Action: June 3, 2013

TMA Action June 3, 2013  
 News and Insights from Texas Medical Association 


INSIDE: TMA Launches Physician Services Organization for Patient Care 

TMA Launches Physician Services Organization for Patient Care
Appeals Court Backs TMA on Workplace Breastfeeding
E-Prescribe by June 30 to Avoid 2014 Penalties
Tech Tuesdays Highlight the Future of Medical Practice
Meaningful Use Attestations by Vendor
DocbookMD Now Includes Your Staff

Physician Business Incubator Kicks Off June 27
Medicaid Patients Must Request ID Cards
Changes Coming July 1 for Aetna and Cigna
Help TMA Recognize Outstanding Health Reporting
This Month in Texas Medicine

TMA Launches Physician Services Organization for Patient Care

Texas' premier physician associations have established an organization to deliver doctors the survival tools they need to provide demonstrably better and more efficient patient care and compete in today's health care marketplace.

"I am confident the Physician Services Organization for Patient Care will save local practices," said Texas Medical Association President Stephen L. Brotherton, MD. "Texas doctors are determined to make health care better and more affordable for Texans. To do that, we need to shift the balance of power away from the government and the large hospital systems, and back to the patients and their physicians."

Besides TMA, the Dallas County Medical Society (DCMS) and the Harris County Medical Society (HCMS) are key members of the organization. It will bring in new and existing physician groups, health plans, and technology vendors as needed to test and develop effective new care models.

The Physician Services Organization for Patient Care will offer services that bolster physicians' clinical and financial autonomy, tailored to a practice's current level of sophistication. A key element will be giving physicians easy access to data to measure and improve their clinical performance and financial viability.

"The health care landscape is changing dramatically for solo physicians to large group practices," said DCMS President Cynthia Sherry, MD. "This new organization will help all types of physicians deal with this great change. DCMS is proud to partner with TMA to provide these essential tools to physicians. Together we will help physicians meet quality benchmarks for patient care, leverage information technology, and compete successfully in changing financial models. The real winners will be patients."

HCMS President Russell W.H. Kridel, MD, said the new organization "will provide services to help physicians navigate the changing health care delivery system. The best use of a physician's time is in directly taking care of the patient one on one, not in dealing with red tape, reporting measures, and compliance regulations. This is exactly what is needed to maintain the sacred patient-physician relationship. It's very exciting to see new innovative projects like this that can help physicians spend more time with their patients."

"This is a physician-driven enterprise to improve patient care," said TMA Board of Trustees member Dan McCoy, MD, who chaired the task force that developed the project plan. He said it will "use the latest technology and data-analytics tools to bolster the bedrock of our profession: the patient-physician relationship."

For example, one service might help physicians comb through their data to identify chronically ill patients who need extra help to stay as healthy as possible and stay out of the hospital. Another might align primary care physicians and specialists to better coordinate the care they provide to their common patients.

"The market is shifting rapidly. Physicians are under tremendous pressure to change what they've been doing. But no one is helping them do that," Dr. Brotherton said. "This is a very high priority."

Added TMA trustee Don Read, MD, of Dallas, "This is the most important thing TMA has done since tort reform."

Specific pilot projects in various geographic areas of the state will be announced in coming weeks.

For more information, email Kim Harmon, director of special projects for TMA.

Appeals Court Backs TMA on Workplace Breastfeeding

The Fifth Circuit U.S. Court of Appeals agrees with TMA and the Texas Pediatric Society (TPS) that a Houston federal judge wrongfully ruled against a woman who says her employer fired her because she wanted to pump breast milk. The court said "discriminating against a woman who is lactating or expressing breast milk" violates federal law. It overturned the decision and sent the case back to the trial court for further proceedings.

TMA and TPS said in a brief to the appeals court that U.S. District Judge Lynn Hughes erred when he ruled that childbirth ends pregnancy-related medical conditions and that Title VII of federal law does not protect women from being discriminated against or fired for lactation and breast pumping.

TMA and TPS filed the brief to support an appeal by the U.S. Equal Employment Opportunity Commission (EEOC) of Judge Hughes' decision in favor of a Houston debt collection agency against the woman, Donnicia Venters. EEOC charged that Houston Funding II Ltd. fired Ms. Venters after she sought approval to pump breast milk at the office. Judge Hughes ruled that even if that were true, Ms. Venters could not claim discrimination under Title VII because lactation is not pregnancy, childbirth, or a related medical condition.

TMA and TPS argue in their brief that federal law protects lactation because it is one of several medical conditions related to pregnancy that require care after childbirth. "Since the yielding of milk by mammary glands is a medical condition caused by pregnancy and childbirth, lactation is a 'related medical condition' as contemplated by Title VII," the brief said.

"Title VII protects employees from being fired 'because of sex' or 'on the basis' of sex," it added. "Congress amended Title VII, in response to a Supreme Court case, to clarify that those terms 'include, but are not limited to, because of or on the basis of pregnancy, childbirth, or related medical conditions.' It is clear that Congress intends to protect women, such as Venters, from being fired based on medical conditions relating to their pregnancy and/or childbirth."

The brief also says breastfeeding benefits both the mother and child and that public policy demands protection for lactating mothers at work. Thus, TMA and TPS said, a jury should decide whether Houston Funding discriminated against Ms. Venters, or, as the company claims, it fired her for abandoning her job.

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:



















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.  


TMAIT Action Ad 4.13 


Tech Tuesdays Highlight the Future of Medical Practice

TMA is starting Tech Tuesdays, a new live webinar series on the third Tuesday of every month from noon to 1 pm CDT. Each session highlights issues and trends surrounding medical technology and how they affect your practice. Whether you are a seasoned computer guru or an inquiring beginner, these programs are sure to satisfy the techie in you.

The series kicks off June 18 with Meaningful Use: Useful for Your Practice. Future sessions will include expansion of health information exchanges and HIPAA security.

For more information, contact the TMA Knowledge Center. Be sure to register to attend as these webinars will fill quickly. Tune in at lunch every third Tuesday to get your hi-tech fix.

Meaningful Use Attestations by Vendor

TMA's Health Information Technology (HIT) Department has analyzed new Centers for Medicare & Medicaid Services data on meaningful use attestations by electronic health record (EHR) vendors in Texas. The numbers help physicians see which products have the greatest success rate in attesting for the meaningful use incentive program. The two most commonly used EHR systems for Texas in the federal database are eClinicalWorks and EpicCare Ambulatory – Core EMR.

TMA will host a meaningful use webinar on Tuesday, June 18, as part of the Tech Tuesdays webinar series. TMA leader Eric Weidmann, MD, and Shannon Vogel, director of TMA's HIT Department, will provide insight and tips into the meaningful use program.

Over the last few years, TMA's HIT Department has developed many tools and resources to help you tackle HIT challenges. The tools can help you select an EHR, understand the EHR incentive program, or prevent an e-prescribing penalty (act by June 30!). You can find links to all of these tools on the Technology page of the TMA website. 

  • EHR Product Evaluation Tool: This tool compares the most-used EHRs in Texas by functionality and pricing.
  • EHR Vendors Most Used in Texas: View the list of commonly used EHR vendors in Texas, as self-reported by Texas physicians and EHR vendors.
  • Meaningful Use Attestations by EHR Vendor in Texas: Find out which EHR vendors have the most meaningful use attestations in Texas.
  • EHR Buyer Beware: Issues to Consider When Contracting With EHR Vendors: This paper discusses eight important EHR contract terms you should consider before signing an EHR contract.
  • EHR Incentive Program Resource Center: This resource center provides details and instructions sheets for the Medicare and Medicaid EHR incentive programs.
  • Meaningful Use Achievement Toolkit: This tool gives detailed instructions about what the government requires, specific to your EHR product, for you to meet any one of the 25 meaningful use criteria. The EHRs represented are eClinicalWorks, e-MDs, GE Healthcare, Greenway Medical, and NextGen. 
  • Texas Regional Extension Center Resource Center: Regional extension centers (RECs) were established across the country, with four in Texas, to give physicians in-depth assistance in selection, implementation, and meaningful use of an EHR. This helps to ensure eligible physicians meet the requirements to earn the EHR incentives. Visit the resource center for details on location, eligibility, and contact information.
  • E-Prescribing Resource Center: Physicians should e-prescribe now to prevent the Medicare penalty and earn the Medicare bonus. Benefits of e-prescribing include medication reconciliation, medication history, eligibility, and formulary information. Visit the resource center for help with e-prescribing.

If you have questions about these HIT tools and resources or if you need additional help, contact the TMA HIT Helpline at (800) 880-5720 or email hit[at]texmed[dot]org.

Deadlines for Doctors: You have until June 30, 2013, to avoid an e-prescribing penalty next year.

DocbookMD Now Includes Your Staff

TMA's HIPAA-secure, mobile communication app DocbookMD historically has been accessible only to physicians. However, this free TMA member benefit keeps getting better.

Due to physician demand for secure communication with their medical staff, the platform is now open to all members of the care team, with the physician still at the center of the communication. Via the latest app update, physicians can now invite their nurses, physician assistants, and other office staff to join them on DocbookMD through the new Care Team feature.

More than ever, those caring directly for patients must be able to connect efficiently and securely. To coordinate care, all members of the team must be able to communicate effectively with each other, while still complying with security and privacy laws. DocbookMD now allows everyone involved in a patient's care to send and receive messages, including images such as x-rays and electrocardiograms and images of wounds or rashes to any physician who has invited them to be a part of his Care Team.

Update to the latest version of DocbookMD in your device's app store and start building your Care Team today. For more information or assistance with DocbookMD, contact the TMA Knowledge Center.   

TMLT Action Ad 4.13


Physician Business Incubator Kicks Off June 27

Physicians interested in becoming entrepreneurs are invited to attend the Walters Physician Incubator inaugural event at 6 pm June 27 in the Thompson Auditorium on the first floor of the TMA building at 401 W. 15th in Austin. The incubator, designed to help physician-entrepreneurs develop their business ideas, is named after the late Robert Walters, MD, who inspired many Austin physician-entrepreneurs.

Dr. Walters' family will make brief remarks, and experiences of physician-entrepreneur members will be showcased.

The Travis County Medical Society and TMA are sponsoring the two-hour event.

RSVP at TCMS[at]tcms[dot]com or (512) 206-1219 by June 20.

Medicaid Patients Must Request ID Cards

The Texas Health and Human Services Commission (HHSC) no longer automatically mails new "Your Texas Benefits" Medicaid ID cards when clients change medical or dental plans. HHSC will send a new card when a client requests one by calling (855) 827-3748. Medicaid clients also can order a new card or print a copy of their card through

Children in Texas' foster care system will continue to automatically get new cards if their Medicaid status changes. Medicaid clients who change medical or dental plans can continue using their existing cards because their Medicaid number will not change.

HHSC says physicians should always verify a Medicaid patient's eligibility regardless of whether he or she presents the card or if some of the information on the card seems outdated.

For more information, call (855) 827-3747.

Changes Coming July 1 for Aetna and Cigna

Aetna and Cigna are making changes to their procedures on July 1 that will affect your practice.

Aetna will make changes to the National Precertification List. The insurer will add Actimmune, Zaltrap, and Xeljanz to the list of drugs needing precertification, and remove oral hepatitis C medications Incivek and Victrelis.

Cigna will stop offering second-level claims denial appeals to physicians unhappy with the way their initial appeal turned out. All appeals will follow a single appeal review process and be completed within 60 days. For more information, log on to the Cigna Network Newsletter, April 2013; scroll down to page 5 and look for the headline "Single appeal reviews." Practices should use the "Request for Provider Payment Review Form" and review the Claim Adjustment and Appeals Guidelines. Both are on the Cigna website

Just two of the important dates and deadlines will occur in coming months. TMA's Deadline for Doctors will help you avoid hassles. The TMA Council on Practice Management Services developed the calendar to keep you abreast of upcoming state and federal regulations and key health policy issues that impact you and your practice. It is filled with the TMA information resources, tools, and educational programs you need stay in compliance. 

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


PC Action Ad June 13 



Help TMA Recognize Outstanding Health Reporting

This year, for the first time, physicians, medical students, county medical societies, and TMA Alliance members can nominate local journalists for a TMA Anson Jones, MD, Award.

The 50-year-old award competition recognizes stellar reporting in print, broadcast (television and radio), and online media, plus a Texas Health Journalist of the Year award. Physician-reporters also are recognized with the Physician Excellence in Reporting category.

Any news published or broadcast in 2013 is eligible. So if you read, see, or hear a great health-related story, let TMA know. Simply email ansonjones[at]texmed[dot]org and include the reporter's name, date of broadcast/publication, and the media outlet. TMA will alert the reporter to your nomination and urge them to complete an award application.

For more information, call Tammy Wishard, TMA Outreach Coordinator, at (800) 880-1300, ext. 1470, or (512) 370-1470 or email ansonjones[at]texmed[dot]org.

This Month in Texas Medicine

The June issue of Texas Medicine explores the benefits and limits of telemedicine, details the Texas version of accountable care organizations, and explains TMA's newest quality improvement tool. It also tells you why a government-hired auditor may want to examine the meaningful use fees you earned, why there is concern over the number of hours that residents work, and why physicians are concerned about health dangers posed by coal-fired power plants.    

Check out our digital edition.  
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   

Getting Older: Beats the Alternative! 
9/20-21 Montgomery 

Healthy Physicians: Healthy Patients 
9/7       Houston 
10/26   San Antonio   

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Last Updated On

January 27, 2016