Action: Nov. 1, 2013

TMA Action Nov. 1, 2013   News and Insights from Texas Medical Association 

INSIDE: Abortion Ruling Supports Physician Judgment

Abortion Ruling Supports Physician Judgment
Texan Leads in Pushing Bipartisan Support for SGR Repeal
TMA Opposes VA's APRN Proposal
TMA Answers Your Patients' Insurance Marketplace Questions
Walk the Walk
Learn about the Blue Advantage HMO Network
Live From Austin: Medicare 2014 

Have You Talked To Your EHR Vendor About ICD-10?
The Digital Practice: Building a Stronger Online Presence
Webinar to Explain CCHD Screening
Good Practices Deserve Recognition
San 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 physicians performing 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 effect, U.S. District Judge Lee Yeakel also upheld a physician's judgment in the use of RU-486 by women seeking an 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 expected.  

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 physicians."  

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

The White House now promises that they will clear up all the 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:

  • – 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.

  TMAIT Action Ad 4.13  

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 help.

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 Antonio. 

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 perspective. 

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 (877) 880-1335.  

TMLT Action Ad 4.13      


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 questions. 

  •  Does your current EHR vendor contract cover your practice's ICD-10-related needs?  
  • 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 partners? 
  • Will your vendor update all its current products and applications for ICD-10? 
  • Has your vendor scheduled training for your staff on the ICD-10 system updates? 
  • 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 deadline. 
  • 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 four-minute demo).  

You can direct questions related to EHRs and other office technologies to TMA's Health Information Technology Department by calling (800) 880-5720 or by email.   

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 Center.   

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 Services Newborn Screening Grand Rounds webinar from 11 am to 12:45 pm CT on Nov. 8. 

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 year.   

 PC Action Ad Nov 13    

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 program.  

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 release.

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 future. 

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.

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.  

 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. 

 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  

Medicare 2014 
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  


TexMed 2014
5/2-3    Fort Worth  

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