Action: May 1, 2015

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

It’s Time to Say Thank-You for SGR Repeal
TDI Sets Standard Drug Preauthorization Form
Sunshine Act Reporting Exclusion Applies to Independent CME
Don't Miss the TexMed 2015 General Session Speakers
Save the Date for the Final 2015 First Tuesdays Event
State Budget Negotiations Begin
TMA PracticeEdge Announces Initial Physician-Led ACO Customers
FDA: Lead Poisoning Possibly Linked to Bo Ying Compound
TMA Education Center Now Optimized for Mobile Devices
Workers' Comp Seminar Focuses on Educating Office Staff
New TMAF Scholarship Endowment Helps Make Medical Education a Reality
Apply for the TMA Leadership College by July 1
This Month in Texas Medicine  

It’s Time to Say Thank-You for SGR Repeal

Texans in Congress played a huge role in getting HR 2, the bill that repealed Medicare's Sustainable Growth Rate (SGR) formula, passed into law. These leaders, and all who voted for the bill, deserve ou+r thanks. (Here's the list — with phone numbers to call.) 

We must start, of course, with Rep. Michael Burgess, MD (R-Lewisville), the primary author of the bill and the driving force for SGR repeal since he first was elected to Congress in 2003. Sen. John Cornyn, the Senate majority whip, used his mastery of Senate rules and expert negotiating to get us over the final hurdle in the Senate. Reps. Kevin Brady (R-The Woodlands) and Gene Green (D-Houston) cosponsored the bill and kept the wheels on the bus when they threatened to fall off. Rep. Henry Cuellar (D-Laredo) included a provision that protects Texas' medical liability reforms and ensures that care standards and guidelines in federal law cannot be used to create new causes of legal action against physicians.

Please take just a moment today to make some thank-you calls

TDI Sets Standard Drug Preauthorization Form

Building on a TMA-supported win from last legislative session, the Texas Department of Insurance (TDI) adopted a rule last month that creates a standard prior authorization form for prescription drug benefits. Prescribing physicians and other practitioners can use the form to request prior authorization from health benefit plan issuers. The new form is available on TDI's website.

Earlier this year, TDI set the standard form for medical care preauthorization. Both the standard forms cover everything but Medicare, the state Workers' Compensation program, and self-funded employer plans. They do away with hundreds of separate forms insurers currently make physicians’ offices use. 

Both rules take effect Sept. 1.

Sunshine Act Reporting Exclusion Applies to Independent CME

In April the Centers for Medicare & Medicaid Services (CMS) issued new frequently asked questions regarding when continuing medical education (CME) would be reportable in the Open Payments System. The new guidance states reporting is not triggered unless the manufacturer requires, instructs, directs, or otherwise causes the third party to provide the payment or transfer of value, in whole or in part, to a covered recipient.  

The American Medical Association notes this is not a free pass. The exclusion applies only to independent CME. AMA strongly encourages medical societies to review their planning processes to ensure adherence to standards for independence. At a minimum, meeting funding should in no way influence program development and other aspects of the planning process, AMA says. AMA encourages maintaining up-to-date conflict-of-interest disclosures from all involved in the planning process.   

For additional guidance, review AMA's policy statement, Financial Relationship with Industry in Continuing Medical Education.  

Don't Miss the TexMed 2015 General Session Speakers

Can't make it to Austin for TexMed 2015 on May 1-2? Or maybe you're planning to attend, but you won't be able to catch the General Session speakers. Not to worry, TMA will live-stream and rebroadcast both of the conference general sessions on TMA TV.

Opening General Session speaker Ira Byock, MD, is one of the country's foremost palliative care physicians. Dr. Byock's session, The Best Care Possible, will focus on moving past our cultural aversion to talking about dying and acknowledging our own mortality. In A Journey Through Medicine, Closing General Session speaker Patricia A. Shands, MD, will discuss her move from private practice to working with the Alaska Native Tribal Health Consortium.

Here's the live-streaming schedule: 

  • Friday, May 1, 4-5 pm: The Best Care Possible by Dr. Byock 
  • Saturday, May 2, 1:30-2:30 pm: A Journey Through Medicine by Dr. Shands 

Here's the rebroadcast schedule: 

  • Monday, May 4, 7:30-8:30 pm: The Best Care Possible by Dr. Byock
  • Tuesday, May 5, 7:30-8:30 pm: A Journey Through Medicine by Dr. Shands 

Action, May 1, 2015


Save the Date for the Final 2015 First Tuesdays Event

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 last 2015 First Tuesdays at the Capitol, May 5, and register today.

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. 

State Budget Negotiations Begin

Every legislative session, in the process of writing a two-year state budget, the Texas Senate and House of Representatives each craft their own version of the spending plan. The work of reconciling the differences between the House and Senate budgets falls to a 10-person conference committee appointed by the lieutenant governor and speaker of the House. The 2015 Texas Legislature reached that milestone for House Bill 1, this session's budget bill, on April 23.

The Senate version would spend $211.4 billion for the 2016-17 state fiscal years. The House plan totals about $209 billion. But the budgets differ in more than just the totals. Each version allocates more or fewer state (and federal) dollars to various state programs. The job of the conference committee is to come up with one number for each program.

Below are the names and Capitol office phone numbers for the budget conferees from each chamber, along with TMA’s HB 1 priorities.

House Budget Negotiators Senate Budget Negotiators
  • John Otto (R-Dayton), chair
    (512) 463-0570
  • Sylvester Turner (D-Houston)
    (512) 463-0554
  • Trent Ashby (R-Lufkin)
    (512) 463-0508
  • Larry Gonzales (R-Round Rock)
    (512) 463-0670
  • Sarah Davis (R-West University Place)
    (512) 463-0389
  • Jane Nelson (R-Flower Mound), chair
    (512) 463-0112
  • Juan “Chuy” Hinojosa (D-McAllen)
    (512) 463-0120
  • Charles Schwertner, MD (R-Georgetown)
    (512) 463-0105
  • Joan Huffman (R-Houston)
    (512) 463-0117
  • Lois Kolkhorst (R-Brenham)
    (512) 463-0118
In the House budget, TMA strongly supports: In the Senate budget, TMA strongly supports:
  • $460 million in general revenue funds to restore Medicaid payments to Medicare levels for certain primary care physicians and services. 
  • $20 million to increase the number of women who can be treated via the Expanded Primary Health Care Program.
  • $15 million to expand the state’s autism intervention program.
  • $20 million for surveillance of Ebola and other infectious diseases.
  • $60 million to improve state hospital funding.
  • $14.2 million to maintain tobacco cessation programs (Quitline and tobacco prevention programs for youth and young adults).
  • 14-percent increase in graduate medical education (GME) formula funding to help offset a portion of teaching costs for residency training.
  • $62.9 million to grow and improve GME expansion programs.
  • Funding of GME expansion programs at $75,000 per resident per year for an estimated 125 new GME positions a year.
  • 22-percent increase in GME formula funding.
  • $3 million to restore the Statewide Primary Care Preceptorship Program.
  • $50 million in enhanced funding for women’s preventive health care.
  • $13 million to expand availability of local mental health crisis services.
  • $8 million to increase substance abuse prevention initiatives.
  • $3 million increase to prevent and treat sexually transmitted diseases.

TMA PracticeEdge Announces Initial Physician-Led ACO Customers

TMA PracticeEdge, LLC, has service agreements with Houston Regional Accountable Care Organization, LLC, and Alliance ACO, LLC, in rural, south-central Texas. TMA PracticeEdge anticipates these physician-led accountable care organizations (ACOs) will initially represent 50-plus physicians providing care and managing the population health for more than 12,000 patients.

TMA PracticeEdge is a new services company developed by TMA to bring physicians the technology and expertise they need to take advantage of new health care payment models. TMA PracticeEdge will provide Texas physicians real options to design their own future. Working with strategic partners, TMA PracticeEdge offers physicians a unique toolkit of ACO services backed by the trusted TMA brand.

"We commend the physicians of Houston Regional and Alliance ACOs for partnering with TMA PracticeEdge to grow and strengthen physician-driven health care in their communities,” said Lou Goodman, PhD, chief executive officer of TMA PracticeEdge. Texas is an emerging national leader in the expansion of value-based care models, he said, and physician-led ACOs, taking the initiative, can use the tools offered by TMA PracticeEdge to grow and remain independent.

"We have been exploring our options for the transition to value-based care models," said Charles Stiernberg, MD, chief operating officer of Hillcroft Medical Clinic Association, the Sugar Land-based medical practice that is launching Houston Regional ACO. "TMA PracticeEdge is a great fit for our organization," he added, stating the company has the expertise and resources to launch an ACO and support the transition to risk-bearing, value-based care contracts.

Strengthening rural Texas communities with physician-led health care is an important goal of TMA PracticeEdge. By deploying its resources to help Alliance ACO form a Medicare Shared Savings Program ACO for January 2016, TMA PracticeEdge demonstrates its commitment to rural-based, physician-led health care in Texas.

Jorge Duchicela, MD, is a family physician in Weimar and a member of the Alliance ACO Board. "TMA PracticeEdge brings our organization valuable expertise and resources for educating and recruiting additional like-minded physicians to this opportunity," Dr. Duchicela said. "It is great to have a trusted partner as we enter into a new business model in which we don't have direct experience."

Physicians and office managers who are interested in learning more about TMA PracticeEdge should visit, email info[at]tmapracticeedge[dot]com, or call (888) 900-0334.


FDA: Lead Poisoning Possibly Linked to Bo Ying Compound

An April 10 Food and Drug Administration (FDA) notice encourages health care professionals and consumers to report to the agency's MedWatch adverse event reporting program any adverse events potentially related to Bo Ying compound, due to the potential risk of lead poisoning in those who use it. Manufactured by Eu Yan Sang (Hong Kong) Ltd., Bo Ying compound, as described in the FDA notice, is "a powdered product marketed for treatment of various ailments in infants and children." FDA warns it "may contain excessive levels of lead." 

The product is available in retail outlets and online and features labeling in Chinese and English that instructs giving the compound to infants and children for influenza, fever, sneezing, and nasal discharge.

FDA says consumers should discontinue use of and discard the product, adding that children who may have been given Bo Ying compound should consult a health care professional for possible blood lead testing.

The Texas Department of State Health Services (DSHS) is asking anyone who finds Bo Ying compound in a store to call the DSHS Regulatory Services Division at (888) 839-6676.

TMA Education Center Now Optimized for Mobile Devices

The TMA Education Center offers a new user experience when you visit from your phone or tablet. Now you can sort, browse, view, and purchase while on the go on our redesigned site specifically crafted for use on mobile devices. 

The process is the same as it has always been. The usability has been greatly improved. Visit the TMA Education Center. Log in, or create your account using your TMA username and password, and start browsing the dozens of courses covering everything from practice management to ethics to mitigating physician stress.

If you've tried the TMA Education Center before, now is a great time to revisit. The improved and optimized format makes finding the perfect continuing medical education (CME) a breeze. With more than 100 courses, and new courses added regularly, you'll find CME that is beneficial, interesting, and now mobile.

Visit the TMA Education Center today, and use coupon code EPROMO to save $20 on TMA's upcoming live seminar Commit to Compliance: Meeting the Challenge.

Workers' Comp Seminar Focuses on Educating Office Staff

The Texas Department of Insurance Division of Workers' Compensation (DWC) has announced the next program in a series of educational seminars. "Texas Workers' Compensation 101 for Medical Office Staff" is free and will take place at DWC's central office (7551 Metro Center Drive in Austin) on May 28 from 9 am to 4 pm.

Geared toward medical office staff members who manage the DWC administrative claims process, the seminar includes presentations on: 

  • Introduction to the DWC system; 
  • Intake and coverage verification; 
  • Treating the injured employee — treatment guidelines, preauthorization, and utilization review; 
  • Billing and reimbursement — medical bill processing and fee guidelines; 
  • Dispute resolution; and  
  • Assistance and resources.  

Register today. If you have questions about seminar registration, email Janice Pousson, or call (512) 804-4685.

PC Action Ad Oct 13  

New TMAF Scholarship Endowment Helps Make Medical Education a Reality

The number of Texas medical and osteopathic schools will increase from nine to 14 by 2017, making the new Texas Medical Association Foundation (TMAF) Patrick Y. Leung, MD, Minority Scholarship Endowment timely.

The endowment helps provide additional scholarships to first-year students through the TMA Minority Scholarship Program. Learn more about this endowment in the spring edition of TMAF's newsletter, SOLUTIONS.

Apply for the TMA Leadership College by July 1

TMA is now accepting applications for the TMA Leadership College Class of 2015. The deadline to apply is July 1.

The TMA Leadership College, established in 2010 as part of TMA's effort to ensure strong and sustainable physician leadership within organized medicine, is geared toward active TMA members younger than 40 or who are in the first eight years of practice.

Graduates serve as thought leaders who can close the divide between clinicians and health care policymakers and as trusted leaders within their local communities. Many also receive priority consideration for appointment to TMA councils and committees.

Visit the TMA webpage for full program details, a class schedule, and application.

For more information, contact Christina Shepherd in the TMA Membership Development Department by email or by calling (800) 880-1300, ext. 1443, or (512) 370-1443.

This Month in Texas Medicine

The May issue of Texas Medicine features a cover story on TMA PracticeEdge, TMA’s practice management and accountable care tool for primary care and multispecialty practices. It also features articles on legislation that would expand the scope of practice for nonphysician practitioners; the American Board of Internal Medicine’s changes to maintenance-of-certification criteria; legislative efforts to clamp down on balance billing; and an update on graduate medical education (GME) legislation and the 2013 GME grant programs.

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

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Last Updated On

December 20, 2016