Action: Dec. 4, 2013

TMA Action Dec. 4, 2013   News and Insights from Texas Medical Association 

INSIDE: SGR Repeal Bill Good, Could Be Better, Must Pass

SGR Repeal Bill Good, Could Be Better, Must Pass
ACA Exchange Plans: Questions and Answers for Texas Physicians
2014 Medicare Participation Deadline Extended
Are You on the Medicaid Fee Increase List?
Tell HHSC How to Simplify Medicaid Managed Care
Texas RECs Offer Free Help to Some Medicaid Specialists
OSHA Deadline: Training About Hazardous Materials

Pediatrician Suggests You Choose Wisely With Patients
Help Patients Choose the Right Flu Shot
ACP Conference Focuses on Medical Home
Nominate Excellent Health Reporting for TMA Award
Call for Quality Improvement Posters
A Special Offer for TMA Members
This Month in Texas Medicine

SGR Repeal Bill Good, Could Be Better, Must Pass

A bipartisan plan to repeal the Medicare Sustainable Growth Rate (SGR) formula is a good start but still needs work, the Texas Medical Association and eight other states in the Coalition of State Medical Societies say in a letter to the chairs and ranking members of the Senate Finance Committee and House Ways and Means Committee.

"Another patch, another 'doc fix,' is not acceptable," the coalition added in a follow-up memo to Congress.

TMA physician leaders and physicians from other coalition-member states spent several days in November meeting with senators and representatives from both parties, stressing mostly Medicare payment reform. 

The Centers for Medicare & Medicaid Services released its final rule with the 2014 Medicare physician payment schedule on Nov. 27. It also posted a fact sheet on the rule. Unless Congress repeals the SGR or takes some other action by Jan. 1, Medicare payments to physicians will be cut by about 24 percent.  

The coalition, which represents 158,500 physicians and medical students in Texas, Arizona, California, Florida, Louisiana, Oklahoma, New York, North Carolina, and South Carolina, said in the letter that it supports five components of proposed legislation to "establish new payment systems that will help physicians keep their doors open to baby boomers and future Medicare patients":  

  • Repeal the flawed Medicare SGR formula. 
  • Retain a fee-for-service program. 
  • Streamline current reporting programs and eliminate the current penalties related to the Physician Quality Reporting System, meaningful use, and the value-based modifier (VMB). 
  • Pay for complex chronic care management, and 
  • Provide timely performance feedback for physicians. 

However, the letter says, "to protect access to care for millions of Medicare patients and to ensure the sustainability of America's health care system, these critical improvements must be made to the current House-Senate proposal":  

  • Provide appropriate annual updates to sustain physician practices.  
  • Put the costly, clinically irrelevant ICD-10 on permanent hold until ICD-11 or another usable replacement for ICD-9 is ready for widespread implementation.
  • Reduce the regulatory burden imposed on physician practices. 
  • Allow options, extended timelines, assistance, and financial aid for any small physician practice that wishes to transition to new payment models, not only for those in certain locations.  
  • Instead of making incentive payments available only to specific physician practices or specific geographic areas, allow incentive payments for a variety of alternative payment models, including ones that DO NOT require physicians to assume full financial risk. 
  • Evaluate the cost-effectiveness of all reporting and incentive programs to determine whether they improve care, reduce total cost, or selectively penalize physicians who serve specific demographic or cultural groups.   
  • Before implementing any of the existing VBM measures and methods in a new value-based payment program, revise them so that:
  1. The measures and standards used do not result in financial penalties for physicians when their patients do not comply with recommendations for testing and treatment;  
  2. Physicians are not penalized for providing services to disadvantaged patients;  
  3. Physicians are not penalized for noncompliance with obsolete or superseded guidelines and standards; and  
  4. Both cost and quality measures are adequately risk-adjusted to eliminate the effects of poverty, poor educational attainment, and cultural differences.

The letter also suggests ways the government can reduce the administrative and financial burden on physicians in Medicare. They include creating a "de minimis amount exception for the duty to return overpayments under threat of the False Claims Act as well as for recovery audits," reversing the requirement that an ordering physician be enrolled in Medicare for the referred physician to be paid for his or her services, and allowing payment for telephone or email consultations after a face-to-face encounter.  

In its follow-up memo, the coalition called on lawmakers to "take immediate action to work together" to repeal the SGR and not opt for another temporary fee freeze or small increase as it has done for several years.

The coalition's message reminded lawmakers that the "track record for Congress is not very good. For 12 years, physicians have toiled under the SGR, which everyone knows is broken. Physician practices have been subject to short-term patches each year, crippling their ability to plan for the future, even making them wonder if they'll be solvent for the current year. The decision to further delay only exacerbates the fiscal albatross around the necks of America's physicians and the Medicare patients we serve. The vast majority of you say the SGR needs to be permanently fixed. Let’s do it. Now is the time for action."

The Senate Finance Committee has scheduled a Dec. 12 "open executive session" on the draft SGR repeal proposal.

2014 Medicare Participation Deadline Extended

Jan. 31 is the new deadline for physicians to decide whether to participate in the Medicare program in 2014. The deadline originally was Dec. 31, but the Centers for Medicare & Medicaid Services (CMS) extended it because CMS released the 2014 physician fee schedule later than usual. 

You do not have to do anything if you wish to continue participating in Medicare next year.

You have three options in deciding whether to participate in 2014:  

  • Sign a participation (PAR) agreement and accept Medicare's allowed charges as payment in full for all Medicare covered services for your Medicare patients.  
  • Elect nonparticipation (non-PAR), which permits you to make assignment decisions on a case-by-case basis and to bill patients up to the Medicare limiting charge for unassigned claims. 
  • Opt out and become a private contracting physician, agreeing to bill patients directly and to forego any payments from Medicare to you or your patients. To become a private contractor, PAR physicians must give 30 days' notice before the first day of the quarter the contract takes effect. For non-PAR physicians, the opt-out effective date is the date the affidavit is signed, provided it is filed within 10 days after the physician signs his or her first private contract with a Medicare beneficiary.

Log on to the Novitas Enrollment Center  for more information and links to CMS forms and the online application process.

Are You on the Medicaid Fee Increase List?

The Texas Medicaid &Healthcare Partnership (TMHP) has compiled a list of primary care physicians eligible for the temporary fee increase for treating Medicaid patients that was authorized by the Affordable Care Act. On the list are the names of physicians who filed the required form by Oct. 16, attesting that they are eligible for the increase.  

Email TMHP if you submitted an attestation form but your name is not on the list or if the information is incorrect.   

The health reform law grants a rate increase for certain primary care providers and services from Jan. 1, 2013, through Dec. 31, 2014. Physicians must self-attest either that they are board certified in family medicine, general internal medicine, pediatric medicine or a subspecialist within those designations as recognized by the American Board of Medical Specialties, the American Osteopathic Association, or the American Board of Physician Specialties, or that 60 percent of their Medicaid billings for the prior year were for certain evaluation and management (E&M) services. Those services include E&M codes 99201 through 99499 and services related to the administration of vaccines (90465, 90466, 90467, 90468, 90471, 90472, 90473, and 90474).

The state plans to begin paying the rate increase as a supplemental quarterly payment for services rendered in January for Medicaid managed care and in April for Medicaid fee-for-service. Retrospective payments will be issued to Jan. 1, 2013, for physicians who self-attest between Jan. 1, 2013, and April 1, 2014. Physicians who wait until after April 1, 2014, to self-attest will qualify only for supplemental payments back to the date their attestation form was received. 

Eligible physicians must self-attest by completing the Texas Medicaid Attestation for ACA Primary Care Services Rate Increase form.

    TMLT Action Ad 4.13  

Tell HHSC How to Simplify Medicaid Managed Care

As the October issue of Texas Medicine reported, physicians are frustrated with the state's Medicaid managed care program. Payment and preauthorization delays, network adequacy, and poor communication by Medicaid HMOs are among the concerns. So how would you simplify the program? The Texas Health and Human Services Commission (HHSC) wants to know. Give your recommendations by Dec. 6. 

HHSC is inviting physicians and other health care professionals, managed care organizations, and consumers to recommend ways to simplify and streamline Medicaid managed care. The 2013 Texas Legislature required HHSC to develop a plan to simplify and reduce administrative requirements for physicians and providers by Sept. 1, 2014. Among the issues to be examined are prompt payment, prompt credentialing processes, uniform standards for prior authorizations, duplicative administrative reporting requirements, and consistency across administrative policies.

To submit ideas, complete Ideas for Administrative Simplification in Medicaid Managed Care by Dec. 6.

Texas RECs Offer Free Help to Some Medicaid Specialists

A grant from Texas Medicaid now allows the four Texas regional extension centers (RECs) to help physicians participating in the Medicaid electronic health record (EHR) meaningful use incentive program. Physicians with at least 30 percent Medicaid volume can receive up to $63,750 in incentives over six years. 

Medicaid is focusing on numerous health priorities and, as a result, is extending EHR consulting help to the following specialties:

  • Cardiologists,  
  • Endocrinologists,  
  • Psychiatrists, and  
  • Pulmonologists.   

To be eligible for the free consulting services, the physician must be eligible for the Medicaid EHR incentive program and must not yet have attested to meaningful use. 

The RECs can help with EHR selection, workflow optimization with the EHR system, meeting the meaningful use measures (including the security risk assessment), and attesting to meaningful use to receive the incentives. 

For more information about the Texas RECs, check out TMA's REC Resource Center. A REC locator tool can help you determine which REC serves your area. 

If you have other questions about EHRs or other health information technology issues, email TMA's Health Information Technology Department or call (800) 880-5720.  

OSHA Deadline: Training About Hazardous Materials

Labels and safety data sheets (SDSs) for hazardous chemicals are getting a makeover, and practices should have trained their staff to understand them by Dec. 1, 2013.

The Occupational Safety and Health Administration (OSHA) has revised its Hazard Communication standard, aligning it with the United Nations' global chemical labeling system. Labels and SDSs will use pictograms and other elements in a new, standard format. Companies have until 2016 to roll out their new labels and SDSs, but you may have started seeing some as early as Dec. 1 — thus the Dec. 1 training deadline.

OSHA has published a training requirements fact sheet that explains what you need to teach your staff, as well as these training aids:

Remember, OSHA requires all employers with hazardous chemicals in their workplace to have labels and readily accessible SDSs for their exposed workers, and to train them to handle the chemicals appropriately.

TMA Can Help

  • Our on-demand OSHA training webinar meets the requirements for annual OSHA training, including the hazard communication training. This five-part webinar comes with downloadable forms and a poster. Register now.
  • In addition, if you purchased a 2012 or earlier edition of OSHA Program Manual for Medical Facilities from TMA, you can download a free Hazard Communication standard update by logging in to your account at Go to My Products, and find the update under the Materials tab for the OSHA manual. You can incorporate the update into your existing manual and also use it as a training aid. The 2013 editions of OSHA Program Manual for Medical Facilities already incorporate the update.
  • You can buy a current edition of OSHA Program Manual for Medical Facilities in the TMA Education Center.
  • Check out TMA's OSHA page for additional information about OSHA standards.

Revised Nov. 22, 2013

TMA Practice E-Tips main page

 TMAIT Action Ad 4.13   

Pediatrician Suggests You Choose Wisely With Patients

Marylou Buyse, MD, pediatrician and chief medical director of Scott & White Memorial Hospital Health Plan, wants Texas physicians to spark discussion with patients by using Choosing Wisely

"This is particularly exciting to Scott & White," Dr. Buyse said. "An initiative like Choosing Wisely has been missing for a long time in specialty care."

Choosing Wisely promotes conversations between physicians and patients based on evidence provided by dozens of national specialty societies. These organizations representing medical specialists were asked to "choose wisely" by identifying tests or procedures commonly used in their field whose necessity physicians and patients should question and discuss. The resulting lists of "Five Things Physicians and Patients Should Question" will aid conversations about many frequently ordered tests or treatments.

Dr. Buyse calls the program a "terrific initiative, a really fresh new view on patient and doctor conversation."  

Scott & White Health Plan recognizes the importance of conversations between patients and physicians. Dr. Buyse explained that when specialty societies signed onto the Choosing Wisely initiative, each one provided a list of recommendations that was supported by their evidence.

"Physicians should be practicing and promoting evidence-based medicine," Dr. Buyse said. "Choosing Wisely gives that to specialty care in a broad way by providing lists," making it easier for physicians and healthier for patients. 

Scott & White Health Plan and Choosing Wisely urge physicians and patients to talk about the recommendations to find what is best for the patient's care, she says. 

"Evidence, patients, and physicians. This triangle is linked in the campaign and is the heart of the campaign," Dr. Buyse said.

Dr. Buyse explained how simplicity makes Choosing Wisely an attainable goal. Information overload leads to errors in health care. But the Choosing Wisely lists help physicians manage the information they share with their patients. She says it takes four times as long without the written lists to explain to patients why a particular choice was made.

"It is an easy way to coordinate care," Dr. Buyse said. "I would advise getting information for patients in the office to remind you. Get information for the conversation. Both physician and patients have a stake in care."

Dr. Buyse has promoted the Choosing Wisely initiative since early 2012. Scott & White Health Plan provides six Choosing Wisely lists that patients need most. Their goal is to try to "close the loop" for primary care by using patient-physician conversations.

The ABIM Foundation awarded TMA and its philanthropic arm, the TMA Foundation, a grant to advance the Choosing Wisely campaign among Texas physicians. Nine Texas county medical societies, six state medical specialty societies, and the Texas Osteopathic Medical Association are participating in the program with TMA. Support for the grant program comes from the Robert Wood Johnson Foundation.   

Help Patients Choose the Right Flu Shot

Are your patients asking questions about flu vaccination? National Influenza Vaccination Week is Dec. 8-14. It's a perfect time to encourage your patients to get vaccinated for the flu to help them stay healthy during the holidays.  

Here are some useful tools:

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.

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

ACP Conference Focuses on Medical Home

You can learn how to make quality work for your practice and your patients and transform care for diabetics and others with multiple comorbid conditions by attending a conference sponsored by the American College of Physicians (ACP) Texas Chapter next month in San Antonio. "Reclaiming the Joy and Building the Value of Your Practice" will take place Jan. 24-25 at the Omni La Mansion del Rio. 

The conference, endorsed by the TMA Board of Trustees, focuses on the patient-centered medical home with a focus on diabetes care. Quality experts will offer practical advice to help you improve quality of care; promote patient, physician, and staff satisfaction; and reduce costs.

The ACP's Practice Advisor will be used a guide for the conference. The program, as well as the Practice Advisor, are free. A series of webinars after the meeting will reinforce the principles covered.

You can earn continuing medical education credit by participating. The program is free but space is limited, and you must register by Jan. 4. To register online, go to

Nominate Excellent Health Reporting for TMA Award

If you've read, seen, or heard something in the media recently on health care that made you take note, nominate it for TMA's Anson Jones, MD, Awards. Your nomination lets journalists know you're paying attention, gives them a pat on the back, and encourages them to keep reporting on medicine. 

TMA has honored award-winning Texas journalists with the Anson Jones, MD, Awards for more than 50 years. This is the first time in its history that TMA family members (physicians, medical students, TMA Alliance members, and county medical societies) can nominate reporters for the Anson Jones, MD, Award.

Enter your local reporter's work by Jan. 3. The news story must have run in 2013. Simply email your nomination and include the reporter's name, name of article (if available), date of broadcast/publication, and the media outlet. TMA will follow up by sending a postcard to the journalist alerting him or her of the nomination. 

If you have questions, email or call Tammy Wishard, TMA outreach coordinator, at (800) 880-1300, ext. 1470, or (512) 370-1470.   

 PC Action Ad May 13      

Call for Quality Improvement Posters

TMA's second annual Quality Poster Session will take place at TexMed 2014 in Fort Worth in May. You will have the chance to share your successes and breakthroughs in improving patient care with your peers from around the state. 

This will be a great opportunity for you to not only report on your quality improvement methods and best practices, but to also gain inspiration from your colleagues' approaches to providing quality patient care and to identify new quality improvement techniques to implement in your own practice.

Have a quality improvement success you want to present? Submit your abstract today. Creatively and visually depict something special that you are doing in your practice that demonstrates one or more of the six aspects of quality care as defined by the Institute of Medicine:  

  • Safe: avoids injuries to patients from care that is intended to help them. 
  • Timely: reduces waits and delays for both those who receive care and those who give care. 
  • Effective: based on scientific knowledge, extended to all likely to benefit while avoiding underuse and overuse. 
  • Equitable: provides consistent quality, without regard to personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status. 
  • Efficient: avoids waste, including waste of equipment, supplies, ideas, and energy. 
  • Patient-centered: respects and responds to individual patient preferences, needs, and values, ensuring that patient values guide all clinical decisions.     

TMA and TMF Health Quality Institute will host an official CME presentation at TexMed, during which the poster authors will have the opportunity to talk about their creations. The posters will then be on display for viewing throughout the rest of the day.

Share your successes, improve the quality of health care in Texas, and support your colleagues. Visit the TexMed Quality Poster Session page for more information or to download an application packet.  

A Special Offer for TMA Members

TMA endorsed-vendor TransFirst has found an average savings of $1,300 for practices that have taken their free merchant statement savings analysis. 

Find more informationabout the special Meet or Beat offer for December, or get your free analysis.

This Month in Texas Medicine

The December issue of Texas Medicine  tells you what Texas medical schools are doing to speed up training of primary care physicians, explains what you need to know about how the new health insurance exchange will affect your practice, and reports on an emergency physician's fight with a hospital over peer review. It also explains why 2014 is a big year for electronic health records and how Medicaid is trying to base payments on quality.

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. 

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. 


OSHA Annual Training Webinar
Training on new requirements must be completed by December

Hard Knocks: An Update on Concussion and Texas Law  


TMA Winter Conference
1/31-2/1    Austin

5/2-3    Fort Worth  

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