Action: March 1, 2017

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

Feds Award $100 Million in MACRA Help to Small, Rural Practices
TMA Outlines EHR Concerns for House Chair
Supervise an APRN or PA? What You Need to Know
Save the Dates for First Tuesdays at the Capitol

TMA Foundation Grants Support Collaborations to Prevent Illness
Visit the Riviera in Style
This Month in Texas Medicine

Feds Award $100 Million in MACRA Help to Small, Rural Practices

The Medicare Access and CHIP Reauthorization Act (MACRA) included funding for organizations to provide support and technical assistance to small and rural practices to help them successfully participate in the Merit-Based Incentive Payment System and alternative payment models. TMA and the American Medical Association have continued to push for this assistance, and the Centers for Medicare & Medicaid Services (CMS) responded to that call by awarding about $20 million to 11 organizations.

The grants cover the first year of a five-year program to provide on-the-ground training and education about the Quality Payment Program for clinicians in individual or small group practices of 15 or fewer clinicians. CMS intends to invest up to an additional $80 million over the remaining four years.

TMF Health Quality Institute is one of the 11 organizations.

The organizations will provide hands-on training to help thousands of small practices, especially those that practice in historically under-resourced areas including rural areas, health professional shortage areas, and medically underserved areas. The training and education resources will be available immediately nationwide and will be provided for free to eligible clinicians and practices.

"Clinicians in small and rural practices are critical to serving the millions of Americans across the nation who rely on Medicare for their health care," said Dr. Kate Goodrich, CMS chief medical officer and director of the Center for Clinical Standards and Quality. Congress "provided the funding for this assistance, so clinicians in these practices can navigate the new program, while being able to focus on what matters most — the needs of their patients."

The technical assistance, for example, will help clinicians choose and report on quality measures. It will include guidance with all aspects of the program, including supporting change management and strategic planning, and assessing and optimizing health information technology.

TMF will provide technical assistance and services in a region comprising Texas, Arkansas, Colorado, Kansas, Louisiana, Mississippi, Missouri, Oklahoma, and Puerto Rico. Customized assistance will include: 

  • Evaluating practice readiness for participating in a new payment model,
  • Engaging practices in continuous quality improvement,
  • Assessing and optimizing health information technology, and
  • Supporting change management and strategic planning. 

Additional federal training on the new Quality Payment Program includes: 

In addition to TMF, CMS awarded contracts to these organizations:  

  • Altarum,
  • Georgia Medical Care Foundation (GMCF),
  • HealthCentric,
  • Health Services Advisory Group (HSAG),
  • IPRO,
  • Network for Regional Healthcare Improvement (NRHI),
  • QSource,
  • QualisQuality Insights (West Virginia Medical Institute), and
  • Telligen. 

For more information on the Quality Payment Program, visit the TMA MACRA Resource Center or the CMS website

TMA Outlines EHR Concerns for House Chair

The potential for electronic health records (EHRs) to transform health care remains constrained by the lack of effective health information exchange (HIE) technology, TMA says in a letter to U.S. House Ways and Means Committee Chair Kevin Brady (R-The Woodlands). 

Matt Murray, MD, chair of TMA's Ad Hoc Committee on Health Information Technology, writes that EHRs have failed to transform health care "primarily because most patient health information is still 'locked' inside the physician's office." TMA's top concerns are lack of EHR interoperability and data security and liability.

Committee Chair Brady requested TMA's assessment to help his committee draft needed reforms.

Dr. Murray explains to Congressman Brady that interoperability problems are due to "the actual movement of data between systems (i.e., an interface)." Interfaces are typically implemented through:  

  • Connecting multiple EHRs to a single HIE organization (e.g., the Houston or San Antonio HIE);
  • Making a direct connection between the computers of two organizations without an HIE (e.g., a laboratory interface to a hospital);
  • Sending information one episode at a time through secure email (e.g., the DIRECT system);
  • Retrieving single pieces of information through a special query (e.g., using the Fast Healthcare Interoperability Resources [FHIR] standard, which is in development and can be useful in some cases where specific information is needed); or
  • Using the "Blue Button" or the equivalent to provide patients a copy of their own data and allowing them to provide it to the next physician/care location. This is rare and sometimes is supported by an HIE or by using the DIRECT email system.  

In terms of data security and liability concerns, TMA's letter states: "Physicians are concerned about the security of health information exchange and need protections to avoid being inappropriately penalized or held financially liable for breaches and other problems that are inherent with electronic data exchange between health care entities."

Until these problems are addressed, the letter concludes, "TMA feels it is not appropriate to penalize physicians who do not participate in health information exchange because of these concerns."

TMAIT Action Ad 6.15

Supervise an APRN or PA? What You Need to Know

Delegating duties to an advanced practice registered nurse (APRN), physician assistant (PA), or other nonphysician can be an excellent way to enhance your practice and improve your patients' access to quality medical care. But, a newly updated TMA white paper cautions, you have to do it right. Your license to practice may be at risk.

Delegation of Duties by a Physician to a Nonphysician is available to TMA members only.

"Generally, latitude is given to a supervising physician in the physician's delegation authority, but which acts a physician may delegate greatly depends upon the education and experience of the person to whom the acts are being delegated," according to the white paper. "A physician must adequately supervise the activities of those acting under the physician's supervision, and may not delegate professional medical responsibility or acts to a person if the delegating physician knows or has reason to know the person is not qualified by training, experience, or licensure to perform the responsibility or acts."

The 18-page white paper covers the law, ethical considerations, billing, standing orders, delegating duties and prescriptive authority, supervisory requirements, administration of anesthesia, and other practical considerations. It discusses supervising and delegating duties to APRNs, PAs, physical therapists, medical assistants, pharmacists, and midwives.

TMA's Office of General Counsel reminds you, however, that the information in the white paper "is of a general nature and should not be used in place of retained legal counsel."

Save the Dates for First Tuesdays at the Capitol

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 March 7, April 4, and/or May 2, 2017. The March 7 event is designated the official TMA Alliance First Tuesday, as well as the young and newly licensed physician event. 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.

Hotel rooms in Austin are in high demand during legislative sessions. Sleeping rooms at TMA's special room rate are sold out for the March, and April events. Reserve your room now for the Monday before May event at the Doubletree Suites by Hilton Hotel. Call (800) 445-8667 and mention you're attending TMA's First Tuesdays at the Capitol event for the special room rate of $219 for March and $209 for May. 

Or reserve a hotel room online, but make sure to enter the correct group code for your stay:

Monday's Date       Group Code       Cut-Off Date
March 6       TAT       (currently sold out — see alternative hotels)
April 3               (currently sold out — see alternative hotels)
May 1       TUE       April 10 

For more information or to register, visit the TMA website, or call (800) 880-1300, ext. 1363.

  Action TMLT Ad 10.15

TMA Foundation Grants Support Collaborations to Prevent Illness

Improving the health of all Texans through prevention is the focus of two grants recently approved by the TMA Foundation Board of Trustees. 

The University of Health is a public health forum held four times a year by the Texas Public Health Coalition (TPHC), of which TMA is a founding member. The 90-minute luncheon events include presentations on Texas' role in public health and safety and the economic impact of public health issues. TPHC comprises more than 35 health professional and health-focused organizations dedicated to disease prevention and health promotion. TPHC members and legislative members and their staff are invited to these forums on public health infrastructure, immunizations, obesity, tobacco use, cancer control, and related topics with the goal of educating, strengthening collaboration, and prioritizing statewide advocacy to improve the health of all Texans.

The foundation's grant to the Tarrant County Medical Society Alliance Foundation supports enhanced promotion and social media for summer immunization events. Alliance members provide funding, volunteers, and leadership to the Immunization Collaboration of Tarrant County (ICTC), which includes more than 40 public and private agencies and organizations that are committed to the systematic eradication of childhood, vaccine-preventable diseases in Tarrant County. ICTC serves more than 7,000 children with 20,000 doses of vaccine each year and distributes 15,000 to 20,000 pieces of education materials throughout the county annually. 

The TMA Foundation is the 501 (c) (3) philanthropic arm of TMA. Learn more about the TMA Foundation and how you can support TMA's health improvement, science and quality-of-care initiatives.

Visit the Riviera in Style

TMA physicians, friends, and family are invited to take advantage of the extended early-bird discount on a highly-anticipated Gohagan & Company trip during Oct.2–10: the Riviera and Islands of France, Italy, and Spain. Gohagan, a leading provider of international and domestic travel experiences, is an approved travel program for TMA members.

View the Riviera and Islands of France, Italy, and Spain brochure for more information, or call (800) 922-3088 to book today. The early-bird rate ends April 15.

Tours in 2017 have filled quickly, so be sure to save the date and book early for these trips, coming in 2018: 


  • Passage Through the Panama Canal and Costa Rica: Feb. 9–17, 2018
  • Celtic Lands: May 24–June 2, 2018
  • Changing Tides of History; Baltic Sea Countries: June 14–23, 2018
  • Circumnavigation of Iceland: July 9–17, 2018
  • Ancient Empires: Sept. 20–28, 2018


Remember, TMA members can always access a worldwide inventory of hotels and car rentals with exclusive discounts. Whether travelling for work or pleasure, you can take advantage of savings that average 10- to 20-percent below the best available rates. 

Find more information on these and other TMA member benefit programs by visiting the TMA website.

PC Action Ad Nov 13

This Month in Texas Medicine

The March issue of  Texas Medicine features a cover story on the rise in school vaccine exemptions among Texas students. Physicians hold hope that this year's dramatic national increase in cases of mumps, including an outbreak in Texas, might give medicine-friendly lawmakers further opportunity to release more data to parents on how many students in their children's schools have received an exemption. The March issue also includes coverage of legal concerns regarding updates to the National Practitioner Data Bank's NPDB Guidebook, new TMA data showing physicians' passion and persistence are paying off as they attempt to negotiate the terms of their health plan contracts, and a guide to understanding how health care rating websites operate.

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 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
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Take Back the Power: Payer Contract Negotiations
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Conferences and Events

TexMed 2017 
May 5-6

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Last Updated On

March 01, 2017