Action: Nov. 14, 2014

TMA Action  Nov. 14, 2014   News and Insights from Texas Medical Association

INSIDE: Write to Congress to Ask for Two-Year ICD-10 Delay

Write to Congress to Ask for Two-Year ICD-10 Delay
TMA to CMS: Suspend Meaningful Use Measures That Force Doctors to Coerce Patients
State Gives “All Clear” on Dallas Ebola Cases
You Can Now Pay Online for DPS Schedule II Prescription Pads
Meaningful Use Requires Reporting Clinical Quality Measures
What’s “Hot” for Employed Physicians?

Get Up to Speed on New Driving Rules, Medical Restrictions
TMA Exploring Accountable Care Leadership Program with UT-Dallas
Physicians, Medical Students: Enter Your Journalism in TMA Awards Competition
Your Profile Is Already in the DocbookMD App
This Month in Texas Medicine  

Write to Congress to Ask for Two-Year ICD-10 Delay

Join physicians from across the United States to ask Congress for a two-year delay in ICD-10. Ask Congress to delay the mandatory implementation until October 2017 so you and your colleagues can spend more time on patient care. Your patients deserve it.

It’s imperative that you contact your representative today and explain how you cannot afford the cost and disruption of ICD-10 implementation to your business, especially now, when you are buried in myriad other bureaucratic burdens.

Take action now. It's easy and doesn't require much time. Just cut and paste the letter below onto your personal stationery, then send it to your representative by mail or by fax. It's important the letter is on your personal stationery. Feel free to add your own personal reasons why ICD-10 is not a good idea. Explain how implementing ICD-10 now will affect your practice and will take even more of your time away from patient care.

You can find the name, mailing address, and fax number of your U.S. representative in TMA's Legislative Action Center.

Your time and actions could make a huge difference. Thank you.


Austin I. King, MD
Texas Medical Association

Use this sample letter:


I'm writing today to ask that you please delay the implementation of ICD-10 until October 2017. The ICD-10 mandate is a huge burden for my practice with absolutely no direct benefit to individual patient care. Here's why:

Too high a price to pay: For physicians, there are about 68,000 diagnostic codes under the new ICD-10 coding system, which is five times more than are in use today under ICD-9. The United States is the only country in the world that ties this coding system to a complex billing system. Experts, including the Centers for Medicare & Medicaid Services, tell us we may not get paid for three to six months due to ICD-10 implementation. If every moving part in our complex medical payment system does not function perfectly on Oct. 1, 2015, then physicians’ income drops to zero, which means many physicians won’t be able to keep their doors open. Patient access to care will be further disrupted. This is a steep price to pay for an imperfect new coding system.

The costs of shifting to ICD-10 are significant. The transition to ICD-10 is expected to cost $1.64 billion over 15 years, with more than 43 percent of that coming from the cost of upgrading information technology systems. That cost is spread across multiple participants — government ($315 million), payers ($164 million), physicians and providers ($137 million), and software developers ($96 million).  

Physicians will be the hardest hit for much of the remaining 57 percent of cost of implementing ICD-10: We will spend $356 million and lose $571 million from decreased productivity.  

Plus, the timing of the transition could not be worse. My staff and I are struggling right now to meet many other government-imposed administrative hurdles, including implementing and achieving meaningful use of electronic health records, meeting quality measures under Medicare’s Physician Quality Reporting System, and other programs.

Please help me take care of my patients. Please take action immediately to stop ICD-10 implementation. Please tell Speaker Boehner, Chairman Fred Upton, and Chairman Pete Sessions that you want to add the ICD-10 delay to a must-pass piece of legislation during the upcoming 2014 lame duck session.  

It is imperative that Congress act to delay ICD-10 before the end of the year.

Thank you.

TMA to CMS: Suspend Meaningful Use Measures That Force Doctors to Coerce Patients

In a letter to Centers for Medicare & Medicaid Services (CMS) Administrator Marilyn Tavenner, TMA asked CMS to immediately suspend meaningful use core measures 7 and 17.  

"These measures are preventing physicians from attesting to stage 2 meaningful use. In 2012 more than 11,000 Texas eligible professionals (EPs) attested to stage 1; so far in 2014, only 120 EPs have attested to stage 2," wrote TMA President Austin King, MD.

Core measure 7 tasks physicians with providing timely online access to health information for more than 50 percent of all unique patients seen during the meaningful use reporting period. It also requires more than 5 percent of all unique patients seen by the physician during the reporting period to view, download, or transmit their health information to a third party. 

Core measure 17 requires more than 5 percent of unique patients seen by the physician during the reporting period to send a secure message using the electronic messaging function of certified electronic health record technology (CEHRT).  

In the letter, TMA recounts feedback from concerned physicians — especially those with a high volume of elderly or indigent patients — who say they feel core measures 7 and 17 force them to coerce patients to sign up to use a patient portal. 

"Patients have complained that they do not like pressure from the practice staff to access their health information and communicate with the staff online," Dr. King wrote, adding, "It is not reasonable for CMS to base financial incentives or penalties on a physician's ability to engineer a patient's online behavior."

The American Medical Association sent CMS a letter in October outlining the multiple overlapping reporting programs that carry penalties for noncompliance, such as meaningful use, the Physician Quality Reporting System, and the value-based payment modifier. AMA called on CMS to synchronize and simplify the requirements for avoiding these penalties and to reverse its proposals to raise total penalties from these programs to 10 percent or more in the future. 

In a second letter to CMS, AMA offers a number of proposed changes to the meaningful use program, including adoption of a more flexible approach for meeting meaningful use, an expansion of hardship exceptions for all meaningful use stages, and more. 

This week, the AMA House of Delegates adopted policy directing AMA to push CMS to "suspend penalties to physicians and health care facilities for failure to meet meaningful use criteria."

TMA and AMA also remind physicians they have until Nov. 30 to file for a meaningful use hardship exception to avoid a penalty in 2015. In addition, those physicians planning to attest by Feb. 28, 2015, can still apply for a hardship exception as a fallback precaution to avoid the penalty. The hardship exception, however, only provides relief from the meaningful use penalty. It will not earn physicians an incentive. 

Meaningful use incentives are still available for those who are able to meet and attest to the Stage 1 or Stage 2 measures by the February deadline. 

For more information, visit TMA's EHR Incentive Program Resource Center

State Gives “All Clear” on Dallas Ebola Cases

The last person — a hospital worker who handled medical waste on Oct. 17 — being monitored in connection with the state's three diagnosed Ebola patients was cleared from twice-daily monitoring on Nov. 7, according to the Texas Department of State Health Services (DSHS). The hospital worker had reached the 21-day mark, the longest incubation period for the disease. 

That means there were no community-acquired Ebola infections in Dallas. DSHS says no additional cases of the disease have been diagnosed in Texas. 

A total of 177 people — a mix of health care workers, household contacts, and community members — were monitored over time because they had contact with at least one of the three Texas Ebola patients, specimens, or medical waste. 

"We're happy to reach this milestone, but our guard stays up," said David Lakey, MD, DSHS commissioner. "We reached this point through teamwork and meticulous monitoring, and we'll continue to be vigilant to protect Texas from Ebola." 

DSHS reports health officials continue to monitor all travelers who return to Texas from countries with widespread Ebola outbreaks. 

Meanwhile, TMA has been busy providing Ebola virus information and resources to Texas physicians.

The TMA Committee on Infectious Diseases urges physicians to study the Centers for Disease Control and Prevention's recommendations for personal protective equipment and environmental infection control measures in ambulatory settings. Physicians can also contact their local health department or regional health office and the DSHS Infectious Disease Control Unit at (800) 252-8239 for further instructions. 

TMA also has developed patient handouts — in English and in Spanish — and released a video, Why You're Not At All Very Likely to “Catch” Ebola, featuring Robert Haley, MD, director of the Division of Epidemiology in the Internal Medicine Department at The University of Texas Southwestern Medical Center in Dallas.

For additional guidance on the virus, visit the TMA Ebola Virus Resource Center 

  TMAIT Action Ad Sept 14 

You Can Now Pay Online for DPS Schedule II Prescription Pads

The Texas Department of Public Safety (DPS) now allows physicians and nonphysician practitioners with a valid controlled substances registration to order and pay online for their prescription pads. 

After paying online:  

For detailed instructions, check out the Guide to Prescription Pad Ordering. If you need assistance, contact a DPS representative by calling (512) 424-7293.  

DPS processes online payments with major credit cards, including Visa, MasterCard, American Express, and Discover. Allow 30 days for prescription pad delivery.

Online payment will help expedite physicians' prescription pad orders following the Oct. 6 reclassification of drugs that contain hydrocodone combinations from Schedule III to Schedule II. Despite TMA's objections, the Drug Enforcement Administration in August made the decision to reclassify hydrocodone combination products and published a final rule in the Federal Register.  

Read TMA's Hydrocodone Reclassification Q&A for Physicians. For information on prescribing Schedule II drugs, see the Texas Medical Board's online FAQs.

Meaningful Use Requires Reporting Clinical Quality Measures

Physicians must report on nine (of 64) clinical quality measures (CQMs) as part of meaningful use. During Stage 1, this was listed as one of the core measures. For Stage 2, it is no longer listed as a separate measure, but it is still required. 

Physicians can use various reporting options for 2014 submission: 

Options that apply only for the electronic health record (EHR) incentive program  

Options that align with other quality programs   

  • Option 3: Report individual eligible professionals' CQMs through the PQRS portal
  • Option 4: Report group's CQMs through the PQRS Portal
  • Option 5: Report group's CQMs through Pioneer ACO participation or Comprehensive Primary Care Initiative participation 

The nine CQMs must be selected from at least three of the six National Quality Strategy domains: 

  • Patient and family engagement (PFE)
  • Patient safety (PS)
  • Care coordination (CC)
  • Population and public health (PPH) 
  • Efficient use of health care resources (HCR)
  • Clinical processes/effectiveness (CPE) 

The Centers for Medicare and Medicaid Services (CMS) has a recommended core set of adult CQMs that may help practices decide which CQMs to report:  

  • Controlling high blood pressure
  • Use of imaging studies for low back pain
  • Preventive care and screening: body mass index screening
  • Use of high-risk medications in the elderly
  • Preventive care and screening: screening for clinical depression
  • Closing the referral loop: receipt of specialist report
  • Preventive care and screening: tobacco use screening and cessation
  • Document of current medications in the medical record
  • Functional status assessment for complex chronic conditions  

More detail about CQMs, including a complete list of the 64 measures and their respective National Quality Strategy domain, may be found on the CMS website

If you have questions related to the EHR meaningful use program, contact TMA's Health Information Technology Department by calling (800) 880-5720 or emailing hit[at]texmed[dot]org.  

What’s “Hot” for Employed Physicians?

What does the medical literature say about physician employment? What are the trends, the pros, and the cons? What do these employment relationships mean for hospitals or other employers? How can prospective physician-employees drive the best professional contracts?

Read all about it in the newly updated TMA Hot Topic Bibliography on Employed Physicians.

The TMA Knowledge Center compiles "Hot Topic Bibliographies" that include recent and relevant literature citations on the latest issues in medicine. Full-text of many citations is available through the Knowledge Center E-Resources, a free benefit of TMA membership. 

 TMLT Action Ad 4.13        

Get Up to Speed on New Driving Rules, Medical Restrictions

Physicians play an important role in helping to ensure drivers of all ages are medically fit to get behind the wheel. For the first time since 1991, Texas has updated its driving guidelines with changes that better reflect advances in medical care in the past 23 years. 

The updated Guide for Determining Driver Limitation

  • Better aligns driving rules with common-sense advice given by doctors to patients;
  • Addresses specific problems not addressed previously, such as dementia and implantable defibrillators; and 
  • Recognizes primary care doctors perform the majority of driver assessments and counseling. 

The guide features rules for driving restrictions for those with medical conditions, such as seizures, dementia, sleep disorders, and cardiac disease.

The Texas Medical Advisory Board (MAB) for Driver Licensing, a group made up of 14 physicians, including members of the Texas Neurological Society, helped update the guide. MAB functions under the direction of the Texas Department of State Health Services (DSHS) and works to reduce traffic deaths, disability, and injury by evaluating medical histories, providing medical opinions, and making recommendations to the Texas Department of Public Safety (DPS) regarding the medical limitations of referred drivers.

The DSHS website has a referral form physicians can use to voluntarily inform MAB of a patient the physician has diagnosed as having a disorder or disability specified in the Texas driving rules. The site also links to information on older and younger drivers, a physician's guide to assessing and counseling older drivers, fact sheets for medical professionals, and more. 

When a physician refers a patient case to MAB for evaluation, the board reviews the medical facts and reaches an opinion. At that time, the board forwards a written recommendation to the DPS Driver License Division, which informs the individual of the decision. DPS is solely responsible for all actions taken with regard to licensing. 

The Texas Neurological Society has helpful resources physicians can consult to get up to speed on the new driving rules. These include a quick guide to health conditions and recommended driving restrictions, as well as a summary of the driving rules

For more information or if you're interested in serving on MAB, contact Patricia Bryars at DSHS by email or by calling (512) 834-6739.

TMA Exploring Accountable Care Leadership Program with UT-Dallas

"Physician-led" is a hot buzzword in health care reform circles, as it should be. Only physician-led programs can ensure that patient care is everyone's top priority in the new accountable care environment. But do you have what it takes to take charge? 

We want to make sure, so TMA is developing a physician leadership program to teach skills needed for success in the new marketplace.

TMA staff met with Michael J. Deegan, MD, clinical professor of health care leadership and innovation in the Naveen Jindal School of Management, The University of Texas at Dallas, to explore affiliating with the school's Healthcare Leadership and Management for Physicians Certificate Program. A TMA Council on Practice Management Services task force will meet with Dr. Deegan later this month to discuss program design and curriculum and to develop mutual goals for the 10-month program. It is anticipated that the first TMA class cohort would be accepted in March.

Physicians, Medical Students: Enter Your Journalism in TMA Awards Competition

Do you write a medical column for your local newspaper, or have you had an article published in a general news outlet? Do you host a health-focused radio show or a segment on local TV news? If so, enter your work in the TMA Anson Jones, MD, Awards contest.

TMA has honored award-winning Texas journalists with the Anson Jones, MD, Awards for excellent medical news reporting for more than 50 years. The Physician Excellence in Reporting category recognizes physician and medical student reporters. 

Enter today. Any story published or broadcast in 2014 is eligible. Entries will be accepted until Jan. 10, 2015. 

Visit the Anson Jones webpage for more information. If you have additional questions, email ansonjones[at]texmed[dot]org or call Tammy Wishard, TMA outreach coordinator, at (800) 880-1300, ext. 1470, or (512) 370-1470.

 PC Action Ad Nov 13  

Your Profile Is Already in the DocbookMD App

Did you know you already have a profile in DocbookMD? That's right. You don't have to waste time building it, but you do have to download the app to view it. The TMA physician directory is built into DocbookMD, making it a breeze to find contact information for your colleagues. You can even see those who have never downloaded the app. But for those who have downloaded the app, DocbookMD goes far beyond a mobile TMA directory.

One in four TMA members have downloaded this free member benefit, which allows them to send HIPAA-secure text messages and images, and even receive their pages, labs, and radiology reports directly on their mobile phones. Download DocbookMD today from the Apple App Store or Google Play, take a look at your profile and picture, and then start easily communicating with colleagues without violating HIPAA.

DocbookMD is available to all TMA members as a free member benefit. Across the country, more than 25,000 physicians in 42 states use DocbookMD, further connecting the community of medicine. DocbookMD is available for iPhone, iPad, and Android devices, as well as PC and Mac. 

Docbook Enterprise offers a scalable and secure way for groups, hospitals, and accountable care organizations 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.

This Month in Texas Medicine

The November issue of Texas Medicine features a cover story on the patient-centered medical home. It examines investments being made in the model by policymakers, payers, and physician practices. In the latest issue, you'll also find tips to prevent employee theft in your practice, details about a virtual kidnapping scheme targeting Texas physicians, efforts by allergists in the state to allow EpiPens on school campuses, and ways that using registries can help take the sting out of quality reporting.

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.    

CMS Medicare Beneficiary Open Enrollment Ends

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 

Prompt Pay and the Revenue Cycle
How to Talk to Patients About Tobacco Cessation
10 Ways to Turn Satisfied Patients Into Loyal Patients
Avoiding the Courthouse: 10 Practice Pitfalls

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Last Updated On

November 14, 2018