| TMA Action Feb.
|| News and Insights from Texas Medical
INSIDE: SGR Repeal Closer Than
Act Now! SGR Repeal
Closer Than Ever
Vote for the Party of Medicine
Board Pulls Plan for
Pharmacists to Check Diagnoses
Projected ICD-10 Conversion Costs
Tell Feds to Expedite RAC Audit Appeals
Seminar Trains Your Staff on ICD-10
|Medicare Meaningful Use Attestation Extended to
Penalty Review Available Until Feb. 28
DocbookMD Connects Texas Physicians in More Ways
Prevention Into Practice: Give Away Helmets in Your Office
Are You Choosing
Month in Texas Medicine
Act Now! SGR Repeal Closer Than Ever
There's a light at the end of the SGR tunnel. Or is it a freight train? You
can make the difference and help ensure that Congress permanently repeals
Medicare's Sustainable Growth Rate (SGR) formula now.
The SGR Repeal and Medicare Provider Payment Modernization Act of 2014
(HR 4014/S. 2000) was introduced in the U.S. Senate and House of
Representatives. Its author is U.S. Rep. Michael Burgess, MD (R-Texas). It
features the handiwork of Rep. Kevin Brady (R-Texas). And it has the support of
key congressional leaders from both parties and in both chambers.
"We may not get this opportunity again," said TMA President Stephen L.
Brotherton, MD. "Take action now to support permanent SGR repeal."
The three key congressional committees involved have come to this bipartisan,
bicameral agreement in advance of the March 31 deadline when physicians'
Medicare payments will be cut by 24.1 percent. It incorporates many Texas
Medical Association-supported recommendations to reform the physician payment
system and improve care for Texas seniors, military families, and people with
disabilities. This legislation would provide physicians with positive annual
payment updates of 0.5 percent for five years. (While these updates won't keep
up with physicians' cost of providing health care to Medicare patients, the
cumulative 2.5-percent update is larger than all of the increases Congress has
provided in the past 12 years, combined.) It also includes important medical
liability reform protections and significant financing and tools to help us
adopt new payment and delivery models.
"Congress is now closer than it ever has been to enacting fiscally prudent
legislation that would permanently repeal the SGR," Dr. Brotherton said. "That
will happen only if Washington hears our loud voice. Please contact U.S. Sens.
John Cornyn and Ted Cruz and your U.S. representative today."
Physicians can send an email through TMA's Grassroots Action Center, and call lawmakers via the
American Medical Association's Physicians Grassroots Network hotline at (800)
Here are the key points to stress:
- For at least 12 years, members of Congress have told us how serious they are
about reforming the Medicare physician payment system. Now that a bipartisan,
bicameral policy has been developed, it is time to stop talking about the
problem and seize the opportunity to solve it.
- Congress must vote as soon as possible in support of a fix that will
permanently repeal the flawed Medicare SGR formula.
- Congress must avoid continuing the fiscally irresponsible cycle of
short-term patches that contribute to the Medicare program's instability and do
nothing to solve the underlying problem.
- Congress must ensure that practicing physicians lead the development of the
alternative payment models and quality incentive programs established in this
"Please call or write today," Dr. Brotherton said. "We may not get this
Vote for the Party of Medicine
Vote early: Beat the crowds … and our opponents!
What could you do on Election Day, March 4, if you have already voted?
- Care for patients?
- Have lunch with your spouse?
- Dinner and a movie?
"That may sound like a fanciful dream, but you could make it a reality by
voting for the Party of Medicine ahead of time," said TEXPAC Board of Directors
Chair Jerry Hunsaker, MD. "Early voting for the primaries runs from Tuesday,
Feb. 18, through Friday, Feb. 28. Surely somewhere in that 10-day span you can
find time to cast your vote."
Not sure whom to support? TEXPAC, your political action
committee, recommends the following outstanding statewide candidates:
- U.S. senator: John Cornyn (R)
- Governor: Greg Abbott (R) (open seat)
- Lieutenant governor: David Dewhurst (R)
- Attorney general: Dan Branch (R) (open seat)
- Comptroller of public accounts: Harvey Hilderbran (R) (open seat)
For Supreme Court of Texas:
- Place 1: Nathan Hecht (R)
- Place 6: Jeff Brown (R)
- Place 7: Jeffrey Boyd (R)
- Place 8: Phil Johnson (R)
Check out the full slate of TEXPAC-endorsed candidates, including men and
women running for the courts of appeals and the Texas Senate and House of
"Remember, TEXPAC is here protecting your practice,
endorsing physician-supported candidates who care about us and our patients,"
Dr. Hunsaker said.
"Please, vote early ― but not often ― and encourage
your family, friends, colleagues, partners, staff, and patients to do the same.
And don't forget, you can vote at any early voting site in your county, not just
at your home precinct."
Board Pulls Plan for Pharmacists to Check Diagnoses
The Texas State Board of Pharmacy (TSBP) quickly killed a proposal that would
have required pharmacists to contact the prescribing physician for each new
patient with a prescription for a controlled substance.
The decision came at a crowded TSBP meeting Feb. 11.
"Another bureaucratic obstacle to medical practice has been stopped," said
TMA General Counsel Donald "Rocky" Wilcox.
The plan, which was never published as a formal rule proposal, stemmed as a
possible response to the increased scrutiny pharmacies face from the federal
Drug Enforcement Administration and other law enforcement agencies to curb the
abuse of prescription narcotics.
"The relationships between physicians and pharmacists in Texas have long been
productive and effective," Mr. Wilcox wrote to TSBP Executive Director Gay
Dodson, RPh, before the meeting. "If pharmacists have an issue with a
prescription presented to them (such as a red flag as to its authenticity, or
even a concern about an allergy or potential drug interaction), they are
certainly permitted to call the prescribing physician and discuss their
"While TMA recognizes that pharmacists share the responsibility of ensuring
that prescriptions for controlled substances are issued for a legitimate medical
purpose, that responsibility does not extend to pharmacists the right, or duty,
to question physicians' independent medical judgment. … It is not the role of
pharmacists to tell a physician or patient what is and is not an appropriate
course of treatment," he wrote.
Several board members spoke out strongly against the idea. "A rule of this
nature does nothing to the bad actors; it is only onerous to those trying to do
it right," said TSBP Vice President Dennis Wiesner, RPh. "Questioning doctors on
their practice can be a can of worms, if not a hive of bees."
Board President Jeanne Waggener, RPh, praised medicine, pharmacy, and
pharmaceutical manufacturing firms for working together to find productive ways
to fight narcotic abuse. She specifically pointed to the first of several expected consensus documents produced by a
stakeholders group that includes the American Medical Association and
Projected ICD-10 Conversion Costs Triple
The costs for physician practices to implement the federally mandated
transition to the ICD-10 code set are three times earlier estimates, according
to a new American Medical Association study.
Using the new report as ammunition, AMA "strongly urged" U.S. Health and
Human Services Secretary Kathleen Sebelius to "reconsider the mandate." In a letter to the secretary, AMA Executive Vice President James
Madara, MD, wrote, "AMA policy adopted by our House of Delegates calls for
repealing ICD-10 for the simple reason that it is not expected to improve the
care physicians provide their patients and, in fact, could disrupt efforts to
transition to new delivery models." (TMA was instrumental in the AMA house
adopting that policy.)
The study, conducted by Nachimson Advisors,
compared current estimates of ICD-10 conversion with Nachimson's widely reported
||Typical Small Practice
||Typical Small Practice
||Typical Large Practice
"The previous estimate did not account for the costs to upgrade to
certified electronic health record (EHR) software since Congress had not yet
enacted the Meaningful Use Program," Dr. Madara wrote. Another major factor is
"the potential for increased payment disruption," the study reports, estimating
that 2 percent to 6 percent of all claims filed under the new coding system will
be denied by payers.
TMA joins AMA in calling for a repeal or delay of
the ICD-10 mandate. "Implementing the massive changes by Oct. 1, 2014, will
bring about confusion and extraordinary burden, particularly to small practices
and primary care physicians," TMA told members of Congress in
early February. "The Centers for Medicare & Medicaid Services (CMS) should,
at a minimum, beta-test this system among a variety of practice types and
locations to make sure it actually works. Even more appropriate would be to
repeal the ICD-10 coding system for physician practices altogether and gear up
for ICD-11, which is right behind."
TMA urges physician members not to count on any respite from Congress or
Secretary Sebelius. The association offers physicians and practice staff
extensive tools and resources to help you prepare for the Oct. 1 deadline:
TMA, AMA Tell Feds to Expedite RAC Audit Appeals
It's a terrible idea to announce a 28-month delay in handling appeals just
as physicians' frustration and ire with Medicare recovery audit contractors
(RACs) are mounting, TMA, the American Medical Association, and nearly 100 other
physician organizations told a federal official.
They called for an immediate solution to the appeals hearings backlog that
has caused the delay. "With the numerous new regulatory requirements that
physicians are facing today, physicians do not have the resources to navigate an
interminable appeals process," they said.
In fact, the groups said in an
official letter to Nancy Griswold, chief administrative law
judge for Medicare appeals at the Department of Health and Human Services (HHS),
physicians want her office and HHS Secretary Kathleen Sebelius to speed up the
appeals process for Medicare, Medicare Advantage, and the Medicare prescription
The letter came in response to a notice from Ms. Griswold's
office that assignment of requests for administrative law judge hearings may be
delayed for up to 28 months and that it might take six months or more after the
judge is assigned for the actual hearing to take place.
"The proposal to
further delay processing appeals is the most recent example of the barriers to
obtaining payment for the delivery of medically necessary and reasonable
services to Medicare beneficiaries," the organizations wrote.
course of years, physicians have increasingly assumed the cost of producing
medical records (often repeatedly at various levels of appeal), meeting exacting
deadlines, and filing a succession of appeals. The foregoing does not capture
the additional opportunity cost associated with the diversion of physician and
staff hours from delivering direct medical care to patients. … The numerous
appeals requirements, actual costs of filing appeals, and often lengthy delays
undermine the ability of physicians to deliver patient-centered
The groups pointed out that the auditors are overturned 43.6
percent of the time when physicians and providers appeal RAC determinations. The
appeals process is lengthy, time-consuming, and expensive for
"Because the Medicare contractors often get it wrong," they
said, "the Medicare appeals process is of utmost importance."
Seminar Trains Your Staff on ICD-10 Documentation
With ICD-10 preparation well under way across the state and the transition
date less than eight months away, it's time to delve deeper into how the ICD-10
coding system will fit into your practice's daily activities.
How does your current documentation stack up to the new guidelines? What
changes do your staff need to make to their standard work flow to ensure a
seamless transition and steady flow of payment?
TMA's new seminar, ICD Documentation and Auditing: Success Is in
the Details, offers hands-on, detailed ICD-10 training for your staff.
Participants will learn how to navigate the expansive ICD-10-CM code book, how
to apply the new coding guidelines when assigning codes, and how to avoid denied
claims through proper documentation and audit methods.
For more information — including seminar locations, dates, and times — visit
Education Center. If you don't yet have an ICD-10-CM code book, you can
receive preferred pricing by bundling the book purchase with your seminar
Medicare Meaningful Use Attestation Extended to March 31
March 31 is the new deadline for physicians to attest to meeting the
Medicare electronic health record (EHR) meaningful use criteria for the 2013
program year, the Centers for Medicare & Medicaid Services (CMS) announced.
The previous deadline was Feb. 28.
Physicians participating in the Medicaid EHR incentive program have until
March 16 to attest.
TMA recommends that physicians not wait until the last minute to attest, as
CMS could experience system overload that may impact your ability to attest on
TMA has developed these step-by-step instructions to help guide physicians
through the process:
CMS has provided these tips on attesting:
- Ensure that your payment assignment and other relevant information is up to
date in the Medicare payment system PECOS.
- Make sure to include a valid email address in your EHR program registration.
- Consider logging on to use the attestation system during nonpeak hours such
as evenings and weekends.
- Log on to the registration and attestation system now; ensure that your
information is up to date and begin entering your 2013 data.
- If you experience attestation problems, report the problem to the EHR
Incentive Program Help Desk at (888) 734-6433.
Direct your questions about the program to TMA's Health Information
Technology Department by calling (800) 880-5720 or by email.
Physicians needing onsite assistance with the EHR meaningful use program may
consider contacting one of the four Texas regional extension centers (RECs).
Visit TMA's REC Resource Center for information about the RECs and
the services they provide.
eRx Penalty Review Available Until Feb. 28
TMA has heard from a few practices that have received the 2-percent
e-prescribing penalty on their Medicare payments even though they successfully
participated in the EHR incentive program and should be exempt from the penalty.
If this is happening to you, you must request a review.
The Centers for Medicare & Medicaid Services (CMS) has implemented an
informal review process for you to request reconsideration. The deadline to
submit these informal review requests is Feb. 28; you must email them to eRxInformalReview@cms.hhs.gov.
CMS will make an informal review decision within 90 days of the original
request. Please note that the informal review decision will be final; there will
be no further review or appeal.
For complete instructions on how to submit an informal review request, see
CMS's "2014 eRx Payment Adjustment Informal Review Made Simple."
Direct your questions about the eRx incentive program to the CMS QualityNet
Help Desk at (866) 288-8912 (TTY 877-715-6222) or email@example.com. Or contact TMA's
Health Information Technology Department by calling 800-880-5720 or emailing HIT@texmed.org.
DocbookMD Connects Texas Physicians in More Ways Than Ever
DocbookMD has branched out to support physicians like never
The free, secure, HIPAA-compliant communications app has always offered
features that connect physicians and help coordinate care. These features
include the ability to send messages that contain protected patient information,
as well as x-rays, EKGs, and other images, directly to another physician.
The introduction of the CareTeam feature in 2013 allows physicians using DocbookMD to invite nonphysician members of their care team
and office staff to join their circle of communication within the app. For the
first time, a physician can reach out to a colleague, have an instant cross-town
consult, and secure an appointment time with his front office staff without ever
leaving the point of care with a patient.
DocbookMD also now serves as a one-stop location for all forms
of communication for many physicians across the state. Recent partnerships with
answering services MedLink and MSB and with Austin Radiological Association allow physicians to receive
their pages and STAT reports, such as x-rays and scans, directly on their mobile
device with a unique ringtone, saving precious time when caring for urgent
DocbookMD is an exclusive member benefit, available for free
in Texas only to TMA members. Across the country, more than 23,000 physicians in
39 states use the app, further connecting the community of medicine.
Download DocbookMD from the Apple App
Store or Google Play.
Put Prevention Into Practice: Give Away Helmets in Your Office
Help your young patients get moving and stay safe by giving away free
bicycle helmets in your office. TMA's Hard Hats
for Little Heads program makes it easy by providing:
- Free helmets. If you buy 25 or 50 helmets,
TMA will match your purchase with 25 or 50 free ones.
- Free educational materials. Bookmarks and a safety brochure
in English and Spanish show proper helmet fit.
- A free video shows how to wear a bicycle helmet correctly.
Here are three ideas to get you started:
- Screen children at well checks to see if they rollerblade or ride bikes,
scooters, or skateboards. If so, encourage them to keep up the physical activity
and ask if they wear/have a helmet. Send a properly fitted helmet home with kids
who don't have one or who could use a new one.
- Enter every child's name who comes in for a visit into a fish bowl. Draw 10
names (or the number you select) to receive a new helmet on a particular day,
week, or at the end of the month. You could do this year-round or during the
next three months: March, Brain Injury Awareness Month; April, Texas Child
Safety Month; and May, Bike Month.
- Introduce the community to your practice by hosting a helmet giveaway event
from your office.
Help TMA give the gift of health and safety. Contact Tammy Wishard, TMA's
outreach coordinator, by telephone at (800) 880-1300, ext. 1470, or (512)
370-1470, or by email.
Hard Hats for Little Heads is made possible through a grant from the TMA
Foundation thanks to top donors - Blue Cross and Blue Shield of Texas,
Prudential, and two anonymous foundations - and generous gifts from physicians
and their families and friends of medicine.
Are You Choosing Wisely?
TMA wants to know if you have implemented the Choosing
Wisely® recommendations in your practice.
We are looking for physicians who have used the Choosing Wisely lists of
recommendations to engage in important conversations with patients to do the
right thing at the right time. TMA wants to share with other physicians how this
program works for you and your patients.
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
Please contact Hella Wagner at TMA by email or by calling (800) 880-1300,
ext. 1403, or (512) 370-1403 to help us tell your Choosing Wisely story.
This Month in Texas Medicine
The February issue of Texas
Medicine explains how physician practices are staying financially
viable, why the TMA Council on Education is considering new policy on medical
licensing exams, how legislators responded to the 2013 Texas Health Perception
Survey, and the progress being made by health information exchanges in the
state. By reading an article on meaningful use and quality improvement and then
completing a post-test and evaluation, you may earn continuing medical education
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
website. Once there, you can download an RSS reader, such as Feedreader,
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for TMA news releases and for Blogged Arteries, the feed for
This Just In ...
Want the latest and hottest news from TMA in a hurry? Then log on to Blogged
Deadlines for Doctors
TMA's Deadlinesfor 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.
HIT:Medicare EHR Incentive Program Attestation Deadline for 2013
SubmissionDeadline for 2013 PQRS Reporting Via EHR-Based Reporting
SubmissionDeadline for 2013 PQRS Reporting via Covisint PQRS
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
Complying With HIPAA Security
OSHA Annual Training Webinar
Hard Knocks: An Update on Concussion and Texas
Physician Health & Wellness, ext. 1342
Healthy Physicians: Healthy Patients
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