TMA Action July 1, 2014   News and Insights from Texas Medical Association

INSIDE:  TMA Opposes Nurse Practitioner Plan

TMA Opposes Nurse Practitioner Plan
TMA to VA: Texas Docs Are Here to Help
TMA Wants Medical Aid for Central American Refugees
TMA Calls for Meaningful Use Moratorium
Medicare Ordering/Referring Edits Extended to Certifying Physicians
TMA Weighs in on Public Health, Medicaid Funding
TMA Members Testify on DSHS, UIL Sunset Review

Get Claims Paid Promptly With TMA Live Webinar
Need Ethics CME? Make PHW Your No. 1 Stop!
Take The Physicians Foundation's 2014 National Physician Survey
Timely Communication for ACOs With DocbookMD
Docright Helps TMA Members Compare EHRs, Other HIT
This Month in Texas Medicine

TMA Opposes Nurse Practitioner Plan

Proposed new rules regulating the scope of practice of advanced practice registered nurses (APRNs) would illegally allow APRNs to make medical diagnoses, and the proposed rules ignore key tenets of a new state law, TMA and nine other state medical societies wrote in a formal comment letter to the Texas State Board of Nursing (TBN).

"Throughout the proposed rules APRNs are given the authority to 'diagnose' medical conditions, yet the Texas Occupations Code … expressly defines 'professional nursing' as not including the acts of medical diagnosis," TMA President Austin I. King, MD, and representatives from the Texas Academy of Family Physicians (TAFP), the Federation of Texas Psychiatry, the Texas Ophthalmological Association, the Texas Orthopaedic Association, the Texas Osteopathic Medical Association, the Texas Pain Society, the Texas Pediatric Society, the Texas Society of Anesthesiologists, and the Texas Society for Gastroenterology and Endoscopy wrote in the letter to TBN. "Medical diagnosis is not among the acts that may be delegated by a physician to a nurse under any circumstances."

The 2013 Texas Legislature — with the strong support of TMA, TAFP, the Texas Academy of Physician Assistants, and the various organizations representing APRNs — passed a law that changed the regulatory structure related to physician delegation of duties for APRNs and physician assistants (PAs). It affected physician delegation and supervision of prescribing privileges and increased the number of PAs and APRNs to whom a physician could delegate. Senate Bill 406 also gave physicians a great deal of leeway in managing their teams of midlevel practitioners according to their style of practice and the needs of their patients.

"When performing those delegated acts, the standards that should be adopted are those of medicine, not nursing," the organizations wrote in their letter. The proposed rules "require APRNs to adhere to standards of nursing practice set forth in the rules and to standards of nursing practice as stated by national professional nursing associations recognized by the TBN. Two medical practice standards or 'schools of medicine,' one for APRNs (when operating under a physician's delegated authority) and one for physicians should not be the result of these proposed rules. Only one school of medicine is supported by the Texas Constitution and the Texas laws authorizing delegation."

The new law gives the physician the authority to decide what acts to delegate to an APRN or PA for a reason. "Due to the limited training and experience required in the abbreviated programs leading to licensure of APRNs (as compared to the required education and training of licensed physicians), it is the delegated physician who must assess the education, training, experience, and competence of each APRN to determine the appropriate amount and type of delegation of medical services," the groups wrote.

TMA routinely fights actions of state agencies that would illegally expand the scope of practice of nonphysician practitioners. 

"This is just one more example of nurse practitioners trying to obtain through rulemaking what they were unable to get from the Texas Legislature, and it goes well beyond the bill they agreed to," said TMA General Counsel Donald P. "Rocky" Wilcox. "We remain vigilant to protect the safety of Texas patients."

TMA to VA: Texas Docs Are Here to Help

TMA President Austin King, MD, announced the registry of private physicians willing to see patients in the Veterans Affairs (VA) health care system in a letter to the director of every VA hospital, clinic, and veterans center in the state. 

"As the Department of Veterans Affairs health care system works to overcome the recently documented access-to-care problems, I am writing to tell you that the physicians of Texas are here to help you and the veterans you serve," Dr. King wrote. Already, more than 200 TMA-member physicians have signed up for the association's registry.

The action came after the American Medical Association House of Delegates, at the urging of Texas physicians, voted overwhelmingly to ask President Barack Obama to provide timely access to entitled care for eligible veterans through the health care sector outside the VA system until VA can provide care in a timely fashion. AMA immediately fired off a letter calling on the president to "take immediate action" to clear the way for private-sector physicians to help reduce the VA backlog. 

If you haven't signed up for the registry, please go to the TMA website and check the "I am willing to serve veterans" box.

TMA Wants Medical Aid for Central American Refugees

The Central American women and children streaming into South Texas need medical assistance, and they need it now, says TMA President Austin King, MD, who traveled to McAllen to personally survey the crisis.

TMA is calling on President Barack Obama and Gov. Rick Perry to provide medical aid to the thousands of women and children who have traveled from Central America to Texas. Many of these children have traveled alone without an adult, while others have entered the United States with their mothers. The children traveling with their mothers often have a relative or friend in the United States awaiting their arrival and can get through the immigration process faster. They then disperse throughout the country using public transportation without knowing their immunization status and without a physical exam or health history by a physician.

Texas physicians want to ensure every child and mother is vaccinated and receives a thorough health examination — and soon. Dr. King explained, "Communicable diseases know no borders, and it’s critical we make certain no one is traveling with tuberculosis, pertussis, measles, or any other contagious disease. Medical aid not only protects the Central American refugees, but it also protects U.S. residents from potentially serious and deadly diseases.

“Taking care of these oppressed people who have traveled days without food, water, or bathing is the humanitarian and right thing to do. By helping them, we also are helping our own residents stay healthy,” added Dr. King.

TMA Calls for Meaningful Use Moratorium

Because physicians "are feeling overloaded by the myriad new Stage 2 meaningful use measures imposed on them," Congress should stop Medicare from requiring any new meaningful use criteria, a TMA leader wrote in a letter to the chair of the U.S. House Energy and Commerce Committee. 

Otherwise, Matt Murray, MD, the chair of TMA's Ad Hoc Committee on Health Information Technology, wrote to U.S. Rep. Fred Upton (R-Mich.), "Texas physicians — out of frustration — will withdraw from the Meaningful Use program at alarming rates." 

The letter also praised Chairman Upton for demanding answers from the National Coordinator for Health Information Technology about the future regulatory burden on physicians' use of electronic health records (EHRs). "TMA strongly recommends that the Centers for Medicaid & Medicare Services (CMS) or Congress suspend the EHR penalties on Medicare charges that are scheduled to take effect Jan. 1, 2015," Dr. Murray added. "We believe CMS will put patient safety at risk by requiring EHR vendors to meet overly burdensome certification requirements and physicians to implement complex EHR upgrades in a compressed period of time." 

Physicians with questions related to the EHR meaningful use program can contact TMA's Health Information Technology Department by calling (800) 880-5720 or emailing HIT@texmed.org


  

Medicare Ordering/Referring Edits Extended to Certifying Physicians

Beginning July 1, the certifying physician reported on a Medicare home health agency (HHA) claim must be enrolled in Medicare. If not, the claim will be denied under Medicare's ordering and referring denial edits.

Previously, these edits applied only to the attending physician on an HHA claim. Starting with home health episodes that begin on or after July 1, the edits will check to ensure both the attending and certifying physicians (when they are different people) have valid national provider identifiers (NPIs) and are eligible to order and refer the HHA items and services. Both physicians must be enrolled in the Medicare Provider Enrollment, Chain and Ownership System (PECOS) — or have validly opted out — as of the date of service. You can verify if a physician is listed in PECOS on the Centers for Medicare & Medicaid Services (CMS) website.

An attending physician signs a patient's plan of care, while a certifying physician certifies or recertifies a patient's eligibility to receive services under the Medicare home health benefit. 

  • If the certifying and attending physicians are different, both physicians are subject to the ordering and referring denial edits. These edits apply to the "Attending" and "Referring Provider" fields in electronic claims. In paper claims, the "Other Provider" field identifies the certifying physician.
  • If the certifying and attending physicians are the same, the edits apply only to the "Attending" field.  

For more information, see the following from CMS: 

 

TMA Weighs in on Public Health, Medicaid Funding

Last week, TMA submitted comments regarding the 2016-17 legislative appropriations request from the Texas Health and Human Services Commission (HHSC) and the Texas Department of State Health Services (DSHS).

TMA encourages DSHS to invest in immunization services, chronic disease prevention, preventive care for low-income women, mental health services, and emergency preparedness.  

In regard to chronic disease prevention, TMA states, "We support DSHS' efforts to promote community-based initiatives to increase physical activity and access to healthy foods in Texas communities." The association adds, "DSHS has been successful in identifying many potentially preventable hospitalizations. If given appropriate resources, the agency could better foster community engagement to help reduce the many conditions related to chronic diseases, such as pneumonia, diabetes, and heart failure, all of which are endemic across Texas."

TMA's comments conclude: "We know DSHS faces a difficult task assigned by the Legislative Budget Board, especially when the state's public health system is at a breaking point. We would welcome the opportunity to further discuss any potential cuts and steps that might be taken to avoid such action and/or recommendation."

In the comments to HHSC, TMA urges the agency to prioritize improving Medicaid patients' access to services, including women's health care. The association specifically asks for support for maintaining the Medicaid primary care physician payment increase and for continued funding of the Texas Women's Health Program. 

Last session, the legislature provided $71.3 million for the Texas Women's Health Program, operated by HHSC. Ninety percent of the dollars replaced federal funding for the Medicaid women's health program, which Texas discontinued in 2012 because of its "affiliate ban rule," which excluded from the federal program clinics affiliated with abortion providers. The Texas program provides low-income women aged 18 to 44 with access to birth control, basic preventive health screenings, and treatment for sexually transmitted diseases. 

"While the investments made in the Texas Women's Health Program in 2013 increased the number of women served, tens of thousands of low-income Texas women still lack access to care. The state must work to maintain or increase the funding for this valuable program to help rebuild the women's health care safety net and ultimately save the state millions in Medicaid dollars," TMA said.

The Affordable Care Act authorized increasing Medicaid payments to Medicare parity for certain primary care physicians and services provided from Jan. 1, 2013, to Dec. 31, 2014.

"Without congressional action, the rate increase will cease at the end of this year. We urge the state to permanently extend the rate increase beyond Dec. 31, 2014. It is vitally important to increase the number of physicians participating in Medicaid so that access is not hindered and Texans can get the care that they need," TMA wrote.

The association also calls for an increase in Medicaid payments for physician specialties not included in the ACA primary care payment increase, including obstetrics and gynecology.

TMA Members Testify on DSHS, UIL Sunset Review

Two TMA member physicians testified June 25 before the Senate Committee on Health & Human Services on the Sunset Advisory Commission's Staff Report on the Texas Department of State Health Services (DSHS). And Houston neurologist Kim Monday, MD, provided preliminary comments on the University Interscholastic League (UIL) sunset review

TMA Trustee Gary Floyd, MD, testified that TMA agrees with the Sunset Advisory Commission's recommendation to reduce the size and footprint of DSHS. "To achieve this, we agree shrinking the regulatory tasks of DSHS is needed," he said.

Dr. Floyd expressed concern over the commission's proposal to eliminate licensure of medical physicists, radiologic technologists, perfusionists, and respiratory therapists from DSHS operations.

"Each of these health care providers has a specialized and unique role in patient care and is a valuable member of the health care team," he said, adding "an appropriate state licensure process [should] be in place to ensure each and every professional group is maintaining its qualifications and upholding standards of practice."

TMA opposes placing any health care profession within the Texas Department of Licensing and Regulation (TDLR), stating the department "does not have appropriate leadership, resources, or background in health care policy or public health matters." In the testimony, Dr. Floyd suggested the Texas Medical Board (TMB) as an alternative, should it be impossible to keep the licensure and regulatory functions of these health professionals in their current location. 

And William S. "Chip" Riggins Jr., MD, executive director of the Williamson County and Cities Health District, testified on DSHS' management of the state's public health system. Overall, TMA agrees with the Sunset Advisory Commission that Texas has a fragmented public health system. 

Dr. Riggins called for a "deliberate, more comprehensive focus on Texas' public health infrastructure," adding that "lack of statutory clarity leaves DSHS with little ability to influence standards and basic level of services provided by local health departments." 

In her testimony on UIL's sunset review, Dr. Monday agreed with sunset staff recommendations regarding steroid testing. "TMA supports science and evidence-based testing and recommends a full review of current testing programs, such as the steroid testing initiative. The review should assess cost-benefit and scientific value as well as the depth of illegal steroid use in Texas athletes," she said.

Dr. Monday also addressed TMA's concerns over the Sunset Commission's lack of attention to the required pre-participation exam for Texas athletes and recommended the UIL dedicate additional resources to collecting aggregate data on injuries among athletes.

  

Get Claims Paid Promptly With TMA Live Webinar

Since their inception in 1991, Texas' prompt pay laws have helped ensure commercial health plans pay a practice's clean claims promptly and correctly. 

Texas law provides for payment no later than 45 days after the date a health plan receives a nonelectronic clean claim and no later than 30 days after receipt of an electronic clean claim. But many physicians are still dealing with payment hassles and finding it necessary to divert practice resources to get paid what the plans owe. 

On July 15, during the noon-1 pm lunch hour, a new live TMA webinar will address prompt pay issues as they relate to your practice and your revenue cycle and will instruct you on how to put yourself in a position of advantage to enforce the prompt payment of your claims. 

Prompt Pay and the Revenue Cycle — Part I (July 15) discusses the following concepts: 

  • The relationship between Texas prompt pay laws and your revenue cycle;
  • Contract terms that affect your ability to enforce prompt payment of your claims;
  • The importance of collecting and tracking specific patient insurance information to support prompt pay enforcement; and
  • The impact of your practice fee schedule and charge capture on prompt pay enforcement. 

Part II of the series will discuss the Texas prompt pay laws in the context of your claim-submission process, accounting for patient responsibility and insurance receipts, practice management system setup, and appeal or reconsideration. Registration for Part II will open soon.

Need Ethics CME? Make PHW Your No. 1 Stop!

The TMA Committee on Physician Health and Wellness (PHW) offers several live presentations on request, as well as online and home study courses, all of which are accredited for AMA PRA Category 1 Credit™ and designated for ethics and/or professional responsibility education.  

  1. Live presentations: Choose from 24 courses to have presented by a PHW education team member at your county medical society, hospital, or other meeting.
  2. Online courses: You may access PHW courses online via the TMA Education Center, which allows for the electronic completion of continuing medical education (CME) courses. Courses are all PDFs, so one click takes you to the primary document to read. Then complete the test and evaluation, and upon successful completion, you are able to access your CME transcript online. Choose from 19 courses in one-hour and two-hour formats.
  3. Home study courses: All of the online topics are available for home study. Read the PDF course, then complete the TMA identification page, test, and evaluation. Send the completed documents to TMA with your administration fee, and TMA will send a CME transcript to you. 

When you need CME and/or ethics credits, make PHW your No. 1 stop. Contact TMA PHW Committee staff at (800) 880-1300, ext. 1342, to request a live presentation or home study course. 

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. 

  PC Action Ad May 13

Timely Communication for ACOs With DocbookMD  

Participation in accountable care organizations (ACOs) is a growing movement, due in part to their potential to overcome some of the rising costs (and hurdles) of current health care delivery. To achieve optimal patient outcomes and lower costs for patients and physicians, ACO networks must be able to communicate in a timely manner to coordinate care between independent physicians and large groups. The solution at the center of this communication network is DocbookMD.

DocbookMD has a unique ability to support ACOs because it is a communication platform that connects physicians directly to their medical colleagues, care teams, and other health information technology (IT) resources. Thus, it acts as a hub for the disparate systems ACO participants currently have in place. Whether it's different electronic medical record systems, health information exchanges, or other health IT, DocbookMD allows all participants to communicate and share patient information in real time — even if they have no other IT solutions in place. This added efficiency ultimately drives down the cost of health care. 

DocbookMD has recently partnered with one of the largest ACOs in the country — Memorial Hermann Physician Network of Houston (MHMD). MHMD physicians will gain significant communication and workflow advantages and be able to securely connect to one another, as well as to other physicians across Houston.

DocbookMD is available to all TMA members as a free member benefit. Across the country, more than 25,000 physicians in 41 states use DocbookMD, further connecting the community of medicine. DocbookMD is available for iPhone, iPad, and Android devices, as well as PC and Mac. The app can be downloaded using the Apple App Store or Google Play.

Docbook Enterprise offers a scalable and secure way for groups, hospitals, and ACOs to meet a wide variety of workflow needs and enhance existing technology systems. To bring the Enterprise version of DocbookMD to your hospital or large group, contact DocbookMD Director of Partnerships Chad Shepler by email or phone, (512) 383-5822.

Docright Helps TMA Members Compare EHRs, Other HIT

Do you need to upgrade or install an electronic health record (EHR) system but aren't sure where to start?

Docright can help you make more informed decisions about medical technology. The TMA affiliate gives TMA physician members free access to a comprehensive database of health care technology products and services. 

In the past, the TMA Council on Practice Management Services has not recommended the association endorse specific EHR products or vendors. Although the council maintains this position, over the years council members have recognized the need to offer further assistance to physicians who look to TMA for help choosing the right EHR for their practices. 

TMA members now have exclusive access to Docright's cloud-based system, which allows physicians to compare EHRs and other health information technology, interact with technology vendors, and share their technology experiences with peers. These tools allow physicians to make faster, more informed decisions about health care vendors and their products and services, in turn reducing costs, increasing revenues, and improving patient care. 

Docright users can see each system's meaningful use ranking, annual sales, and the year the company started. Physicians can also view key product information provided by the vendor or easily schedule a product demonstration. More tools from Docright, including an online request for proposal to assist in selecting the best technology solutions for your practice, are coming soon.

TMA has developed other tools and resources to assist physicians with EHR selection, implementation, and meaningful use in lieu of endorsing any particular product. These include TMA's EHR Product Evaluation Tool, which is a members-only resource that allows users to view and compare information on functionality, pricing, and customer and technical support for the EHR products that represent more than a 3-percent market share in Texas. Visit the TMA Health Information Technology Resource Center for more information.  

This Month in Texas Medicine

The July issue of Texas Medicine examines the evolution of telemedicine and addresses a new Federation of State Medical Boards model policy aiming to create a roadmap for the safe, appropriate practice of telemedicine. It also informs physicians about cyber liability insurance, policymakers' price transparency efforts, an initiative to improve health literacy in the state, and the status of e-prescribing controlled substances.

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.  

7/1/14

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

Optional Physician and Teaching Hospital CMS Registration Phase 2 

 10//1/14

HIT: First-Year Participants: Deadline to Attest to Meaningful Use for the 2014 Medicare EHR Incentive Program  

HIT: Upgrade EHR for Meaningful Use Stage 2  

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.  

On-Demand Webinars

Dealing with Difficult Patients 
Making Discussions About Death and Dying Easier 
Meaningful Use: Information Technology Bundle  

Live Webinar  

Prompt Pay and the Revenue Cycle: Part I  
7/15, noon-1 pm 

Physician Health and Wellness, ext. 1342

 Physician Well-Being for Life  
10/24-25 Dallas                  

Healthy Physicians: Healthy Patients 
9/27    El Paso  
10/4    Tyler  

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