Action: April 3, 2017

TMA Action April 3, 2017   News and Insights from Texas Medical Association

Houston Heart Surgeon Wins Millions in Defamation Claim
How to Submit the Bare Minimum to Avoid 2019 MIPS Penalty
TMA and Health Plans Tackle Medicaid Credentialing Hassle
Medicare Delays New Bundled Payment Models
Bugs Are Back, So Is Zika
Meaningful Use Hardship Exemption Application Due by July 1
Medicaid Help in Five-Minute Doses

A Free Member Benefit You'll Want to Use
New White Paper Helps You Stay HIPAA Secure
Famed Texas Pathologist's Records Released
New Form Required for All Medicaid EHR Incentive Program Participants
ImmTrac2 Launches April 3
This Month in Texas Medicine

Houston Heart Surgeon Wins Millions in Defamation Claim

A Harris County jury has awarded $6.4 million in damages to a Houston cardiothoracic surgeon whom TMA supported in his years-long battle with Memorial Hermann Health System over a defamation claim.

Miguel Gomez, MD, filed suit after he left Memorial Hermann Memorial City Medical Center in 2012. Dr. Gomez claimed that after he began planning a move to Houston Methodist West Hospital, Memorial Hermann began a "whisper campaign" to discredit him as a surgeon, which included "selective and improper dissemination" of manipulated data. He claimed the hospital attempted to create an image that patients were more likely to die in his care. It was all part of an effort to undermine his surgical business as he prepared to move to a competing hospital, Dr. Gomez claimed.

The jury's decision last Wednesday found Memorial Hermann had defamed Dr. Gomez and had conspired with others to "restrain trade" by causing referring physicians to stop referring cardiovascular and thoracic surgery patients to him. 

As part of his suit, Dr. Gomez attempted to compel Memorial Hermann to release what the hospital said were confidential peer review documents, which he believed would provide evidence of the smear campaign. When the fight over the peer review documents reached the Supreme Court of Texas, Dr. Gomez contacted TMA and its Committee on Patient-Physician Advocacy for help. TMA submitted a friend-of-the-court brief supporting Dr. Gomez's case, which argued for an exception in the confidentiality of peer review records. The Supreme Court's 2015 decision resulted in the release of most of the records Dr. Gomez sought. After the high court's decision, Dr. Gomez said when he needed TMA "at my most difficult period in my medical career, they came in and did the right thing."

After Wednesday's jury verdict, Memorial Hermann hospital officials said they would evaluate whether to appeal, according to the Houston Chronicle.

How to Submit the Bare Minimum to Avoid 2019 MIPS Penalty

Under the new Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) rules, physicians submit data on their 2017 performance, and that data will affect their 2019 Medicare payment rates. TMA has compiled some easy steps you can take now to avoid the 4-percent Medicare penalty in 2019.

To implement MACRA, the Centers for Medicare & Medicaid Services (CMS) designed a new Quality Payment Program that has two paths: the Merit-Based Incentive Payment System (MIPS) and advanced alternative payment models (APMs). Although you don't submit data for the 2017 performance period until early in 2018, you may take the necessary steps now to avoid the 2019 MIPS penalty. Here's how.

For the first year, CMS offers a "pick-your-pace" approach to participation. In 2017, you may participate in an advanced APM or submit data under the MIPS program for a full year or for a partial year (90 days), or you may just test the system by submitting a minimum amount of data for any point in time to avoid a penalty. If you choose not to participate in any path in 2017, you will receive an automatic 4-percent pay cut on a per-claim basis to your Medicare Part B payments in 2019. 

CMS will exempt physicians from MIPS in 2017 if they are in their first year of Medicare Part B participation, part of an advanced APM, or are below the low-volume threshold of $30,000 or less in Medicare Part B charges or 100 or fewer Medicare Part B enrolled beneficiaries annually. CMS tells TMA it will soon add a website tool to help physicians determine if they are below the low-volume threshold and exempt from MIPS in 2017. TMA will notify physicians once the tool is made available by CMS. 

Bare Minimum Requirements

If you are not in an advanced APM and are not exempt from MIPS in 2017, you must complete at least one of the following bare minimum requirements to avoid the 2019 MIPS penalty:

Quality Category  

  • To submit the bare minimum for this category, you only need to report data on one quality measure for one patient for any point in time in 2017. TMA recommends physicians report on more than just one patient to ensure sufficient data is received by CMS. 
  • Review the list of 271 MIPS quality measures and select a measure that applies to you and your patients.
  • The most affordable and easiest way to submit the bare minimum for the quality category is through claims-based reporting. The process to report data on quality measures via claims should be similar to what it was for PQRS, except you will need to refer to 2017 MIPS measure specifications to obtain the most current data codes for the quality measure you choose to report. NOTE: Make sure you use only MIPS codes and not old PQRS codes.
  • Access the TMA guide for step-by-step guidance on how to select a quality measure and review measures specifications to obtain quality data code(s) that you will use on a claim form.
  • The deadline for claims-based reporting for the quality category for the 2017 performance period is Feb. 28, 2018, but you can fulfill this bare minimum requirement now. 

Improvement Activities Category  

  • To submit the bare minimum for this category, you only need to report that you completed one improvement activity for a minimum of 90 days in 2017. 
  • Review the list of 92 improvement activities, and identify at least one improvement activity your practice already does and will continue to do or which activity your practice could implement or engage in to receive credit for the first performance period.
  • The most affordable and easiest way to submit data on improvement activities is by attesting to participation via the CMS MIPS portal. This portal is not yet ready, but will be made available by January 2018. Once available, it is expected that all you will need to do is log in and attest to one activity on the list. 
  • The deadline for attestation for the Improvement Activities category for the 2017 performance period is March 31, 2018. 

Advancing Care Information Category  

  • To submit the bare minimum for this category, you only need to attest to meeting the four or five measures that are required for the base score. CMS will accept a minimum of 90 consecutive days of data in 2017. 
  • Review the list of up to 15 measures and two reporting options, and select your reporting option and number of measures required for the base score that corresponds with your electronic health record (EHR) edition.
  • For the measure requiring a yes/no response, the answer must be "yes." For numerator/denominator measures, you must report at least "one" in the numerator, meaning at least one patient per measure during the 90-day reporting period to meet the bare minimum requirements for the base score. 
  • Contact your EHR vendor to inquire about these requirements, whether you will be able to meet them through your EHR system, and to discuss fees for MIPS reporting.
  • The deadline for attestation for the Advancing Care Information category for the 2017 performance period is March 31, 2018.  

According to CMS, completing one of the above actions in 2017 will ensure you avoid the 2019 MIPS penalty. However, the more data you submit, the greater the potential for a higher performance score and bonus payment. If you decide to report more data in 2017 to shoot for a bonus payment in 2019, review the TMA MACRA Checklist to learn about requirements for full year or partial year participation. 

As always, visit the TMA MACRA Resource Center to stay up to date on the latest information. 

TMA and Health Plans Tackle Medicaid Credentialing Hassle

TMA and the Texas Association of Health Plans (TAHP) announced a joint effort to reduce red tape and administrative burdens for physicians and providers who participate, or want to participate, in the Texas Medicaid program. The two organizations selected Aperture, LLC, for a statewide credentialing verification organization (CVO) contract to be used by all 20 Medicaid health plans in Texas to streamline the credentialing process.

"Countless Texas physicians want to care for Medicaid patients, but the barrier of Medicaid's bureaucratic red tape and administrative burdens simply discourage them," said TMA President Don R. Read, MD. "We hope simplifying doctors' credentialing and recredentialing process will ease the path for more Texas physicians to see Medicaid patients."

Through the credentialing process, Medicaid managed care organizations (MCOs) gather and assess background information on physicians and providers to confirm they are in good standing, ensure patient safety, and prevent fraud, waste, and abuse. Currently, each MCO gathers this background information separately and with varying deadlines, requiring physicians to submit and resubmit their information to all 20 Medicaid health plans individually and at different times.

The idea of a statewide CVO was endorsed by a bill the Texas Legislature passed in 2015. Under the contract with Aperture, the CVO will be a single source for all credentialing information. That means physicians who wish to participate in more than one Medicaid MCO need only supply their information once. In addition, the Medicaid health plans agreed to adopt a single recredentialing date, so physicians will have to be recredentialed only once for all of the plans. Physician recredentialing for Medicaid HMOs generally occurs every three years.

The project implementation will begin immediately, with statewide operations expected to begin in October 2017.

"We look forward to continuing to work with TMA to establish a one-stop shop for providers that greatly reduces their paperwork burden, ensures a more seamless process, and boosts access to safe, quality care for Texans who rely on the Medicaid program for their health care needs," said TAHP Chief Executive Officer Jamie Dudensing. She added that she is hopeful health plans will include additional lines of business, such as commercial insurance and Medicare, to the CVO project in the future.

Medicare Delays New Bundled Payment Models

Medicare won't expand its bundled payment program for orthopedic surgery and won't start several similar programs for cardiac care until Oct. 1 — and maybe later — the Centers for Medicare & Medicaid Services (CMS) announced.

Those projects were initially slated to begin July 1. In the notice of the change, CMS asked for comments on further delaying those changes until Jan. 1, 2018.

Under the Comprehensive Care for Joint Replacement program, which began last year as a pilot project in 67 metropolitan areas, all related care for hip and knee replacements within 90 days of hospital discharge is included in the episode of care. CMS had planned to expand that program to include surgical hip and femur fracture treatment and recovery in those same 67 metropolitan areas.

The Acute Myocardial Infarction (AMI) Model and the Coronary Artery Bypass Graft (CABG) Model were set to begin July 1 in 98 metropolitan areas. The Cardiac Rehabilitation Incentive Payment Model, also initially expected to start July 1, would test financial incentives for the use of cardiac rehabilitation in 90 regions. 

Several media reports speculated that the delays might be a sign that Medicare bundled payment models might be on their way out.

"Prior to his confirmation, HHS Secretary Tom Price repeatedly expressed concerns about CMS' mandatory bundled payment programs," said Eric Cragun, senior director of health policy at the Advisory Board. "The latest announcement indicates that the Trump administration continues to review these programs, although their ultimate fate is still not certain."

Action TMLT Ad 10.15

Bugs Are Back, So Is Zika

As we hit the first official days of spring, anticipation builds over of the threat of Zika virus cases spread by mosquito bites in Texas, and TMA is preparing an event to help you help your patients. 

Texas' first locally-transmitted Zika case occurred in November in the Rio Grande Valley. As of March 10, the Department of State Health Services (DSHS) reported seven new Zika cases affecting Texas residents this year. Public health officials are concerned the relatively mild winter will contribute to the growth of mosquitoes spreading the virus to more people in the Lone Star State.

TMA is joining forces with DSHS to convene a second critical "tele-town hall" conference call with Texas physicians.

"Our goal is to ensure you are ready to counsel your patients and take the right actions when the inevitable happens — more cases of mosquitoes spreading Zika in Texas," TMA President Don R. Read, MD, said in announcing the event. "Physicians across the state are concerned about reporting and testing in their communities as the long, hot summertime bug season approaches."

TMA is taking to the phone — your home phone — to spread the vital information. Answer your phone at 7 pm CT, Wednesday, April 12, to take part in TMA's Tele-Town Hall Meeting on Zika. 

TMA will call you at the home phone number on file in your membership record. If you want us to call a different number — or if you do not want us to call you at all — please email the TMA Knowledge Center or call (800) 880-7955 by 5 pm CT on Friday, April 7.

Our growing list of speakers includes: 

  • John Hellerstedt, MD, DSHS executive commissioner; 
  • David Lakey, MD, former DSHS commissioner and current chair of the TMA Council on Science and Public Health;
  • Catherine Eppes, MD, MPH, co-director of the High-Risk Obstetrics Infectious Disease Clinic at Ben Taub Hospital, Houston;
  • Philip Huang, MD, MPH, medical director and health authority for Austin Public Health; and
  • Rajendra Parikh, MD, medical director, Medicaid and Chip Division, Texas Health and Human Services Commission.

The call will include an update on the state's Zika preparedness planning, a briefing on reported Texas Zika cases, and the latest on Zika testing. And during this interactive, hour-long event, you may ask questions of Dr. Hellerstedt and the other expert Texas physicians. Dr. Lakey will serve as facilitator. 

The Texas Medical Association designates this activity for a maximum of 1 AMA PRA Category 1 Credit™. This course has been designated for 1 credit of education in medical ethics and/or professional responsibility. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who remain on the call for at least 53 minutes will automatically receive CME credit.

TMA is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Learn more about Zika in the TMA Infectious Diseases Resource Center

Meaningful Use Hardship Exemption Application Due by July 1

Physicians who are not participating in the Medicare electronic health record (EHR) incentive program, also known as meaningful use, will be penalized by Medicare beginning Jan. 1, 2018. To prevent the penalty, physicians must have either attested to meaningful use by March 13, 2017, or applied for a hardship exemption by July 1, 2017.

Physicians who meet these criteria are automatically exempt from the program and do not need to file an exemption application: 

Specialties: If you're classified in the Medicare Provider Enrollment, Chain and Ownership System (PECOS) as one of these five specialties, you don't need to file an exemption and will be exempt for payment year 2018:  

  • Diagnostic radiology,
  • Nuclear medicine, 
  • Interventional radiology, 
  • Anesthesiology, and 
  • Pathology.  

New to practice: If you are in your first year of practice, you do not need to claim an exemption. The Centers for Medicare & Medicaid Services (CMS) says it will know you are new to practice and will automatically exempt you. 

Hospital-based: If you perform more than 90 percent of services using place-of-service codes 21 or 23 (hospital), then you will automatically be exempt from the Medicare penalty. 

Other exemptions are available, but you must take the time to fill out the 10-page application and submit it to CMS by July 1. If more than 100 physicians are applying for the same hardship, please attach an Excel spreadsheet listing each physician’s first name, last name, and NPI.

You can apply for a hardship exemption for these circumstances:  

  • Insufficient internet connectivity: You must demonstrate that your practice is in an area without sufficient internet access to comply with meaningful use and that you face insurmountable barriers to obtain such connectivity. 
  • Extreme and uncontrollable circumstances: This exemption can be claimed in the case of a natural disaster, practice closure, or bankruptcy, or for EHR certification/vendor issues. 
  • Lack of control over the availability of certified EHR technology: You have no control over the availability of certified EHR technology in one or more practice locations where more than 50 percent of the patient encounters occurred. 
  • Lack of face-to-face patient interactions: Your specialty isn't listed above as exempt and you lack face-to-face interactions with your patients.  

Exemptions must be renewed annually, and you may not claim an exemption for more than five years.

If you never successfully attested to meaningful use in the past, but plan to report for program year 2017 (which would prevent a 2019 Medicare fee-for-service penalty) under the MACRA Merit-Based Incentive Payment System (MIPS), you can submit a Transitioning to MIPS Hardship Form by Oct. 1, 2017, to avoid the penalty in 2018. 

Contact TMA's Health Information Technology Department with questions by email or by calling (800) 880-5370. 

Medicaid Help in Five-Minute Doses

Texas Health Steps Online Provider Education (OPE) recently released two quick courses. Quick courses give you five minutes of targeted instruction on timely topics or policy updates.

The new courses are: 

Texas Health Steps OPE is a one-stop source for free, online continuing education that supports improved health and well-being for Texas infants, children, and adolescents enrolled in Medicaid.

 TMAIT Action Ad 6.15

A Free Member Benefit You'll Want to Use

On May 5-6, TMA members and your practice staff can take advantage of one your most valuable member benefits ― TMA's annual conference, TexMed 2017. TexMed is free for all members and for practice staff, so register today.

At the conference, choose from more than 80 hours of multidisciplinary CME to help "Renew Your Passion" for medicine. Unique program tracks will focus on topics such as early career planning, disaster medicine and emergency preparedness, quality payment programs, public health, cancer, and telemedicine. 

Other conference highlights include nationally renowned general session speakers, including Kevin Pho, MD, from, as well as one-on-one consultations (sign up today, slots are limited) with TMA's Practice Help experts. Physicians can connect with leaders from across the state during the free networking luncheon inside the Expo Hall, at the TMA Foundation Gala, and during the House of Delegates business meetings. 

Take advantage of discounted room rates at the Marriott Marquis ― the newest addition to the Houston skyline. Rooms will be available at the TMA rate of $209 until April 13 or when the room block is full, so make your reservation today. The new hotel includes six highly-anticipated restaurants, as well as a Texas-shaped lazy river pool, all adjacent to Houston’s 12-acre Discovery Green.

For more information, visit the TexMed 2017 section of the TMA website

New White Paper Helps You Stay HIPAA Secure

TMA and DocbookMD are offering a new, free white paper to help answer your HIPAA questions about the proper use of mobile technology in health care. 

TMA members interested in adding or strengthening the use of mobile technology in their practice should invest only in services that are purpose-built and HIPAA-secure. The new white paper discusses how to implement mobile technology into a medical practice by focusing on three primary components. 

  1. A practice should formally assess the risk posed by all mobile devices when accessing protected health information. By establishing a log of every mobile device that has been or is being used, a practice can create a comprehensive picture of where vulnerabilities may lie.
  2. All mobile devices in use at a practice should have a strong, multitiered set of security features. This includes strong passwords and two-factor authentication, as well as remote disabling options and firewall protection.
  3. Medical practices should ensure they have a clear policy of do's and don’ts for physicians and practice staff ― especially covering what happens if a device is lost, stolen, or compromised. All practice staff should be regularly trained on the risks of mobile use as well as how to mitigate those risks.  

For complete details, download the white paper today.

As a TMA member, you have free access to one of the most rapidly growing, HIPAA-secure messaging applications for smartphones and tablet devices ― DocbookMD. With more than 30,000 physician users across 41 states, DocbookMD puts physicians in control of technology and across practice settings by enabling immediate, secure communication with practice staff and fellow practitioners. 

Download the DocbookMD App for free in the Google Store or via iTunes.

Famed Texas Pathologist's Records Released

Fort Worth pathologist May Owen, MD, blazed many a trail during her long career in medicine. Now, digital versions of the papers and records that document her path are available in the Portal to Texas History.

Clinically, Dr. Owen is perhaps best known for discovering that the talcum powder used on surgical gloves caused infections and scarring in patients. She was also a glass-ceiling buster in organized medicine, serving as the first female president of the Texas Society of Pathologists, of the Tarrant County Medical Society, and – in 1960 – of the Texas Medical Association. She is a member of the Texas Women's Hall of Fame and the National Cowgirl Hall of Fame.

The collection that TMA made available to the Portal to Texas History includes letters from, to, and about Dr. Owen as well as newspaper clippings documenting her career. In one item, a draft of an article entitled "Why I Have Shared," Dr. Owen discusses her reasons for establishing the May Owen Trust, which to this day underwrites loans for Texas medical students

MayOwen-WhyIHaveShared"I have been committed to a medical career since age nine," she wrote. "It seemed then ― as it has always and likewise now ― that through medicine, I can best help others. Does it not follow, then, that I would want to do everything possible to help men and women who aspire to study medicine? Without help, counseling, encouragement, and financial aid, I could have failed. What an ungrateful person I would be if I forgot all the help I have received, and had not found ways to pay back by investing in youngsters."

Created and maintained by the University of North Texas (UNT) Libraries, the Portal to Texas History is a digital gateway to historical materials from or about Texas from private collectors, libraries, museums, historical archives, and other historical groups. Every month, more than half a million visitors from around the world discover historical treasures from across the state via free public access to the portal.

In 2015, TMA entered into an agreement with UNT Libraries and the Portal to Texas History through their Rescuing Texas History (RTH) mini-grant program. RTH periodically invites institutions and individuals to apply for digitization "mini-grants." Winners receive services that include scanning, description, and hosting of their items on the portal. TMA initially received a grant worth $1,000 to digitize notable issues of TMA's monthly publication the Texas State Journal of Medicine (now Texas Medicine), including the centennial and sesquicentennial issues.

In 2016, TMA submitted another successful RTH mini-grant application to digitize and present the association's May Owen, MD, collection. 

PC Action Ad May 13

New Form Required for All Medicaid EHR Incentive Program Participants

Starting April 1, all participants of the Medicaid electronic health record (EHR) incentive program for program year 2017 or later must complete a Third Party Attestation Authorization Form indicating whether you intend to use a third party to complete your meaningful use attestation.

You can complete the form on a computer using a digital signature and upload it to the Texas Medicaid EHR Incentive Program portal. Alternatively, you may print it, sign in ink, and scan it as an electronic file for upload. Participants will be prompted during the attestation process to upload the form through the secure upload function in the portal. You must complete and submit the form before receiving an incentive payment.

To find out more about the Medicaid EHR incentive program and attestation requirements, see the Texas Medicaid website.

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

ImmTrac2 Launches April 3

Starting April 3, an updated state immunization registry, ImmTrac2, replaces the earlier ImmTrac system and offers enhanced capabilities for immunization history and forecasting and for generating reports. 

By law, physicians who provide immunizations to patients younger than 18 years must submit immunization data to the statewide registry. Parents must consent for their child to be included in the registry. Physicians also are encouraged to submit data on immunizations of adults who agree to be included in the registry. 

TMA continues to advocate for a strong, well-populated immunization registry. TMA supports the registry as a tool for physicians to turn to as a dependable vaccination record as well as for public health officials to monitor vaccine coverage in communities. 

The Department of State Health Services (DSHS) provides training resources for ImmTrac2 on its website, including an implementation guide, instructional videos, and webinars. 

Registered ImmTrac users should have received their new log-in credentials during the week of March 27. You will need these credentials to access the system for the first time. 

Questions about ImmTrac2 can be sent to DSHS via email

This Month in Texas Medicine

The April issue of Texas Medicine features a cover story on potential Medicaid reforms. Questions abound as to what capped Medicaid funding would look like and what effect it would have on the current Medicaid-eligible population, covered services, and physician payments. The April issue also includes coverage of TMA's HPV Work Group and its plans to improve HPV vaccine rates, the latest rule change on resident duty hours, and problems encountered when physicians change electronic health record vendors. A Journal article examines the relationship of mental health to alcohol and substance use among Texas college students..

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. 

Medicaid EHR Incentive Program Attestation Deadline for 2016 Participation

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.  


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On-Demand Webinars

Innovation in Education for Cardiovascular Risk Patients: Heart Healthy Diet and Lifestyle

Making Discussions About Death and Dying Easier

HIPAA Training for Medical Office Staff

Conferences and Events

TexMed 2017 
May 5-6

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Last Updated On

March 22, 2018