Action: April 1, 2015

TMA Action April 1, 2015   News and Insights from Texas Medical Association

SGR Cuts Begin April 1, Will Last If Senate Doesn’t Act

Free CME and Free to Attend — That's TexMed
Draft Rules Raise Meaningful Use Reporting Bar
Feds Finally Fess Up to PQRS/eRx Audits
Automatic Patient Enrollment in Dual Eligible Demo Starts April 1
Meet the Ever-Changing Compliance Challenge
Save the Date(s) for First Tuesdays 

TEXPAC Leadership Applications Due April 7 at Noon
Texas Obesity Rate Grows to 30 Percent of Adults
Recognize a Local Journalist's Excellence in Health Reporting
TMAF Health Improvement Grants Now Available
Register for This Summer's 3rd Annual Texas Primary Care and Health Home Summit
This Month in Texas Medicine  

SGR Cuts Begin April 1, Will Last If Senate Doesn’t Act

Because Congress adjourned last week before patching or repealing Medicare's Sustainable Growth Rate (SGR) formula, a 21-percent Medicare pay cut automatically became effective April 1, and will remain in effect, at a minimum, until the U.S. Senate returns from its two-week break on April 13.

The U.S. House of Representatives, led by Rep. Michael Burgess, MD (R-Texas), overwhelmingly passed the Medicare Access and CHIP Reauthorization Act on March 24, The Senate, however, left for its Easter recess without acting on the legislation. Senate Majority Leader Mitch McConnell (R-Ky.) has pledged to take up the bill quickly when senators reconvene.

According to the American Medical Association, the Centers for Medicare & Medicaid Services has told its carriers to hold for 10 business days any claims received for services provided on April 1 and beyond until Congress resolves the matter. The 10-business-day hold means that April claims will be held through Tuesday, April 14. Because, by law, no claims can be paid sooner than 14 calendar days from their receipt, this hold should have little practical impact on Medicare remittance in the short term, although billing for copayments and claims reconciliation will be more complicated.

If Congress allows the 21-percent cut to stand, Medicare would pay physicians at the reduced amount no matter what the physician billed, and no further action would be necessary. However, nonparticipating physicians who have collected balance-billing amounts for unassigned claims based on the currently allowed amount could be required to make refunds to their patients based on new, lower balance-billing limits.

Free CME and Free to Attend — That's TexMed

From Practice Management to Quality and Patient Safety, TexMed 2015 is packed with a variety of continuing medical education tracks — some 80 hours in total. It's all offered May 1-2 at the Austin Convention Center.

Looking for a little something different? Get CME for your morning workout with Let's Get Active! or view the latest in quality improvement initiatives by visiting the third annual TexMed Poster Session — an author-hosted walk-through on Saturday from 8 am to 9 am. Categories have been expanded this year to offer physicians and medical practice staff more opportunities to participate. For additional information or to submit an application, visit the Poster Session webpage.

TexMed 2015 will feature two general sessions, each with its own stimulating speaker. During TexMed's Opening General Session on Friday, Ira Byock, MD, will address palliative care and dying in America. Dr. Byock, author of The Best Possible Care and one of the foremost palliative care physicians in the country, argues that to ensure the best of end-of-life care possible, we not only must remake our health care system but also move past our cultural aversion to talking about dying. 

On Saturday, Patricia A. Shands, MD, will share her unique journey through health care during TexMed's Closing General Session. An orthopedic surgeon, Dr. Shands lives and works in Anchorage, Alaska, and for the Alaska Native Tribal Health Consortium. Her motivational recount of her work with Native/Inuit tribes at the hospital as well their remote villages provides an extraordinary look at the path medicine has taken her on. 

For a full schedule of events, continuing medical education, exhibitors, lodging information, fun things to do in and around Austin, and how to get more involved in TMA policy creation, visit the TMA website. Be sure to register today to reserve your spot to enjoy this free benefit of your TMA membership.

Draft Rules Raise Meaningful Use Reporting Bar

The Centers for Medicare and Medicaid Services (CMS) released proposed rules March 20 that would set higher benchmarks for physicians to prove meaningful use of electronic health records by 2018.

With a few exceptions, all participants are expected to conform to the new requirements by 2018 and to begin reporting on a full calendar cycle in 2017. Program participants have the option to start Stage 3 in 2017 or 2018, but everyone must use the Stage 3 standards by 2018. 

Physicians, hospitals, and other eligible providers who do not meet the requirements in CMS's Stage 3 draft rule of the Medicare and Medicaid electronic health records (EHRs) incentive program lose incentive pay eligibility and face penalties.

The number of core objectives has been reduced from 17 in Stage 2 to eight in Stage 3. For three of the eight core objectives — health information exchange, consumer engagement, and public health reporting — physicians do not have to meet every component measure. Instead, they can select a certain number from each that is most relevant to their practice setting.

And while physicians must now fulfill only two of the three patient engagement objectives — patient electronic access to their own records, secure messaging between patients and providers, and collection of patient-generated health data — the new rules raise the benchmarks on the two objectives that physician groups found most objectionable.

Instead of having to get 5 percent of their patients to view, download, or transmit their medical records as Stage 2 required, physicians must now get 25 percent of their patients to do so, or else lose eligibility for incentive pay and face penalties. Also, 25 percent of a physician's patients must now email their doctor under the new rules, instead of the 5 percent required under Stage 2.

TMA's efforts to get CMS to drop the coercive patient engagement objectives that have nothing to do with clinical care or outcomes and over which physicians have no control was met with a resounding "no" from CMS. 

The program previously operated in stages where objective definitions changed to become progressively more stringent with each stage, and physicians new to the program could start with the lower requirements of stages 1 or 2. Under the new rules, however, all physicians and providers will report on the same set of objectives, regardless of when they began participating in the program. This will be optional in 2017 but mandatory in 2018. 

CMS describes this move as its way of reducing complexity and addressing participant complaints about the program's multiple reporting periods, stages, and objectives. For example, by doing away with all 90-day reporting periods and requiring all participants to report on a calendar year beginning in 2017, CMS has aligned EHR meaningful use reporting timetables with other CMS programs, such as the Physician Quality Reporting System, in what the agency says will reduce administrative burdens.

CMS is taking comments on the rule until May 29. TMA's Ad Hoc Committee on Health Information Technology (HIT) will work with staff to craft comments. If you are interested in providing input, contact Shannon Vogel, TMA's director of HIT, at (512) 370-1411, or (800) 880-1300, ext. 1411, or by email.

In related news, the U.S. Department of Health and Human Services Office of the National Coordinator for Health Information Technology also released on March 20 the 2015 Edition Health IT Certification Criteria that overhauls the certification for health care information technology. The revised criteria aim to ensure certified EHR products can meet practices' meaningful use requirements.

Feds Finally Fess Up to PQRS/eRx Audits

After several requests from TMA for more information about an unusual Medicare audit notification a physician member had received, the Centers for Medicare and Medicaid Services finally posted a fact sheet about the audit on its website late last month.

Action reported in the March 16 issue that CMS had started an audit or voluntary survey of the Physician Quality Reporting System (PQRS) and Electronic Prescribing (eRx) Incentive Program through an information technology company called Arch Systems, based in Maryland. 

TMA was concerned with the validity of the notification because CMS had not posted any information on its PQRS website. Also, representatives from the QualityNet Help Desk were unaware of such audits and were not able to confirm the program existed until two weeks after TMA's inquiry.

CMS calls it the PQRS/eRx Primary Source Verification (PSV) and has contracted with Arch to perform measure-specific validation. A nurse reviewer will contact physicians and providers whose records have been selected for review from Feb. 25 through July 19. No single review should last longer than 45 days, CMS said. 

Nurse reviewers are now looking at records from 2013 to compile the overall rate of reporting error for PQRS and eRx, and identify measures or measure types for which reporting errors are most prevalent and the most common sources of those errors.

CMS says participation in the PSV program is voluntary and will help identify errors, if any, and improve accuracy of reported data and measures. 

For additional information, contact the CMS QualityNet Help Desk, Monday through Friday, 7 am to 7 pm CT, by phone, (866) 288-8912, or by email; or contact Arch Systems, by phone, (410) 277-9782, or by email. You may also contact the TMA Knowledge Center by phone, (800) 880-7955, or by email.

 TMLT Action Ad 4.13   

Automatic Patient Enrollment in Dual Eligible Demo Starts April 1

Unless they have opted out, thousands of Texas patients who receive both Medicare and Medicaid and who reside in a target county will be automatically, or passively, enrolled in the Texas Health and Human Services Commission's (HHSC's) six-county Dual Eligibles Integrated Care Demonstration Project starting April 1.

More than 165,000 Texas patients in Bexar, Dallas, El Paso, Harris, Hidalgo, and Tarrant counties qualify for the program and may eventually be covered under the new plan. 

The project is a partnership between Texas and the Centers for Medicare & Medicaid Services (CMS) to test a new model for providing coordinated care to patients enrolled in both Medicare and Medicaid. Texas and CMS will contract with Medicare and Medicaid managed care plans to coordinate patient care across both programs.

Nationally, more than 9.6 million seniors and people with significant disabilities are dually eligible for both programs, and as many as 2 million of them may be included in the demonstrations. Often, medically fragile, dual-eligible patients are typically poorer and sicker than other Medicare beneficiaries and use more health care services. 

The project's objectives include:

  • Making it easier for clients to get care,
  • Promoting independence in the community,
  • Eliminating cost shifting between Medicare and Medicaid, and
  • Achieving cost savings for the state and federal government through improvements in care and coordination. 

Patients will be included in the project if they: 

  • Are age 21 or older;
  • Get Medicare Parts A, B, and D, and are receiving full Medicaid benefits; and
  • Are in the Medicaid STAR+PLUS program, which serves Medicaid clients who have disabilities or get STAR+PLUS Home and Community Based Services waiver services.  

In the demonstration, health plans must provide the full array of Medicaid and Medicare services. This includes any benefits that will be added to the STAR+PLUS service array by March 1, such as nursing facility services, psychosocial mental health rehabilitation, and targeted case management. 

Passive enrollment begins April 1, progresses incrementally through August, and will apply to 20 percent of nonfacility patients within a county by ZIP code. For example, all dual-eligible patients eligible for passive enrollment who live in a pilot county and who are in cohort 1 ZIP codes (see list), will be passively enrolled on April 1 unless they opted out. Enrollment of dual-eligible nursing facility patients will begin Aug. 1 in Bexar and El Paso counties, followed by Harris County nursing facility patients on Sept. 1 and those in remaining counties on Oct. 1.

HHSC has developed a detailed enrollment grid by county to help practices better understand how patients will be assigned to a plan.

Patients had the choice to opt out of the project before the pilot began and may still elect to opt out after being enrolled in a plan. If they opt out, the change will take effect the first of the following month. Patients who opt out may subsequently return to the pilot. Thus, physicians should verify patient eligibility at each visit. Physicians cannot steer patients to a particular managed care plan, but can inform patients about the demonstration plan(s), if any, in which they participate.

Patients Still Have a Choice

Patients eligible for the demonstration were or will be sent introduction letters 90 days before enrollment and additional reminder letters 60 days and 30 days before passive enrollment begins. If a patient is enrolled in a plan whose network does not include their physician(s), continuity of care must be protected for the first 90 days. 

Specifically, the contract between CMS, HHSC, and the plans specifies that a patient's care must not be disrupted when the patient enrolls in a plan: "The STAR+PLUS Medicare and Medicaid Plan (MMP) allows enrollees receiving any services at the time of enrollment to maintain their current providers, including with providers who are not part of the STAR+PLUS MMP's network, and service authorizations, including drugs, for at least up to ninety (90) days after the enrollee's enrollment effective date or until the Plan of Care and/or ISP are updated and agreed to by the enrollee, whichever is earlier."

The contract further states that the STAR+PLUS MMP must ensure continuity of care for new enrollees whose health or behavioral health condition has been treated by specialty care providers or whose health could be placed in jeopardy if medically necessary covered services are disrupted or interrupted.

Visit the HHSC or CMS websites for more information about the project, including the Texas proposal and memorandum of understanding.

To see how CMS will be monitor and evaluate the Texas demonstration project, read Measurement, Monitoring, and Evaluation of State Demonstrations to Integrate Care for Dual Eligible Individuals.

HHSC website resources include: 


Meet the Ever-Changing Compliance Challenge

Do you have a compliance plan? A formal, written plan that everyone in your practice understands and follows?

Government rules, regulations, and standards are many and complicated — and constantly changing. Today's practice policy may be tomorrow's violation, and the consequences for a single violation can be high! Following a written compliance plan with built-in reviews is the only way to stay on top of it all.

Join us for TMA's new full-day seminar, Commit to Compliance: Meeting the Challenge, one day only in Austin on Friday, May 8, from 9 am to 3:30 pm CT, to learn the core elements of a sound compliance plan and how to avoid legal and administrative violations.

Use coupon code EPROMO when you register, and save $20! Register today, and take control of your compliance success! 

The seminar will be held in the TMA building. These hotels are within walking distance from TMA:  


Save the Date(s) for First Tuesdays

First Tuesdays at the Capitol continues next week, and the Family of Medicine needs you to be there.

The "White Coat Invasion" has been the key to physicians' successes in the Texas Legislature since the inception of First Tuesdays at the Capitol in 2003. Our senators and representatives listen when their hometown doctors appear in their offices. Our influence is so much greater when physicians and alliance members arrive en masse in the House and Senate galleries. It's time again to bring out Texas medicine's strongest weapon.

Mark your calendar for the remaining 2015 First Tuesdays at the Capitol, and register today:

  • April 7 and
  • May 5.

TMA continues to work for what's best for patients and their physicians. Medicine's 2015 legislative agenda, based on TMA's Healthy Vision 2020, Second Edition, will focus on:

  • Increasing funding for graduate medical education.
  • Improving physicians' Medicaid and CHIP payments to more appropriately reflect the services they provide to patients.
  • Holding health insurance companies accountable for creating and promoting adequate physician networks.
  • Devising and enacting a system for providing health care to low-income Texans that improves efficiencies by reducing bureaucracy and paperwork.
  • Stopping any efforts to expand scope of practice beyond that safely permitted by nonphysician practitioners' education, training, and skills.
  • Promoting government efficiency and accountability by reducing Medicaid red tape.
  • Protecting physicians' ability to charge for their services.
  • Improving the state's public health defense to better respond in a crisis.
  • Preserving Texas' landmark medical liability reforms.
  • Protecting the patient-physician relationship from corporate intrusions. 

 TMAIT Action Ad Sept 14   

TEXPAC Leadership Applications Due April 7 at Noon

Applying for appointment to a committee or board is a great way to let the TEXPAC leadership know you want to be more involved in the process. 

TEXPAC is looking to fill spots on:  

  • TEXPAC Executive Committee, which makes operational and financial decisions,
  • TEXPAC Candidate Evaluation Committee, which makes recommendations on which political candidates TEXPAC will support, and
  • TEXPAC Board of Directors, which makes decisions through democratic representation in regard to PAC operations and political candidate support.  

The Nominations Committee will meet the week of April 6 to make recommendations to the TMA Board of Trustees for appointments.

To apply, complete this form and email it to TEXPAC Director Clayton Stewart at clayton.stewart[at]texmed[dot]org

Texas Obesity Rate Grows to 30 Percent of Adults

Although Texas in 2014 improved its overall health ranking among U.S. states from 36th to 31st, according to the United Health Foundation's annual report, the percentage of obese adult Texans — those who have a body mass index of 30 or higher — grew to 30.9 percent.

From 2013 to 2014, smoking in Texas decreased 13 percent, immunization coverage among children increased 12 percent, and disparity in health status decreased 18 percent, according to the annual study. But obesity increased from 29.2 percent of adult Texans in 2013 to 30.9 percent in 2014.

Obesity-related conditions include heart disease, stroke, type 2 diabetes, and certain types of cancer — some of the leading causes of preventable death.

David Lakey, MD, the former state health commissioner, told the House Public Health Committee recently that diabetes due to obesity costs the state economy $9 billion a year, and he predicted that costs will grow to $30 billion by 2030.

Dr. Lakey said the unhealthiest areas of the state are far South Texas along the Mexican border and in deep East Texas. "Many folks now believe ZIP code is a bigger predictor of health than genetic code," Dr. Lakey said, according to a March 3 article in Texas Monthly.

Physicians Lead Patients Toward a Healthier Lifestyle in Walk With a Doc Texas Program

Take your patients on a walk. They'll get healthier, and you'll all probably enjoy it. TMA supports the Walk With a Doc (WWAD) program, a national grassroots movement devoted to encouraging healthy, sustainable physical activity. 

With its monthly, physician-led walks, WWAD has a proven track record of helping people commit to a healthy lifestyle. 

Through a grant from the TMA Foundation with generous support from TMAIT, TMA provides physician leaders with start-up kits that include T-shirts, pedometers, liability insurance, and marketing materials. Strengthen your trusted leader role in your community, and lead your patients in a healthy activity. 

Join the movement. For more information, contact Debra Heater in TMA's Division of Communication at (512) 370-1390 or (800) 880-1300, ext. 1390, or by email. You can also find out more on the TMA website.

Recognize a Local Journalist's Excellence in Health Reporting

If you read or hear a great health news story, nominate the reporter for one of TMA's Anson Jones, MD, Awards, which recognize excellence in health journalism in Texas. TMA has honored Texas journalists for excellence in reporting for more than 50 years. 

Physicians, medical students, TMA Alliance members, and county medical societies can nominate local print or broadcast journalists for an award. Nominations can be submitted throughout 2015.

You may send your nominations via email. Include the reporter's name, date of broadcast/publication, and the media outlet. TMA will send a postcard to the reporter with a handwritten note alerting him or her of your nomination.

The award is named after Anson Jones, MD, a pioneer Texas physician who served the Republic of Texas as a member of Congress, secretary of state, and its last president from 1844 to 1846. 

PC Action Ad Sept 13

TMAF Health Improvement Grants Now Available

The TMA Foundation (TMAF) is accepting applications for its two health improvement grant programs for 2015-16. County medical societies and TMA Alliance chapters may apply for up to $7,500 in matching funds from the TMAF Medical Community Grant Program. Medical student chapters may apply for up to $3,000 in matching funds from the TMAF Medical Student Community Leadership Grants Program.

TMAF grants have funded wellness fairs, vaccination programs, a flu shot drive-thru event, and many other collaborative community programs that target TMA priorities.

For more information, including summer deadlines, or to download a grant application, visit the TMAF webpage.

Learn more about the projects the foundation funds in the spring edition of TMAF's newsletter, Solutions. TMAF grants are made possible by its generous donors. See a list of recent donors in Solutions and learn more about TMAF on its webpage, or call (800) 880-1300, ext. 1664.

Register for This Summer's 3rd Annual Texas Primary Care and Health Home Summit

Join your colleagues from around Texas at the 2015 Texas Primary Care and Health Home Summit June 18-19 in San Antonio at the Marriott Plaza Hotel. This year's theme, Supporting the Quadruple Aim: The Triple Aim of High Value Patient Care and Provider Joy, focuses on emerging trends in primary care, including value-based contracting, building a successful accountable care organization, practices without walls, and direct primary care.

Other sessions offered include the elements of health homes, using data to improve care, best practices in care transitions and medication adherence, and engaging patients and families in their care. There will be additional break-out sessions on pediatric health homes.

Conference highlights include: 

  • Opening keynote, "Revitalizing Primary Care: All Hands on Deck!" by Andrew Morris-Singer, MD, internist and primary care innovator,
  • Peggy McManus from the "Got Transition" project will share successful strategies for transitioning adolescents and young adults from pediatric to adult medical care. This is especially critical for the 18 percent of adolescents with chronic physical, emotional, behavioral, and developmental challenges for whom care transition is frequently not well planned, resulting in disruptions in care and preventable complications,
  • James (Larry) Holly, MD, a true pioneer in the field of health/medical homes and electronic patient management will speak on using data to improve care. Dr. Holly has guided the growth of Southeast Texas Medical Associates (SETMA) from one clinic in Beaumont in 1995 to six clinics today. SETMA is the only practice in the country accredited as a medical home by the four different accreditation agencies,
  • Terry McInnis, MD, will speak on "Comprehensive Medication Management to Improve Patient Outcomes," and Marie Brown, MD, will speak on strategies to improve medication adherence in persons with chronic conditions,
  • Christine Bechtel will speak on the challenges and promise of engaging patients and families in their care,
  • Paul Grundy, MD, founding president of the Patient-Centered Primary Care Collaborative and IBM's director of global health care transformation, will close the conference with "Primary Care: Where Are We and Where We Should Be Going." 

The conference is presented by the Texas Medical Home Initiative and the Texas Health Institute.

For more information or to register, go the Texas Health Institute summit website; you may read a draft agenda here

This Month in Texas Medicine

The April issue of Texas Medicine guides you through the what, when, why, and how behind Medicare value-based care; examines the educational and workforce benefits of resident moonlighting; discusses a Texas court case in which the telehealth provider Teladoc argues that a face-to-face meeting is unnecessary for new patients; explains the proposed health service enterprise gateway, which would connect to local health information exchanges and give physicians a single place to exchange data with all state health agencies; and introduces Ira Byock, MD, who will speak at TexMed's General Session in May about providing the best care possible at the end of life. 

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.  

ICD-10 Implementation Compliance   

First-Year Participants' Last Day to Begin 90-day Reporting Period of Meaningful Use for the 2015 Medicare and Medicaid EHR Incentive Programs   

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.  


Commit to Compliance: Meeting the Challenge: May 8

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 

Conferences and Events

TexMed 2014
May 1-2

About Action       

 Action, the TMA newsletter, is emailed twice a month to bring you timely news and information that affects your practice

To change the email address where you receive Action, go to Member Log-In on the TMA website, then click on "Update Your TMA Demographic Information (including newsletter subscriptions and preferences)."

To unsubscribe from Action, email TMA's Communication Division at tmainfo[at]texmed[dot]org.

If you have any technical difficulties in reading or receiving this message, please notify our managing editor, Shari Henson. Please send any other comments or suggestions you may have about the newsletter to Crystal Zuzek, Action editor.


Last Updated On

December 20, 2016