Action: June 15, 2015

 TMA Action June 15, 2015   


Victory! CSR Permit Program to Be Eliminated Next Year
Federal Judge Sides with Teladoc, Blocks TMB Telemedicine Rule
AMA Calls for Two-Year ICD-10 Grace Period If Coding Transition Implemented
Start the PQRS GPRO Registration Process Now
TMA Tells Feds to Scrap Meaningful Use Rule
TMA, AMA Support Sunshine Act Open Payments Reporting Exclusion
Supreme Court Ruling Maintains Six-Year Limit on Damage Claims
CDC Issues Bird Flu Health Advisory
CDC Releases Updated Ebola Monitoring Protocol
Ebola Resource Examines Dallas Contact Tracing, Monitoring
Revised Student Vaccine Requirements Available
AMA, AHA Principles Guide Successful Physician-Hospital Relationships
TMA Foundation Gala Sets Record
Apply for the TMA Leadership College by July 1
Participate in Medicaid HIT Survey
This Month in Texas Medicine  

Victory! CSR Permit Program to Be Eliminated Next Year

Thanks to the Texas Medical Association's advocacy this legislative session, the controlled substances registration (CSR) permit program will be eliminated, effective Sept. 1, 2016. Senate Bill 195 by Sen. Charles Schwertner, MD (R-Georgetown), and Rep. Myra Crownover (R-Denton) also moves the Prescription Drug Monitoring Program from the Texas Department of Public Safety (DPS) to the Texas State Board of Pharmacy and broadens physicians' authority to delegate who can access the information.

But until the CSR program is eliminated, established physicians must maintain — and newly licensed physicians must obtain — a permit. A physician's ability to prescribe medications hinges on possession of a valid CSR, which is necessary to obtain a permit from the Drug Enforcement Administration. Just as critical, a physician whose CSR permit lapses faces (at least) temporary suspension of hospital privileges, as maintaining current certifications is a requirement to retain medical staff privileges in Texas.

Fortunately, the CSR permit renewal process already had been streamlined due to TMA advocacy in the 2013 legislature. Physicians can now renew their CSR permits on the Texas Medical Board (TMB) website. Doing so will align the permit and medical license expiration dates. 

Before renewing either, check the DPS website to see when the CSR permit expires. If it has the same expiration date as the medical license, renew both on the TMB website for quicker service. 

Federal Judge Sides with Teladoc, Blocks TMB Telemedicine Rule

Last month, U.S. District Judge Robert Pitman granted Teladoc's request for a temporary restraining order (TRO) and preliminary injunction that blocks the Texas Medical Board's (TMB's) recently adopted telemedicine rule, which prohibits prescription of dangerous drugs or controlled substances without a "defined physician-patient relationship." That includes a physical examination via face-to-face visit or in-person evaluation, as TMB defines those terms in the rules. TMB adopted the rule on April 10, it and was set to take effect June 3.

In its application for a TRO, Teladoc argued TMB has engaged in anticompetitive actions that would put the company out of business in Texas and lead to "higher prices, reduced choice, reduced access, reduced innovation, and reduced overall supply of physician services." In response, TMB argued the rule is consistent with "sound medical practice" and is "reasonably necessary for and beneficial to patient welfare." In the order, Judge Pitman concludes "the balance of respective interests of the parties and the public weigh in favor of granting [Teladoc's] application for a preliminary injunction."

TMA, Southwest Pharmacy Solutions, the American Osteopathic Association, the Texas Osteopathic Medical Association, and the Federation of State Medical Boards filed briefs in opposition to the application for TRO and preliminary injunction.

The injunction will continue until Teladoc's federal antitrust lawsuit against TMB is resolved. 

TMA President Tom Garcia, MD, said in a statement that "TMA is sorely disappointed with the court's decision allowing the writing of prescriptions for dangerous drugs without first establishing a patient-physician relationship. Protecting patient health and safety and improving the quality of patient care are the Texas Medical Board's responsibilities. TMA supports the challenged rules and believes they fulfill the board’s mission."

AMA Calls for Two-Year ICD-10 Grace Period If Coding Transition Implemented

The American Medical Association House of Delegates unanimously adopted the Texas-backed proposal to ask the federal government to adopt a two-year, penalty-free grace period following the expected Oct. 1 mandatory implementation of the new ICD-10 coding system. 

Delegates voted without objection in support of the grace period plan, which the Reference Committee on Legislation cobbled together based on suggestions from the Alabama and Texas delegations, as well as other states, at the AMA House of Delegates Annual Meeting last week in Chicago.

As the reference committee noted in its report, "Our AMA will continue to prioritize our existing AMA policy that first seeks to stop the implementation of the ICD-10 code set and, only if a delay is not feasible, seek mitigation strategies."

The adopted language reads:

"If a delay of ICD-10 implementation is not feasible, that our American Medical Association ask the Centers for Medicare & Medicaid Services (CMS) and other payers to allow a two-year grace period for ICD-10 transition, during which physicians will not be penalized for errors, mistakes, and/or malfunctions of the system. Physician payments will also not be withheld based on ICD-10 coding mistakes, providing for a true transition where physicians and their offices can work with ICD-10 over a period of time and not be penalized.

"That our AMA educate physicians of their contractual obligations under Medicare and insurance company contracts should they decide to not implement ICD-10 and opt to transition to cash-only "practices which do not accept insurance.

"That our AMA aggressively promote this new implementation compromise to Congress and CMS since it will allow implementation of ICD-10 as planned, and at the same time protect patients' access to care and physicians' practices.

"That our AMA provide the needed resources to accomplish this new compromise ICD-10 implementation and make it a priority.

"That our AMA seek data on how ICD-10 implementation has affected patients and changed physician practice patterns, such as physician retirement, leaving private practice for academic settings, and moving to all-cash practices and that, if appropriate, our AMA release this information to the public."

The policy represents an effort by AMA to help U.S. physicians dodge a dangerous bullet.

Thanks to strong lobbying from AMA, TMA, and other physician groups, the original Oct. 1, 2013, ICD-10 deadline has been pushed back twice.

TMA and AMA still formally oppose ICD-10. They've pointed out that many physicians, especially those in small practices, are still not ready to use the new coding language. Some cite the high cost of transition; others blame electronic health record vendors that have not yet made ICD-10-compliant software available. Those who aren't ready run the risk of having all or some of their Medicare, Medicaid, and commercial insurance claims going unpaid.

TMA supports HR 2126, the Cutting Costly Codes Act of 2015, by U.S. Rep. Ted Poe (R-Humble), which would prohibit the government from requiring physicians and health care providers to use ICD-10.

Texas physicians at the AMA meeting spoke out about the dangers they foresee, especially for primary care practices. Greg Fuller, MD, a family physician from Keller, said the wide array of medical problems primary care physicians treat is forcing them to try to learn thousands of new codes.

"We need to stop ICD-10," Dr. Fuller told the Reference Committee on Legislation. "Any delay in pay is going to kill these practices."

E. Linda Villarreal, MD, an internist in the Rio Grande Valley, said she is concerned about the ramifications for access to care in South Texas, many parts of which already face a dire shortage of physicians. "I've taken three courses in ICD-10, and I still don't get it," Dr. Villarreal said.

But Washington watchers say Congress has no stomach for delaying the implementation date one more time. "The ICD-10 Coalition has done a better job than [medicine has] over the past four years," one delegate said.

That leaves organized medicine in a tough spot, said Fort Worth pediatrician Gary Floyd, MD, a member of the TMA Board of Trustees. Groups like AMA and TMA must continue to push for a last-minute reprieve and at the same time work to protect their members from the likely upheaval that will come with ICD-10, he explained.

"Our message is this," Dr. Floyd said, "don't give up the ship, but make sure the lifeboats are manned and at the ready."

TMA offers extensive ICD-10 coding training materials, including specialty-specific online ICD-10 documentation training, on-demand webinars, and customized on-site ICD-10 training.

Start the PQRS GPRO Registration Process Now

The Physician Value-Physician Quality Reporting System (PV-PQRS) registration system is open through June 30. This registration applies to group practices with two or more eligible professionals (EPs) interested in participating in the 2015 PQRS program year under the group practice reporting option (GPRO). 

According to the Centers for Medicare & Medicaid Services (CMS), physician groups of all sizes and physician solo practitioners will be subject to payment adjustments in 2017 based on quality and cost performance in 2015. Failure to report data on quality measures to Medicare for the 2015 PQRS program year will result in an automatic 2-percent pay cut under PQRS, plus another automatic 2-percent to 4-percent pay cut under Medicare's Value-Based Payment Modifier program, all in 2017. The payment adjustments will apply to all Part B covered professional services under the Medicare physician fee schedule.

To access the PV-PQRS registration system, you will need to obtain an Individuals Authorized Access to the CMS Computer Services (IACS) account. It takes at least 24 hours for CMS to process an IACS account request. This step should be completed now or as soon as possible to avoid last-minute delays before the deadline.

To determine if the GPRO is right for your practice, visit the GPRO webpage. To learn about the registration process, review the 2015 PQRS GPRO Registration Guide or visit the PQRS GPRO Registration webpage. Group practices that previously reported under the GPRO and plan on reporting PQRS data again via GPRO must register every year. If you plan to report your data on quality measures as an individual EP and not under the GPRO, you do not need to sign up or register anywhere to participate in the 2015 PQRS program year. 

If you are not sure where to begin for the 2015 PQRS program year or do not know which reporting mechanism to select, visit the CMS How To Get Started webpage. And watch this CMS video presentation for an overview of PQRS and to learn how your participation in PQRS in 2015 will determine how the value modifier will be applied to physicians' payment in 2017.

For free consulting services on Medicare's quality reporting programs, turn to the TMF Quality Innovation Network Quality Improvement Organization, an offshoot of the TMF Health Quality Institute. Under contract with Medicare, TMF has created several educational networks you can join:   

Stay informed about the latest PQRS news by subscribing to the PQRS listserv. For questions, contact the CMS QualityNet Help Desk, Monday through Friday, 7 am to 7 pm CT by phone, (866) 288-8912, or email. You also can contact the TMA Knowledge Center by phone, (800) 880-7955, or email

TMLT Action Ad 4.13   

TMA Tells Feds to Scrap Meaningful Use Rule

TMA's comments to the Centers for Medicare & Medicaid Services (CMS) on proposed meaningful use Stage 3 rules offer a number of suggestions, including dismantling the program and "adopting reasonable baseline rules that physicians can meet to avoid penalties under the meaningful use program and additional requirements they may meet to receive incentive payments."

TMA's strongest comments are related to the patient engagement measures. TMA asserts that CMS continues to push patients toward electronic interaction with their physicians, which some patients may not prefer. TMA stresses CMS should honor patient preference for communication.

TMA expects CMS to issue a final rule for the third and final stage of meaningful use later this summer or in early fall. TMA will be ready to educate physicians on changes to the meaningful use program, scheduled to take effect in 2017. 

Questions about the meaningful use program or other health information technologies may be emailed to TMA's Health Information Technology Department. 

TMA, AMA Support Sunshine Act Open Payments Reporting Exclusion

TMA and the American Medical Association want to ensure certain educational programs and materials are excluded from Open Payments System reporting. In a letter, TMA, AMA, and dozens of medical organizations and specialty societies assert their support for HR 293 by Texas Congressman Michael C. Burgess, MD. 

The legislation would make the current regulatory exemption for independent continuing medical education (CME) permanent. In addition, medical textbooks and journal reprints would be added to the list of exempt transfers of value. 

The letter states the Centers for Medicare & Medicaid Services has concluded in its interpretation of the Sunshine Act "that medical textbooks, reprints of peer reviewed scientific clinical journal articles, and abstracts of these articles are not directly beneficial to patients, nor are they intended for patient use. This conclusion is inconsistent with the statutory language on its face, congressional intent, and the reality of clinical practice where patients benefit directly from improved physician medical knowledge."

The letter concludes: "The Sunshine Act was not passed to limit or construct additional barriers to the dissemination of new medical knowledge that improves patient health outcomes. H.R. 293 is needed to ensure patients benefit from the most up-to-date and relevant medical knowledge."

Supreme Court Ruling Maintains Six-Year Limit on Damage Claims

A U.S. Supreme Court ruling has physicians who care for patients enrolled in federal health care programs breathing easier. The ruling in KBR v. United States of America Ex Relator Benjamin Carter prevents doctors from facing civil lawsuits for an unlimited period of time and maintains the six-year limitation on damage claims under the False Claims Act.

The Litigation Center of the American Medical Association and State Medical Societies filed an amicus curiae brief last year that said doctors could be "forced to defend against stale, repetitive, and frequently meritless claims" if the statute of limitations were removed. 

For more information, read the May 29 edition of AMA Wire

CDC Issues Bird Flu Health Advisory

The Centers for Disease Control and Prevention (CDC) issued a health advisory concerning identification of highly-pathogenic avian influenza A H5 viruses in U.S. birds. 

CDC says public health workers and clinicians need to be aware of the potential for human infection with these viruses and should follow CDC recommendations for patient investigation and testing and for infection control, including the use of personal protective equipment and antiviral treatment and prophylaxis. 

The alert includes direction for physicians who assess patients presenting with respiratory illness or symptoms and who have had possible contact with infected birds or who have been exposed to certain environments.

CDC has additional resources on surveillance and testing, infection control, antiviral medications, and H5 viruses in the United States

TMAIT Action Ad 6.15    

CDC Releases Updated Ebola Monitoring Protocol

The Centers for Disease Control and Prevention (CDC) released new guidance on monitoring travelers from Liberia to the United States for potential Ebola infection. With the World Health Organization's (WHO's) designation of Liberia as "Ebola free" in May, CDC has developed a "step-down" screening protocol for low-risk travelers to the United States from Liberia. 

Under the new screening protocol, states can decide to continue the current active monitoring of low-risk travelers from Liberia entering their state or to allow low-risk travelers to self-monitor. Travelers will be given a modified CARE kit (without the cellphone) and advised to report to the local health department if they develop any Ebola-like symptoms. 

The Texas Department of State Health Services and all other state health departments are assessing if active monitoring should continue or if CDC's recommended step-down protocol will be followed in Texas. TMA will provide updates on how this will proceed in Texas. 

For more information, visit the WHO website. CDC also has a flyer that instructs patients on what to do when arriving to the United States from a country that had an Ebola outbreak.

Ebola Resource Examines Dallas Contact Tracing, Monitoring

It has been months since the last U.S. Ebola patient received a clean bill of health, yet public health officials continue to examine the response to the disease to plan and prepare for possible future cases. 

"Active Tracing and Monitoring of Contacts Associated With the First Cluster of Ebola in the United States," published in the May edition of the Annals of Internal Medicine, discusses the process of contact tracing during the U.S. Ebola investigation. The paper identifies key experiences from contact tracing implementation and monitoring that may assist ongoing Ebola preparedness efforts.

Wendy Chung, MD, chief epidemiologist for Dallas County Health and Human Services, and former Texas Department of State Health Services Commissioner David Lakey, MD, are among the paper's authors. 

Revised Student Vaccine Requirements Available

The revised 2015-2016 Texas Minimum State Vaccine Requirements for Students Grade K-12 is now available from the Texas Department of State Health Services (DSHS) Immunization Branch. 

School administrators, health personnel, and parents will receive letters regarding the revised immunization requirements, which play a vital role in maintaining the health and well-being of Texas students.  

Contact the DSHS Immunization Branch at (800) 252-9152 for more information.  

AMA, AHA Principles Guide Successful Physician-Hospital Relationships

Implementing health care delivery and payment reforms isn't easy. A recent American Medical Association study with RAND Corporation points to the need for collaboration among physician and hospital leadership in an ever-changing health care environment. 

The new Principles of Integrated Leadership for Hospitals and Health Systems (AMA log-in required) from AMA and the American Hospital Association can help physicians "bring clinical skills and business insights together at the leadership level to foster more collaborative and cohesive decision-making at hospitals and health systems," according to the June 3 edition of AMA Wire

AMA lists six principles of success for integrated leadership between hospitals and physicians: 

  1. Physician and hospital leaders who are united.
  2. An interdisciplinary structure that supports collaborative decision-making. 
  3. Clinical physician and hospital leadership present at all levels of the health system. 
  4. A partnership built on trust. 
  5. Open and transparent sharing of clinical and business information. 
  6. A clinical information system infrastructure that is useful.  

TMA provides education and services to help employed physicians, including the publications Employment Contracts for Physicians: The Comprehensive Guide, Second Edition and Business Basics for Physicians, as well as the on-demand webinar Business Boot Camp: Take Charge of Your Finances.

For additional resources, visit the TMA Employed Physicians Resource Center

PC Action Ad Nov 13  

TMA Foundation Gala Sets Record

The TMA Foundation's (TMAF's) May 1 event, A Lawn Party, held in Austin during TexMed 2015, broke previous gala fundraising records, thanks to the leadership of cochairs Michelle A. Berger, MD, and David N. Tobey, MD, and Susan M. Pike, MD, and Harry T. Papaconstantinou, MD, and the generosity of sponsors and guests.

The 22nd annual TMAF gala raised more than $386,000, which enables the foundation to support TMA's annual award-winning programs, such as Hard Hats for Little Heads and the Minority Scholarship Program, Walk With a Doc Texas, and dozens of local programs sponsored by county medical societies and TMA Alliance and medicals student chapters of TMA.

Nearly 500 physicians, alliance members, and guests enjoyed A Lawn Party at the Hilton Austin. Top sponsors St. David's Healthcare/St. David's Foundation (lead sponsors), H-E-B, the Texas Medical Liability Trust, Pfizer, Baylor Scott and White Health, Blue Cross and Blue Shield of Texas, the TMA Insurance Trust, and TMA joined 40 additional sponsors and more than 60 volunteers to ensure the event's success.

The foundation honored its Austin Health Leaders for their collaborative efforts at creating a Healthy Now and a Healthy Future for more Texans. Austin physician Celia Neavel, MD, was recognized as the Individual Health Leader, and St. David's Foundation was recognized as the Program Health Leader. 

Guests enjoyed silent and live auctions, lawn games, and the Blue Mist Band, a fun and funky Austin group that kept everyone grooving until doors closed. Guests voted for the best Lawn Legs among four TMA leaders by donating for their favorite. TMA Chief Executive Officer Lou Goodman won.

Proceeds from the gala support TMAF and the TMA and TMA Alliance programs that mobilize medicine, business, and community to improve the health of all Texans. Learn more about the work of TMAF and the outstanding programs it makes possible.

Apply for the TMA Leadership College by July 1

TMA is now accepting applications for the TMA Leadership College Class of 2016. 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.

Participate in Medicaid HIT Survey

The Texas Health and Human Services Commission (HHSC) has partnered with the F. Marie Hall Institute for Rural and Community Health of the Texas Tech University Health Sciences Center to survey Texas physicians regarding various health information technology (HIT) programs. 

Your response to this survey guides Texas Medicaid, HHSC, and their partners when planning HIT programs aimed at benefiting the Texas health care community. 

The survey should take less than 10 minutes to complete. 

This Month in Texas Medicine

The June issue of Texas Medicine features a cover story on Congress' permanent and immediate repeal of the flawed Sustainable Growth Rate (SGR) formula used for years to pay physicians who see Medicare patients. In the issue, you’ll also find the latest on litigation over the ownership of Knapp Medical Center in Weslaco, information about an initiative aimed at preventing 1 million heart attacks and strokes by 2017, findings from a report that reveals the toll gestational diabetes takes on the state's Medicaid recipients, and vendor contract guidance for physicians in private practice. 

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.  

On-Demand Webinars

 Achieving ICD-10 Implementation Success    
ICD-10 Documentation and Auditing: Success Is in the Details
ICD-10 Starts With Physicians 

Conferences and Events

TMA Fall Conference
Sept. 25-26

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Last Updated On

December 19, 2016