|TMA Action April 1,
|| News and Insights from Texas Medical
INSIDE: Congress Patches SGR, Delays
SGR, Delays ICD-10
Aetna Seeks to Axe $120M Ingenix Class
The Physicians Foundation's 2014 National Physician Survey
CMS Proposes New Medicare
Advantage Network Rules
TMA Opposes Audiology Scope Expansion
Apply For Meaningful Use
Exemption by July 1
OIG Starts Fraud Education Series for
Attend the Choosing Wisely CME Track at
|DocbookMD Adds MedPage Today News for Physician
Broadway Tenors Are Playing at TMAF’s 21st Annual Gala!
CME Spotlight Brings CME
to Your Inbox
Nominate a Psychiatrist for DSHS Advisory
the Texas Physician Practice Quality Improvement Award
Register for the UT
Nutrition Institute Conference
This Month in Texas Medicine
Congress Patches SGR, Delays ICD-10
Congress has done it again. For the 17th time, lawmakers slapped yet another
Band-Aid on Medicare to stave off a 24-percent physician payment cut under the
fatally flawed Sustainable Growth Rate (SGR) formula. It sets the next SGR cliff
for April 1, 2015.
On March 27, the House of Representatives quickly passed HR 4302, the
Protecting Access to Medicare Act of 2014, on a voice vote with opposition from
the American Medical Association and some other physician organizations. Senate
Finance Committee Chair Ron Wyden (D-Ore.) appealed to his fellow senators to
consider a permanent fix for the SGR to no avail. The Senate passed the bill the
evening of March 31, narrowly averting the drastic physician pay cut set to take
place April 1.
AMA reports that under the bill, the geographic adjustment (GPCI) "floor" of
1.0 for physician work in the Medicare fee schedule would be extended for 12
months. Also, the secretary of Health and Human Services would have discretion
to continue suspending recovery audit contractor postpayment audits under the
"2-Midnight" policy through June 2015.
To cover the costs of the patch and other provisions, the bill:
- Establishes targets of 0.5 percent in savings from "misvalued" Medicare
physician payment schedule services from 2017 through 2020, for an estimated
savings of $4 billion.
- Revises the payment system for diagnostic tests and the laboratory fee
schedule, based on market-based private sector rates ($2.5 billion).
- Reduces payments for using CT equipment that does not meet certain dosage
standards and implements appropriate use criteria for advanced imaging services
- Revises the Medicare sequester in 2024 to effectively amplify the
sequester's impact on all Medicare providers in that year ($4.9 billion).
After months of bipartisan progress in both the House and the Senate, this
last-minute stall is most frustrating.
From 2003 to March 2014, Congress enacted 16 SGR patches to the tune of
$153.7 billion, a total the Texas Medical Association, AMA, and other
organizations say far exceeds what it would cost to reform the Medicare
physician payment system once and for all. The 10-year cost of bipartisan,
bicameral legislation that would have repealed the SGR is $138 billion.
On the other hand, the measure shows Congress has been listening to what TMA
has been saying about the Oct. 1, 2014, mandatory transition to the ICD-10
coding system. Survey after survey document that physicians are nowhere near
ready for this ridiculously expensive and unnecessary shift to a brand new
coding language. The legislation delays the ICD-10 start date for one year, to
Oct. 1, 2015. This represents the second deadline extension for ICD-10.
Adding to the confusion, the Centers for Medicare & Medicaid Services
(CMS) has ordered Medicare contractors like Novitas to hold physicians' claims
for two weeks after the April 1 deadline.
In a March 28 email notice to health professionals, the agency stated the
claims hold would only affect 2014 Medicare Physician Fee Schedule claims with
dates of service of April 1, 2014, and later and "should have minimal impact on
provider cash flow, because under current law, clean electronic claims are not
paid any sooner than 14 calendar days (29 days for paper claims) after the date
CMS noted "all claims for services delivered on or before March 31, 2014,
will be processed and paid under normal procedures."
Aetna Seeks to Axe $120M Ingenix Class Settlement
Late last year, Aetna Inc. announced a proposed class settlement of up to
$120 million over its use of the flawed Ingenix database. The settlement covered
physicians and health care professionals who delivered out-of-network services
to Aetna subscribers any time between June 3, 2003, and Aug. 30, 2013, and
received less than the billed charge.
The U.S. District Court in New Jersey planned to consider final approval of
the settlement at a March 18 hearing. Less than one week before the hearing,
Aetna notified the court it was invoking a provision of the settlement that
allowed it to terminate the agreement if settlement claims of health
professionals and subscribers opting out exceed $20 million.
Aetna told the court, "Based on the list of opt-outs provided by the
settlement administrator to Aetna and class counsel, the opt-out levels exceed
the threshold." Aetna did not provide specific numbers.
Attorneys for the plaintiff physicians are determining whether Aetna has
properly terminated the settlement. If that is the case, the class action
lawsuits against Aetna will proceed to trial.
Physicians who've been practicing medicine since 2003 and delivered out of
network care to Aetna subscribers may be able to join as class representatives.
If you wish to join the amended lawsuit, please email TMA Vice President and
General Counsel Rocky Wilcox, or call him at (800) 880-1300, ext. 1335.
TMA, the American Medical Association, and the medical societies of
California, Connecticut, Florida, Georgia, North Carolina, New Jersey, New York,
Tennessee, and Washington sued Aetna in 2009 over its use of databases licensed
from Ingenix, a UnitedHealth Group Inc. subsidiary. Ingenix underpaid physicians
for out-of-network services, the lawsuit said. It also challenged other ways
Aetna determined out-of-network payment rates and accused Aetna of failing to
disclose how it figured those rates. A patient filed a similar suit in 2007.
UnitedHealthcare entered into a $350 million class settlement in 2009 for
out-of-network underpayments. Aetna, United, and other insurers agreed to stop
using the Ingenix database as part of the settlement, which created FAIR
Health to take over and improve the database and establish transparent,
current, and reliable health care charge information.
For additional information about the settlement, visit the Aetna UCR
Take The Physicians Foundation's 2014 National Physician Survey
Let your voice be heard! Complete the 2014 National Physician Survey, sponsored by The Physicians
Foundation, a nonprofit organization that works to improve physician
satisfaction. The foundation's third national survey gives you and your
colleagues a chance to comment on the current state of the medical profession in
what may be the most comprehensive survey of American physicians ever
Your responses to the survey will help The Physicians Foundation provide a
state of the union of the medical profession to policymakers, political leaders,
and the public so that the physicians' perspective can command the attention it
And here's a bonus: When you take the survey and include your email address,
you'll be entered into a drawing for a $10,000 travel voucher, a $2,000 Apple
voucher, or an iPad Air. Plus, participants who provide an email address will
receive a copy of the full survey report.
CMS Proposes New Medicare Advantage Network Rules
The Centers for Medicare & Medicaid Services (CMS) recently announced it
is considering new rules aimed at safeguarding Medicare Advantage enrollees when
health plans significantly reduce their physician networks.
The CMS announcement follows UnitedHealthcare's termination of thousands of
Texas physicians from its Medicare Advantage plans last fall. The insurer's
actions had national implications.
Connecticut's Fairfield County Medical Association and Hartford County
Medical Association sued United after the organizations learned the insurer
began removing physicians from its Medicare Advantage network in October. The
American Medical Association and TMA filed supporting amicus briefs in the case.
For more on the lawsuit, read "A Bitter Pill."
TMA officials say the legal action and subsequent media coverage helped spur
CMS to act.
CMS is considering requiring Medicare Advantage organizations to provide:
- Enrollees at least 30 days' notice of significant network changes;
- Health professionals at least 60 days' notice of a contract termination;
- CMS regional office account managers at least 90 days' notice before the
effective date of significant changes to provider networks.
According to CMS, notification would allow for coordination between the
Medicare Advantage organizations and their account managers "to ensure that
affected providers and enrollees receive timely notification of such changes."
The 90-day advance notice also would help CMS ensure the Medicare Advantage
organizations "will continue to meet required network standards if the planned
network changes are implemented." The rules could be finalized as early as April
TMA Opposes Audiology Scope Expansion
Audiologists lack the "medical training necessary to perform the same duties
as physicians" and aren't able to "provide patients with the medical diagnosis
and treatment options they require." That's the message TMA, the American
Academy of Otolaryngology – Head and Neck Surgery, 38 state and local medical
associations, and dozens of specialty societies and national organizations sent
in a letter to House and Senate leaders.
The groups strongly oppose HR 4035 by Rep. Jim McDermott (D-Wash.) and S 2046
by Sen. Sherrod Brown (D-Ohio), saying they give audiologists unlimited, direct
access to Medicare patients without a physician referral. Representative
McDermott introduced the resolution in the House in February at the request of
the American Academy of Audiology.
The letter acknowledges audiologists play a crucial role as valuable members
of the physician-led health care team but states that "aspirations of some
audiologists to independently diagnose hearing disorders transcends their level
of training and expertise."
TMA and the organizations that signed on to the letter implore lawmakers "to
oppose any efforts to advance this ill-advised legislation" for the sake of
America's senior citizens.
Apply For Meaningful Use Exemption by July 1
Physicians who are not participating in the Medicare electronic
health record (EHR) incentive program, also known as meaningful use, will be
penalized by Medicare beginning Jan. 1, 2015. To prevent the penalty, physicians
must either attest to meaningful use by Oct. 1, 2014, or apply for a hardship
exemption by July 1, 2014.
Physicians who meet the following criteria are automatically exempt from the
program and do not need to file an exemption application:
Specialties: If you're classified in the Medicare Provider
Enrollment, Chain and Ownership System (PECOS) as one of these five specialties,
you don't need to file an exemption and will be exempt for payment year 2015:
- Diagnostic radiology,
- Nuclear medicine,
- Interventional radiology,
- Anesthesiology, and
New to practice: If you are in your first year of practice,
you do not need to claim an exemption. Based on Medicare data in PECOS, the
Centers for Medicare & Medicaid Services (CMS) says it will know you are new
to practice and will automatically exempt you.
Hospital-based: If you perform more than 90 percent of
services using place of service codes 21 or 23 (hospital), then you will
automatically be exempt from the Medicare penalty.
Other exemptions are available, but you must take the time to fill out the 14-page application and submit it to CMS by July 1, 2014. If
multiple physicians at one practice are applying, be sure to include the multiple NPI addendum.
You can apply for a hardship exemption if your circumstances fall under one
of the following categories:
- Infrastructure: You must demonstrate that your practice is
in an area without sufficient Internet access to comply with meaningful use and
that you face insurmountable barriers to obtain such connectivity.
- Unforeseen circumstances: This exemption can be claimed in
the case of a natural disaster, closing of a practice, bankruptcy, or if the EHR
vendor goes out of business.
- Lack of face-to-face patient interactions: If your
specialty isn't listed above as exempt and you lack face-to-face interactions
with your patients, you can claim an exemption.
- 2014 EHR vendor issues: If your EHR vendor was unable to
obtain a 2014 certification by July 1, 2014, you should file an application for
Exemptions must be renewed annually, and you may not claim an exemption for
more than five years.
For more information on penalties and exemptions, please refer to TMA's one-pager. Contact TMA's Health Information Technology
Department with questions by email or by
calling (800) 880-5370.
OIG Starts Fraud Education Series for Physicians
The Texas Health and Human Services Commission's Office of Inspector General
(OIG) has begun a Provider Education series to inform health professionals on
OIG's efforts in detecting, deterring, and correcting fraud, waste, and abuse in
the Texas Medicaid system. The first topic is Understanding Waste, Abuse, and
OIG will use the series as a forum to cover such topics as:
- Defining fraud, waste, and abuse,
- Problem areas OIG has identified,
- The audit process,
- Payment holds,
- Overpayments, and
- The due process rights afforded health professionals.
If you'd like to suggest a topic for the series, email OIG.
Attend the Choosing Wisely CME Track at TexMed
TMA will offer a continuing medical education (CME) track titled Choosing Wisely:
Quality and Patient Safety on Saturday, May 3, from 10 am to 2 pm at the
Fort Worth Convention Center during TexMed 2014.
The program will include several physician speakers from throughout the
state. Each speaker's presentation will highlight the benefits of Choosing
Wisely® for different practice settings and specialties.
The keynote speaker is David H. Johnson, MD, chair of the American Board of
Internal Medicine (ABIM) Board of Directors and chair and professor of the
Department of Internal Medicine at The University of Texas Southwestern Medical
School. Lisa L. Ehrlich, MD, chair of the TMA Health Quality Council, and Frank
Villamaria, MD, will cochair the CME program.
Take advantage of the opportunity to ask your questions by participating in a
Choosing Wisely in-depth panel discussion.
Visit CME Programming to plan your day at TexMed, or click here to see the full CME database. CME is free with TexMed
Choosing Wisely promotes conversations between physicians and
patients based on evidence provided by specialty societies that have identified
tests or procedures that should be discussed. The ABIM Foundation awarded TMA
and its philanthropic arm, the TMA Foundation, a grant to advance the Choosing Wisely campaign among Texas physicians. Support for
the grant program comes from the Robert Wood Johnson Foundation.
TMA is 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. We want to share with other physicians how this
program works for you and your patients. 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
DocbookMD Adds MedPage Today News for Physician Users
All TMA member physicians will soon be able to receive breaking medical news
from MedPage Today from the DocbookMD app.
DocbookMD has partnered with MedPage Today to provide physicians with
an instant, trusted news service.
Accessible directly from the DocbookMD menu, you
will be able to access an embedded feed of news and articles from MedPage
Today to stay abreast of industry trends that interest you and your
DocbookMD is also now available for your large group or hospital. Physicians
within such systems can access a secure, enterprise-wide communication platform
that allows them to discuss patient care and share data in real time in
compliance with HIPAA. This is the ultimate in fast, efficient, and coordinated
DocbookMD is an exclusive member benefit, available free in
Texas only to TMA members. Across the country, more than 24,000 physicians in 39
states use DocbookMD, further connecting the community of medicine. DocbookMD
can be downloaded using the Apple App
Store or Google Play.
The Broadway Tenors Are Playing at TMAF’s 21st Annual Gala!
See some of Broadway's best, and enjoy a performance filled with musical
hits when you join your colleagues and gala cochairs Dr. Joe and Susan Todd, of
Fort Worth, at the TMA Foundation's (TMAF's) 21st gala.
A Masqued Ball is scheduled for Friday, May 2, 2014, at the
Omni Fort Worth and will be held in conjunction with TexMed 2014. Don your
most festive mask for an evening of revelry fit for a carnival of incognito
partygoers, with two guest receptions, a silent auction, dinner, and performances by Soprano Colleen
Mallette and The Broadway Tenors. VIP tickets (greater recognition and early
entrance) may be purchased for $225, and regular tickets are $175 through April
New this year is a Scrub Top Silent Auction. Get a preview of this and the regular silent auction on the TMAF website.
Proceeds from the evening's generous donors benefit TMA's health
promotion programs including Be Wise ─ ImmunizeSM, Hard Hats for
Little Heads, the Ernest and Sarah Butler Excellence in Science Teaching Awards,
Choosing Wisely, the Minority Scholarship Program, and more! Proceeds also help
fund TMAF's Healthy Now, Healthy Future initiatives including the Champion of
Health Award, Medical Community Grants Program, and other local grants to
support health improvement projects that join medicine, business, and community
in a shared vision of a healthier Texas.
For more information or to purchase tickets, visit the TMAF website,
or contact Sean Dunham by telephone at (800) 880-1300, ext. 1664, or (512)
370-1664, or by email.
Be Wise — Immunize is a service mark of the Texas Medical
CME Spotlight Brings CME to Your Inbox
Looking for continuing medical education (CME) that is timely and practical?
Need help wrapping your head around new rules and regulations?
The TMA Education Center has it all, adding new webinars,
publications, and seminars every month. To find out what's new each month,
subscribe to TMA's e-newsletter CME Spotlight. The newsletter brings
you a quick summary of new and timely education available to you at special TMA
member pricing, with links for more information and easy registration.
To subscribe, log in to the TMA website, and go to the Subscriptions page. Check "CME Spotlight Newsletter” to find
out what's new each month.
Need help? Contact the TMA Knowledge Center by telephone at (800) 880-7955 or
Nominate a Psychiatrist for DSHS Advisory Board
The Texas Department of State Health Services (DSHS) is seeking physician
nominees certified in psychiatry to serve on the department's Medical Advisory
Board (MAB). Physicians appointed to the MAB work with DSHS and the Department
of Public Safety on determining whether driver's license applicants or current
license holders are medically capable of safely operating a motor vehicle.
Physician members also review concealed handgun license applications.
MAB meetings occur twice a month in Austin. DSHS requires members to attend
approximately six meetings a year, and the department provides $100
reimbursement to board members per meeting attended.
If you'd like to nominate a psychiatrist to serve on the MAB, email the
potential nominee's contact information to TMA's Director of Public Health Margaret Mendez by April 18.
For more information on the MAB, visit the DSHS website.
Apply for the Texas Physician Practice Quality Improvement Award
Texas physician practices continue to make great strides in providing
reliable preventive services by using health information technology and
effective care management methods. If you're among these practices, you should
be recognized for your hard work.
TMA, the TMF Health Quality Institute, and the Texas Osteopathic Medical
Association have partnered again to provide the Texas Physician Practice Quality
Improvement Award program.
Learn more about the award program. The online application
will be available this month. Practices have until June 13 to apply.
Register for the UT Nutrition Institute Conference
Registration for the second annual University of Texas
Nutrition Institute (UTNI) Conference is now open. The theme for this year's
event is "Nourish." The conference will take place May 22-24 on the UT-Austin
campus at 200 W. 24th St.
Ari Brown, MD, an Austin pediatrician and author of the 411 book series, will
be the keynote speaker this year. The conference's emphasis on nutrition
research, culinary arts, and wellness makes it ideal for physicians, physician
assistants, nurses, and other nonphysician practitioners.
Award-winning chef David Bull returns this year and will give his popular
"flavor profiling" lecture and will teach hands-on cooking classes. He'll also
prepare lunch Thursday and Friday.
Follow UTNI on Twitter for daily updates. Use #UTNI2014 to search for
conference information and to post comments and questions.
This Month in Texas Medicine
The April issue of Texas
Medicine examines how Texas practices are coping with challenges brought
about by the Affordable Care Act, new rules that overhaul residency training
accreditation, the impact of patient noncompliance on quality outcomes and
physician ratings, the challenges physicians face in giving the HPV vaccine, new
DocbookMD features, and a profile of the TexMed 2014 General Session speaker,
Zubin Damania, MD.
out our digital
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,
Sharpreader, Sage, or NetNewsWire Lite. You also can subscribe to the RSS feeds
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 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.
Last Day For First-Year Participants to Begin the 90-day Reporting Period for
the 2014 Medicare EHR Incentive Program
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
ICD-10 Documentation and
4/8 Fort Worth
Dealing with Difficult
Making Discussions About Death and Dying
Meaningful Use: Information Technology
Physician Health & Wellness, ext. 1342
Healthy Physicians: Healthy Patients
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