Action: March 1, 2016

TMA Action March 1, 2016   News and Insights from Texas Medical Association

TMA Asks TMB to Withdraw Proposed Call Coverage Rules
Physicians: CMS Must Improve PQRS Feedback, Review Processes
Today Is Election Day; Vote for Medicine's Candidates
CMS Clarifies Meaningful Use Hardship Exemptions
PQRS: Report 2015 Data Now to Avoid 2017 Penalties
TexMed 2016 Coming to Dallas April 29–30; Register Now
Physicians Foundation Survey Gauges Your Satisfaction
TMA Live Webcast Explores Hot Button Legal Issues
TMA Foundation Grants Record Amount to TMA Programs
Special Offer for TMA Members From TransFirst
TMA Foundation Gala Entertainment by Hunter Sullivan
This Month in Texas Medicine

Physicians: CMS Must Improve PQRS Feedback, Review Processes

Problems with the Centers for Medicare & Medicaid Services (CMS) feedback and informal review processes in the Physician Quality Reporting System (PQRS) continue to plague physicians. The American Medical Association, the Medical Group Management Association (MGMA), and 43 national specialty societies told CMS Acting Administrator Andrew Slavitt in a letter that "the agency is merely adding red tape to an already administratively onerous program" rather than driving quality improvement.

The letter describes a multitude of data errors by CMS and the agency's mishandling of data submitted by physicians who participated in the 2014 reporting period for the PQRS and value-based payment modifier (VBM) programs. It expresses concern "that physicians and group practices will be incorrectly penalized under the PQRS Program as a result of CMS' inadequate feedback and informal review request processes." 

The Texas Medical Association advocates relief for physicians who face penalties based on the hassle caused by CMS. In a Dec. 8 letter, TMA President Tom Garcia, MD, along with AMA, asked Congress "to tell CMS to back off on penalizing physicians who in good faith participated in PQRS in 2014." Dr. Garcia emphasized in the letter CMS' "'issues' meant that thousands of U.S. physicians will now see their Medicare payments cut by 2 to 4 percent next year." 

"Our experience of just the past few months has proven that CMS is much better at generating mass confusion than it is at helping physicians care for Medicare and Medicaid patients," Dr. Garcia wrote. "The agency's incompetence only multiplies the burden of numerous, overly complex regulations it forces onto physicians."  

As a result of the flawed PQRS reporting results, physicians could get hit with up to a 6-percent payment cut in 2017 and 2018. The letter warns that as Medicare converts to the Merit-Based Incentive Payment System, the "need for relevant and comprehensive performance information will only increase."

Among the blunders uncovered with the 2016 feedback and informal review processes "was a complete lack of transparency regarding the reason that CMS assessed a penalty or determined an eligible professional (EP) or group practice was ineligible for an incentive. Although the lynchpin of successful PQRS participation was achieving a reporting rate of 50 percent or greater for the required number of measures, CMS failed to include any reporting rate information in the 2014 PQRS Feedback Reports. Rather, CMS included only the measure performance rate, which looks not at the frequency with which measures were reported, but at the number of reported encounters that met the desired process of care or outcome, and is completely distinct from PQRS evaluation." The letter stresses physicians spent countless hours attempting to interpret their PQRS performance "only to eventually arrive at the conclusion that this information was inapplicable."

Read more about this issue and TMA's advocacy efforts in the March issue of Texas Medicine

CMS' missteps may have a lasting impact on physicians and group practices who participated in PQRS. The letter says "needless obstacles" that vexed the 2016 PQRS feedback and informal review processes "prevented physicians and group practices from understanding their performance, which in turn prevented them from contesting potentially unwarranted penalties. Without complete and actionable data as well as a streamlined process for correcting data inaccuracies and unwarranted penalties, physicians and group practices may not only be subjected to unfair Medicare reductions in the immediate payment year, but also in future years as they are unable to correct unidentified reporting issues."

The organizations that signed the letter also provide recommendations for CMS to improve the processes, specifically delving into CMS' incomplete and inconsistent feedback, lack of recourse for vendor transmission issues, inadequate assistance from the QualityNet Help Desk, and faulty informal review process. They "strongly recommend" CMS: 

  • Clearly articulate the cause for a penalty assessment in the PQRS feedback report;
  • Promptly communicate and remedy errors in the PQRS feedback reports;
  • Hold harmless groups and physicians whose data was unsuccessfully transmitted by third-party vendors;
  • Expand QualityNet Help Desk training and access to feedback information; and
  • Fix flaws in the informal review process. 

Help From TMA

TMA is collaborating with TMF Quality Innovation Network Quality Improvement Organization (QIN-QIO) to connect TMA members to free consulting services and technical assistance to help them navigate Medicare requirements to avoid penalties and maximize value-based payments. Join the TMF Value-Based Improvement and Outcomes Network to take advantage of free services. (Learn more about TMF QIN-QIO in the December 2015 issue of Texas Medicine.) 

Visit TMA's PQRS Resource Center for more on how to participate in the PQRS and VBM programs.

TMA Asks TMB to Withdraw Proposed Call Coverage Rules

TMA weighed in strongly against proposed new Texas Medical Board rules that one Dallas physician called "totally bizarre and dangerous." The new rules state that physicians who enter into call coverage agreements "are contractually obligated and mutually responsible for meeting the standard of care" for established patients and for sharing documentation of any call coverage provided. 

TMA asked the board to withdraw the proposed rules and start over. "Physicians are, and should be, responsible for their own acts, not for the acts of other physicians solely due to on-call arrangements," TMA President Tom Garcia, MD, wrote in TMA's formal letter to TMB. "Physicians are, and should be, responsible for exercising reasonable care in making on-call arrangements, but cannot and should not be held liable for the acts of another physician who accepts on-call responsibility, and vice-versa. On-call arrangements do not involve 'delegated' acts in which the physician is supervising another health care worker."

"As currently drafted, the proposed rules raise numerous valid questions, place into jeopardy current on-call arrangements that work well and add barriers to maintaining and obtaining on-call arrangements," the letter states.

Today Is Election Day; Vote for Medicine's Candidates

Did you miss your chance to vote early? That doesn't mean you missed your chance to vote in the party primaries. Today is Election Day, and TEXPAC's endorsed candidates — selected with the support of your local colleagues — need your vote.

Here's the full list of TEXPAC's endorsed candidates. These are going to be some very tight races, so encourage your family, friends, colleagues, staff, and patients to vote as well.

"If you're waiting for the November General Election to get engaged in Texas politics this year, you'll be too late," said TEXPAC Board Chair Brad Holland, MD. "With so few competitive districts around the state, the action is now, in the party primaries. The men and women who win their party's nominations in the next few weeks very likely will be the people who will be making the final decisions in the legislature and in the courtrooms next year."

In addition to 16 state Senate races, 127 Texas House contests, and eight courts of appeals candidates, TEXPAC has endorsed three candidates for the Texas Supreme Court. They are: 

  • For Place 3: Justice Michael Massengale (R)
  • For Place 5: Justice Paul Green (R) — Note: there are two men named "Green" who are seeking this seat. Both are lawyers. That's about all they have in common. Which Green? Paul Green for Supreme Court.
  • For Place 9: Justice Eva Guzman (R) 

The polls are open until 7 pm local time today. Remember, you need to take a photo ID. Please vote.

CMS Clarifies Meaningful Use Hardship Exemptions

The Centers for Medicare & Medicaid Services (CMS) says physicians applying for the meaningful use hardship exemption for payment year 2015 (which affects 2017 penalties) are not precluded from receiving the incentive if they successfully attest to meaningful use for the 2015 payment year.  

The attestation deadline for the 2015 electronic health record (EHR) meaningful use (MU) program is 10:59 pm CST on Friday, March 11. The original deadline was Monday, Feb. 29. 

Groups and individual physicians have July 1 to submit the hardship application. CMS provided more information on the hardship exception instructions

If the 2015 meaningful use modification rule delay prevented you from meeting the criteria for the 2015 reporting year, you need to review the hardship application categories to see if any of them apply to you. Categories include:  

  • Insufficient Internet connectivity, 
  • Extreme and uncontrollable circumstances, 
  • Lack of control over the availability of certified EHR technology, and
  • Lack of face-to-face patient interaction.  

If you have questions about the exemption and application, contact TMA's Health Information Technology Department by email or calling (800) 880-5720. 

 Action TMLT Ad 10.15       

PQRS: Report 2015 Data Now to Avoid 2017 Penalties

If you plan to participate in Medicare's Physician Quality Reporting System (PQRS) and value-based payment modifier (VBM) programs for the 2015 performance period, now is the time to submit your data on quality measures. Depending on the reporting mechanism used, deadlines vary from February through March 2016.

According to the Centers for Medicare & Medicaid Services (CMS), all eligible professionals who get paid under the Medicare Part B Physician Fee Schedule (MPFS) must comply with quality reporting requirements annually. In 2017, Medicare payment under the MPFS will be based on 2015 quality and cost performance, assessed under the PQRS and VBM programs. Failure to report data will result in an automatic 2-percent pay cut under PQRS, plus another automatic 2-percent to 4-percent pay cut under VBM. To see how much these penalties will affect your practice in 2017, visit the TMA PQRS Resource Center to access the Medicare payment adjustment calculator. To avoid the penalties, choose a reporting mechanism that best fits your practice, and submit your 2015 data by the deadline. 

Submission Deadlines for the 2015 PQRS Reporting Period  

Note: Data submitted to PQRS do not automatically satisfy the clinical quality measure component of the meaningful use program. However, the option to report data only once for Medicare's quality programs is available and requires a specific submission process. For complete details, see this CMS guide and visit the CMS website

Get Free Help From TMF

Do you report PQRS data and need some help, or are you new to PQRS and don't know how to get started? Join the TMF Value-Based Improvement and Outcomes Network for no-cost technical assistance, education, and consulting services on how to navigate Medicare's requirements to successfully participate in the PQRS and VBM programs. Read more about TMF in the December 2015 issue of Texas Medicine

More Information

Stay informed about the latest PQRS news by subscribing to the free CMS PQRS listserv. For PQRS questions, contact the CMS QualityNet Help Desk, Monday through Friday, 7 am to 7 pm CT, by phone, (866) 288-8912 (select option 3, then 7), or email. For VBM questions, contact the CMS Physician Value Help Desk, Monday through Friday, 7 am to 7 pm CT, by phone (888) 734-6433 (select option 3), or email. You also can contact the TMA Knowledge Center by phone, (800) 880-7955, or email. Visit TMA's PQRS Resource Center for more information on how to participate in the PQRS and VBM programs.

TexMed 2016 Coming to Dallas April 29–30; Register Now

Join us for TexMed 2016, TMA's annual meeting, April 29–30 at the Hilton Anatole in Dallas, where we will explore Bridging the Gaps in Health Care. TexMed is a free member benefit. Register today, and review the TexMed 2016 Advance Program

You can choose from more than 80 hours of free CME programming. From business operations and the future of medicine to quality initiatives and performance improvement, TexMed offers multidisciplinary programming that encourages cross-specialty dialogue. 

Help mold TMA policy and business decisions by attending the House of Delegates and participating in reference committee meetings, where all TMA members can testify on resolutions being presented before the house. 

Visit the Expo Hall, where you'll see the newest in medical devices, technology, and practice services. Sign up for a free, 15-minute Quick Consult at the TMA Member Services booth #263 to meet face-to-face with TMA staff experts about your specific questions and practice needs.

TexMed is the place to reconnect with old friends while meeting new ones at the Welcome Reception, the TMA/TMA Alliance 2016–17 Presidents' Reception, and the TMA Foundation Gala, As Time Goes By, An Evening in Casablanca.

TexMed has something to offer everyone. Find out more in the TexMed 2016 Advance Program, or watch Texas Physicians — Come to TexMed

Visit the TMA webpage, email the TMA Knowledge Center, or call (800) 880-7955 for more information.

See you in Dallas!

Physicians Foundation Survey Gauges Your Satisfaction

How satisfied are you with the current state of medicine? The Physicians Foundation is surveying you and your 650,000 physician colleagues across the country to determine just that. The survey asks for your thoughts on health reform, electronic health records, new physician payment methods, ICD-10, and a variety of other topics. Take a few minutes to complete the survey

A full copy of the final survey report will be emailed to all physicians who participate, and participants will also be entered to win one of five $500 Amazon gift cards and one $5,000 Amazon gift card. Additionally, the Physicians Foundation is offering a $5,000 grant to the state medical society that achieves the most total survey responses and a $5,000 grant to the state medical society that achieves the highest per capita response. As a founding member of the Physicians Foundation, TMA expects to be in the running to win both of those grants. 

"This is the one national survey that allows physicians to share their perspective on the state of the medical profession," said Walker Ray, MD, Physicians Foundation president. "We'd like to hear from as many physicians as possible so we can accurately understand — and share with the public — physicians' perspectives on the most significant issues in medicine and health care today."

A nonprofit, grant-making organization, the Physicians Foundation is determined to strengthen the patient-physician relationship and help physicians sustain their medical practices in today's practice environment. The Physicians Foundation focuses on physician leadership, physician practice trends, physician shortage issues, and the impact of health care reform on physicians and patients.

To access previous Physicians Foundation surveys, visit the foundation's website.  

 TMAIT Action Ad 6.15     

TMA Live Webcast Explores Hot Button Legal Issues

By Amanda B. Hill, JD

Physician groups are growing rapidly. Along with such growth comes an entirely new set of issues, some of which have legal and financial risks to a practice. You can learn more during a live webcast I'll be presenting for TMA, Hot Button Legal Issues in a Physician Practice, March 10 at 6:30 pm CST. Register now.

Some of the topics covered are: 

  • HIPAA training and policies;
  • Staff training on fraud and abuse;
  • Audits;
  • Physician and nonphysician practitioner contracts; 
  • Joint ventures; and
  • Business associate agreements.

The first thing I encourage practices to do is form a compliance plan. While it used to be discretionary, now it's mandatory. Having a robust compliance plan is a lifesaver for a practice because it helps you spot issues before they become major problems.

Another area of weakness I often see falls in the world of contracting. Payer contracts have to be negotiated and renegotiated to consistently ensure market rates. There are also physician and nonphysician practitioner contracts. Make sure there are provisions covering noncompetes, tail insurance, and clear termination clauses if the relationship turns sour. Similarly, vendor contracts can be tricky, locking a practice into years of services without relief. It's a good idea to make sure venue for any contract dispute is set locally and there's a clear exit strategy. And if the vendor at all touches protected health information, you might need a HIPAA business associate agreement. 

Policies are also important. Your employee handbook can contain valuable protections for your practice, spelling out non-retaliation issues, explaining your position on overtime, and encouraging reporting of compliance concerns. Also, if a HIPAA violation occurs, the first thing the Centers for Medicare & Medicaid Services will do is ask for a copy of your HIPAA policies and procedures. Also, I recommend practices take a look at their company bylaws or operating agreements. 

The world of health care is extremely complicated. Codes, rules, and billing practices change over time. It's wise for physician groups to perform a legal audit, either internally or with the help of someone on the outside. 

Amanda Hill is a health care attorney based in Austin.

TMA Foundation Grants Record Amount to TMA Programs

TMA's health improvement, quality, and science initiatives will reach more Texans in 2016 thanks to a record high of more than $540,000 in grants awarded by the TMA Foundation. The increase reflects newly funded programs, such as the University of Health and expansions in previously funded initiatives, such as Be Wise—ImmunizeSM and the Award for Excellence in Academic Medicine.

Funded TMA initiatives in 2016 are: 

  • Hard Hats for Little Heads,
  • Be Wise — Immunize,
  • Ernest and Sarah Butler Awards for Excellence in Science Teaching,
  • Minority Scholarship Program,
  • Walk with a Doc — Texas,
  • Award for Excellence in Academic Medicine,
  • University of Health,
  • Hepatocellular Carcinoma Awareness Campaign,
  • HPV webinar CME, and 
  • Texas Two-Step: How to Save a Life Initiative.

The Choosing Wisely program retired in April 2015, but physician and patient education materials are still available on the TMA website. Visit the TMA Foundation online for more details on each of these outstanding TMA programs.

Grants are made possible thanks to donations from individuals, corporations, and foundations, as well as endowments. TMAF is the 501 (c)(3) charitable arm of TMA. Learn more about the initiatives that the foundation supports or make a tax-deductible gift online or by calling call (800) 880-1300, ext. 1466, or (512) 370-1466.

Be Wise — Immunize is a service mark of the Texas Medical Association.

Special Offer for TMA Members From TransFirst

TransFirst, a TMA-endorsed payment processing vendor, is offering special flat-fee pricing and a free EMV (Europay, MasterCard, and Visa) credit card processing terminal for TMA members. 

Flat-fee pricing includes a 2.49-percent fee on all credit card transactions, as well as no setup, application, or additional transaction fees. This offer also ensures no Payment Card Industry fee or gateway fees. As an added benefit, members can also get a free Ingenico iCT 220 EMV-ready chip card processing terminal (a $399 value). 

Please note all accounts are subject to TransFirst credit approval to qualify for this offer, which is good until March 31. Members can get started by calling TransFirst at (844) 254-4280 and mentioning this offer. 

TransFirst is just one of many services and discounts offered as a perk of membership through TMA's endorsed vendor services. Discounts offered, which include computer, office supply, web marketing services, and more, allow you to leverage your membership in the largest state medical association in the country. Available only to TMA members, these programs are an excellent value that can help you save money on products and services you use every day in your practice or in your home.   


TMA Foundation Gala Entertainment by Hunter Sullivan

TMA Foundation (TMAF) board member and major donor Lee Ann Pearse, MD, and Einar Vagnes, of Dallas, serve as host city chairs for an evening inspired by the 1944 Academy Award-winning film Casablanca on Friday, April 29, held in conjunction with TexMed 2016 at the Dallas Hilton Anatole. The gala features two guest receptions, a silent auction, an elegant dinner with a spirited game of Heads or Tails, and a chance to outbid your friends for a trip to Paris in the live auction. 

Hunter Sullivan, a Dallas-based singer/songwriter/bandleader, will provide after-dinner entertainment. Mr. Sullivan and his ensembles bring to the gala their authentic presentation of the best in Great American Songbook, classic pop, and romantic ballads. He will perform not only the Big Band classics (Benny Goodman, Count Basie, Duke Ellington, Glenn Miller, and others) but also custom vocal renditions of material popularized by Frank Sinatra, Bobby Darin, Tony Bennett, Sammy Davis Jr., and others. 

Your attendance supports TMA's award-winning initiatives, such as Walk with a Doc Texas, Be Wise — ImmunizeSM, Hard Hats for Little Heads, and more. 

Advance tickets to the foundation's gala are available for $200 each, or get VIP tickets for $250, by calling TMAF at (800) 880-1300, ext. 1466, or (512) 370-1466. Tickets also are available on TMAF's webpage. After April 22, ticket prices increase to $225 for general guest tickets and $275 for VIP guest tickets.

Be Wise — Immunize is a service mark of the Texas Medical Association.

This Month in Texas Medicine

The March issue of Texas Medicine features a cover story that highlights a new partnership in West Texas that addresses some of the challenges the state faces in getting physicians into rural practice. The University of North Texas Health Science Center and the Texas College of Osteopathic Medicine are partnering with Midland College and Midland Memorial Hospital to keep their own crop of future doctors in the Permian Basin. In the issue, you'll also find information on Austin Regional Clinic's successful patient feedback pilot program; using the informed consent process as an opportunity to improve patient safety and patient-centered care; the Texas Association of Acupuncture and Oriental Medicine's scope of practice lawsuit against the Texas Board of Chiropractic Examiners; physicians at risk of payment cuts stemming from difficulties the Centers for Medicare & Medicaid Services had with collecting and analyzing 2014 quality data; and medicine's efforts to bring awareness to rising rates of hepatocellular carcinoma.

Click to launch the digital 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.  

 Last Day for Registry Reporting via Covisint PQRS

Last Day for PQRS Electronic Health Record (EHR) Reporting 
Last Day for PQRS Group Practice Reporting Option (GPRO) Web Interface Reporting
Last Day for PQRS Qualified Clinical Data Registry Reporting (using QRDA III format)


 Last Day for Registry Reporting via PQRSwizard

Last Day for PQRS Qualified Clinical Data Registry Reporting (using XML format) 
Last Day for PQRS Registry Reporting

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.  

Live Webcast

Hot Button Legal Issues in a Physician Practice
March 10, 6:30 pm CST

On-Demand Webinars

Making Discussions About Death and Dying Easier
Business Boot Camp: Take Charge of Your Finances
Avoiding Fraud and Abuse 

Conferences and Events

TexMed 2016
April 29-30
Dallas Hilton Anatole

About Action       

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Last Updated On

October 13, 2017