Action: Nov. 16, 2015

 TMA Action Nov. 16, 2015   News and Insights from Texas Medical Association

Tell ONC Your EHR Complaints
Texans Take Three Resolutions to AMA House Meeting
Review Your PQRS Feedback Report and QRUR Now
Lawmakers Get Head Start on 2017 Health Care Issues
Dr. John Hellerstedt Is the New DSHS Commissioner
AMA Group Aims to Reduce Inappropriate Opioid Prescribing
TMA Wants Improvements in Medicaid and Medicaid Managed Care
Be One of Tomorrow's Physician Leaders
Looking for the Top Health News of 2015
TMF Network Aims to Boost Adult Immunization Rates
Be a Preceptor; Help Shape the Next Generation of Medicine
New Resource for Children With Special Health Care Needs
Register for DSHS Infectious Disease Response Workshops
This Month in Texas Medicine

Tell ONC Your EHR Complaints

Electronic health records (EHRs) are becoming ubiquitous, with 69 percent of Texas physicians now using them to record patient visits. Physician satisfaction varies with EHRs, and sometimes it depends on the product purchased or leased.  

The Office of the National Coordinator for Health Information Technology (ONC) oversees the certification of EHR products. ONC wants to hear your health information technology (HIT)-related concerns or complaints. These complaints can cover a variety of topics, such as:  

  • Health IT certification issues, 
  • Information blocking, 
  • Health IT safety, 
  • Product usability, 
  • Privacy and security, and 
  • Clinical quality measures. 

Use the Health IT Complaint Form website so ONC can hear your concerns.

On a side note, physician and rapper Zubin Damania, MD, known as ZDoggMD, released a video that starkly presents physician attitudes toward EHRs. Take a moment to enjoy his perspective. The video was created in collaboration with EHR vendor athenahealth. While not a formal complaint system, athenahealth is collecting stories from physicians about EHR issues in an effort to influence industry change. 

Additionally, in an ongoing effort to improve EHRs and interoperability of EHRs, the American Medical Association is assisting ONC with gathering information to improve the patient summary document produced for the Transitions of Care objective in Stage 2 of meaningful use. Completing this 5- to 10-minute survey on the data for the summary-of-care document will help ONC standardize the necessary data elements, reducing the length of the document, eliminating data "noise," and making it easier to find relevant information.  

The survey closes on Nov. 30. Your input will make information at the point of care valuable for you and your patients.  

If you have questions about EHRs and meaningful use, contact TMA's HIT Department by email or by calling (800) 880-5720.  

Texans Take Three Resolutions to AMA House Meeting

The American Medical Association House of Delegates convened for its 2015 interim meeting in Atlanta on Nov. 14. The Texas Delegation to the AMA took three new policy resolutions for the house to consider: 

  • Resolution 808 is the first of two items we are taking regarding balance billing. It asks AMA to seek changes in federal law to require health insurers to disclose their median in-network payment rates and the amount they pay for out-of-network emergency services. It also asks for a federal law to allow people who buy their insurance from the Affordable Care Act marketplace to be able to buy additional coverage that would pay in-network benefits for out-of-network claims for labor and delivery, emergency care, and any subsequent in-hospital care.
  • Resolution 215 is a reaction to the National Association of Insurance Commissioners' (NAIC's) move to inappropriately regulate physicians by prohibiting out-of-network billing in certain circumstances. Our resolution calls on AMA to push the Centers for Medicare & Medicaid Services (CMS) — not NAIC — to develop and adopt strong network adequacy standards for health plans offered on the ACA exchange.
  • Resolution 216 would direct AMA to advocate that CMS develop a one-portal system with a single user name and password for all physician data reporting and retrieval in Medicare quality programs.   

Review Your PQRS Feedback Report and QRUR Now

If you submitted data to Medicare's Physician Quality Reporting System (PQRS) for the 2014 reporting period, now is the time to review your quality reports. The reports include information about your quality and cost performance and whether you'll get hit with penalties or receive bonus payments. You must act quickly, as the deadline to appeal any errors is Dec. 16, 2015. 

Quality Reports

Medicare is moving toward physician payment that is based on value rather than volume. The intent of the quality programs is to let you assess the quality and efficiency of your medical care through feedback reports so you can identify gaps in care and improve performance, resulting in better care and reduced costs for Medicare fee-for-service beneficiaries. 

On Sept. 9, Medicare announced the release of two quality reports. The first report is the 2014 PQRS feedback report, which contains information about your quality performance and whether you will receive a payment cut in 2016 or an incentive payment this year. If you receive the penalty, you will be subject to a 2-percent pay cut on a per-claims basis under the 2016 Medicare Physician Fee Schedule. If you are eligible for the bonus, Medicare will issue a separate, consolidated incentive payment to you electronically or via check later this fall.

The other report is the annual Quality and Resource Use Report (QRUR), and it is available to all solo physicians and group practices this year. The QRUR is a component of Medicare's value-based payment modifier (VBM) program. The VBM aligns with and is based on your participation in PQRS. The QRUR provides detailed information about your quality and cost performance and how you compare to your peers. Under this program, Medicare used quality and cost data from 2014 to calculate the value-modifier score for group practices with 100 or more eligible professionals. That score determines whether the physicians in the group practice will receive an adjustment payment boost, no change, or a cut up to 2-percent on a per-claims basis under the 2016 fee schedule. 

For group practices with 10 to 99 eligible professionals, physicians will receive no payment change or a 2-percent increase in 2016. High performers treating high-risk beneficiaries will receive an additional 1 percent in payment in both group sizes. For solo physicians and smaller group practices, the QRUR is provided for informational purposes this year, and the VBM will not affect payment in 2016. Note that in 2017 the VBM will apply to all solo physicians and groups regardless of practice size based on 2015 data. Read more about Medicare's quality reports in the July 2015 issue of Texas Medicine.  

In July, Medicare retired the Individual Authorized Access to CMS Computer Services (IACS) system and transitioned data to the Enterprise Identity Management System (EIDM). Please note that you will need an EIDM account to access your quality reports. It has been brought to TMA’s attention that registration for an EIDM account may take as long as two weeks, so start this process now before it’s too late. 

Appeals Process 

If you disagree with Medicare's analysis of your performance or believe your final determination is incorrect, submit what is called an "informal review request" by Nov. 23, 2015. This is the only appeals process Medicare has for the PQRS and VBM programs. Once a request has been submitted, Medicare will review your data and respond to you through email within 90 days of your submission.  

Where to Turn For Help

For no-cost technical assistance on how to access and interpret your report, turn to the TMF Quality Innovation Network Quality Improvement Organization (QIN-QIO). Under contract with Medicare, the TMF QIN-QIO provides free consulting services and technical assistance to solo physicians, group practices, and other health care professionals for Medicare's quality programs.

For help with your quality reports or the informal review request process, contact Tracy Swoboda at the TMF QIN-QIO by phone at (361) 258-1053 or email. And join the free TMF Value-Based Improvement and Outcomes Network to learn how to successfully participate in the PQRS and VBM programs to improve performance and maximize your Medicare payment.

Visit TMA's PQRS Resource Center for more on how to participate in the Physician Quality Reporting System.

Lawmakers Get Head Start on 2017 Health Care Issues

The 140 days the Texas Constitution allocates every other year for a state legislative session is never enough time for lawmakers to study and grasp all they need to do with the most complex issues. House and Senate committees use the time between sessions — the interim — to conduct research, hold hearings, and draft bills. Lt. Gov. Dan Patrick and House Speaker Joe Straus have laid out their interim charges to the committees; health care issues will get a share of legislators' attention. 

Medicaid — including the 1115 waiver — trauma systems, workers' compensation, out-of-network billing, public health preparedness, chronic diseases, telemedicine, prompt pay, and behavioral health are all on the committees' lists. TMA leaders and lobbyists will monitor the work closely, providing background and perspective to lawmakers and their staff, arranging witnesses for hearings, and suggesting language for the draft bills that emerge. Stay tuned.

Notable Senate interim charges include: 

  • Review the Texas Medicaid programs providing long-term services and support to adults or children with medical, physical, or intellectual and developmental disabilities (IDD). Study reimbursement methodologies, the historical appropriated slot allocation compared with the actual fill rate, the procedure of releasing slots to providers, and the impact and timeline of carving services into Medicaid managed care. Identify potential obstacles for the delivery of community long-term services and support, including the availability of community care workers. Make any needed recommendations to improve community long-term services and supports.
  • Examine the historical growth of the Texas Medicaid program, including factors affecting caseload and cost trends. Review legislative or policy initiatives created to detect or deter waste, fraud, and abuse; to reduce cost; or improve the quality of health care in the Texas Medicaid program. Evaluate the effectiveness of, and identify savings associated with, these initiatives.
  • Review the Health and Human Services Commission's Medicaid managed care organizations' policies and procedures including a review of quality initiatives. Study contract management and assess the Vendor Drug Program drug formularies and current function. Identify the savings achieved by moving Medicaid into managed care. Determine what mechanisms or policies could be modified or strengthened to encourage increased participation or retention of health care providers in the Medicaid managed care system.
  • Examine the effectiveness of previous legislative efforts to encourage transparency and adequacy of health care networks and of legislation to protect consumers from the negative impacts of disputes over out-of-network services. Study whether enhancements in transparency or regulation are necessary.
  • Examine the history of telemedicine in Texas and the adequacy of the technological infrastructure for use between Texas health care providers. Review the benefits of using telemedicine in rural and underserved areas and current reimbursement practices. Explore opportunities to expand and improve the delivery of health care and identify methods to increase awareness by provider groups, including institutions of higher education, and payers of telemedicine activities being reimbursed in Texas. 

Notable House interim charges include: 

  • Study the impact of the Section 1115 Texas Health Care Transformation and Quality Improvement Program Waiver on improving health outcomes, reducing costs, and providing access to health care for the uninsured, and monitor the renewal process of the waiver. Explore other mechanisms and make recommendations to control costs and increase quality and efficiency in the Medicaid program, including the pursuit of a block grant or a Section 1332 Medicaid State Innovation Waiver for the existing Medicaid program.
  • Study and make recommendations on the appropriate use, scope, and application of tele-monitoring and telemedicine services to improve management and outcomes for adults and children with complex medical needs and for persons confined in correctional facilities. Examine barriers to implementation of these services and any impact on access to health care services in rural areas of the state.
  • Study and make recommendations on establishing collaborative partnerships between state-owned mental health hospitals and university health science centers to improve inpatient state mental health services, maximize the state mental health workforce, and reduce health care costs.

In addition, Speaker Straus created a special committee to study and recommend improvements in mental health care. 

    TMAIT Action Ad 6.15 

Dr. John Hellerstedt Is the New DSHS Commissioner

Austin pediatrician John Hellerstedt, MD, is returning to state government as the new Texas health commissioner. He will begin his new duties on Jan. 1, 2016. 

Dr. Hellerstedt is the former state Medicaid director. Before that, he spent 18 years with Austin Regional Clinic. He is currently vice president of medical affairs for Dell Children's Medical Center. The Texas Department of State Health Services has been without a commissioner since David Lakey, MD, left in January. 

Austin pediatrician Stephen Pont, MD, tweeted on Nov. 9, "A big win for kids and all Texans! Thanks and congrats, Dr. Hellerstedt." 

AMA Group Aims to Reduce Inappropriate Opioid Prescribing

Physicians have a professional obligation to reverse the nation's opioid epidemic. That's the message of the American Medical Association Task Force to Reduce Prescription Opioid Abuse. The task force focuses on reducing the inappropriate prescribing of opioids and the growing crisis of heroin overdose and death. The task force, chaired by AMA Chair-Elect Patrice A. Harris, MD, includes physician leaders and staff from across the nation. For more information, AMA members can log in and download the Task Force Overview document.

AMA says each of the task force's 25 medical society members recognize physicians must be the ones to develop and implement specific recommendations designed to have a measurable impact on ensuring effective pain management practices and the evidence-based prescribing of opioids. Physicians also have a role in promoting appropriate referrals and access to care for patients with substance use disorders and taking necessary steps needed to reduce opioid-related harm, according to AMA. 

The five goals of the task force are:  

  1. Increase physicians' registration and use of effective prescription drug monitoring programs.
  2. Enhance physicians' education on effective, evidence-based prescribing. 
  3. Reduce the stigma of pain and promote comprehensive assessment and treatment. 
  4. Reduce the stigma of substance use disorder and enhance access to treatment.
  5. Expand access to naloxone in the community and through co-prescribing. 

Expanded access to naloxone, which reverses an overdose, is now available in Texas. The drug can be administered in an emergency department but also prescribed as a take-home medication to be used in emergencies. The new Texas law, strongly supported by TMA, allows doctors to prescribe naloxone directly or by standing order to:  

  • A person at risk of experiencing an opioid-related drug overdose, and
  • A family member, friend, or other person in a position to assist a person at risk of experiencing an opioid-related drug overdose.  

Naloxone can be supplied as an intramuscular injection, intramuscular auto-injector, or intranasal spray. The intranasal formulation is considered off label and is delivered through an atomizer.  

TMA Wants Improvements in Medicaid and Medicaid Managed Care

TMA and the Texas Pediatric Society submitted 16 recommendations to the Texas Health and Humans Services Commission (HHSC) that would improve the Medicaid and Medicaid managed care "provider and patient experience," per HHSC Commissioner Chris Traylor's invitation. 

Among the recommendations, the two groups request that HHSC: 

  • Require Medicaid managed care organizations (MCOs) to simultaneously process physician credentialing applications while the physician pursues Medicaid enrollment via the Texas Medicaid and Healthcare Partnership. TMA explains doing so would allow "concurrent Medicaid enrollment and HMO credentialing application processes," shortening "the timeframe for new physicians to join HMO networks, thus allowing them to see patients more quickly."
  • Simplify and streamline the Medicaid Vendor Drug Program. TMA says the program is "inordinately complex given that the management of the prescription drug benefit is split between HHSC and the MCOs." TMA says "making the pharmacy benefit more transparent and easier to use will reduce program hassles for physician practices."
  • Eliminate use of the Texas provider identifier and use only the national provider identifier (NPI) number. TMA says using the NPI number instead "will streamline both processes [acute care Medicaid and Texas Health Steps] for physicians and the state."
  • Abide by Texas insurance requirements establishing that coordination of benefits is an insurance function, thus eliminating the need for costly Medicaid recoupments from physicians when a Medicaid health plan discovers a patient was erroneously enrolled in the plan. TMA says eliminating these recoupments "will help reduce Medicaid administrative costs, making the program more attractive to physicians." 

Over the coming months, TMA's Select Committee on Medicaid, CHIP, and the Uninsured will continue to solicit recommendations from county medical and specialty societies, as well as TMA's council and committee members. TMA invites physicians to submit examples of Medicaid MCO best practices so TMA can encourage their replication by other plans. TMA would also like to hear from physicians in regard to MCO practices that do not work. Email examples to Helen Kent Davis

Additionally, Medicaid physicians can now find their patients' medical histories on via the new "Blue Button." The improvement is a result of TMA advocacy efforts to make the Medicaid system easier for physicians to use and navigate.

With one easy click, the Blue Button allows doctors to view, download, print, or export consenting clients' health information, generated from the current database and claims data stored in the Medicaid Claims Administrator System.

The Texas Health and Human Services website has complete details. 

  Action TMLT Ad 10.15  

Be One of Tomorrow's Physician Leaders

The TMA Accountable Care Leadership Program graduated its inaugural class this month. The program helps ensure physicians are leading the charge in health care transformation and supports the development of physician-led organizations. The program is recruiting for the 2016 class now. If you're interested in participating, email Christina Shepherd. The next class is expected to begin in the first quarter of 2016.

"Medicine is changing, and who better than TMA to help empower our physician leaders of today and tomorrow to adapt to, and help orchestrate, these changes." said Tom Garcia, MD, TMA president. "I am truly excited that our TMA is offering physicians guidance to help them thrive and succeed in the leadership and business aspects of medical practice."

TMA launched the Accountable Care Leadership Program with TMA PracticeEdge, a physician services organization designed to support physicians in taking advantage of new payment models. 

Participants in the 10-month certificate program get an education in topics like communication skills, teamwork, and population health management. The program helps physicians adapt in a rapidly changing environment that demands more clinical and financial accountability. Payers are taking notice, with UnitedHealthcare the first on board to sponsor the TMA course with a financial grant. 

The course targets practicing physicians who recognize they need new skills and new tools to successfully oversee change in their own organizations. TMA's Ad Hoc Committee on Accountable Care worked with The University of Texas at Dallas Naveen Jindal School of Management faculty to develop the leadership program. 

UT Dallas' Healthcare Leadership and Management for Physicians certificate program delivers the program's primarily online curriculum. Physicians can access lectures, readings, quizzes, and case studies 24/7, putting in an estimated 10 hours of homework every three weeks. Ten months later, they earn a certificate from UT Dallas, plus more than 80 continuing medical education credits from TMA. About 20 physicians signed on to the pilot course, and future classes are expected to accommodate 25 to 30 participants.

"After taking this course, I feel better prepared for the many changes that are coming in health care," said Brenda Vozza-Zeid, MD, a Henderson internist. "It has helped strengthen my leadership skills and helped me to better work with people and make positive changes in the future."

For more about the program, read "Creating Leaders" in the November issue of Texas Medicine.

Looking for the Top Health News of 2015

Help TMA find the best Texas health news coverage of 2015. The TMA Anson Jones, MD, Awards honor outstanding health and medical journalism, and TMA needs your help to identify the best. If you’ve seen, heard, or read a health news report that caught your attention, nominate it for an award.

TMA family members (physicians, medical students, TMA Alliance members, and county medical societies) can nominate Texas journalists for the Anson Jones awards. Categories cover print, television, radio, and online media. Any Texas-based story from 2015 is eligible.

To nominate a journalist, simply email your nomination: the reporter's name, name of article (if available), date of broadcast/publication, and the media outlet. Please try to include a URL. 

TMA will send the reporter a postcard with a handwritten note. TMA will let the reporter know you nominated him or her and for which story/broadcast. 

Visit the Anson Jones webpage for complete nomination details and contest rules and categories. If you have questions, contact Tammy Wishard, TMA outreach coordinator, at (800) 880-1300, ext. 1470, or (512) 370-1470. 

TMF Network Aims to Boost Adult Immunization Rates

Despite the availability of effective vaccines to help prevent influenza, pneumonia, and shingles, immunization rates for adults remain too low. To help improve these numbers, the TMF Quality Innovation Network Quality Improvement Organization (QIN-QIO) has developed a new program, the Immunization Network. Participating physicians receive free help tracking and reporting immunizations via certified electronic health records, as well as help reviewing practice workflows to identify opportunities to enhance payments.

This network is just one of three physician-focused programs the TMF QIN-QIO established to help physicians save time, improve patient care, and reduce costs associated with meeting certain Centers for Medicare & Medicaid Services requirements. The other networks, which focus on behavioral health and value-based improvements, such as Medicare's Physician Quality Reporting System and value-based payment modifier program, help physicians benefit from — and not be penalized by — Medicare mandates.

For more information on participating in the Immunization Network, or to get started, visit the TMF QIN-QIO website, or download and complete the network participation agreement. Once complete, this can be emailed to your TMF QIN-QIO quality improvement consultant, or faxed to (512) 334-1775, Attention: Participation Agreement. Please note: If you wish to provide an electronic signature, you will need to download and save the document to your computer before completing it. 

For more about TMF's networks, read the December issue of Texas Medicine

Be a Preceptor; Help Shape the Next Generation of Medicine

The Texas Chapter of the American College of Physicians (TXACP) is seeking physician mentors for the summer 2016 General Internal Medicine Statewide Preceptorship Program (GIMSPP).  

Preceptors open the doors to their practice to provide a medical student with personal instruction, training, and supervision for three to four weeks. Students get the opportunity to observe the daily routine of the physician, experiencing the variety the practice of internal medicine provides. For physicians, benefits of preceptorship include:  

  • The opportunity to give back, while rekindling your passion for medicine; 
  • The ability to help advance primary care in Texas; and 
  • An enriching experience for the student and preceptor. 

"GIMSPP isn't just good for the students, it's good for the preceptors," said Susan Andrew, MD, TXACP member and long-standing preceptor. 

Preceptors must be board certified in internal medicine, possess a current Texas medical license with no restrictions from the Texas Medical Board, and practice at least 40 percent to 50 percent general internal medicine apart from any other subspecialties. 

For more information on the program or to download the preceptorship application, visit the TXACP website.  


New Resource for Children With Special Health Care Needs

Do you see children with special needs in your practice? There's a new resource you can share with their parents. 

The state's Task Force for Children with Special Needs website, Navigate Life Texas, assists families, caregivers, doctors, and other medical professionals with information about the availability of services for children with disabilities and special health care needs.

Visit or for more information.

Register for DSHS Infectious Disease Response Workshops

The Texas Department of State Health Services (DSHS) Health Emergency Preparedness and Response Section will host eight three-day workshops — one in each of the DSHS health service regions — to share in-depth, Texas-specific infectious disease preparedness and response information. The workshops will provide current strategies, assess individual levels of preparedness and response, and identify gaps in service. 

Visit the workshop website for a brochure with information on the agenda and featured speakers. To register, visit

Workshop Dates and Locations   

  • Dec. 8-10, 2015, in McAllen
  • Jan. 20-22, 2016, in New Braunfels
  • Feb. 2-4, 2016, in Houston
  • Feb. 16-18, 2016, in Austin
  • March 1-3, 2016, in Tyler
  • March 29-31, 2016, in Lubbock
  • May 3-5, 2016, in Dallas
  • June 7-9, 2016, in El Paso  

For more information, email info[at]texas-hcid-workshops[dot]org 

This Month in Texas Medicine

The November issue of Texas Medicine features a cover story on the 2015 Texas Legislature's passage of a law that heeds TMA's call for improvements in the Office of Inspector General's (OIG's) Medicaid fraud investigations of physicians. The story chronicles one physician's ongoing battle with OIG over Medicaid overpayment allegations levied against him from 2005 to 2008. In the issue, you'll also find information on the Walk With a Doc fitness program; efforts some medical schools are undertaking to arm future doctors with the nutrition knowledge they'll need; the inaugural graduating class of TMA's Accountable Care Leadership Program; and TMA's request for reversal of a court ruling that allows a Texas negligence case to proceed in New Mexico.

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.      

Nov. 23
Last Day to Appeal Errors in Your PQRS Feedback Report and QRUR

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.  


Medicare Now and Tomorrow
Nov. 3-Dec. 3

Live Webinar

Medicare Now and Tomorrow
Dec. 1

Conferences and Events

2015 TMA Advocacy Retreat
Dec. 4-5
Omni Barton Creek Resort in Austin

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 09, 2016