Action: Dec. 1, 2016

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

Sunset Review of TMB Fails to Address Disciplinary Process Improvements
TDI Proposes HMO Rule Rewrite
PQRS: CMS Extends Informal Review Deadline to Dec. 7
Year-End Checklist for Meaningful Use
Webinar Gives Overview of MACRA 2017; Register Now
Pay It Forward and Be an MD Mentor

Texas Announces Local Zika Virus Case in Rio Grande Valley
Navigate Health Care’s Rocky Future as a TMA Accountable Care Leader
Don't Miss First Tuesdays at the Capitol in 2017
2017 TMA Winter Conference: Physician Leaders Unite
'Tis the Season to Share Advancements in Medicine
This Month in Texas Medicine

Sunset Review of TMB Fails to Address Disciplinary Process Improvements

In comments to the Sunset Advisory Commission on its 2016–17 review of the Texas Medical Board (TMB), TMA says one important matter is disappointingly absent from the agency's thorough and detailed report: improving TMB's disciplinary process. While TMA generally supports the sunset staff's report, the association says more could be done to ensure effective operations at the medical board. 

In the comment letter, TMA asks the sunset staff to reexamine the board's disciplinary process and provides these specific recommendations for improvement:

  • Require the board to remove publication of a physician's remedial plan after the passage of time. TMA says publishing the information for an indefinite amount of time has a "punitive effect, because something as simple as an administrative error becomes a permanent blemish on a physician's profile."
  • Remove the lifetime limitation of remedial plans. TMA says doing so would "allow both the licensee and the board to avoid the expense of protracted investigations for minor administrative violations …."
  • Require the board to provide all available information to the licensee prior to informal meetings, especially exculpatory evidence. TMA says this requirement "would ensure that a licensee has all available information when preparing a case or when making the determination to agree to an agreed order" while ensuring the board considers all information "when making a decision relating to the physician's license to practice."
  • Ensure that the board does not provide any information directly or indirectly identifying the expert physician reviewer to the physician who is the subject of the review. TMA says revealing a reviewer's identity could discourage physician participation, which the board relies upon heavily. 
  • Provide express authorization for the board to file a complaint against a license holder who maliciously makes a complaint the license holder knows to be false. TMA says legislative authorization "will do more to remove the incentive to make malicious complaints and will reduce the likelihood that physicians and the board staff are hassled with baseless complaints."
  • Require the State Office of Administrative Hearings to expedite cases involving a physician's temporary suspension.  

Attorneys and medicine alike have long been concerned about the evolution of TMB's informal show compliance and settlement conferences (ISCs). Former TMB Executive Director Mari Robinson told Texas Medicine the hearings have "become more formal in nature." In scathing written comments TMA submitted to TMB in July in response to the board's proposed ISC rules, TMA said ISCs have become "more and more formal, prescriptive, and regulated," without giving physicians a fair forum to defend themselves. The proposed rules appeared to be a clarification of how the board already conducts ISCs. But after critical comments from TMA and other stakeholders, TMB chose not to adopt the rule amendments. 

While the sunset commission's report failed to address TMB's disciplinary process, it does include these findings: 

  • Statutory licensing provisions and board procedures do not follow model licensing practices, presenting unnecessary hurdles to applicants and reducing the efficiency of TMB operations.
  • The process for authorizing qualified physicians from other states to practice in Texas is not streamlined.
  • The medical board's pain management clinic inspection program does not follow best practices to make efficient use of the board's limited investigatory resources.
  • Limited medical radiologic technologist certification is unduly complicated and creates administrative inefficiencies.
  • The unclear relationship between the Texas Physician Health Program and TMB contributes to organizational instability. 

The state has a continuing need to regulate the practice of medicine and the allied health professions housed at TMB. That means the sunset staff is recommending another 12 years of life for the medical board.

Visit the Sunset Advisory Commission website to access the full report and the agency's recommendations. For more about TMA's call for fair TMB informal disciplinary hearings, read "On Trial" in the November issue of Texas Medicine.  

TDI Proposes HMO Rule Rewrite

Whenever a state agency undertakes a wholesale overhaul of a set of regulations important to physicians and patients, TMA examines the proposal extremely carefully. That's why a TMA staff team spent weeks studying the Texas Department of Insurance's (TDI's) Oct. 7 proposed repeal and rewrite of the entire regulatory chapter on HMOs. 

In a 101-page comment letter, TMA focused on payment for emergency out-of-network care and network adequacy standards. TMA urged TDI to continue to require HMOs to "fully reimburse" non-network physicians at the usual and customary rate or at an agreed rate for out-of-network services provided when a network physician is not available and the patient is referred out of network. TMA was pleased TDI did not weaken, as an early draft indicated, the mileage standards for determining HMO network adequacy, and TMA encouraged it to strengthen those standards and other consumer protections the association helped win in TDI's rules on PPOs. 

TMA strongly supported TDI's proposed inclusion of requirements for HMOs to:

  • File annual network adequacy reports to aid the department in monitoring HMO compliance with network adequacy standards;
  • Notify enrollees of a substantial decrease of network facility-based physicians in network facilities;
  • Provide enrollees with certain network demographic information; and
  • Designate their networks as an "approved hospital care network" or a "limited hospital care network," depending upon their compliance or failure to comply with the network adequacy requirements for hospitals. 

PQRS: CMS Extends Informal Review Deadline to Dec. 7

If you submitted data to Medicare's Physician Quality Reporting System (PQRS) for the 2015 program year, make sure you 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. The Centers for Medicare and Medicaid Services extended the deadline to appeal errors in your report to 10:59 pm CT, Wednesday, Dec. 7, 2016. The original deadline was Nov. 30.

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 Dec. 7, 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.  

Year-End Checklist for Meaningful Use

The Medicare and Medicaid electronic health record (EHR) incentive programs' 90-day reporting period for 2016 ends on Dec. 31. Now is a good time to review your meaningful use data and the program requirements to make sure you're on track.  

Here are some things to keep in mind: 

  • Be sure your EHR is 2014 certified.
  • Check your meaningful use registration details.
  • Review your meaningful use program reports. Take this opportunity to make any necessary workflow adjustments, or ask for help to ensure you meet the required measure percentages for the numerators and denominators. Everyone should be following the 2016 program requirements.
  • Review the public health reporting measures, and determine whether you meet any of the exclusions.
  • Complete your security risk analysis (SRA) before the end of 2016. The SRA is a key requirement of the HIPAA Security Rule and a requirement for physicians participating in the EHR incentive programs.
  • Be sure you document your progress and keep records for any future audits. Review this TMA article on how to prepare for a meaningful use audit.  

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

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Webinar Gives Overview of MACRA 2017; Register Now

Register for the TMF Quality Innovation Network webinar to be held Thursday, Dec. 8, from noon to 1 pm CT. 

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) created the new Quality Payment Program, which allows physicians and clinicians to choose one of two payment program options: the Merit-based Incentive Payment System or advanced alternative payment models.

Centers for Medicare & Medicaid Services Chief Medical Officer David Nilasena, MD, will give an overview of the Quality Payment Program for 2017 and how physicians will be paid for the value and quality of care they provide under the new payment paths. Register today.

Pay It Forward and Be an MD Mentor

You probably remember what first motivated you to become a doctor: a family legacy, an aptitude for biology, or the desire to help those in need. But do you remember who had the biggest influence on how you practice medicine? Chances are it was a physician mentor.

TMA is calling on internists to pay it forward. Follow in the footsteps of those who influenced you by volunteering to serve this summer as a mentor for a Texas medical student. 

Applications are now open for the 2017 General Internal Medicine Statewide Preceptorship Program (GIMSPP). Eager students across the state are lined up for a preceptorship match — with more joining the list each week. 

Preceptors spend two weeks, three weeks, or four weeks from May to August providing personal instruction and supervision to medical students. Students meet with their preceptor daily to follow rounds and interact with patients. This hands-on guidance gives medical students a clinical leg up before the start of residency and in many cases commits them to working in primary care. 

Selected preceptors will be notified in March, with all student matches completed no later than April.

By making mentorship a priority, you're supporting the next generation of young physicians. Sign up to be a GIMSPP preceptor today. 

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Texas Announces Local Zika Virus Case in Rio Grande Valley

The Texas Department of State Health Services (DSHS) and Cameron County Department of Health and Human Services announced the first case of Zika virus disease likely transmitted by a mosquito in Texas. DSHS is supporting Cameron County's response to the case and to the ongoing risk of Zika in the community.

DSHS is again asking health care professionals to consider Zika virus infection in their patients and order the appropriate testing. DSHS recommends testing all pregnant women who have traveled to areas with active Zika transmission during their pregnancy. DSHS also recommends testing pregnant women who have two or more of the typical Zika symptoms in Cameron, Hidalgo, Starr, Webb, Willacy, or Zapata counties without travel history, and anyone with at least three symptoms statewide. Physicians can find additional information at

The patient is a Cameron County resident who is not pregnant and who was confirmed last week by lab test to have been infected. She reported no recent travel to Mexico or anywhere else with ongoing Zika virus transmission and no other risk factors. Laboratory testing found genetic material from the Zika virus in the patient's urine, but a blood test was negative, indicating that the virus can no longer be spread from her by a mosquito. There are no other cases of suspected local transmission at this time, but health officials continue to conduct disease surveillance activities as part of the state's ongoing Zika response.

"We knew it was only a matter of time before we saw a Zika case spread by a mosquito in Texas," said John Hellerstedt, MD, DSHS commissioner. "We still don't believe the virus will become widespread in Texas, but there could be more cases, so people need to protect themselves from mosquito bites, especially in parts of the state that stay relatively warm in the fall and winter."

Cameron County, DSHS, and the Centers for Disease Control and Prevention are working together to investigate and respond to the case. Further investigation will be necessary to attempt to pinpoint how and where the infection occurred, and health officials are also responding in a number of other ways. DSHS has activated the State Medical Operations Center to support the response and is providing expertise, personnel, and equipment for activities from disease investigation to mosquito surveillance to public education.

With DSHS support, Cameron County and the City of Brownsville have conducted an environmental assessment at the patient's home and have been trapping and testing mosquitoes to learn more about activity in the area. Brownsville has recently sprayed for mosquitoes in the area and will continue to take action to reduce the mosquito population. 

Due to the risk of birth defects associated with Zika, pregnant women should avoid traveling to Mexico and should avoid sexual contact or use condoms with partners who have traveled there. Other precautions include: 

  • Using Environmental Protection Agency-approved insect repellent.
  • Wearing long pants and long-sleeved shirts that cover exposed skin.
  • Using air conditioning or window and door screens that are in good repair to keep mosquitoes out of homes.
  • Removing standing water in and around homes, including water in trash cans, toys, tires, flower pots, and any other container that can hold water.

Zika virus is transmitted to people primarily through the bite of an infected mosquito, though sexual transmission can occur. The four most common symptoms are fever, itchy rash, joint pain, and eye redness. While symptoms are usually minor, Zika can also cause severe birth defects, including microcephaly and other poor birth outcomes in some women infected during pregnancy.

Texas has had 257 confirmed cases of Zika virus disease. Until now, all cases had been associated with travel, including two infants born to women who had traveled during their pregnancy and two people who had sexual contact with infected travelers. 

In response to the possible local transmission of Zika and risk to the local community, the Texas Health and Human Services Commission (HHSC) is reinstating the Medicaid benefit for mosquito repellent due to the first reported case of Zika virus disease likely transmitted by a mosquito in Texas. 

Texas quickly made the decision to bring back the benefit, which had ended Oct. 31, given the possibility of local transmission and risk of Zika in the local community. The benefit began Nov. 29 and will be in place through December, as the state collects more information about the case and scope of transmission in Texas.

"We will do all that we can to protect Texans and slow the spread of the Zika virus," said HHSC Executive Commissioner Charles Smith. "Insect repellent is the best way to protect yourself, and we want it to be widely available."

Eligible Texas women can go to participating pharmacies to pick up mosquito repellent, as Texas Medicaid has a standing order for mosquito repellent prescriptions for women who are between the ages of 10 and 45 or pregnant. The benefit includes two cans per month per eligible beneficiary. Women are encouraged to call the pharmacy ahead of time because supply can vary by location.

Women eligible for the Medicaid, Children's Health Insurance Program (CHIP), and CHIP-Perinate programs are covered. Women covered under the Healthy Texas Women and Children with Special Health Care Needs programs also can receive the benefit.

The following Zika-related items also are covered under current Texas Medicaid benefits: 

  • Family planning services,
  • Contraceptives,
  • Diagnostic testing,
  • Targeted case management,
  • Physical therapy,
  • Long-term services and support,
  • Acetaminophen and oral electrolytes for Zika symptoms, and
  • Potential coverage for additional ultrasounds for pregnant women.

Additional information is available at

Navigate Health Care's Rocky Future as a TMA Accountable Care Leader

Accountable care made big strides this year, and TMA has set the stage for members to get ahead of the curve while demystifying the paradigm shift. Applications are now open for TMA's 2017 Accountable Care Leadership Program. Participants will earn more than 95 hours of continuing medical education. 

The makes it easier for physicians to succeed under future accountable care regulations. Past participants describe it as "the clearest information I've ever received on MACRA and MIPS" with "great insight into where health care is headed and how it will likely get there."

Over the course of 10 months, program participants learn about risk-based payment initiatives, clinic-based balanced scorecards, and the development of accountable care organizations (ACOs) and patient-centered medical homes. Strategies for effective negotiation, conflict management, and stakeholder reliance are also part of the curriculum. 

ACOs across the nation have brought in more than $1.2 billion in Medicaid savings since 2012. Learn how you can add on to these savings and influence how value based care will affect your practice and your patients by joining TMA's Accountable Care Leadership Program.

Apply early as the 2017 leadership class will be limited to 30 participants. The application deadline is Jan. 6. For complete coursework details, program requirements, and participation fees, visit the TMA website.   

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 event 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 the TMA website, or call (800) 880-1300, ext. 1363. 

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2017 TMA Winter Conference: Physician Leaders Unite

Reconnect with colleagues while earning continuing medical education credit at the 2017 TMA Winter Conference at the Hyatt Regency Austin downtown, Jan. 27–28. Whether facing local or national health care challenges, physicians unite under the TMA umbrella to improve the health of all Texans. Join the conversation and your colleagues for collaboration and education. 

Attend the General Session on Saturday from 8:30 am to noon to hear how health insurers are adapting to the changing health care landscape and how it will affect you. You'll also learn how physicians are responding to physician-led accountable care organizations, receive a legislative update, and hear the story of a Dallas trauma surgeon who responded to the Dallas police department shootings. Check out the conference agenda for more details. 

All Saturday meetings will take place at the Hyatt Regency Austin. The group rate is $199 plus tax. TMA expects rooms to sell out, so make your reservation online today, or call (888) 421-1442.

Meetings will take place on Friday, Jan. 27, at both the Hyatt Regency and the TMA building. A shuttle will be provided. The first shuttle will leave the Hyatt at 7 am, and the last shuttle will leave the TMA building at 8:30 pm. 

You can register for the conference online, or you can register on site Friday at the TMA building from 7 am to 7 pm or at the Hyatt from 7:30 am to 7:30 pm. Registration is available at the Hyatt on Saturday from 6 am to 12:30 pm. 

'Tis the Season to Share Advancements in Medicine


Have you or your colleagues implemented a recent clinical success or compiled innovative research that could improve the practice of medicine in Texas? The TexMed 2017 Poster Session is the perfect stage to share your insights and analysis with a large audience of Texas doctors while getting the kudos your work deserves.

TMA's call for poster abstracts is now open, and selected abstract authors will be invited to the author-hosted continuing medical education Poster Session at TexMed 2017 on May 6 in Houston. 

Categories for submission include Quality Research, Quality Improvements, and Clinical. These focus areas have also been expanded to encompass Disaster Medicine and Emergency Preparedness, as well as Enhanced Perioperative Recovery. 

Submissions are due by March 17. Abstracts will be judged by TMA physician experts, and the top three winners in each category will receive a cash prize. Physicians who attend TexMed will vote one outstanding poster for the coveted Doctors' Choice Award. 

For complete details and to submit your abstract, visit the TMA website.  

TexMed 2017 will be held May 5–6 in downtown Houston at the new Marriott Marquis and George R. Brown Convention Center. Mark your calendars and plan to attend. Conference registration will open in January.  

This Month in Texas Medicine

The December issue of Texas Medicine features a cover story on Texas' exit from the federally funded refugee resettlement program, which assists refugees with relocating to the United States by helping them find jobs, learn English, and get basic health and social services. In the issue, you'll also find coverage of federal language access requirements for patients with limited English proficiency, the movement to eliminate the U.S. Medical Licensing Exam Step 2 Clinical Skills test, and Texas' rising maternal mortality rate.

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!
Dec. 6: Houston

Conferences and Events

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

2017 TMA Winter Conference
Jan. 27–28, 2017
Hyatt Regency Austin

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Last Updated On

September 26, 2018