Action: Oct. 3, 2016

TMA Action Oct. 3, 2016   News and Insights from Texas Medical Association

TMA's Medicaid Recommendations Can Improve Care, Reduce Costs
CMS Releases PQRS Feedback Reports, QRURs
Meaningful Use Deadlines Approaching
Houston Judge Says DOs Can't File Commitment Papers
TMA Survey Documents the State of EHRs in Texas
Focus on Member Services: Future-Proofing Your Practice

I.C. System Helps You Collect More Patient Payments
Boost Community Immunity With a Be Wise — Immunize Grant
DSHS Grand Rounds Event Focuses on Down Syndrome Law
Walking Goes Viral With the U.S. Surgeon General
This Month in Texas Medicine

TMA's Medicaid Recommendations Can Improve Care, Reduce Costs

As state lawmakers begin preparing for the 2017 legislative session, TMA and four state specialty societies delivered a detailed, five-page document with significant recommendations to improve the Texas Medicaid program. Among the suggestions submitted to the Senate Health and Human Services Committee:   

  • Enact creative solutions to increase health care coverage among low-income Texans;
  • Cut Medicaid managed care red tape, and pay physicians competitive Medicaid and Children's Health Insurance Program rates;
  • Promote better birth outcomes by enhancing women's access to preventive, primary, and behavioral health care;
  • Increase access to evidence-based community and crisis mental health and substance abuse services; and
  • Improve state efforts to provide women's preventive and primary care. 

The organizations' recommendations cite Texas' uninsured rate, with more than 5 million Texans lacking health insurance. "Among adults, the majority of the uninsured work, but either they cannot afford employer-sponsored insurance, or it isn't available. Purchasing private health insurance is prohibitively expensive for low-income families. But insuring more low-income Texans does not have to mean expanding traditional Medicaid. A half-dozen conservative states —  including Indiana and Michigan — have implemented innovative programs to privately insure more people mostly paid for with federal dollars," the testimony states. 

Rather than expanding traditional Medicaid, TMA, the Texas Pediatric Society, the Texas Academy of Family Physicians, the Texas Association of Obstetricians and Gynecologists, and the American Congress of Obstetricians and Gynecologists-District XI urge lawmakers to "develop a plan, tailored to Texas' unique circumstances, to cover more than 1 million uninsured individuals." They explain the plan would "provide low-wage, working Texans with private insurance that includes copays and personal responsibility."

The organizations' testimony also supports efforts to extend the 1115 Medicaid Transformation Waiver. "Even with broader health care coverage, the safety net system's ability to care for vulnerable Texans will be seriously imperiled if hospitals lose supplemental federal funding for uncompensated care. Moreover, the Delivery System Reform Incentive Payments funding designed to test new ways to deliver and pay for care is starting to show genuine improvements in health outcomes. The waiver renewal must ensure greater community-based physician involvement in waiver planning and evaluation," they wrote. 

CMS Releases PQRS Feedback Reports, QRURs

If you submitted data to Medicare's Physician Quality Reporting System (PQRS) for the 2015 program year, 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. Access and review your reports now, as the deadline to appeal any errors is Nov. 30, 2016.

Quality Reports

On Sept. 26, Medicare announced the release of two quality reports. The first report is the 2015 PQRS feedback report, which contains information about your quality performance and whether you will receive a payment cut in 2016. If you receive the penalty, you will get a 2-percent pay cut on a per-claim basis under the 2017 Medicare Physician Fee Schedule (PFS). 

The second report is the annual Quality and Resource Use Report (QRUR), a component of Medicare's Value-Based Payment Modifier program. The QRUR provides detailed information about your quality and cost performance and how you compare with your peers. Under this program, Medicare used data on quality measures submitted to PQRS for the 2015 program year and data on cost measures and claims-based quality measures obtained from 2015 claims data to calculate the 2017 value modifier for all solo physicians and group practices. The value modifier is determined using a quality-tiering approach, and the annual QRUR indicates your quality tier designation: high, average, or low quality and cost. Depending on the designation, your payments will be adjusted up or down on a per-claim basis under the 2017 Medicare PFS. 

Please note that reviewing your PQRS feedback report and QRUR is part of the TMA Five-Step Checklist for MACRA Readiness. Analyzing your quality reports now will help you prepare for MACRA's new Merit-Based Incentive Payment System (MIPS). Additionally, TMA reminds physicians that Medicare had data issues and calculation errors in its quality reports last year, resulting in revised reports and mass confusion. For this reason, it is important that you review your reports as soon as possible to make sure your data are correct and you don't receive a penalty in error. 

Appeals Process 

If you disagree with Medicare's analysis of your performance or believe your data are incorrect, submit what is called an "informal review request" by Nov. 30, 2016. This is the only appeals process Medicare has for the PQRS and value modifier programs. Once a request has been submitted, Medicare will review your data again and respond to you through email within 90 days of your submission.  

Where to Turn For Help

TMA Practice Consulting offers quality improvement services to help prepare physician practices for the upcoming transition under the Medicare Access and CHIP Reauthorization Act (MACRA). TMA's practice management consultants can conduct a MACRA readiness assessment of your practice and provide customized on-site assistance to help you with your practice's specific needs. The assessment will focus on clinical processes, electronic health record optimization, and workflow improvement opportunities to help increase your MIPS scoring. TMA is dedicated to working with you and your practice to earn an incentive payment, not just avoid the penalty. To learn more, email[at]texmed[dot]org, or call (800) 523-8776.

You also can turn to the TMF Quality Innovation Network Quality Improvement Organization (QIN-QIO) for help. Under contract with Medicare, the TMF QIN-QIO provides education 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 Suzie Buhr at TMF QIN-QIO at (214) 477-1407 or by email. To learn more, join the TMF Value-Based Improvement and Outcomes Network

Visit TMA's PQRS and VM Resource Center for guidance on quality reporting for the 2016 program year and the MACRA Resource Center to learn about how these programs will be combined to create the new MIPS program.  

Meaningful Use Deadlines Approaching

If this is your first year to participate in the Medicare meaningful use program and you are trying to avoid the 2017 penalties, you must have successfully attested to meaningful use no later than Oct. 1, 2016. You can, however, attest by Feb. 28, 2017, to avoid the 2018 penalty. Returning Medicare program participants must successfully attest to meaningful use by Feb. 28, 2017, to avoid the 2018 penalty. 

Many participants will be trying to attest via the CMS portal by next year's Feb. 28 deadline. To avoid any delays or problems, TMA encourages physicians to attest earlier than the final deadline.

The Centers for Medicare & Medicaid Services recently proposed a 90-day reporting period for 2016. Stay tuned for more information as that rule should be finalized soon, and TMA will report the details in an upcoming edition of Action.  

Visit the TMA website to get information and resources on the program. If you have questions, contact TMA's Health Information Technology Department by email, or call (800) 880-5720. 

Action TMLT Ad 10.15 

Houston Judge Says DOs Can't File Commitment Papers

TMA and a host of other physician organizations are fighting a judge's ruling that would prohibit doctors of osteopathy (DOs) from filing certificates of medical examinations needed for mental health commitments.

On Sept. 2, Judge Rory Olsen of Harris County Probate Court #3 issued a directive that his court would not accept mental health commitment papers signed by DOs.

Responding to a request from a leading Houston psychiatrist who is also a DO, TMA's legal staff initially contacted Judge Olsen via telephone. TMA, the Harris County Medical Society, the Texas Osteopathic Medical Association, the Federation of Texas Psychiatry, and the American Osteopathic Association (AOA) then wrote a joint letter to Judge Olsen explaining the legal equivalence in Texas of allopathic and osteopathic physicians.

"Eliminating DOs' authority in the most populous county in Texas could have disastrous consequences for the health and safety of persons who physicians have determined need protective psychiatric care," they wrote.

Lawyers for AOA and the Texas Medical Board also sent Judge Olsen detailed legal briefs on the issue. All of the organizations involved continue to work toward a quick resolution of the problem before it precipitates a mental health crisis in Houston or spreads to other parts of the state.

TMA Survey Documents the State of EHRs in Texas


TMA's biennial Physician Survey identifies emerging issues, tracks the impact of practice and economic changes, assesses physician priorities, and develops data to support TMA advocacy efforts. TMA has distilled the preliminary findings of one part of that survey into a two-page infographic that highlights Texas physicians' perceptions of the pros and cons of electronic health records (EHRs).


In May of 2016, TMA surveyed 38,340 physicians regarding their opinion and experiences with health information technology (HIT). The current survey is a benchmark of physicians' needs and experiences with EHRs, especially important as TMA tailors services and resources to help physicians qualify for federal incentives and avoid penalties related to EHR use. 

Visit to view the survey findings. For questions about EHRs or HIT, contact the TMA HIT Helpline via email or call (800) 880-5720.

Focus on Member Services: Future-Proofing Your Practice

As medical practices collect and store more information electronically, physicians will encounter more frequent technology breaches. The cost of a breach can be huge: an average of $402 per compromised record, plus fines. TMA makes robust security for your practice easy through education and services designed to manage the worst technology risks. 

As a TMA member, you have access to resources designed to help you safeguard your practice, while continuing to deliver quality care to your patients:  

  • TMA's Technology Resource Center and Quality Improvement Resource Center feature information on everything from meaningful use to the Medicare Access and CHIP Reauthorization Act (MACRA). 
  • Mobile tools like DocbookMD, a HIPAA-secure application, allow you to communicate securely with physicians and practice staff while coordinating care.
  • TMA's MACRA calculator (members only) helps you determine whether MACRA is worth your while. 
  • TMA has more than 30 continuing medical education courses on technology and quality improvement topics like HIPAA security, MACRA, and ransomware (discounts for members only).
  • Join your colleagues Nov. 18–19 for the Texas Quality Summit, featuring a powerful pre-conference workshop on Friday and a full-day summit on Saturday. Physicians interested in quality improvement and patient safety will learn how to improve performance, increase efficiency, and continue to deliver high-quality care to patients in an ever-changing health care landscape. (Conference discounts are available to members only). For more information, read "Learn From the Experts" in the October 2016 issue of Texas Medicine.
  • Schedule a HIPAA assessment with the TMA team, or take advantage of cyber liability consulting services and insurance from TMA-endorsed vendor Texas Medical Liability Trust (members only).  

For more information on all the ways TMA can help you future-proof your practice, visit the TMA

   TMAIT Action Ad 6.15

I.C. System Helps You Collect More Patient Payments

Patient debt collection can severely hamper a practice's productivity and diminish your bottom line. Recent studies show that only 21 percent of patient balances not collected up front, at the time of service, are ever collected. When staff spends valuable time on collections, practices stand to lose even more. In fact, practices would have to cut costs by roughly 31 percent to make up for lost patient revenue.   

To optimize collections, consider engaging your patients during appointment scheduling, at check-in, at check-out, and during follow-up. Other options include establishing a credit-card-on-file program, providing online bill pay, or seeking medical collections support.

To help your practice recover past-due accounts via collections support, TMA has endorsed I.C. System. Since 1938, I.C. System has collected debts ethically to improve cash flow for health care facilities across Texas. TMA members can receive a free consultation by calling (800) 279-3511 or by visiting the I.C. System webpage for TMA Members. While there, be sure to request a copy of the complimentary guide "Nice People Can Collect Bad Debt." 

Boost Community Immunity With a Be Wise — Immunize Grant

Do you want to help improve the health of your community by hosting a shot clinic? Apply for a grant from TMA's Be Wise — ImmunizeSM program by Nov. 1 to support your local vaccination event. The grants of up to $2,500 are available to TMA member physician practices/clinics, county medical societies, TMA Alliance chapters, and medical student chapters.  

The funds can be used for shot clinics to vaccinate children, adolescents, and/or adults. Applicants should apply for a grant at least four months before their project is scheduled to begin, and grantees have up to 12 months to use the funds. 

Since 2012, TMA's Be Wise — Immunize vaccine advocacy program has awarded 64 Local Impact Grants totaling nearly $120,000 to vaccinate Texans against the flu, pertussis, bacterial pneumonia, and other vaccine-preventable diseases. More than 8,000 uninsured or underinsured Texans have received a vaccination.

To plan your free or low-cost vaccination event, check out the Be Wise — Immunize Quick Start Manual: A Step-by-Step Vaccination Outreach Guide. For more information, contact Tammy Wishard, TMA's outreach coordinator, at (512) 370-1470 or (800) 880-1300, ext. 1470.

TMA actively works to improve vaccination rates in Texas through its Be Wise — Immunize program. Physicians and volunteers have given more than 300,000 shots to Texas children, adolescents, and adults since the program began in 2004. 

Be Wise – Immunize is a joint initiative led by TMA physicians, medical students and the TMA Alliance. It is funded by the TMA Foundation in 2016 thanks to major gifts from H-E-B and TMF Health Quality Institute, along with generous contributions from physicians and their families. 

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

DSHS Grand Rounds Event Focuses on Down Syndrome Law

The Texas Department of State Health Services (DSHS) is hosting a free Grand Rounds presentation, Down Syndrome Today: New Information and New Obligations for Clinicians, on Wednesday, Oct. 5, from 11 am to 12:30 pm in the K-100 Lecture Hall in Austin (see Central Campus-Austin map) and via live webinar. 

Less than 35 years ago, a diagnosis of Down syndrome was an indicator of a depressingly short life. In 1983, the average life expectancy for someone diagnosed with the chromosomal abnormality was just 25 years, according to the National Down Syndrome Society (NDSS). Today, the average is 60 years, according to NDSS, and children with Down syndrome are growing up to do things previous generations never thought they could do. 

Down syndrome advocates say many parents who get the disconcerting news that their child has Down syndrome don't receive the most updated information from their physician, and sometimes they get no information.

Those parents' stories were a driving force behind the passage of last year's House Bill 3374, a measure that requires Texas physicians who diagnose a child with Down syndrome to provide parents with state-prepared, evidence-based information on the disorder. 

Join attorney Suzanne Shepherd, health care chair of the Down Syndrome Association of Central Texas, and Adam Barta, MD, attending physician at Blackstock Family Health Center and clinical assistant professor at The University of Texas at Austin Dell Medical School, for a presentation about the new law. They also will cover the current range of medical and developmental outcomes of individuals with Down syndrome, status of Down syndrome cognition research, and current published research about prenatal cell-free DNA testing. 

To register, visit the DSHS Grand Rounds website. If you have questions, email grandrounds[at]dshs[dot]state[dot]tx[dot]us.

For more information, read "Clearing Up the Myths" in the September issue of Texas Medicine

Mark your calendars for these other Grand Rounds presentations:  


PC Action Ad June 13 

Walking Goes Viral With the U.S. Surgeon General

On Oct. 5, U.S. Surgeon General Vivek Murthy, MD, plans to release a two-week #StepItUp challenge to celebrate his call to action on walking and walkability. TMA wants you and your patients to participate. Join Walk With a Doc Texas leaders by getting moving during the two-week period. You can prepare now. 

If you are a current Walk With a Doc Texas leader: 

  • Get your participants excited about the competition. The chapter with the most virtual walkers will win a real visit from Walk With a Doc founder David Sabgir, MD. 
  • Add a walk or two to your schedule during the two-week period. 

If you are not a current walk leader: 

  • Consider starting a walk in your community. Contact Debra Heater at TMA for more information. Email debra.heater[at]texmed[dot]org, or call (800) 880-1300, ext. 1390, or (512) 370-1390. 
  • Good news: You don't have to be a walk leader to participate. Just track your steps. 

Promote the competition and encourage people to track their steps. Use social media and tag TMA (@texmed), Walk With a Doc (#wwadtx or #justwalk), and the surgeon general (#StepItUp).

Tracking your steps is easy and virtual. Choose a tracker (electronic or an old-fashioned pedometer) to log your steps. On Oct. 5, the TMA website will have details on where and how to download your steps. You will choose our team, WWAD Texas, and enter your personal steps. We need your help to get Texans walking and to get national recognition for TMA and Texas.

This Month in Texas Medicine

The October issue of Texas Medicine features a cover story on complementary and alternative medicine; TMA policy recommends physicians stay on top of evidence-based studies of complementary and alternative therapies and routinely ask patients about their use of such therapies. In the issue you'll also find coverage of five steps physicians can take right now to prepare for the transition to the new Medicare payment system; TMA's Hard Hats for Little Heads program, which has given away more than 235,000 helmets to Texas children in the past 22 years; a negligence lawsuit with broad legal implications; and the Texas Quality Summit, hosted by TMA and the American College of Medical Quality.

Check out our digital edition

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.  

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 and MACRA: Get Clarity and Direction!
Medical Records: Most Wanted Answers  
Straight From a Lawyer's Mouth: Answers to Your Legal Questions  

Conferences and Events

2016 TMA Advocacy Retreat
Dec. 2-3
Omni Barton Creek Resort

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Last Updated On

May 13, 2020