Action: Nov. 15, 2016

TMA Action Nov. 15, 2016   News and Insights from Texas Medical Association

Texas Doctors See Post-Election Opportunity to Reshape Health Care
TMB-Teladoc Lawsuit on Hold
TMA Fights Medicaid Anesthesia Proposal
Feds Cut Meaningful Use Reporting Period to 90 Days
Last Chance to Register for this Weekend's Texas Quality Summit
Students: Get Real-World Training This Summer
Don't Miss First Tuesdays at the Capitol in 2017
Celebrating MDs Ahead of the Curve: TMA's 2016 Accountable Care Leaders

Wanted: Your Best Local Health News of 2016
TMA PracticeEdge Is Looking to Grow
DSHS Issues Hepatitis A Health Advisory
Join the Movement to Get Smart About Antibiotics
CME Course Covers Obesity Management in Children, Adolescents

Texas Doctors See Post-Election Opportunity to Reshape Health Care

The 2016 elections brought physicians an excellent opportunity to rebuild America's health care systems, TMA officials say.

"Everything is on the table — the Affordable Care Act (ACA), Medicare, and Medicaid," said David Henkes, MD, chair of the Texas Delegation to the American Medical Association. "Today, we are crafting plans to remake the system so it truly serves our physician members and our patients."

Fortuitously, the interim meeting of the AMA House of Delegates brought dozens of TMA leaders together just four days after the Nov. 8 elections. They laid out key strategic directions that TMA staff will use to devise a detailed plan.

"We need one document for all physicians, all specialties, to take to Congress and the administration and say, ‘This is what medicine believes in,' " Houston facial plastic surgeon Russ Kridel, MD, a member of the AMA Board of Trustees, said at an hour-long health care reform conversation among members of the Texas Delegation to the AMA, who are in Orlando, Fla., for the interim meeting of the AMA House of Delegates. "We need to act now, and we need to do those things that will put us at the table."

"The ACA was a first step, now we need to take another step," said former AMA and TMA President Jim Rohack, MD.

The Texas physicians said they are looking for an approach that simplifies the health care system for physicians and patients, reduces the huge regulatory burden on physicians, and reduces the cost of U.S. health care. 

"This whole system is just too complicated for most people to handle," said Dallas psychiatrist Clifford Moy, MD.

Many of the ideas in President-Elect Donald Trump's "Great Again" health care platform and the health care agenda in House Speaker Paul Ryan's "Better Way" plan are consistent with TMA policy.

TMA actively opposed passage of the ACA in 2010 but has since adopted an approach to "Keep what's good, fix what's broken, and find what's missing." Speaker Ryan echoed that approach during a Nov. 13 television interview, when he said, "We can fix what is broken in health care without breaking what is working in health care."

Six years of near absolute gridlock in Washington, DC, prevented even the tiniest ACA reforms from passing. One significant achievement — from TMA's "find what's missing" category — was the repeal of Medicare's Sustainable Growth Rate formula via the Medicare Access and CHIP Reauthorization Act (MACRA), which passed in 2015.

"Texas Solution" Gets New Life

It's important to remember that what happens in Washington not only affects Medicare, commercial health insurance, and coverage for uninsured patients, but also plays a big role in how states implement the Medicaid program. 

"We are entering into a new time," U.S. Rep. Michael Burgess, MD (R-Lewisville), said at a fundraising reception TMA hosted for him in Orlando. "I would love it if the governors came to Washington and said, ‘OK, guys, you deliver the mail and secure the border, we'll take care of our sick folks.' That would be a far, far more reasonable way to approach it." 

Dr. Burgess likely will be a key player in the health care debate in the next Congress. 

Both the Trump and Ryan plans call for Medicaid changes that mirror the "Texas Solution" for expanded coverage that TMA has promoted since 2013. The Texas Solution calls for a comprehensive plan that:  

  • Improves patient care;
  • Draws down all available federal dollars to expand access to health care for poor Texans;
  • Gives Texas the flexibility to change the plan as our needs and circumstances change;
  • Clears away Medicaid's financial, administrative, and regulatory hurdles that are driving up costs and driving Texas physicians away from the program;
  • Relieves local Texas taxpayers and Texans with insurance from the unfair and unnecessary burden of paying the entire cost of caring for their uninsured neighbors; and
  • Pays physicians for Medicaid services at a rate at least equal to Medicare payments.

TMA staff are preparing a white paper on "Post-Election Strategies for Health System Reform" for discussion at the TMA Advocacy Retreat, Dec. 2–3 in Austin. 

TMB-Teladoc Lawsuit on Hold

The Texas Medical Board (TMB) and Teladoc are in "negotiations," as both have filed motions to put Teladoc v. TMB on hold until April 19, 2017. The previous trial date was set for February. 

According to Law 360, "the move comes about two weeks after the Texas Medical Board voluntarily dismissed its appeal asking the Fifth Circuit to bar Teladoc Inc.'s antitrust challenge of the state rule requiring a face-to-face visit. U.S. District Judge Robert Pitman lifted the stay in the case on Oct. 25 and ordered the parties to submit a revised scheduling order by Nov. 8. But Teladoc and the medical board asked the court to reconsider." The court granted the stay on Nov. 4.

The Nov. 2 report of the Texas Sunset Commission on TMB does not address in any way the antitrust TMB exposure Teladoc asserted in the lawsuit. It also does not mention the Federal Trade Commission's staff position that state licensing bodies that have a majority of the licensees it regulates in control of the board are not protected from federal antitrust actions. For more information about Teladoc's antitrust claims against TMB, read "Seeking Invalidation" in the April issue of Texas Medicine.

Other states are attempting to address the antitrust issue, and some have passed remedial legislation to bolster their state action exemption argument to protect their licensure boards. The Texas Legislature may do the same next year. In addition to TMB, all of the state's professional licensing agencies are up for sunset review in the 2017 legislative session.

TMA Fights Medicaid Anesthesia Proposal

The Texas Society of Anesthesiologists (TSA) and TMA sent a formal letter and testified in person against a Texas Health and Human Services Commission (HHSC) plan to eliminate the "Physician-Led Anesthesia Care Team Model Billing" for Texas Medicaid. The change would cut payments to anesthesiologists who supervise certified registered nurse anesthetists and anesthesia assistants. 

According to the letter, the model involves a physician anesthesiologist medially directing nurse anesthetists and/or anesthesiologist assistants. "Extremely undervalued Medicaid rates have already led to significant access issues for Medicaid patients. This proposed change will further aggravate deficiencies in access to quality anesthesia care for Medicaid patients and will discourage the maintenance of high quality physician-led Anesthesia Care Team Model. TSA believes this will lead to increased anesthesia costs due to greater utilization of emergency services," the letter states.

TMA's letter, and testimony from TSA President Deborah Plagenhoef, MD, and Austin anesthesiologist Jeff Jekot, MD, emphasized the two organizations' concerns that the proposal will increase Medicaid anesthesia costs and hinder access to care. TMA and TSA leaders will meet with HHSC officials again before the agency makes a final decision on the question.

Feds Cut Meaningful Use Reporting Period to 90 Days

The Centers for Medicare & Medicaid Services (CMS) has reduced the meaningful use electronic health record (EHR) incentive program reporting period from a full year to 90 days in 2016. In 2017, physicians participating in the Merit-based Incentive Payment System (MIPS) will have several reporting options, including reporting on one patient to prevent a penalty, 90 days for a potential incentive, and a full year to receive an incentive. Physicians participating in the Medicaid meaningful use program will continue reporting the meaningful use measures for 2017 and will have a 90-day reporting period.  

TMA, the American Medical Association, and many other physician organizations had pushed for the change, arguing that the reporting systems are too complex and cumbersome for physicians to have to use for an entire year. 

Any continuous 90-day period between Jan. 1 and Dec. 31 of the participation year constitutes the EHR reporting period. 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.

If you have questions about the meaningful use program, contact TMA's Health Information Technology Department by email, or call (800) 880-5720.

TMAIT Action Ad 6.15  

Last Chance to Register for this Weekend's Texas Quality Summit

Limited seats remain for this weekend's Texas Quality Summit, co-hosted by the TMA Council on Health Care Quality and the American College of Medical Quality (ACMQ). The meeting takes place in Austin at the TMA building in the Thompson Auditorium.

Join us for a powerful discussion on quality improvement and patient safety, and learn how to improve performance, increase efficiency, and deliver high-quality care.

The summit begins as a pre-conference workshop this Friday, Nov. 18 with quality improvement scenarios and group exercises highlighting the tools and theories of leadership necessary for successful quality and patient safety programs. On Saturday, Nov. 19, the summit hosts a broader audience and offers a series of expert physician panels, as well as presentations on quality, value, and payment. Programming throughout the event will address population health trends in Texas, concrete steps for transitioning to value-based care, and in-depth discussion of alternative payment models and implementation of Medicare's New Quality Payment Program. Register for Friday only, Saturday only, or a two-day package.

CME credit is available on Friday, Nov. 18 for 5.25 AMA PRA Category 1 Credits™ designated as ethics and/or professional responsibility, and on Saturday Nov. 19 for 7.25 AMA PRA Category 1 Credits™, also designated as ethics and/or professional responsibility.

Students: Get Real-World Training This Summer

First- and second-year medical students looking to get a leg up on their peers are in luck. Applications for the 2017 General Internal Medicine Statewide Preceptorship Program (GIMSPP) are now being accepted. 

Each summer students receive hands-on training in communities across Texas on the methodologies and daily routine of internal medicine practitioners. Students are matched with an internist in primary care and spend two to four weeks receiving personal instruction and supervision. This practical exposure is oftentimes a student's first foray into the more human side of medical care as they connect the science of medicine with actual patients. 

Past GIMSPP student John Demis described the program as a vital experience. "The early exposure you get not only helps with classes, but it teaches you the kind of doctor you want to be."

Last year 163 medical students completed the program. This year, the Texas Chapter of the American College of Physicians (TXACP) is working to match even more students in communities large and small across the Lone Star State. Students who are selected and paired with a preceptor receive a stipend for participation. Because student preceptorships are available on a first-come, first-served basis, TXACP encourages all students to apply early. Matches are final by April each year. Students must be currently enrolled in a Texas medical school to participate. 

Don't Miss First Tuesdays at the Capitol in 2017

Your patients and your profession need you to be a lobbyist for a day. Mark your calendar now to join the Party of Medicine in Austin for First Tuesdays at the Capitol during the 85th Texas Legislature on Feb. 7, March 7, April 4, and/or May 2, 2017. The March 7 event is designated the official TMA Alliance First Tuesday, and the April 4 event is dedicated to medical students and residents. Registration is now open

TMA's comprehensive 2017 legislative agenda advocates what's best for patients and their physicians, from preserving physicians' right to bill for services to improving Medicaid payment rates and reducing red tape and hassles.
If you're traveling to Austin from out of town for First Tuesdays, reserve your room for the Monday before each event at the Doubletree Suites by Hilton Hotel by calling (800) 445-8667. Don't forget to mention you are attending TMA's First Tuesdays at the Capitol for the special room block rate of $219 for February, March, and April and $209 for May. Hotel rooms in Austin are in demand during legislative sessions, so make your reservations now. 
You also can reserve a room online, but make sure to enter the correct group code for your stay (February: FTC; March: TAT; April: CAP; and May: TUE). For more information or to register, visit, or call (800) 880-1300, ext. 1363.

Celebrating MDs Ahead of the Curve: TMA's 2016 Accountable Care Leaders

Accountable care is making big strides this year, most recently last month with the release of the final Medicare Access and CHIP Reauthorization Act (MACRA) rule. A collective of TMA physicians are eagerly matching pace. This month, 27 will graduate from TMA's 2016 Accountable Care Leadership Program.

The Accountable Care Leadership Program makes it easier for physicians to succeed under future accountable care regulations. Participants agree. Ninety-five percent found the program's focus on practice-based performance improvements to be informative and relevant. In the anonymous post-class survey, others praised the program's curriculum.

Among their comments: 

  • It provided me with the clearest information I've ever received on MACRA and the Merit-based Incentive Payment System. 
  • It gave me great insight into where health care is headed and how it will likely get there. 

Graduating participants from the 2016 class will be honored with a commencement ceremony in Austin on Nov. 19 during the Texas Quality Summit

While many physicians are optimistic that changes in health care delivery models will result in healthier patients, others are concerned. TMA's Accountable Care Leadership Program addresses both camps by focusing on change as a process that can be managed constructively. Over the course of 10 months, participants are guided through risk-based payment initiatives, clinic-based balanced scorecards, as well as the development of accountable care organizations and patient-centered medical homes. Strategies for effective negotiation, conflict management, and stakeholder reliance are also part of the curriculum. 

Join your colleagues to become a forward thinking leader in effective, value-based care. Applications for the 2017 Accountable Care Leadership class are now open. Apply early, as the 2017 class will be limited to 30 participants. For complete coursework details, program requirements, and participation fees, or to submit your application, visit

Action TMLT Ad 10.15   

Wanted: Your Best Local Health News of 2016

TMA's Anson Jones, MD, Awards will celebrate 60 years of honoring outstanding health journalism in 2017. Help TMA make the anniversary memorable by nominating outstanding stories from your local media that have caught your attention this year. 

TMA will alert the journalist of your nomination and enter him or her into one of the 12 award categories. It's a great way to give kudos to local journalists for their quality health news reporting. (The contest is open to Texas general-interest news outlets.)

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. 

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

Texas' best health and medical stories of 2016 are eligible. A Fort Worth Star-Telegram reporter won the first award in 1957.

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

TMA PracticeEdge Is Looking to Grow

TMA PracticeEdge will expand to Dallas-Fort Worth and West Texas next year and is looking for primary care physicians and internal medicine specialists to anchor several new physician-led accountable care organizations (ACOs) there. Establishing a new physician-owned ACO from scratch typically requires a significant capital expenditure. The TMA PracticeEdge turnkey solution, however, includes the majority of the upfront financial outlay. 

The investment PracticeEdge needs from physicians under the TMA PracticeEdge model is ACO leadership and active governance participation. The company currently provides ACO services to more than 500 physicians in Central and Southeast Texas and numerous border communities. These physicians are caring for more than 100,000 patients in commercial ACOs, Medicare Shared Savings Program ACOs, and Medicare Advantage. 

In addition to the new ACOs in North and West Texas, the existing ACOs want to add physicians interested in succeeding under value-based care and population health models. Join your independent colleagues across the state, and take control of your future by leading a physician-led ACO in your community. To learn more, please contact Kim Harmon or Dave Spalding at TMA PracticeEdge.

DSHS Issues Hepatitis A Health Advisory

A Texas Department of State Health Services (DSHS) health advisory states the International Company for Agricultural Production and Processing (ICAPP) in Egypt has recalled all frozen strawberries and frozen strawberry products it has imported into the United States since Jan. 1, 2016. According to the advisory, the recall is the result of a current hepatitis A outbreak investigation by the U.S. Food and Drug Administration, the U.S. Centers for Disease Control and Prevention (CDC), and state health departments. DSHS says Texas has one suspected case of hepatitis A.

DSHS instructs physicians to consider hepatitis A as a diagnosis for any patients presenting with symptoms of acute hepatitis. The department says serological testing is required to confirm the diagnosis of hepatitis A. The confirmatory test for hepatitis A is IgM anti-HAV. 

Those with the hepatitis A virus are most infectious two weeks prior to symptom onset, the advisory states. The incubation period is approximately 28 days (range 15–50 days). Symptoms include fever, fatigue, loss of appetite, nausea, vomiting, abdominal discomfort, dark urine, clay-colored bowel movements, joint pain, and jaundice. Symptoms can last for several weeks and typically do not last more than two months. Children younger than 6 years of age with hepatitis A are often asymptomatic.

Texas' infectious disease reporting regulations require confirmed or suspected acute hepatitis A cases to be reported within one work day. Hepatitis A reports should be made to your local health department or by calling (800) 705-8868.

DSHS reminds physicians to check the vaccination history of all patients and to offer hepatitis A vaccine to anyone who is not up to date with the vaccine schedule. Two doses of hepatitis A vaccine given six months apart remains an effective way to prevent disease and outbreaks, DSHS says. Hepatitis A vaccine is recommended for:  

  • All children at 1 year of age,
  • Food service workers or other food handlers, 
  • International travelers, including on cruise ships, 
  • Men who have sex with men, 
  • Drug users (injection and non-injection), 
  • Persons with clotting-factor disorders, 
  • Persons who work with non-human primates or with hepatitis A in a research laboratory,
  • Persons with chronic liver disease, including HBV- and HCV-infected persons with chronic liver disease,
  • Family and care givers of recent adoptees from countries where hepatitis A is common, and 
  • Anyone else seeking long-term protection.

Detailed guidelines for hepatitis A vaccination are available on the CDC website

PC Action Ad July 13

Join the Movement to Get Smart About Antibiotics

In March 2015 the White House released the National Strategy for Combating Antibiotic-Resistant Bacteria to guide public health officials in limiting the emergence of antimicrobial-resistant organisms. The U.S. Centers for Disease Control and Prevention's (CDC's) Get Smart About Antibiotics program provides information and tools to physicians and providers on optimal use of antibiotics according to evidence-based clinical guidelines. The program also helps educate patients on the appropriate use of antibiotics. 

This week is Get Smart About Antibiotics Week, a time to raise awareness of appropriate antibiotic use and prescribing and to urge physicians to evaluate their practices and identify opportunities for improvement. Here are some steps every prescriber can take: 

  • Educate yourself and your patients about the importance of appropriate use of antibiotics and the recommendations in evidence-based clinical practice guidelines.
  • Use antibiotics only when indicated to treat bacterial infections. Antibiotics have no beneficial effect on viral infections, may be associated with adverse events requiring additional health care, and pre-dispose people to superinfection with resistant bacteria including C. difficile diarrhea.
  • Use diagnostic tests to identify bacterial infections before initiating antibiotics. An example would be Group A streptococcal testing in patients with pharyngitis.
  • Administer vaccines by age and health condition.
  • When using antibiotics, take an "antibiotic time out" at 48 to 72 hours (an opportunity to reassess patient status) to determine if antibiotics are still indicated.

For more information, visit the CDC website. And read CDC's Core Elements of Outpatient Antibiotic Stewardship

CME Course Covers Obesity Management in Children, Adolescents

A new Texas Health Steps continuing medical education (CME) program can help to equip Texas Health Steps physicians and providers and others with best practices in the assessment, treatment, and prevention of overweight and obesity in children and adolescents.

Overweight and obesity among young people has reached crisis proportions, and U.S. Centers for Disease Control and Prevention data show Texas adolescents are among the most obese in the country. Risk assessment, early intervention, and promotion of healthy lifestyle choices are keys to improving health and preventing the development of chronic health conditions. Former Texas Pediatric Society President Kimberly Avila Edwards, MD, presents the course, which provides a step-by-step approach to assessment, diagnosis, and treatment, along with guidelines for promoting family-based adoption of healthy habits. Visit the Texas Health Steps website to enroll in the course.

Participants can earn 1.5 AMA PRA Category 1 Credits™ for completing the course.


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!
Nov. 1: Dallas
Nov. 2: Tyler
Nov. 3: Fort Worth
Nov. 9: El Paso
Nov. 15: Houston
Nov. 16: San Antonio
Nov. 17: Corpus Christi
Nov. 30: Austin  

Can't make it to the seminar? Attend the live webcast on Nov. 30.

Conferences and Events

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

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

September 26, 2018