their physician counterparts.

Senate Bill 303 could be another big step forward in helping to resolve the end-of-life debates that are a regular session item of late. The legislation protects doctors' rights to do what they believe is ethically and medically best for patients in their last days, while updating the Texas Advance Directives Act to give patients and their families more time and help during such discussions. Senator Deuell worked on the bill with TMA, the Texas Hospital Association, the Texas Alliance for Life, and other health care, religious, and right-to-life groups.

On the insurance front, House Bill 620 introduced by Rep. Craig Eiland (D-Galveston) seeks to regulate the so-called "silent PPO" market and prevent health plans from subcontracting physicians' discounted rates without doctors' knowledge.

However, TMA officials have a careful eye on Senate Bill 257 (Representative Deuell), which could limit physicians' ability to challenge an incorrect payment made by health plans.

House Bill 522 by Rep. John Kuempel (R-Seguin) authorizes health plans to directly pay ambulance providers and could apply to physicians not in a patient's plan. But TMA lobbyists say it is unclear whether the bill would be more administratively burdensome for doctors than the current assignment-of-benefits process.

Cutting Red Tape
To help reduce administrative burdens for practices, TMA supports HB 1032 by Representative Zerwas. The bill requires the Texas Department of Insurance to appoint a stakeholder workgroup to design a uniform and standard prescription drug prior authorization form applicable across all payers, including Medicaid, the Children's Health Insurance Program, and workers' compensation. A similar bill in the works addresses the standardization of a prior authorization form for medical services.

TMA also is pressing for measures to relieve doctors from Department of Public Safety backlogs by making the renewal of their license to prescribe controlled substances concurrent with the medical license renewal process.

On the other hand, House Bill 595 could create another hassle factor for physicians: The bill, sponsored by Representative Kolkhorst, requires various health care entities to report to the state on quality and costs. TMA is monitoring the bill to discern to what degree physicians would have to submit such data.

On public health, Rep. Myra Crownover (R-Denton) said she plans to reintroduce a bill supporting the TMA and Texas Public Health Coalition's goals for statewide smoke-free legislation, particularly for employees who have little option but to work in smoke-filled environments.

Several vaccination bills filed would help the coalition advance its vaccine policy: Senate Bills 62, 63, and 64 by Senator Nelson, and Senate Bill 40 by Sen. Judith Zaffirini (D-Laredo). In the House, legislation by Rep. Donna Howard (D-Austin) preserves young adult vaccination data of those whose parents consented.

TMA leaders also testified in support of half-a-dozen bills to ban texting while driving. A similar effort passed both chambers in 2011 but Governor Perry vetoed it.

Record February "First Tuesdays"
Legislators heard all about medicine's agenda through TMA's initial First Tuesdays at the Capitol lobbying event on Feb. 5 with a record turnout. Nearly 300 physicians, medical students, and TMA Alliance members knocked on the doors of their representatives and senators to discuss Medicaid, medical education funding, public health, and other critical issues.

The remaining First Tuesdays events are March 5, April 2, and May 7.

Amy Lynn Sorrel, associate editor of Texas Medicine, prepared this special supplement to 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  

Healthy Physicians: Healthy Patients
4/6 Lubbock
4/27 Fort Worth

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