Action: June 14, 2013

TMA Action June 14, 2013           News and Insights from Texas Medical Association 

 INSIDE: Calling All Doctors June 25       

Calling All Doctors June 25
TMA: Make SGR Replacement Plan Better
E-Prescribe by June 30 to Avoid 2014 Penalties
Many Texas Physicians Not Fully Using EHRs
TMA Helps Make Cheerleading Safer
HHSC Changes Medicaid ID Card Policy
Physician Business Incubator Kicks Off June 27
Changes Coming July 1 for Aetna and Cigna
TEXPAC Gears Up for 2014
TMA Offers ICD-10 Transition Toolkit
Become a STAR for TMAF!
This Month in Texas Medicine

Calling All Doctors June 25

Legislators delivered for Texas physicians and their patients during the 2013 legislative session. The Texas Medical Association wants to make sure you know what happened that will help you, your practice, and your patients. That's why at 8 pm CT on Tuesday, June 25, TMA President Stephen L. Brotherton, MD, will call you at your home telephone number. All you have to do is stay on the line for TMA's Tele-2013 Legislative Update.

Dr. Brotherton and TMA's lobby staff will discuss the 2014-15 state budget and new laws that will: 

  1. Reduce your red tape and administrative hassles;
  2. Prevent third-party payers from stealing from you;
  3. Rein in overzealous Medicaid fraud-and-abuse investigations;
  4. Provide tax relief for small businesses;
  5. Establish physician-led medical teams;
  6. Strengthen Texas' physician workforce; and
  7. Protect your medical judgment.  

You may ask questions after each topic and use your phone to participate in a survey. And, the best part, you will earn 1 AMA PRA Category 1 Credit™ for your time (providing you stay on the line for the entire program).

If you prefer that Dr. Brotherton call you on your cell or office telephone, please contact the TMA Knowledge Center by telephone at (800) 880-7955 or by email  by Monday, June 24, and let us know. We hope to talk to you on June 25. 

TMA: Make SGR Replacement Plan Better

TMA told congressional leaders it "generally supports" their efforts to replace the Sustainable Growth Rate (SGR) formula, which continually threatens drastic cuts in Medicare payments to physicians, but offered suggestions to make the reform effort even better. TMA President Stephen L. Brotherton, MD, made the suggestions to improve the SGR Formula Replacement Proposal in a letter to leaders of the House Ways and Means and Energy and Commerce committees and two of their subcommittees.

 Among Dr. Brotherton's suggestions are: 

  • The plan to replace the SGR with a "period of stable payments" must cover physicians' practice operating costs, be updated annually in a way that covers increased operating costs, and at least equal the annual Medicare Economic Index increase.
  • Keep payment for services rendered (fee for service) as a major payment option.
  • An update to Medicare payment locality definitions is overdue and should be required for all multilocality states, not for a select few.
  • A proposal to design new methods for assessing and rewarding quality care does not mention the Medicare value-based payment modifier starting in 2015. TMA hopes Congress will not just add another "quality" program, but replace the current program, "which has serious flaws and may result in financial penalties for physicians who treat disadvantaged patients." 
  • Prohibit performance measurement methods that depend on patient compliance. Do not penalize a physician for a patient's refusal to undergo recommended treatment or diagnostic procedures.
  • Do not impose new administrative requirements unless they produce quantifiable returns.
  • Implement efficiency incentives only if they are developed by physicians, tested in a wide variety of patient care settings, and proven to produce no adverse consequences on patient care.  

"There is also an unstated, yet very alarming, premise when discussing efficiency," Dr. Brotherton wrote. "To be efficient, one must produce or be capable of producing an intended result within a defined set of resources. TMA is concerned about who decides the appropriate resources (and number or amount of resources) that should be brought to any particular patient. The decision on the care that is to be brought to a patient for cure or alleviation of discomfort, pain, or suffering is traditionally left to the patient and physician. Deciding upon whether any particular course of treatment is worth the resources to be expended is extremely value-laden. TMA suggests the government should avoid intervening in these decisions."

The American Medical Association also wrote congressional leaders that "eliminating the SGR formula is essential to developing a high performing Medicare program." AMA said these "driving principles" can be a foundation for a transition plan that organized medicine can support:

  • Successful delivery reform is an essential foundation for transitioning to a high-performing Medicare program that provides patient choice and meets the health care needs of a diverse patient population.
  • The Medicare program must invest and support physician infrastructure that provides the platform for delivery and payment reform.
  • Medicare payment updates should reflect the costs of providing services as well as efforts and progress on quality improvements and managing costs.  

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          

Many Texas Physicians Not Fully Using EHRs

Does your practice use your electronic health record (EHR) system's full potential? Is the use of technology boosting your revenue and showing measurable increases in quality? For many physicians across Texas, the answer unfortunately is no, even though the Health Information Technology for Economic and Clinical Health Act of 2009 provides incentives to adopt and meaningfully use an EHR. Having an EHR system in place is not enough. You and your staff must also learn to understand and use the data at your fingertips for the benefit of your patients and your practice.

By analyzing and reporting on data compiled in an EHR, physicians can not only acquire incentives for meaningful use, but also identify areas for performance improvement that could lead to better patient health outcomes. Used properly, EHRs have the ability to increase patient safety, enhance the quality of care, and reduce health care costs. TMA's newest webinar (a part of the Tech Tuesdays series) will show you how, by tracking and measuring data related to quality, care coordination, and patient engagement, your practice potentially can achieve – and prove – better patient health outcomes and start earning the monetary incentives of meaningful use.

Join us Tuesday, June 18, from noon to 1 pm, for the new webinar, Meaningful Use: Useful for Your Practice, to discuss complete and proper use of an EHR. Be sure to browse through the rest of the upcoming Tech Tuesday webinars covering everything from HIPAA security to how to manage your practice's online reputation.

TMA Helps Make Cheerleading Safer

TMA's advocacy to improve safety in interscholastic athletics has helped convince state officials to adopt rules to reduce cheerleaders' risk of concussions.

On June 11, the University Interscholastic League (UIL) Legislative Council followed its Medical Advisory Committee recommendations and voted  to require cheerleaders to comply with state law on prevention, treatment, and oversight of concussions. Cheerleading coaches and sponsors must now be trained on safety guidelines to minimize the risk.

In January, TMA urged UIL to improve cheerleading safety. "Epidemiologic data suggest concussions and other serious injuries are a risk in physical activities such as cheerleading as well as in traditional contact sports. National data on injuries associated with cheerleading, and some recent projections on the risk and incidence of cheerleading injuries, are alarming," the association told UIL officials in a letter from Jason Terk, MD, then-chair of the TMA Council on Science and Public Health, and Gilbert Handal, MD, then-chair of the TMA Committee on Child and Adolescent Health.

"Including cheerleading within the scope of the UIL can be a bold move to ensure we have a state system focused on injury prevention under consistent, evidence-based safety guidelines," they wrote. "Providing a governance structure for cheerleading will help guarantee that participants and leaders throughout the state are trained in proper techniques, are informed about the signs and symptoms of concussions, and follow a process for consistently reporting injuries."

In 2012, the TMA House of Delegates referred the cheerleading issue to the Council on Science and Public Health for further study after the Harris County delegation raised concerns in a resolution. Then during its meeting at TexMed 2013, the house adopted policy that TMA advocate stronger UIL oversight of cheerleading programs; work with other groups to increase injury surveillance; promote educational programs for students, coaches, and physicians; and encourage physicians to get involved in local development of policies and strategies focusing on injury prevention through school health advisory councils. 

HHSC Changes Medicaid ID Card Policy

The Texas Health and Human Services Commission (HHSC) has changed its mind and will continue to automatically mail new Medicaid ID cards when a client changes medical or dental plans. On May 31, HHSC said it would send a new card only when the client requests one or orders one from

But on June 4, the commission reversed the decision. "Based on feedback from providers concerned about validating client eligibility, HHSC will not be implementing this policy change," the commission said in a statement. "Clients will continue to receive a new ID card whenever changes are made to his or her plan. The Health and Human Services Commission apologizes for any confusion this policy change has caused."

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


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 or (512) 206-1219 by June 20. 

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

In Texas, the new Cigna policy applies only to self-funded ERISA plans. Those plans will have only one level of appeal within Cigna. They will have the Independent Review Organization (IRO) level of appeal, which is external and required under the Patient Protection and Affordable Care Act. Due to state regulations, Cigna must continue to offer two levels of appeal for administrative appeals, and two levels of appeal for medical necessity appeals, for all other plans.

These are just ust 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

TEXPAC Gears Up for 2014

The Texas Medical Association Political Action Committee (TEXPAC) Board of Directors held its initial meeting at TexMed 2013 in San Antonio in May to prepare for the 2014 elections. Chair Jerry Hunsaker, MD, of Corpus Christi, was joined by Candidate Evaluation Chair Arlo Weltge, MD, of Houston, and Membership Chair Bradford Holland, MD, of Waco, to help lead TMA through the challenges the upcoming election cycle will surely offer. 

The 2012 elections saw an unprecedented number of physician and alliance members running for state office. TEXPAC will be at the forefront helping to elect medicine-friendly candidates in 2014 to have another great legislative session in 2015.

If you joined TEXPAC this year, thank you for your support. If you have yet to renew your dues, please do so by visiting the TEXPAC website. Your membership dues will go a long way in helping TEXPAC maintain a physician- friendly environment at the Capitol.

PC Action Ad June 13 




TMA Offers ICD-10 Transition Toolkit

Wish you had someone to hold your hand through the changeover to ICD-10? TMA's new Simple Solutions ICD-10 Transition Toolkit will guide you step by step through learning, planning, organizing, implementing, and analyzing your practice's ICD-10 transition. It includes all the tools – including budgets, organization surveys, and impact assessments – needed for a successful transition.  

The toolkit walks your practice through every aspect of preparation, including policies, procedures, processes, relationships with other organizations, and technology. Your transition plan is laid out on an easy-to-follow timeline that allows you to assign tasks to staff members and track your practice's progress. Post-ICD-10 transition, the toolkit provides payer-by-payer analytics that make it easy to compare revenue with previous years, spot trouble areas, and address payer problems.

The toolkit comes with two provider licenses for the Simple Solutions ICD-10 Transition Software and an instructional video series. For a preview of this toolkit, watch this four-minute demo

Become a STAR for TMAF!

When approximately 500 physicians, their spouses, and community leaders attended the TMA Foundation's (TMAF's) Roaring Twentieth Anniversary Gala at TexMed 2013, they helped to bring "Healthy Now and Healthy Futures" to thousands of Texans. 

Now, your support can join with theirs and help the foundation earn this year's $10,000 matching grant from the John P. McGovern Foundation in Houston, ensuring that even more healthy Texans benefit from TMAF-funded programs.

Donate today, and make a difference in the health of all Texans. Double your impact by donating to the TMAF Star Campaign!

This is the sixth year the John P. McGovern Foundation has pledged to match your Star Campaign donations up to $10,000. We are well on our way, but not quite there, to making the match. That's why we are asking for your help. Please contribute to the Star Campaign in honor of your colleagues, family members, or health leaders who have influenced your journey in medicine.

Learn more about this effort, and help ensure TMAF wins this generous match by donating now.  

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   

About Action   

Action, the TMA newsletter, is emailed twice a month to bring you timely news and information that affects your practice. 

To change the email address where you receive Action, go to Member Log-In on the TMA website, then click on "Update Your TMA Demographic Information (including newsletter subscriptions and preferences)."

To unsubscribe from Action, email TMA's Communication Division at

If you have any technical difficulties in reading or receiving this message, please notify our managing editor, Shari Henson. Please send any other comments or suggestions you may have about the newsletter to Larry BeSaw, Action editor.