Action: Feb. 18, 2014

 TMA Action Feb. 18, 2014   News and Insights from Texas Medical Association 

INSIDE: SGR Repeal Closer Than Ever 

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 Triple
TMA, AMA Tell Feds to Expedite RAC Audit Appeals
Seminar Trains Your Staff on ICD-10 Documentation 

Medicare Meaningful Use Attestation Extended to March 31
eRx Penalty Review Available Until Feb. 28
DocbookMD Connects Texas Physicians in More Ways Than Ever
Put Prevention Into Practice: Give Away Helmets in Your Office
Are You Choosing Wisely?
This 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) 833-6354.

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 bill.

"Please call or write today," Dr. Brotherton said. "We may not get this opportunity again."

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 Representatives.

"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 concerns.

"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 others.

        

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 2008 report.

  Typical Small Practice Typical Small Practice Typical Large Practice
2008 estimate $83,290 $285,195 $2,728,780
2014 estimate $56,639-$226,105 $213,364-$824,735 $2,017,151-$8,018,364


"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 drug benefit.

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.

"Over the 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 care."

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 physicians.

"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 the TMA 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 registration.

TMAIT Action Ad 4.13     

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 time.  

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 qnetsupport@sdps.org. 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 before.

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 patient needs.

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

 

 PC Action Ad July 13  

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 Johnson Foundation.

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 credit.

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.  

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.

2/28/14
HIT:Medicare EHR Incentive Program Attestation Deadline for 2013 Payment YearParticipation

SubmissionDeadline for 2013 PQRS Reporting Via EHR-Based Reporting Method

3/1/14
SubmissionDeadline for 2013 PQRS Reporting via Covisint PQRS Registry    

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. 

Webinars

Complying With HIPAA Security
2/19

On-Demand Webinars

OSHA Annual Training Webinar 
 
Hard Knocks: An Update on Concussion and Texas Law  

Conferences  

TexMed2014
5/2-3    Fort Worth  

Physician Health & Wellness, ext. 1342

Healthy Physicians: Healthy Patients 
3/29      Galveston 
4/5        Amarillo 

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