|TMA Action Nov. 1,
|| News and Insights from Texas Medical
INSIDE: Abortion Ruling Supports Physician
Supports Physician Judgment
Texan Leads in Pushing Bipartisan Support for SGR
Opposes VA's APRN Proposal
TMA Answers Your Patients' Insurance Marketplace
about the Blue Advantage HMO Network
Live From Austin: Medicare 2014
You Talked To Your EHR Vendor About ICD-10?
The Digital Practice: Building a Stronger Online
Webinar to Explain CCHD Screening
Good Practices Deserve
Antonio Leadership Conference Canceled
This Month in Texas Medicine
Abortion Ruling Supports Physician Judgment
An Austin federal judge blocked enforcement of a provision of the
state's new antiabortion law that requires
abortions to have admitting privileges at a hospital within 30 miles of their
facility. On Oct. 28, the day before the law was to take
U.S. District Judge Lee Yeakel also upheld a physician's judgment in the use of
RU-486 by women
abortion. The state immediately appealed the
ruling to the U.S. 5th Circuit Court of Appeals, and on Oct. 31, the court
lifted Judge Yeakel’s injunction, allowing the state to enforce the regulations.
The legal battle is expected to continue.
The day Judge Yeakel issued the injunction, Gov. Rick Perry
said it "will not stop our ongoing efforts to protect life and ensure the women
of our state aren't exposed to any more of the abortion-mill horror stories that
have made headlines recently. We will continue fighting to implement the laws
passed by the duly-elected officials of our state, laws that reflect the will
and values of Texans."
Judge Yeakel said hospital admitting privileges "make no
difference in the quality of care received by an abortion patient in an
emergency room, and abortion patients are treated the same as all other patients
who present to an emergency room." He added the admitting privileges provision
"does not bear a rational relationship to the legitimate right of the state in
preserving and promoting fetal life or a woman's health."
Another provision of the law requires women to follow a regimen approved by
the U.S. Food and Drug Administration for use of RU-486. The judge said while
the requirement does not "generally place an undue burden on a woman seeking an
abortion," it does if it bans an abortion when a "physician determines in
appropriate medical judgment, such a procedure is necessary for the preservation
of the life or health of the mother."
Opponents of the law did not challenge two other provisions
of the law. One bans abortions at 20 weeks
postfertilization and took effect Oct. 29. The other provision, which requires
abortion clinics to meet the same requirements as day surgery centers, does not
take effect until Sept. 1, 2014. A legal challenge to that provision is
The Texas Medical Association did not take a position in the abortion
debate during the legislative session but raised concerns with the legislative
intrusion into the patient-physician relationship and the practice of medicine
and with a legislatively created standard of care. "This bill includes
determinations that should be made by the medical community and science, not by
the legislature," TMA President Stephen L. Brotherton, MD, wrote in a letter to
the House State Affairs Committee in June.
Texan Leads in Pushing Bipartisan Support for SGR Repeal
U.S. Rep. Bill Flores (R-Bryan) joined a Democratic congressman in
urging House leaders to repeal Medicare's Sustainable Growth Rate (SGR) formula
this year. Representative Flores and Rep. Dan Maffei (D-N.Y.) are asking their
colleagues to sign on to a bipartisan letter to House Speaker John Boehner and
Minority Leader Nancy Pelosi.
"We should not pass up this chance to repeal the SGR — with fiscally
responsible offsets — and enact a permanent solution," they wrote. "This year
represents a great opportunity to repeal the flawed SGR formula, reform health
care delivery to drive quality and efficiency, and set Medicare on a more stable
and predictable course for current and future generations of patients and
Two Texans — Reps. Blake Farenthold (R-Corpus Christi) and Mike Conaway
(R-Midland) — already have signed on. Two other Texans — Reps. Michael Burgess,
MD (R-Lewisville), and Kevin Brady (R-Conroe) — have been among the leading
House forces all year to advance the SGR replacement bill.
TMA Opposes VA's APRN Proposal
It's a bad idea.
That's the gist of what TMA, the American Medical Association, and
other state medical societies say in a
letter to Robert Petzel, MD, undersecretary for health in the Department of
Veterans Affairs about the proposal in the Veterans Health Administration (VHA)
Nursing Handbook to designate advanced practice nurses (APRNs) as independent
providers and allow them to practice without physician supervision regardless of
individual state regulations.
"We are concerned that some of the changes proposed may significantly
undermine the delivery of care within the VHA while disregarding the states'
role in regulating the health and safety of their residents in the delivery of
health care services," the letter says. It adds the proposal "effectively
eliminates physician-led, team-based care within the VHA system. In lieu of
team-based care, the draft handbook requires APRNs to attain independent
practice and penalizes those who do not wish to attain this status by
prohibiting such APRNs from practicing as APRNs within the VHA. Similarly, local
facilities that wish to continue to provide physician-led, team-based care will
be prohibited from doing so."
They urge federal officials to revise the handbook to "ensure that
current VHA policies in support of physician-led health care teams and
state-based licensure and regulation remain unchanged."
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 third month on
video, on the Internet, and in the news media. To keep up with the program or to
refer your patients, go to heydoc.texmed.org.
The White House now promises that they will clear up all the healthcare.gov
computer glitches by Nov. 30, so patients 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 3 — "All About the Plans" — 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:
- Healthcare.gov – the federal government's official website for
consumer information on the marketplace and the health care law overall.
- Marketplace.cms.gov – another federal resource with
explanations, checklists, and official forms, applications, and language
- 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.
Family Foundation's (KFF's) State Health Insurance Marketplace Profiles – an
interactive map detailing each state's insurance marketplace.
Subsidy Calculator – a tool to help families estimate how much they could
spend on health insurance and whether they qualify for financial assistance.
Walk the Walk
Ready to practice what you preach? TMA's Walk With a Doc program is
part of a national grassroots movement devoted to encouraging healthy physical
activity. We want to reverse the consequences of a sedentary lifestyle and
improve the health and well-being of our country, and we want your
The program has a proven track record of helping people commit to a healthy
lifestyle through monthly, physician-led walks throughout the community.
Strengthen your trusted leader role in your community and participate in a
healthy activity with your patients.
Walk With a Doc in Texas is promoted by TMA's Council on Health Promotion and
funded by a grant from the TMA Foundation with major support from the Aetna
Foundation. The council is specifically seeking TMA member-physician walk
leaders who practice in underserved areas of Austin, Dallas, Houston, and San
Join the movement and get moving with your patients. Contact Debra
Heater in TMA's Division of Communication for more information.
Learn about the Blue Advantage HMO Network
If you signed a contract with the new Blue Advantage HMO network, you
might want to attend a physician orientation session.
Blue Cross and Blue Shield of Texas (BCBSTX) will offer the Blue
Advantage HMO through the federal health care insurance marketplace under the
Affordable Care Act.
In anticipation of the "go live" date, Jan. 1, 2014, BCBSTX is hosting
the orientation sessions across the state, now through Feb. 6, 2014. To register
for a session, print and complete a registration form, and fax it to your BCBSTX provider
relations office. Not sure if you are participating in this network? Contact
your BCBSTX provider relations representative to find out. The registration form
contains a list provider relations office fax and phone numbers.
Live From Austin: Medicare 2014
You can go to TMA's Medicare 2014 update at one of 10 seminar locations across the
state starting Nov. 5. Or, it can come to you as a live webcast on Nov. 5 from
8:30 am until 12:30 pm CT. If you and your staff register for a
virtual seat, you'll get the same interactive experience as in-person
participants. You can watch the seminar as it happens,
be able to ask questions in real time, and receive electronic handouts and other
supplements without the hassle and cost of travel.
TMA Director of Payment Advocacy Genevieve Davis will take you through a mock
Medicare experience from the first patient phone call through payment. Ms. Davis
will give insight on avoiding the most common pitfalls, show methods to
streamline your workflow, and give you the rare opportunity to view your
Medicare processes from the patient's perspective as well as your practice's
The seminar also will cover changes to Medicare's Electronic Health Record Inventive Program, the Physician Quality Reporting System, and the Electronic Prescribing Incentive Program, and tell you what
you need to do in 2014 to prevent penalties; and will provide updates from
Novitas about audits, ICD-10, and its new website features.
Register today to reserve your seat in the classroom, or register for the live webcast and attend from anywhere. This
seminar series will fill very quickly. To register by phone, call toll-free
Have You Talked To Your EHR Vendor About ICD-10?
Vendors are key partners who can help you prepare for ICD-10. You can
assess an electronic health record (EHR) vendor's capabilities by answering
- Does your current EHR vendor contract cover your practice's ICD-10-related
- What is the vendor's timeline for the ICD-10 transition?
- Will your vendor install products well before the Oct. 1, 2014, deadline, so
you can begin testing them in 2013?
- Has your vendor scheduled with you to test your system with your trading
- Will your vendor update all its current products and applications for
- Has your vendor scheduled training for your staff on the ICD-10 system
- Will the EHR give you the ability to search for codes by the ICD-10
alphabetic and tabular indexes? By clinical concept?
- Will the EHR allow for coding in both ICD-9 and ICD-10 to accommodate
transactions with dates of service before Oct. 1, 2014, and transactions with
dates of service after Oct. 1, 2014?
For a more in-depth list of questions to discuss with your EHR vendor,
view the American Health Information Management Association's ICD-10 Readiness Questionnaire for EHR Vendors.
Communication During Your Transition
After assessing your
EHR vendor's capabilities, continue to communicate with its representative
throughout the ICD-10 transition:
- Include your vendor in planning the transition. Communicate your needs and
goals, and ask for assurance in writing that products and testing plans will
fulfill your requirements. Ask your vendor to share some strategies other
clients have used successfully.
- Work with your vendor to update and test clinical, financial, actuarial, and
reporting processes. Your vendor should offer technical support and guidance
during and after installation of new software.
- Find out how your vendor will provide support as you begin testing ICD-10
transactions with payers and other business trading partners. Begin testing with
trading partners as soon as possible in advance of the Oct. 1, 2014, ICD-10
- Determine what role your vendor will play in resolving any testing failures.
The Centers for Medicare & Medicaid Services has created checklists
with ICD-10 transition tasks and estimated time frames for large practices and small and medium practices.
Under these recommended schedules, testing with your business trading
partners such as payers, clearinghouses, and billing services should begin
immediately and will take 10 months minimum to complete.
Be sure to bookmark TMA's ICD-10 resource
page for news, tools, education, and updates. TMA's on-demand webinar, ICD-10 Now! How and Why? examines everything physicians need
to know and do to prepare for ICD-10. Our Complete ICD-10 Implementation Solution toolkit comes with two
licenses for Simple Solutions Transition Software and instruction videos, and walks your
practice through every aspect of preparation. (View a
You can direct questions related to EHRs and other office technologies
to TMA's Health Information Technology Department by calling (800) 880-5720 or
The Digital Practice: Building a Stronger Online Presence
The latest consumer statistics suggest that more than 90 percent of
potential patients will research your practice online before deciding where they
will go for their health care. So what does your
online presence say about your practice?
Is your website properly structured and designed? Do you offer online
appointment scheduling and digital forms? Are you getting good patient reviews
and positive social media talk? Creating and managing a top-notch Internet
presence and positive reputation is imperative to building your practice and
maintaining relationships with current patients.
TMA is offering a new live webinar on Nov. 19
from noon to 1 pm to address these issues and help you evaluate your current
online credibility. This webinar, The Digital Practice: Building a Stronger Online
Presence, is the final installment of the Tech Tuesday series,
which covered a variety of technology topics from HIPAA Security to electronic
health record concerns.
Aimee Ostrander, creative director of Akaro Graphics, and Kim
Mallinger, who handles marketing and patient relations for Cedar Park Pediatric
& Family Medicine, will teach the course.
The series' June-October webinars are available to
view on-demand through the TMA Education
Webinar to Explain CCHD Screening
The rationale for screening for critical congenital heart disease
(CCHD) in newborns will be explained during a Texas Department of State Health
Screening Grand Rounds
webinar from 11 am to 12:45 pm CT on
Elena Catherina Ocampo, MD, a member of the Cardiovascular Intensive Care
Section of Pediatric Cardiology at Texas Children's Hospital in Houston, will
discuss supporting evidence for the use of pulse oximetry in the newborn nursery
to detect CCHD.
The legislature passed a bill requiring CCHD screening earlier this
Good Practices Deserve Recognition
Texas physician practices continue to make great strides in providing
reliable preventive services by using health information technology and
effective care management methods. These practices should be recognized for
their hard work.
TMA, the Texas Osteopathic Medical Association, and the TMF®
Health Quality Institute have partnered again to provide the Texas Physician Practice Quality Improvement Award
The application process is simple. Complete an online application between
April 1, 2014, and June 13, 2014. Award-winning practices will receive
commemorative items to display and will be recognized through a statewide media
San Antonio Leadership Conference Canceled
The IMQ/PACE Platinum Level Training Program for Physician
Leaders scheduled for
Nov. 7-9 at the Grand Hyatt Hotel in San Antonio has been canceled
because not enough people registered.
Organizers say the same program in San Diego is
still scheduled and they have not given up hope of offering it in Texas in the
This Month in Texas Medicine
The November issue of Texas
Medicine tells you why physicians are glad the legislature
restored funding for women's health but say problems still exist. You'll also
learn about plans for expanding graduate medical education, why TMA is
challenging a CIGNA policy, what physicians say needs to be done about the
state's antiquated mental health hold law, and what state and federal laws say
about communicating with patients.
out our digital edition.
Texas Medicine RSS Feed
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This Just In ...
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TMA Deadlines for
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
Updating Policies and Code Edits
Agency: New OSHA Deadline: Training About Hazardous Materials
2013 E-Prescribing Incentives.
End-of-year reporting deadline to claim a 0.5-percent bonus
Program Reporting Period Ends for 2013 Payment Year
Deadline for 2013 Incentive
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
11/21 San Antonio
Hard Knocks: An Update on Concussion and Texas Law
5/2-3 Fort Worth
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