Action: April 15, 2013

TMA Action April 15, 2013                    News and Insights from Texas Medical Association            

INSIDE: State May Raise Premiums to Medicaid HMOs

  State May Raise Payments to Medicaid HMOs
CMS Call to Cover ICD-10 Transition
Non-Enrollees' Medicare Claims Denials Start May 1
E-Prescribe by June 30 to Avoid 2014 Penalties
TMA Webinar Teaches Fraud/Abuse Avoidance
TEDMEDLive
TMA Membership Earns Dell Deals
TexMed 2013: Remember the Patient
Tickets for TMA Foundation Gala Selling Fast
Take TMA With You
TMA Helps Improve Quality, Avoid Penalties
TMA Wins Choosing Wisely Grant
This Month in Texas Medicine
Budget, TMA-backed Bills on the Move
                   

State May Raise Payments to Medicaid HMOs

Texas Medical Association President Michael E. Speer, MD, says that any new money going to Medicaid HMOs should go to patient care.

MarketWatch and the Texas Tribune report that the Texas Health and Human Services Commission (HHSC) is considering increasing the premiums it pays to Medicaid HMOs. HHSC is requesting a 2.6-percent increase to managed care premiums, a 0.8-percent increase to long-term and acute care service premiums, and a 1.8-percent rise in children's health plan premiums. The premium increases would cost an additional $59.2 million, which includes $23.7 million in state general revenue, for the last three months of fiscal year 2013.

In response, Dr. Speer said that for years, "the HMOs have promised the Texas Legislature and the citizens of Texas that Medicaid managed care would save the state money, provide 'budget certainty,' and better coordinate health care for Medicaid recipients. A number of the HMOs have failed to keep these promises."

Noting that physicians "are forced to leave the Medicaid program in droves," he said it is critical "that any new money be dedicated to improving patient care and the availability of that care. Any new money needs to be used to ensure Medicaid recipients have a medical home and that they can obtain needed care from specialists."

Dr. Speer added that the "physicians of the Texas Medical Association have worked hard to make sure our state leaders understand where and how our Medicaid system is broken." He said the TMA action plan calls for: 

  • Equalizing Medicaid payments for patient care to those of Medicare;
  • Significantly reducing the reams of paperwork and exasperating, irreconcilable red tape that plague physicians who want to care for patients enrolled in the Medicaid program; and
  • Requiring Medicaid auditors to focus on actual financial fraud instead of second-guessing real-life medical treatment decisions.  

"The 2013 Texas Legislature is making significant progress on the paperwork and fraud investigation issues. Requiring Medicaid HMOs to spend any new money on patient care would further our prescription to mend our broken system," Dr. Speer said.

CMS Call to Cover ICD-10 Transition

Centers for Medicare & Medicaid Services (CMS) officials will give you information on preparing for the Oct. 1, 2014, switch to the ICD-10 coding system in a nationwide conference call for physicians and staff on Thursday, April 18. The 90-minute call begins at 12:30 pm CDT. 

The agenda includes: 

  • Planning for transition to ICD-10
  • Claims processing
  • National implementation issues
  • National coverage decisions
  • Outreach 

Click on the link above for more information and to register.

You must begin preparing for ICD-10 now if you haven't already. TMA has a variety of ways to help you prepare. They include:

  • ICD-10 Now!, a three-hour seminar series in 18 cities in May and June and in September and October across Texas that will offer a detailed look at everything you need to know and do to prepare for ICD-10. The presentation begins with an overview of ICD-10, then delves into real-world explanations of how to assess your practice's readiness and to plan and implement a successful transition. The workshops cover policies, procedures, processes, relationships with other organizations, and information systems and technology. Attendees will receive forms and questionnaires to help create an ICD-10 transition plan.
  • Simple Solutions ICD-10 Transition Software to assist practices with the transition to ICD-10. This tool, available as a download or web-based, will help you quickly and easily identify which ICD-10 codes replace the ICD-9-CM codes your practice uses now.
  • An on-demand webinar, ICD-10 Starts With Physicians: A Primer for Beginning the Process.
  • On-site ICD-10 training. The one-hour and half-day programs are customized to your needs.

You can start by watching the short TMA video, "Doctor, What's Your Role in Transitioning to ICD-10?"

Coming soon is an ICD-10 Transition Toolkit that will guide you through learning, planning, organizing, implementing, and analyzing the ICD-10 transition. It will include the tools – budgets, organization surveys, and impact assessments – you need for a successful transition.

For the latest information, visit the ICD-10 page on the TMA website and the CMS ICD-10 website

 TMA Practice Consulting also offers a variety of services to help ensure your reimbursement doesn't suffer during the ICD-9 to ICD-10 transition. Contact TMA Practice Consulting by telephone at (800) 523-8776 or by email.

Non-Enrollees' Medicare Claims Denials Start May 1

Starting May 1, Medicare will deny claims for services ordered or referred by a physician who is not enrolled in Medicare. Physicians who receive claim denials will need to contact the ordering or referring physician to verify that he or she has enrolled in Medicare to prevent future denials.

Use TMA's free tool to check your Medicare ordering and referring status.

The Centers for Medicare & Medicaid Services (CMS) says physicians who order such services and are not enrolled should do so immediately, or the applications may not be processed before May 1. The national CMS ordering/referring file can be found on the CMS website.

Physicians who have opted out of Medicare can order items or services for Medicare beneficiaries by submitting an opt-out affidavit to Novitas Solutions, the Texas Medicare claims administrator. The opt-out information must be current: An affidavit must be completed every two years, and the physician's National Provider Identifier (NPI) is required on the affidavit.

For more information, read the MLN Matters article.

If you are reconsidering your Medicare participation status, TMA offers a webinar on physicians' Medicare participation options.

E-Prescribe by June 30 to Avoid 2014 Penalties

To avoid penalties in 2014 (2 percent of Medicare Part B claims), Medicare physicians must report e-prescribing using G-code G8553 via claims on at least 10 unique Medicare encounters by June 30.

To qualify for the 2013 incentive (0.5 percent of Medicare Part B claims) and prevent the penalty in 2015, physicians must report at least 25 unique e-prescribing Medicare encounters during 2013. Follow the instructions in TMA's 2013 e-prescribing informational paper.

Escalating Medicare penalties for failing to e-prescribe began in 2012:   

 

 

 

2012

2013

2014

Beyond

Incentive

 

1%

0.5%

None

None

Penalty

 

1%

1.5%

2%

2%


If you plan to apply for the Medicare electronic health record (EHR) incentive in 2013, note that you can't receive the e-prescribing incentive in the same payment year. Physicians applying for the Medicaid EHR incentive are still eligible for e-prescribing incentive payments.

 

 

Find out more, including information about exemptions, on the TMA 2013 E-Rx Penalty and Incentive Guidelines page. If you need help with e-prescribing, turn to the Texas regional extension centers (RECs). RECs provide support 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 questions about e-prescribing or other health information technology (HIT) issues, contact TMA's HIT Department by telephone at (800) 880-5720 or by email, or visit the TMA EHR Incentive Program Resource Center.           

TMLT Action Ad 4.13         

TMA Webinar Teaches Fraud/Abuse Avoidance

Tune in Thursday, April 25, for a live one-hour webinar on avoiding allegations of fraud and abuse. The webinar, Avoiding Fraud and Abuse, begins at 6 pm CDT.

Attorney Amanda Hill will explain the areas subject to audits, the importance of documentation and frequent self-audits, and how to develop and maintain a plan that will keep you in compliance.

Physicians insured with the Texas Medical Liability Trust (TMLT) may earn professional liability insurance discounts by participating in approved continuing education activities. Policyholders who earn 3 TMLT credits within 12 consecutive months will earn a 3-percent discount (not to exceed $1,000), which will be applied to their next eligible policy period.

TMA also designated this course for 1 credit of education in medical ethics and/or professional responsibility.

TEDMEDLive

COMING SOON ... TMA is hosting a live simulcast, April 17, of the TEDMED lectures direct from the John F. Kennedy Center for the Performing Arts in Washington, D.C.

What's TEDMED? It's an annual meeting of the minds during which multidisciplinary innovators discuss hot topics and new developments in health and medicine. Past TEDMED speakers include Temple Grandin, President Bill Clinton, and TMA's 2013 General Session speaker Abraham Verghese, MD, to name a few. This year's speaker lineup includes 50+ global leaders from medicine, science, research, technology, academia, business, government, and the arts. Don't miss out!

Though much of the focus of the event is on stage, it is important to remember that TEDMED is a fast-paced, all-encompassing and immersive event that provides stimulation and exciting discourse from start to finish … onstage and off.

Come prepared to think; come prepared to interact – but most of all, come prepared to have fun! You're sure to find TEDMED an unforgettable experience. 

ATTENDANCE IS FREE FOR TMA MEMBERS! Register now.

Download the flyer to view the schedule of speakers.

Two ways to attend:  

  1. Join us live April 17, 1:30-6:30 pm, at the Doubletree Suites by Hilton Hotel, Bluebonnet Room, at 303 W. 15 St., Austin, TX 78701.
     
  2. Mobile access to all four days and all speakers!  

Go beyond passively watching. Use the TEDMEDConnect mobile app to connect "live" to the TEDMED stage and participate in live polls and activities, ask and answer questions, and share comments with the speakers. Be part of the conversation about the future of health and medicine!

Download the TEDMEDConnect mobile in your app store. The app will:  

  • Allow all of our 1,200+ Kennedy Center delegates and tens of thousands of TEDMEDLive participants to connect "live" to the speakers on the TEDMED stage and ask them questions or transmit comments.
  • Contain the up-to-the-minute TEDMED schedule, including a handy "What's On Now" feature.
  • Provide users the ability to view photos from TEDMED and upload photos from TEDMEDLive viewing locations.
  • Allow users to participate in live polls and games.
  • Give users the opportunity to request a follow-up "Science-Kit" from speakers.
  • Allow users to download the conference program.
  • Connect users to Facebook and Twitter.

    Texas Medical Association Location ID: L82830

    When prompted by the app, input the TEXAS MEDICAL ASSOCIATION location ID L82830 and your personal email address so each user can be identified and communicate with the Kennedy Center stage or speakers.

Free parking is available in the TMA building.

Beverages and light refreshments will be available courtesy of TMA.

The event is limited to 100 guests. Register now. You may register for two tickets per session.

You can read about TEDMED 2013 here

If you have any questions about the event, please contact TMA's Knowledge Center at (800) 880-7955.

TEDMED LIVE 2013

TMA Membership Earns Dell Deals

TMA members can count on a best price guarantee at Dell.com. Visit www.Dell.com/mpp/texmed to browse Dell's latest technology with special member discounts of up to 30 percent.

Don't miss out. From April 15 to April 21, Dell also will offer an additional 20 percent off any PC or tablet purchase. Use member ID HS57183230 when you call to verify you are associated with TMA.

Also, don't forget to sign up for the free rewards program to receive free second-day delivery and 5 percent back in the form of a gift card.          

 TMAIT Action Ad 4.13  

TexMed 2013: Remember the Patient

With the increasing complexities of modern technology, coupled with the spiraling labyrinth of rules and regulations, physicians can find themselves scattered to the edge of distraction. TMA is working to help physicians remain focused on the mission of medicine – the patient.

Join us for TexMed 2013 at the Grand Hyatt San Antonio and the Henry B. Gonzalez Convention Center on May 17-18 as we remember the patient.

Highlights of TexMed 2013 include:

Friday, May 17

7:30 am-3 pm
CME Tracks
Allergy,  Anesthesiology, Cancer, Colon Rectal Surgery, Diabetes/Endocrinology,  Emergency Medicine, General Session, Geriatrics, Occupational Medicine, Ophthalmology, Otolaryngology, Pain Medicine, Physical Medicine & Rehab, Physician Health, Practice Management, Psychiatry, Quality

8-9:30 am
House of Delegates Opening Session

9:30 am-noon
House of Delegates Reference Committees

11:30 am-1:30 pm
Networking Lunch in Expo Hall, sponsored by Blue Cross and Blue Shield of Texas

2:30-3:30 pm
Candidate Forum

3:30-5 pm
General Session with Abraham Verghese, MDA Doctor's Touch, sponsored by the Texas Medical Liability Trust

5-6 pm
Welcome Reception, sponsored by the Texas Medical Liability Trust
Welcome Reception and Book-signing, Cutting for Stone, with Dr. Verghese

6-7 pm
TMA/TMAA 2013-14 Presidents' Reception, sponsored by the Texas Medical Association Insurance Trust 
TMA President Stephen Brotherton, MD, Fort Worth, and TMAA President Cheryl Jones, Temple

7-11 pm
TMA Foundation's Roaring Twentieth Gala

9 pm-2 am
Student, Resident, and Young Physician Mixer

Saturday, May 18

6-8 am
County Medical Society Caucus Meetings

8:30 am-noon
House of Delegates

8 am-5 pm
CME Tracks

Register online. April 23 is the deadline to make a hotel reservation and pay the special rate of $199 single/double.

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

Tickets for TMA Foundation Gala Selling Fast

Join your colleagues, gala cochairs Drs. Rajam and Somayaji Ramamurthy and Dr. Bernard T. Swift Jr., and Mrs. Kathy Swift, all of San Antonio, at the TMA Foundation's 20th anniversary gala, Roaring Twentieth, on Friday, May 17, at the Grand Hyatt San Antonio, in conjunction with TexMed 2013.

Jazz and ragtime entertainment of the 1920s, signature cocktails of the era, and a 1920s photo booth, plus silent and live auctions, are just a few of the attractions. The evening includes dinner, live music, and dancing. 

Proceeds benefit TMA's health promotion programs supported by the TMA Foundation, including Be Wise ─ ImmunizeSM and Hard Hats for Little Heads, as well as the foundation's Medical Student Community Leadership Grants Program.   

You can purchase VIP tickets (greater recognition and early entrance) for $225. Regular tickets are $175 through May 14. Purchase your ticket or table now because prices increase on May 15.

For more information or to purchase tickets, visit the TMA Foundation's website or contact Sean Dunham at (800) 880-1300, ext. 1664, or (512) 370-1664, or by email

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

Take TMA With You

The TMA website is now optimized for viewing on mobile devices. Log on to www.texmed.mobi to get all the news, contact information, continuing medical education (CME), practice help, and member services in the palm of your hand. If you're reading this on a mobile device, any link to a story on TMA's website will bring up the mobile version of the page.

The information on the site is organized into these categories so you can easily find what you need: 

  • Member Search,
  • TMA CME Courses,
  • Contact Us,
  • About TMA, and
  • Benefits and Services.  

Try out the mobile website for yourself and be automatically entered to win a $50 TMA Education Center gift card! 

Your feedback will help TMA better serve you. If you have thoughts on how the mobile website could improve, please let TMA know.

Be sure to register for TexMed 2013 in San Antonio May 17-18, then stop by the TMA Member Services booth (booth # 231) to see all your member services and to try out TMA’s new mobile website. TexMed registration is free. 

TMA Helps Improve Quality, Avoid Penalties

PQRS is switching from the carrot to the stick. 

Introduced in 2007, Medicare's Physician Quality Reporting System (PQRS) offers physicians bonuses for tracking and reporting on clinical quality measures. In 2015, however, the Centers for Medicare & Medicaid Services (CMS) will impose a 1.5-percent penalty on physicians who do not successfully report on this data. Physicians must act now because CMS will base the 2015 penalties on the quality data reported for 2013.

In response, TMA launched the Clinical Quality Tools page on the TMA website. It will be updated frequently to showcase the many new tools TMA creates as they are completed. The first set of these tools includes a series of prevention tools and calculators.

These interactive, but simple, calculators show you the requirements and billing codes associated with each quality metric. Enter your data on patients seen and contracted rates for each identified code into the calculator. This allows you to see the benefits of providing such care, as well as to analyze the fiscal sustainability of providing this preventive service. 

 

Practice Consuling Ad Action 4.13  

TMA Wins Choosing Wisely Grant

TMA, partnering with the TMA Foundation, is among 21 state and specialty medical societies and regional health collaboratives that won grants from the ABIM Foundation to advance the Choosing Wisely campaign. Support for the grant program comes from the Robert Wood Johnson Foundation (RWJF).  

The program encourages physicians and patients to discuss the appropriateness of medical tests and procedures that may be unnecessary or even harmful. To date, 25 medical specialty societies have identified and created lists of more than 130 tests and procedures they say are overused or inappropriate. 

The $50,000 grant will allow TMA to promote Choosing Wisely to Texas physicians in collaboration with county medical societies, the Texas Osteopathic Medical Association, and state medical specialty societies. The grant runs from April 1, 2013, to March 31, 2015.

A recommendation for TMA's formal involvement in the campaign goes before the House of Delegates in May, after receiving initial approval from the Council on Health Care Quality and the Board of Trustees.

TMA continues to develop educational materials and clinical tools to help ready physicians for upcoming quality improvement, patient safety, and performance measurement challenges, and views Choosing Wisely as another potential vehicle.

Choosing Wisely gained momentum since it launched in April 2012 with lists from nine specialty societies. In February 2013, 17 physician-led organizations announced new lists of tests and procedures to question. Campaign partners include the American Academy of Family Physicians, the American College of Cardiology, the American College of Radiology, the American Academy of Pediatrics, and the American College of Obstetricians and Gynecologists.

Consumer Reports also is a partner in Choosing Wisely to engage patients in the effort.

For more information, read the December 2012 Texas Medicine story.   

This Month in Texas Medicine

The April issue of Texas Medicine explains why state and federal authorities are cracking down on pain management clinics and gives you information you need before buying, serving as medical director of, or joining any medical practice. It also outlines TMA's recommendations for improving Medicaid, tells you why TMA backs bills against distracted driving, details why it's necessary to plan for what happens to your practice and your patients if you die unexpectedly, and provides insight on how quality measures are developed.  

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: Budget, TMA-backed Bills on the Move

With roughly six weeks to go in the Texas Legislature's 2013 session, lawmakers are near the finish line in drafting a state budget for the next two years. The process has been rather smooth sailing compared to last session as medicine marches closer to accomplishing its goals of reversing the drastic cuts from 2011.  

Meanwhile, even though the House of Representatives ditched a budget amendment to explore expanded coverage options for the working poor in Texas, a budget conference committee will discuss the issue because it is included in the Senate version of the budget.

TMA-backed bills to reduce red tape, regulate payers' under-the-table activities, and promote immunizations move full steam ahead. But medicine is working hard to fend off sneak attacks that use measures to weaken the Texas Medical Board to undermine the beneficial effects of medical liability reforms.

The House approved its version of the state budget in early April, about two weeks ahead of schedule, after wading through numerous amendments. TMA Vice President for Advocacy Darren Whitehurst says budgeteers have historically taken their time in crafting a final two-year budget.

Now, the Senate and House will appoint a conference committee to reconcile the differences between the two budgets by early May. The House budget stands at $198.3 billion for 2014-15, and the Senate version is $195.5 billion, representing a 2- to 3-percent increase over the current budget.

Mr. Whitehurst says the gaps between the two are not too wide in terms of health care funding. Both increase spending in key TMA priority areas, including graduate medical education, women's preventive health care, and mental health.

Making Medicaid Better 
During the House budget debate, Rep. Lon Burnam (D-Fort Worth) ultimately withdrew an amendment that would have opened the door for state-federal negotiations over Medicaid expansion. A similar rider remains in the Senate budget directing the Health and Human Services Commission to develop an expansion plan should state-federal negotiations ever come about. Such a plan must include cost-saving measures such as establishing sliding-scale copays, deductibles, and premiums; health savings accounts; reduced uncompensated care costs; and wellness and pay-for-performance initiatives.

TMA supports a plan to expand coverage for the working poor that fits Texas and includes significant reforms to the Medicaid program. Some of those reform efforts already are under way.

TMA testified in support of House Bill 2731 by Rep. Richard Raymond (D-Laredo), which would streamline the myriad Medicaid HMO administrative requirements that end up needlessly costing physician practices extra time and money. TMA lobbyist Michelle Romero says that bill "would go a long way toward improving the program. This is a nonbudget way to help doctors save money in their practices."

Such measures, she says, are needed because funding has not materialized this session to boost overall physician Medicaid payments and alleviate earlier cuts to payments for treating patient dually eligible for Medicare and Medicaid. Also, the Senate in late March approved Senate Bill 7 by Sen. Jane Nelson (R-Flower Mound), which looks to save money by expanding Medicaid HMOs to people with disabilities and nursing home residents. The move is projected to save $8.5 million in 2014.

TMA also continues to advocate for fair treatment by the Office of Inspector General (OIG) when doctors are accused of Medicaid fraud and has worked with the agency to resolve the due process issue.  

Voted out of the Senate in April was Senate Bill 1803 by Sen. Joan Huffman (R-Houston). It improves due process and transparency in the OIG process when a physician is accused of a "credible allegation of fraud" or Medicaid overpayment. Meanwhile, House Bill 1536 by Rep. Bobby Guerra (D-Mission) is pending in the House Human Services Committee. It would ensure physicians' due process rights through an administrative hearing before – not after – officials try to recoup an overpayment. Sen. Chuy Hinojosa (D-McAllen) sponsors the companion bill, Senate Bill 785.

Red-Tape Bills Advance
The red tape for physicians doesn't stop with Medicaid, and key TMA-backed legislation to help physician practices improve efficiency is moving.

The Senate approved Senate Bill 166 by Sen. Bob Deuell, MD (R-Greenville), which would allow practices to check in patients using the electronic strip on the back of their driver's licenses. The House companion, House Bill 395 by Rep. Lyle Larson (R-San Antonio), is pending in the House Technology Committee. House and Senate committees also took up bills that would sync the renewal of physicians' Department of Public Safety controlled substances registration with the Texas Medical Board's medical license renewal process.

House Bill 1032 by Rep. John Zerwas, MD (R-Simonton), requiring the Texas Department of Insurance to appoint a workgroup to design a standard prescription drug prior-authorization form for all payers, was approved by the House Insurance Committee with only one nay vote. Senate Bill 1216 by Sen. Kevin Eltife (R-Tyler) and House Bill 1604 by Rep. Sarah Davis (R-Houston) would do the same for health care services, but neither has been heard yet.

Senate bills 1609 and 1610 would help clear up some unintended hassles for doctors trying to comply with a 2011 medical records privacy statute – House Bill 300. SB 1609 standardizes privacy training requirements for employees in individual physician practices, while SB 1610 clarifies that physicians need only comply with Texas privacy laws and federal statutes in notifying patients of a breach that may cross state lines.

Meanwhile, TMA testified against a hassle-factor bill that TMA lobbyist Patricia Kolodzey described as a "back-door way to prohibit balance-billing," and address unexpected out-of-pocket costs patients are stuck with for going out of a health plan's network. House Bill 2838 would require physicians and other health care professionals to give patients a binding quote on the price accepted as payment in full for services they plan to provide – something difficult for doctors to predict – in writing and at least 48 hours in advance, or doctors must forfeit payment.          

On the other hand, House Bill 1406 by Rep. John Smithee (R-Amarillo) attempts to address balance billing by requiring health plans to share how they calculate out-of-network payments for their enrollees. It also attempts to define "usual and customary charge" to mean the 99th percentile of the actual charges by a physician or provider who doesn't participate in the health plan network. TMA supports health plans' disclosure of their out-of-network methodology, but has concerns with putting a specific payment rate in statute.

TMA supported "silent PPO" bills HB 620 and SB 822. The bills would regulate these activities for the first time and prohibit health plan networks or companies from selling, leasing, or sharing privately negotiated physician payment rates without doctors' consent. Both won approval from their respective House and Senate committees. 

Similar protections are included in the Medicaid version, Senate Bill 1221 by Sen. Ken Paxton, which would bar health plans from using a Medicaid-based fee schedule for reimbursement for services other than Medicaid, unless the physician or provider had agreed to that fee schedule. The Senate State Affairs Committee approved it. 

Preserving Medical Board Reforms
A battle is under way to preserve TMA-won reforms to TMB's complaint system and tort reforms. A handful of bills attempt to open up confidential complaints at the board and disclose the identity of physician expert reviewers involved. TMA leaders say the legislation would undermine the board's mission of protecting Texas patients and undo reforms meant to ensure a fair disciplinary process, prevent unnecessary lawsuits, and protect patients from harassment by bad doctors.

Also raising alarm bells is a telemedicine bill, House Bill 1806 (by Representative Smithee), that would subvert current TMB regulations requiring a face-to-face encounter between a physician and patient and permit diagnosing over the telephone. TMA also backs a measure to ensure physicians get paid fairly for telemedicine services like telephone consults – particularly when health plans already pay vendors for those services. 

On the scope-of-practice front, TMA continues to put out fires, which appear smaller than usual this session.

TMA hopes an attempt to have advanced practice registered nurses (APRNs) and physician assistants (PAs) bill for their Medicaid services separately from physicians they practice with and at a reduced rate – resulting in an 8-percent payment cut for APRNs and PAs – will be scuttled. TMA believes the measure would undermine team-based care models like Senate Bill 406 by Senator Nelson, an agreed-to bill by physicians, nurse practitioners, and PAs. It would replace current site-based restrictions for prescriptive delegation and supervision with a more flexible, collaborative model. That bill goes to the House Public Health Committee now that it has cleared the Senate.

Immunizations Front and Center
TMA-backed legislation to ban smoking in certain work and public places appears to be losing ground, but medicine has made headway on a pair of immunization bills. The Senate approved Senate Bill 63 – allowing minors who are pregnant or who already have children to consent to their own immunizations – and Senate Bill 64 – requiring licensed child-care facilities to develop and implement an immunization policy.

Physician leaders oppose Senate Bill 1013 by Sen. Larry Taylor (R-Friendswood) to allow pharmacists to vaccinate children aged 7 years and older. They told the Senate Health and Human Services Committee that passage of the bill would fragment health care delivery, undermine medical homes, and cause children to forego complete medical evaluations. TMA lobbyist Troy Alexander also says recent data show Texas ahead of national averages for child vaccination rates and a better strategy would be to target the gaps.

The House and Ways Committee approved legislation – House Bill 1310 by Rep. Angie Chen Button (R-Richardson) – that allows physicians to deduct vaccine purchase costs from taxable revenues. On obesity, the Senate approved Ssenate Bill 684 making the now-required physical fitness assessments for schoolchildren optional. TMA opposes it

TMA supports Senate Bill 303, an end-of-life bill that passed out of committee and is poised for deliberation on the Senate floor. TMA leaders say the legislation protects the current processes under the Texas Advance Directives Act for resolving conflicts out of court. Opponents seek to eliminate the review process, a move that could force doctors to violate their moral beliefs and professional ethics.

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 

Healthy Physicians: Healthy Patients
4/27       Fort Worth
    


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