Action: June 2, 2014

 TMA Action June 2, 2014   News and Insights from Texas Medical Association

INSIDE: TMB Inspects Registered Office-Based Anesthesia Locations  

TMB Begins Inspecting Registered Office-Based Anesthesia Locations
CMS, Texas Partner to Coordinate Care for Dual Eligibles
CMS Announces Changes to QIO Program
Texas Takes Two Candidates, Six Resolutions to AMA HOD
Free Research Summaries From AHRQ for TMA Members
Consider Dengue in Patients Who Travel to Areas With Transmission Risk

Take Advantage of TMA Member Discounts Today
Take The Physicians Foundation's 2014 National Physician Survey
Good Health Grants Available From TMAF
DocbookMD HIPAA-Secure Messaging Now on PC, Mac
New App Links Veterans to Resources
This Month in Texas Medicine

TMB Begins Inspecting Registered Office-Based Anesthesia Locations

The Texas Medical Board (TMB) has begun inspecting Texas practices registered with the board as providing office-based anesthesia (OBA) to ensure compliance with Chapter 192 of board rules. Practices that provide OBA must register with the board, pay a biennial fee of $210 per physician, and identify the level of anesthesia services provided at each practice site.

According to the TMB website, the board will give physicians at least five days' notice before inspection and will request information from registered physicians at or before the time of inspection.

CMS, Texas Partner to Coordinate Care for Dual Eligibles

On May 23, the Centers for Medicare & Medicaid Services (CMS) announced it's partnering with Texas to test a new model for providing Medicare-Medicaid enrollees with more coordinated care. The demonstration builds on Texas’ STAR+PLUS Medicaid HMO program in six counties: Bexar, Dallas, El Paso, Harris, Hidalgo, and Tarrant. In total, 168,000 individuals will be eligible to enroll in the demonstration. 

Under the demonstration, Medicare-Medicaid Plans (MMPs) will cover Medicare benefits in addition to the existing set of Medicaid benefits they currently offer under STAR+PLUS, allowing for an integrated set of benefits for enrollees.

Texas physicians who care for dual-eligible patients say they see the need for better coordination but remain concerned about how well the demonstration project will work.

"I'm all for saving money in a program that's very fragmented. It's crazy to have to go to Medicaid for some things and Medicare for others. And from the patient side, it would be simpler if it works out the way it shows on paper," San Antonio pulmonologist John Holcomb, MD, told Texas Medicine in an article in the May 2014 issue of the magazine. "But the devil is always in the details, and we just don't have much faith that managed care companies are really going to do what needs to be done to coordinate care for these patients."

To ensure each MMP can serve Medicare-Medicaid enrollees, all participating plans must first meet core Medicare and Medicaid requirements, state procurements standards, and state insurance rules. Each plan must also pass a comprehensive readiness review operated by CMS and the state. 

Enrollment is set to begin March 1, 2015, with one month of opt-in-only enrollment. Passive enrollment will be phased in over six months starting April 1, 2015.

Currently, Medicare-Medicaid enrollees navigate multiple sets of rules, benefits, insurance cards, and health providers (Medicare parts A, B, D, and Medicaid). CMS says many dual-eligible patients suffer from multiple or severe chronic conditions and could benefit from better care coordination and management of health care and long-term services. 

In July 2011, CMS announced the opportunity for states to partner with CMS through one of two models:

  1. Managed fee-for-service model: A state and CMS enter into an agreement by which the state would be eligible to benefit from savings resulting from initiatives to improve quality and reduce costs for Medicare and Medicaid.
  2. Capitated model: A state and CMS contract with health plans or other qualified entities that receive a prospective, blended payment to provide enrolled Medicare-Medicaid enrollees with coordinated care.

Texas' demonstration falls under the capitated model.

Texas currently operates the STAR+PLUS program, which provides managed care services to Medicaid members with disabilities or those aged 65 and older, including those dually eligible for Medicaid and Medicare. Eligible Medicaid members receive long-term support and services through participating health plans.

Under Texas' demonstration, MMPs will cover Medicare benefits in addition to the Medicaid benefits currently covered through STAR+PLUS. CMS says the change will allow MMPs to offer Medicare-Medicaid enrollees an integrated set of benefits to more comprehensively address their individual service needs. 

Visit the Texas Health and Human Services website for additional information about the STAR+PLUS program in Texas and the demonstration. 

CMS Announces Changes to QIO Program

The Centers for Medicare and Medicaid Services (CMS) on May 9 awarded Ohio-based KEPRO the Beneficiary and Family-Centered Care (BFCC) Quality Improvement Organization (QIO) Program contract for Texas, 32 other states, and the District of Columbia.

CMS stated in a news release KEPRO "will be responsible for ensuring consistency in the review process with consideration of local factors important to beneficiaries." The agency also said the award is part of a restructuring effort "to gain efficiencies, to eliminate any perceived conflicts of interest, and to better address the needs of Medicare beneficiaries using BFCC QIOs to focus on providing patients a voice through conducting quality of care reviews, discharge and termination of service appeals, and other areas of required review in various provider settings."

The selection of KEPRO and Maryland-based Livanta, LLC — which will represent 17 states, Puerto Rico, and the Virgin Islands — is phase one of restructuring, aimed at allowing the contractors to "support the program's case review and monitoring activities separate from the traditional quality improvement activities of the QIOs."

In the second phase — expected in July — CMS will award contracts to organizations that will work directly with physicians, hospitals, other health professionals, and communities on data-driven quality initiatives to improve patient safety, reduce harm, and improve clinical care and transparency at local, regional, and national levels.

CMS will introduce the program changes Aug. 1.

TMF Health Quality Institute Director of Communications and External Relations Emilie Fennell notes the BFCC QIO contract award pertains only to the review portion of the QIO program. 

She says CMS has made significant changes to its national QIO program. 

"The biggest change is there will be two new types of QIOs, and organizations are not allowed to serve as both types of QIO," Ms. Fennell said.

She clarifies BFCC QIOs will be responsible for protecting Medicare patients by reviewing individuals' concerns about their care. Because TMF pursued the quality improvement portion (phase two) of the Medicare QIO contract, the organization could not pursue the case review contract. 

"TMF Health Quality Institute has elected to focus on quality improvement technical assistance. This contract is scheduled to be awarded in July, and we look forward to building on TMF's decades of quality improvement work in the state," she said. 

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Texas Takes Two Candidates, Six Resolutions to AMA HOD

The Texas Delegation will have plenty of work to do when the American Medical Association House of Delegates convenes in Chicago this month. Actually, it looks like the delegation can put a checkmark in the "done" box for one of its chores. 

Tyler anesthesiologist Asa Lockhart, MD, is running for the Council on Medical Service, and there are only four announced candidates for the four seats up for grabs. However, Russ Kridel, MD, of Houston, is one of eight men and women seeking five seats on the AMA Board of Trustees.

The delegation is also carrying six resolutions from the Texas House of Delegates to AMA: 

  • Work to prevent recoupments if an Affordable Care Act marketplace insurer has not notified the physician that a patient is in the last 60 days of the grace period for not paying his or her premiums;
  • Push for a federal law requiring insurers to provide real-time claims adjudication;
  • Have the AMA Council on Ethical and Judicial Affairs issue rulings on whether AMA's continued support for parts of ACA violates the AMA Code of Medical Ethics;
  • Commission a study to compare the federal estimates of direct and indirect costs attributable to the Physician Quality Reporting System, meaningful use, and ICD-10 with the actual time and costs required by physicians to comply with these mandates;
  • Organize an official protest of the "immediate-use" exception to the United States Pharmacopeia Chapter 797 guidelines on sterile compounding; and
  • Eliminate the law requiring private sector laboratories to report to Medicare their payment rates for lab tests.

Free Research Summaries From AHRQ for TMA Members

A new set of tools on the TMA website can help you share the latest evidence-based clinical information with your patients in a way that invites discussion about their specific conditions. 

TMA is collaborating with the federal Agency for Healthcare Research and Quality (AHRQ) to support physicians in the practice of evidence-based medicine with a series of research summaries you can download, print, or order online.

Through AHRQ’s Effective Health Care Program, TMA members can obtain free printed treatment summaries for patients and caregivers and related research summaries for physicians. Under the direction of the TMA Council for Health Care Quality, TMA is initially offering five such sets of summaries related to diabetes and cardiovascular disease. You can get each summary at no cost either as a downloadable PDF or in easy-to-order packets of 25 printed copies (up to 500 copies) from the TMA website.

In addition, AHRQ offers summaries of 17 other chronic health conditions, such as breathing conditions, cancer, mental health, obesity, and renal disease, available as downloadable PDFs through the AHRQ website or printed copies via email or telephone orders.

"AHRQ's Effective Health Care Program reviews and synthesizes published and unpublished scientific research evidence in an unbiased manner and translates research findings into useful tools and resources to help patients, physicians, policymakers, and others make informed, evidence-based health care decisions," said council Chair Lisa Ehrlich, MD. 

Each treatment summary for patients and caregivers is a colorful, plain-language discussion of the treatment options for a specific condition. The companion research summary includes a "clinical bottom line" that succinctly organizes the results of comparative effectiveness research on the benefits and risks of treatments for various health conditions.

"These research summaries are not clinical recommendations or guidelines," said Dr. Ehrlich. "They are physician support tools that help doctors absorb the latest clinical information quickly and discuss it with their patients. That's why TMA is pleased to start bringing them to our members."

Consider Dengue in Patients Who Travel to Areas With Transmission Risk

The TMA Committee on Infectious Diseases encourages you to consider dengue in patients who have traveled to areas with known dengue transmission risk and who present with symptoms consistent with this mosquito-borne disease.

Dengue is endemic throughout the tropics and subtropics, including parts of Mexico, Central and South America, Puerto Rico, the U.S. Virgin Islands, the Caribbean, Southeast Asia, Africa, and Australia. In 2013, 23 cases of dengue were locally acquired in three South Texas counties. 

Early recognition and anticipatory supportive treatment of severe symptoms can significantly lower the risk of death or serious complications. Dengue symptoms begin after an incubation period of three to 14 days and can range in severity. 

Dengue fever usually lasts two to seven days and can include severe headache, retro-orbital pain, muscle and joint pain, rash, and minor hemorrhagic manifestations. The severe illness presentations of dengue hemorrhagic fever and dengue shock syndrome may additionally include hepatomegaly and, after defervescence, the development of hemorrhage, plasma leak, or shock. Severe forms of illness usually manifest after a two- to seven-day febrile phase. 

Dengue is a notifiable condition. For more information on reporting dengue, contact DSHS or your local health department or call DSHS at (800) 252-8239.

The CDC website has clinical guidance. 

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Take Advantage of TMA Member Discounts Today

With TMA's Group Discount Programs, members receive exclusive discounts on everyday products and services. 

The Economist is raising its price for current subscribers. TMA members will experience an increase of 25 percent on the annual price, from $101.49 to $127. Save by renewing your subscription before the increase takes effect on June 20. Learn more on the TMA website.  

Visit TMA's Group Discount Programs page on the TMA website for great discounts and deals. And don't forget to take advantage of TMA Endorsed Services, which offer exclusive savings and stellar customer service on practice solutions and resources vetted and approved by TMA. 

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 undertaken.

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 deserves.

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.

Good Health Grants Available From TMAF

The TMA Foundation (TMAF) is accepting applications for its 2014-15 Medical Community Grants and Medical Student Leadership Grants programs. Eligible applicants include TMA county medical societies and alliance and medical student chapters. 

TMAF is seeking programs that feature collaborations among medicine, business, and community and that address TMA priorities such as obesity, tobacco, immunizations, health disparities, unplanned pregnancy, mental health, environmental health, violence, and disaster preparedness and response. Society and alliance chapters may apply for up to $7,500; medical student chapters may apply for up to $3,000. 

Find out more, including summer deadlines, on the TMAF webpage   

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DocbookMD HIPAA-Secure Messaging Now on PC, Mac

Visit today, and you will notice a new addition to the menu bar at the top of the webpage: A red button inviting you to log in announces the addition of PC and Mac access for the previously mobile-only HIPAA-secure messaging platform. Now, using the same email and password for the app on your phone and tablet, you can access DocbookMD on any computer via the new web version without having to install new software.

Mobile is still at the core of what DocbookMD offers, but with the new web version, you have a unified communication platform for you and your staff, regardless of the device used. The key is to allow physicians and care team members to communicate at the point of care.

DocbookMD, built by physicians for physicians, is a rapidly growing HIPAA-secure messaging app for smartphones, tablet devices, and computers via this brand-new web version. More than 24,000 physician users across 40 states rely on DocbookMD to streamline their communication, including more than 8,000 of your fellow TMA members. By putting doctors in control of the technology, regardless of practice setting or existing medical technology solutions, DocbookMD enables the kind of immediate, secure communication that can change the face of health care.

New App Links Veterans to Resources

You can connect your Texas military veteran patients to local, state, and national resources, including crisis hotlines, with the new Texas Veterans App from the Texas Health and Human Services Commission (HHSC). The app can be downloaded from Google Play and the App Store

Veterans can use the app to: 

  • Get direct access to the national Veterans Crisis Line,
  • Connect with other veterans in their area, and
  • Quickly find services available to military veterans. 

The Veterans Crisis Line is a free, confidential, 24-hour phone line staffed by qualified responders with the U.S. Department of Veterans Affairs. Veterans and their family members and friends may call the crisis line for help with challenges they encounter when transitioning back to civilian life. 

The app's Connect with Texas Veterans feature puts veterans in contact with a member of the Texas Military Peer Network, made up of Texas service members, veterans, and their families. The network provides veterans with peer support and information about available community resources.

The app also links veterans to the national Hotline for Women Veterans and the Texas Veterans Portal, which includes a comprehensive list of local, state, and federal services and benefits.

This Month in Texas Medicine

The June issue of Texas Medicine delves into Congress' decision to patch the flawed Medicare Sustainable Growth Rate payment formula for the 17th time and highlights the publication of physician quality data, resources to reduce electronic health record errors, recommendations aimed at reducing cesarean sections, the release of Medicare physician payment data, and evidence-based decisionmaking tools physicians can share with patients.

Click to launch the full edition in a new window.  

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 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.  


HIT: Last Day For First-Year Participants to Begin the 90-day Reporting Period for the 2014 Medicare EHR Incentive Program 

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. 


New NPP Regulations: Rules You Need to Know
6/4       El Paso
6/10     Wichita Falls
6/11     Lubbock
6/17     Fort Worth
6/18     Dallas
6/19     Tyler

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Healthy Physicians: Healthy Patients 
9/27    El Paso  
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