Action: Oct. 15, 2013

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

INSIDE: CMS Extends PQRS Deadline for Three Days

CMS Extends PQRS Registration Deadline for Three Days
National, State Lawmakers to Address Fall Conference
TMA Answers Your Patients' Insurance Marketplace Questions
You Love Patients, Hate EHRs

 Meaningful Use Requirements Change in 2014
This Month in Texas Medicine

CMS Extends PQRS Registration Deadline for Three Days

Physicians have three more days to register for the Physician Quality Reporting System (PQRS) and avoid a 1-percent cut in Medicare payments. The American Medical Association says it convinced the Centers for Medicare & Medicaid Services (CMS) to extend the registration deadline from Oct. 15 to Oct. 18 because several hundred large-group practices were threatened with fee cuts. 

 CMS says the deadline extension applies to individual physicians and group practices of all sizes.

AMA says it is working for a longer extension, but the government shutdown may prevent it.

Individual physicians can registerhere; group practices can register here.

The TMA website has more information on PQRS.  

The Affordable Care Act requires CMS to apply a value-based modifier (VBM) to all physicians' Medicare payments by 2017 and to some physicians' payments starting in 2015. AMA says CMS intends to apply a 1-percent VBM penalty to the Medicare payments of physicians in groups of 100 or more that did not participate in PQRS in 2013. This VBM penalty would be in addition to another 1.5-percent penalty that would apply to all physicians who did not participate in PQRS either as an individual or as part of a group.  

AMA says the help desk telephone number listed in error messages on the PQRS registration portal is incorrect. Instead, call the PV-PQRS Help Desk at (888) 734-6433, option 3, for questions about registration. You may also contact CMS' QualityNet Help Desk at (866) 288-8912.  

National, State Lawmakers to Address Fall Conference

The patient-physician relationship will be the focus of the TMA Fall Conference, Friday and Saturday, Oct. 18-19, at the AT&T Conference Center in Austin.

Saturday's session begins at 7:30 am with a Dawn Duster session on TMA's new Physician Services Organization for Patient Care.

The general session begins at 8:45 am with remarks by TMA President Stephen Brotherton, MD. U.S. Sen. Ted Cruz (R-Texas) will follow with an update on issues in Congress. Sen. Jane Nelson (R-Flower Mound) will then make a presentation on the 10th anniversary of passage of tort reform in 2003.

Next on the agenda will be a panel discussion on Protecting the Patient-Physician Relationship. Panel members will be state Reps. Susan King (R-Abilene), Sarah Davis (R-Houston), and Nicole Collier (D-Fort Worth).

The session ends with a recap of the 2013 legislative session by Evan Smith, chief executive officer and editor-in-chief of the Texas Tribune.

You can get your flu shot and other vaccinations recommended for health care professionals at the conference. Physicians and their families, medical students, and office staff can get a vaccination Saturday, Oct. 19, from 7:30 to 8:30 am. The event is sponsored by TMA's Committee on Infectious Diseases and TMA's Be Wise — ImmunizeSM program. 

Flu shots, including the new quadrivalent vaccine, and flu mist will be available. You also can get a Tdap (tetanus, diphtheria, and pertussis) or MMR (measles, mumps, and rubella) vaccination.

The cost for a flu shot is $27; for quadrivalent vaccination (limited supply), $40; for FluMist, $40; for Tdap, $80; and for MMR, $105.

Be Wise — Immunize is a joint initiative led by TMA physicians and the TMA Alliance, funded by the TMA Foundation through generous grants from H-E-B and the TMF Health Quality Institute. Since the program began in 2004, more than 235,000 vaccinations have been given to Texas children, adolescents, and adults.

TMA councils, boards, committees, and sections will meet during the conference.

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

  TMLT Action Ad 4.13      


TMA Answers Your Patients' Insurance Marketplace Questions

"Hey, Doc," TMA's multimedia patient education campaign about the Affordable Care Act (ACA) health insurance marketplace, continues into its fifth this week on video, on the Internet, and in the news media. To keep up with the program or to refer your patients, go to

Since Oct. 1, people who brave the computer glitches can buy insurance from the marketplace to comply with ACA's "individual mandate," which requires everyone to be covered next year. The goal of "Hey, Doc" is to provide your patients with no-nonsense answers to their top questions.

As we roll out the campaign for the public, we will also share the questions and answers with you. Segment 2 – "Who Can Enroll, Who Must Enroll, What Happens If You Don't Enroll" – is now available.

Remember, though, plenty of questions right now have no answers, have partial answers, or have answers that will continue to change.

These websites provide details on the insurance marketplace, what to expect, and how to sign up:

  • – the federal government's official website for consumer information on the marketplace and the health care law overall.
  • – another federal resource with explanations, checklists, and official forms, applications, and language materials.
  • Be Covered Texas – an English-Spanish website set up by Blue Cross and Blue Shield of Texas to help Texans understand how the marketplace will work here and how to sign up. The site also offers materials such as printable fact sheets on the marketplace and the health reform law and checklists to get ready.
  • Kaiser Family Foundation's (KFF's) State Health Insurance Marketplace Profiles – an interactive map detailing each state's insurance marketplace.
  • KFF's Subsidy Calculator – a tool to help families estimate how much they could spend on health insurance and whether they qualify for financial assistance. 

You Love Patients, Hate EHRs

Giving patients high-quality care is the most satisfying thing about being a physician, according to a RAND Corporation study sponsored by the American Medical Association. The study, "Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems, and Health Policy," identifies electronic health records (EHRs) as a prime source of stress and dissatisfaction.

Researchers based their findings on information gathered from 30 physician practices across the country, including a family medicine practice in Pflugerville. The practices included a wide assortment of medical specialties and organizational models. AMA sponsored the study to identify factors influencing physicians' professional satisfaction. 

The researchers said that while physicians acknowledge some advantages of EHRs, they complain they are cumbersome to operate and are an important contributor to their dissatisfaction. "Many things affect physician professional satisfaction, but a common theme is that physicians describe feeling stressed and unhappy when they see barriers preventing them from providing quality care," said Mark Friedberg, MD, the study's lead author.  

Key findings of the study include physicians' concern that current EHR technology interferes with face-to-face discussions with patients, requires them to spend too much time performing clerical work, and degrades the accuracy of medical records by encouraging template-generated notes. They also worry that the technology costs more than expected and that different types of EHRs cannot "talk" to each other, preventing the sharing of critical patient medical information when it is needed.

Other findings from the study include:  

  • Excessive productivity quotas and limitations on the time spent with each patient are major sources of physician dissatisfaction. The cumulative pressures associated with workload were described as a "treadmill" and as being "relentless," sentiments especially common among primary care physicians.
  • Physicians describe the cumulative burden of rules and regulations as overwhelming, draining time and resources from patient care.
  • Perceptions of collegiality, fairness, and respect are key factors affecting whether physicians are satisfied. Within the practices studied, frequent meetings with other doctors and other health professionals fostered greater collegiality and satisfaction.   

Researchers say that physicians report being more satisfied when their practices give them more autonomy in structuring clinical activities, as well as more control over the pace and content of patient care. Doctors in physician-owned practices or partnerships are more likely to be satisfied than are those in practices owned by hospitals or corporations. 

The study's recommendations are:  

  • Physician practices need a knowledge base and resources for internal improvement. 
  • As physician practices affiliate with large hospitals and health systems, paying attention to professional satisfaction may improve patient care and health system sustainability. 
  • When implementing new and different payment methodologies, the predictability and perceived fairness of physician incomes will affect professional satisfaction. 
  • Better EHR usability should be an industrywide priority and a precondition for EHR certification. 
  • Reducing the cumulative burden of rules and regulations may improve professional satisfaction and enhance physicians' ability to focus on patient care.  

Researchers did not identify health care reforms as having prominent effects on physician satisfaction, either positive or negative. Most physicians and practice administrators are uncertain about how the Affordable Care Act will affect physician satisfaction and practice finances. It was clear, they said, that a common response to health care reform is for physician practices to seek economic security by growing in size or affiliating with hospitals or larger delivery systems.   

    TMAIT Action Ad 4.13       

 Meaningful Use Requirements Change in 2014

Ready for Stage 2? The first year of Stage 2 meaningful use under the Medicare and Medicaid electronic health records (EHRs) incentive programs begins in 2014 for eligible physicians and other health care professionals. Stage 2 brings changes to the program.  

Here is a snapshot of some of the changes to core and menu requirements worth noting.  

  • Stage 2 has 23 meaningful use criteria. Of those, 17 make up a core set, and six are in a menu from which physicians must choose three. When selecting the menu criteria, physicians need to choose three for which exclusions do not apply.   
  • Drug-drug and drug-allergy interaction checks are no longer separate measures. They are now incorporated in the clinical decision support measure.
  • The up-to-date problem list, active medication list, and active medication allergy lists are now part of the summary of care document.
  • Drug-formulary checks are now part of the e-prescribing measure.
  • NEW CORE! Secure messaging: At least 5 percent of the patients you see during a reporting period must send you a secure message.
  • NEW CORE! More than 5 percent of unique patients must view, download, or transmit their health information.
  • NEW CORE! The summary of care information is expanded. 
  • NEW MENU! Enter at least one electronic progress note you create, edit, and sign for more than 30 percent of patients. 
  • NEW MENU! More than 10 percent of all imaging results are incorporated into the EHR. 
  • NEW MENU! Incorporate and review family health history for more than 20 percent of patients. 
  • NEW MENU! Submit cancer case information into a cancer registry. 
  • NEW MENU! Successful ongoing submission of specific case information to a specialized registry. 
  • Clinical quality measures (CQMs) are no longer a core objective, but you must report on them to demonstrate meaningful use. CQMs are now integrated with the Physician Quality Reporting System (PQRS).  
  • Batch reporting is now available for groups. 
  • 2014 only: A three-month reporting period is allowed for physicians in their second or later year of the meaningful use program. Reporting must align with calendar quarters. It cannot be any 90 days as with first-year participants. Note: If reporting CQMs for PQRS, that is a full-year reporting period.   

To see all of the Stage 2 meaningful use measures, view the TMA summary, or go to TMA's EHR Incentive Program Resource Center.  

TMA recognizes the complexities of the EHR incentive program and recommends physicians struggling with it to consider contracting with one of the Texas regional extension centers (RECs). Details about the REC program and which one serves your area are available in TMA's Texas REC Resource Center.    

If you have questions about the EHR incentive program or need additional help, contact the TMA HIT Helpline by telephone at (800) 880-5720 or by email.  

This Month in Texas Medicine

The October issue of Texas Medicine  explains why physicians across the state are frustrated with the Medicaid managed care program. It also tells you what you need to do to prepare for the coming of ICD-10 a year from now, why you need to pay attention to tougher new privacy laws, and how physicians help shape public health policy in Texas. You'll also meet the new commissioner of the Texas Department of Insurance.

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.  

   PC Action Ad July 13


 This Just In ...

Want the latest and hottest news from TMA in a hurry? Then log on to  Blogged Arteries.   

TMA Deadlines for Doctors

TMA's Deadlines for Doctors alerts you and your staff to upcoming state and federal compliance timelines and offers information on key health policy issues that impact your practice. 

 2013 AIM Clinical Guideline Changes  

 Updated Humana Provider Manual  

 Blue Cross and Blue Shield of Texas Updating Fee Schedule

 Humana Updating Policies and Code Edits  

 Federal Agency: New OSHA Deadline: Training About Hazardous Materials

 2013 E-Prescribing Incentives. End-of-year reporting deadline to claim a 0.5-percent bonus  

 EHR Incentive Program Reporting Period Ends for 2013 Payment Year  

 E-Prescribing Deadline for 2013 Incentive

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. 

Live Seminars  

11/5      Austin 
11/6      Abilene 
11/12    Dallas 
11/13    Tyler 
11/14    Fort Worth 
11/19    McAllen 
11/21    San Antonio 
12/3      Houston 
12/4      Houston 


Hard Knocks: An Update on Concussion and Texas Law  


TMA Fall Conference
10/18-19    Austin    

TexMed 2014
5/2-3    Fort Worth  

Physician Health and Wellness, Ext. 1342  

Healthy Physicians: Healthy Patients
10/26  San Antonio  

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Last Updated On

January 27, 2016