Action: Feb. 1, 2017

TMA Action Feb. 1, 2017   News and Insights from Texas Medical Association

Federal Court Order Blocks Aetna-Humana Merger
TMA Offers Cyber Security and Ransomware Tools
AMA Publishes Newly Updated Code of Medical Ethics
Success in Value-Based Care: Accountable Care Program Seeks to Fill a Void
TMA Is 50,000 Members Strong and Growing

Host a Shot Clinic With Help From TMA's Be Wise — Immunize
Join the Texas Two Step: Save a Life Campaign 2017
Major Donors, Champions of Health Honored by TMA Foundation
Registration Open for the Texas Primary Care and Health Home Summit
This Month in Texas Medicine

Federal Court Order Blocks Aetna-Humana Merger

U.S. District Judge John Bates sent a clear message last month when he issued an order imposing an injunction on Aetna's $37 billion acquisition of Humana, which focused largely on buying up Humana's Medicare Advantage business. The judge found the merger would "be likely to substantially lessen competition" in the Medicaid Advantage market. Indeed, it would have a significant impact across Texas — and 13 other states — likely enhancing Aetna's market power to concerning levels per the federal government's own standards, according to a comprehensive American Medical Association analysis.

Aetna spokesman T.J. Crawford told U.S. New & World Report on Jan. 23 that the insurer was "reviewing the opinion now and giving serious consideration to an appeal." 

Despite objections to the merger from TMA and AMA and the filing of a U.S. Department of Justice (DOJ) antitrust lawsuit to prevent the Aetna-Humana merger from going through, Aetna cited robust competition in the market and defended the consolidation as leading to greater savings, better products, and new payment models. But TMA and its physician members say any supposed merger benefits come at doctors' and patients' expense in the form of take-it-or-leave-it payment contracts and take-it-or-leave-it insurance premiums. 

Physicians worry that consolidation raises insurers' leverage over negotiated rates with physician practices, more than half of which in Texas and across the nation are small groups, according to TMA and AMA research. 

In TMA's October 2015 letter to DOJ opposing the Aetna-Humana deal, Joseph S. Valenti, MD, then-chair of TMA's Council on Socioeconomics, expressed concern that other dominant insurers don't benefit from the Aetna-Humana deal. In the past, medicine successfully advocated that DOJ, which oversees antitrust issues, force merging insurers to sell off some of their combined business to a third party to reduce their market power. If federal regulators follow that prescription, TMA strongly opposed any partial acquisition by large players with significant market control.

TMA's letter to DOJ cautioned, too, against anticompetitive effects in Texas' Medicare Advantage market, pointing out the newly combined entity would control 36 percent of that business across the state. The government's complaint against Aetna and Humana delves into the impact the merger would have on seniors who rely on Medicare Advantage plans. "Aetna's attempt to buy Humana undermines the central role that competition is meant to play in Medicare Advantage and on the public exchanges in holding down health care costs and improving quality for seniors, families, and individuals," DOJ wrote. "If permitted to proceed, Aetna's purchase of Humana likely would lead to higher prices and reduced benefits for seniors, families, and individuals."

In a statement on Judge Bates' order, AMA President Andrew W. Gurman, MD, said, "Aetna's strategy to eliminate head-to-head competition with rival Humana posed a clear and present threat to the quality, accessibility, and affordability of health care for millions of seniors," adding the order "acknowledged that meaningful action was needed to preserve competition and protect high-quality medical care from unprecedented market power that Aetna would acquire from the merger deal." AMA previously testified against the merger. The American Hospital Association also has been vocal in its opposition to the deal.

For more information about the merger and TMA's opposition to it, read "Bigger Isn't Always Better" in the December 2015 issue of Texas Medicine

TMA Offers Cyber Security and Ransomware Tools

Ransomware has reached Texas, and its emergence highlights the importance of up-to-date security. Health care is particularly vulnerable to the ransomware threat. KPMG's 2015 Health Care and Cyber Security Survey, which polled 223 U.S.-based health care executives, found four-fifths of respondents said cyber attacks had compromised their information technology.  

Several large health systems have been high-profile ransomware targets. When smaller practices are the target, the perpetrators adjust their ransom demands accordingly. You can take steps to protect your practice.

TMA is raising awareness and educating physicians on ways to manage security and technology risks. A webinar, Cyber Security and Ransomware: Protect Your Practice, is available in the TMA Education Center. The webinar outlines how to mitigate cyber risk and respond appropriately in the event of a breach or ransomware demand.

TMA's Ransomware and Cyber Security Resource Center offers cyber security articles, education resources, consulting services, and endorsed vendor information — all in one place. 

If you have cyber security questions, call TMA's Health Information Technology Department at (800) 880-5720, or send an email.

AMA Publishes Newly Updated Code of Medical Ethics

Completely updated after an eight-year modernization project, a revised edition of the Code of Medical Ethics is available from the American Medical Association in hardcover or ebook. The revised edition contains ethical guidance improved for relevance, clarity, and consistency to help physicians keep pace with emerging demands they face with new technologies, changing patient expectations, and shifting health care priorities. 

The Code of Medical Ethics has played a central role as medicine's authoritative guide to professional values and responsibilities since its creation in 1847. 

"The new edition of the Code of Medical Ethics will remain a useful and effective resource that physicians can continue to rely on, while remaining faithful to the virtues of fidelity, humanity, loyalty, tenderness, confidentiality, and integrity that are enshrined in the original code," said AMA Past President Steven J. Stack, MD.

   Action TMLT Ad 10.15 

Success in Value-Based Care: Accountable Care Program Seeks to Fill a Void

The future of the Accountable Care Act may be uncertain, but the move to value-based care is here to stay. As a physician, you’re prepared to diagnose and treat, but what about all the nonclinical issues like billing and patient flow that come your way? 

TMA’s 2017 Accountable Care Leadership Program will help you lead successful, outcomes-based improvements in your practice. This 10-month, in-depth course guides physicians through leadership fundamentals and effective population health management that is patient-centered, cost-effective, and equitable. Applications are due Feb. 17, so enroll today. Physicians will strengthen their existing leadership and management skills, shifting from the individual physician-patient level to a broader examination of issues at a systemic level. Course material is transferable to any specialty or practice setting and includes more than 95 hours of continuing medical education, as well as a certificate from The University of Texas at Dallas.  

If you're ready to take the next step and successfully lead your practice through significant changes in the health care system, enroll in TMA’s Accountable Care Leadership Program. The program starts Feb. 27. For complete details, visit the TMA website.  

TMA Is 50,000 Members Strong and Growing

TMA is proud to announce the association ended 2016 with more than 50,000 members! Reaching this major milestone is a first for any state medical association, and the achievement is much more than a feather in TMA's cap. 

Surpassing the 50,000 member mark will boost TMA's advocacy efforts, allow for new member benefits and physician services, and help America's largest and most influential state medical society better serve current members like you. The more physicians and medical students TMA represents, the more it can amplify the voice of Texas medicine and help ensure the state remains the best place to practice medicine in the country.

Do you know of a physician or medical student who should be a TMA member but isn't? Point him or her to the TMA website. Thank you for your membership; let's keep the momentum going all the way to the Capitol!

 TMAIT Action Ad 6.15    

Host a Shot Clinic With Help From TMA's Be Wise — Immunize

TMA has a way to help you boost local vaccination rates: a Be Wise — ImmunizeSM Local Impact Grant. TMA is accepting applications until March 1 for grants of up to $2,500 to support local vaccination events. TMA member-physician practices/clinics, county medical societies (CMSs), TMA Alliance chapters, and medical student chapters can apply. 

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 event, and grantees have up to 12 months to use the funds. TMA will accept applications again on July 1 and Nov. 1 for shot clinics in late 2017 and early 2018. 

In 2016, TMA's Be Wise — Immunize program awarded 15 grants for projects to vaccinate Texans against flu, bacterial pneumonia, and other vaccine-preventable diseases. Since 2012, TMA has given more than $120,000 through the Local Impact Grants program to ensure Texans who are uninsured or underinsured receive needed vaccinations.

To plan your 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. More than 315,000 shots have been given 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 2017 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.

Join the Texas Two Step: Save a Life Campaign 2017

On Saturday, Feb. 11, and Sunday, Feb. 12, medical students from all 11 Texas medical schools will join forces with cardiothoracic surgeon Dr. Mehmet Oz, his national nonprofit HealthCorps, the American College of Emergency Physicians, the Texas College of Emergency Physicians, leadership consulting firm MaveRx, health law and consulting firm the Spiers Group, hospitals, and medical schools across the state for the 2nd Annual Texas Two Step: Save a Life Campaign. 

Free hands-only CPR training will be offered over the two days at public sites in Amarillo, Austin, College Station, Dallas, El Paso, Fort Worth, Galveston, Houston, Lubbock, San Antonio, the Valley, and Waco.

During five-minute training sessions, participants will learn how to act quickly in the event of cardiac emergencies by following two easy steps: Call 911, and initiate hands-only CPR. 

Dr. Oz will be participating in training sessions held in Houston on Feb. 11 and in Dallas and Fort Worth on Feb. 12. Visit the campaign website for details.

Last year's event trained more than 4,200 people, with more than 650 medical students in 53 locations. The students hope to train 10,000 Texans this year and plan to grow the event into a nationally driven initiative in the future.

The participating medical students attend Baylor College of Medicine; Texas A&M Health Science Center College of Medicine; Texas Tech University Health Sciences Center School of Medicine; Texas Tech University Health Sciences Center El Paso Paul L. Foster School of Medicine; University of North Texas Health Science Center at Fort Worth/Texas College of Osteopathic Medicine; The University of Texas at Austin-Dell Medical School; The University of Texas Health Science Center at Houston McGovern Medical School; The University of Texas Medical Branch at Galveston; The University of Texas Medical School at San Antonio; The University of Texas Rio Grande Valley Medical School; and The University of Texas Southwestern Medical School. 

TMA supports this unique campaign thanks to a grant provided by the TMA Foundation, the philanthropic arm of the association.

Learn more about the Texas Two Step: Save a Life Campaign, and show support for this event by following @TX2StepCPR on Twitter. 

Major Donors, Champions of Health Honored by TMA Foundation

The TMA Foundation (TMAF) recognized 23 Major Donors for their generosity and vision for a healthier Texas at the TMA Winter Conference on Jan. 28 in Austin. These TMA and TMA Alliance members and friends of medicine were honored for donating at least $10,000 during their years as a TMAF donor. This brings the total of Major Donors to 202.

Seven levels recognize the lasting impact made by Major Donors, ranging from the entry level (Pacesetter) of $10,000 in cumulative cash contributions to the top level (Visionaries) of $1 million or more in lifetime giving. As a lasting tribute of their generosity and vision, each Major Donor name is inscribed on a brass plate as part of the recognition walls on the 10th floor of the TMA building. Major Donors also have their names listed in a variety of publications and receive special recognition at the TMA Winter Conference and an invitation to the VIP reception at the TMAF annual gala. 

Also on Jan. 28, TMAF presented its 2017 John P. McGovern Champion of Health Awards to two Texas programs that are creating a "Healthy Now" and a "Healthy Future." This year's top winner is Seed to Soul — Growing Healthy Families From the Garden to Table, a program of Promise of Peace Gardens, Dallas. The program promotes healthier lifestyles through a garden and cooking classes at Bayles Elementary School in Dallas. The second place winner is the WATCH Champions of Health Award of the Fort Bend Independent School District. Read more about these programs.

For more information, contact Lisa Stark Walsh, TMAF executive director, by email or by calling (800) 880-1300, ext. 1666, or (512) 370-1666. 

PC Action Ad Oct 13

Registration Open for the Texas Primary Care and Health Home Summit

This year's Texas Primary Care and Health Home Summit will be the fifth annual statewide conference focused on expanding access to high-quality, person-centered primary care for Texans and their families. Sponsored by TMA, the summit will offer stakeholders the opportunity to learn about innovative primary care models, including the health home. 

Attendees will become conversant with best practices for innovation in primary care and will have opportunities to interact with program experts at various stages of implementation. Register now to attend the summit May 11–12 at the Sheraton Gunter in San Antonio.

The summit's goal is to provide opportunities for participants to hear from practitioners who have been successful in making transformational changes to their practices. The summit will offer practical, tangible, and useful tips and tools to help practices at all stages of their transformation. Check out the agenda.

This year's summit will appeal to primary care practices of all sizes and affiliations. It will include sessions on readiness for value-based contracting, integrating behavioral and oral health into primary care, building effective teams, population health strategies, improving chronic care management, and successful business models for the health home. Sessions will cover creating a pediatric health home and will provide an update on STARKids. Thursday morning pre-summit sessions are available for those who want to explore topics in greater depth. There will be additional opportunities for practices to share their successes and best practices with their peers. 

Participants will leave the summit with:   

  • An understanding of the health home and how it promotes accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective health care.
  • Awareness of best practices to improve the primary care practice for all types of patients (children, adolescents, adults, and individuals with special needs and/or chronic diseases).
  • An understanding of value-based contracting and how practices can participate in it.
  • Knowledge about the elements of accountable care organizations (ACOs) with the opportunity to learn from successful ACOs in Texas.
  • Examples of successful integration of behavioral health services into primary care practices. 
  • A focus on consumer engagement and strengthened partnerships among families, physicians, and the health care system. 

For additional information, visit the summit website.

This Month in Texas Medicine

The February issue of Texas Medicine is a symposium on infectious diseases. The special edition of the magazine features clinical articles that cover ethical challenges related to infectious diseases, emerging infectious diseases, future epidemics, the infectious disease outbreak investigation process, health care-associated infection prevention, antimicrobial resistance, the hygiene hypothesis, and infectious disease physician workforce needs.

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

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. 

PQRS: Last Day for Claims-Based Reporting

Medicare EHR Incentive Program Attestation Deadline for 2016 Participation

PQRS: Last Day for Dual Participation in PQRS and the Medicare Electronic Health Record (EHR) Incentive Program

PQRS: Last Day for Electronic Reporting Using an EHR via EHR Direct and EHR Data Submission Vendors

PQRS: Last Day for Qualified Clinical Data Registries (QCDRs) — QRDA Format


Medicaid EHR Incentive Program Attestation Deadline for 2016 Participation

PQRS: Last Day for Group Practice Reporting Option (GPRO) Web Interface

PQRS: Last Day for QCDRs — XML File Format

PQRS: Last Day for Qualified Registries

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.  


Love Being a Doctor Again
Can't attend in person? Register for the webcast

Take Back the Power: Payer Contract Negotiations
Can't attend in person? Register for the webcast.

Conferences and Events

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

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Last Updated On

September 26, 2018