Action: June 1, 2017

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

Medicine’s Winners and Losers as Legislature Wraps Up
New Leaders Take the Helm at TMA
TMA Foundation Also Chooses Leadership
Just Like Summer, West Nile Virus Season Heating Up
Boost Your Community’s Immunity: Apply for a TMA Vaccination Grant
Medicare Further Delays New Bundled Payment Models
Medicine Fights Proposed Medicaid Specialty Care Cuts
Get Dual Incentives through MACRA, Meaningful Use

Venous Blood Lead Test Not on the Level
TMA Joins Large Coalition Backing Physician-Owned Hospitals
Focus on Member Services: HR Help
Have Your Say on Hospital Levels of Care for Maternity Patients
Double Your Impact on the Health of Texans
Get Awarded for Quality Improvements
This Month in Texas Medicine

Medicine’s Winners and Losers as Legislature Wraps Up

The 2017 regular session of the Texas Legislature gaveled to a close May 29. For medicine, the session was a mosaic of many richly colored tiles with some dark spots and quite a few shades of grey. The artists were shifting alliances and divisions of senators and representatives, Democrats and Republicans, and various factions of the GOP.

The final product includes one obvious empty space. Thanks to a long-brewing, House-Senate feud over unrelated issues, the legislature adjourned without passing a bill to reauthorize the Texas Medical Board (TMB) and the Medical Practice Act beyond their scheduled Aug. 31, 2017, demise.

"This is a fight that has nothing to do with the physicians or with the TMB, and everyone at the Capitol knows that," said TMA President Carlos J. Cardenas, MD. "The TMB serves a critical state function, licensing physicians and protecting the health and safety of Texans. We have no reason to believe that any of our state leaders want the TMB to go away, and we have every expectation that they will find a way to make sure that doesn’t happen."

At a news conference May 29, Gov. Greg Abbott said he will announce his plans for a special session in the future. "When it gets to a special session," he said, "the time and topics are solely up to the governor of the state of Texas."

Below is a comprehensive look at the bills that were of interest to TMA and its members.

Medicine's Bills Signed by the Governor

Senate Bill 507 by Sen. Kelly Hancock (R-North Richland Hills) and Rep. John Frullo (R-Lubbock) will expand the billing mediation process to all physicians and others providing out-of-network services at certain in-network facilities. It also expands mediation to out-of-network situations for emergency care.

Senate Bill 680 by Senator Hancock empowers physicians to override health plans’ step therapy protocols, allowing them to continue prescribing an effective medication even if the insurer’s step therapy plan calls for a change in medication.

Senate Bill 1107 by Sen. Charles Schwertner, MD (R-Georgetown), establishes a statutory definition for telemedicine and clarifies that the standard of care for a traditional, in-person medical setting also applies to telemedicine services. In the House, Rep. Four Price (R-Amarillo) added language making it clearer that telemedicine is not a distinct service but a tool physicians can use. The bill also prohibits health plans from excluding telemedicine from coverage just because the care isn’t provided in person.

Senate Bill 224, Sen. Kirk Watson’s (D-Austin) Cancer Prevention Research Institute of Texas sunset bill, extends the sunset date of the cancer research organization from 2021 to 2023, while also adding two years to its eligibility to allocate funds, to 2022. Its House sponsor was Rep. Sarah Davis (R-West University Place). 

Medicine's Bills Sent to the Governor

Thanks to the more than 1,250 Texas physicians who rallied to support this bill during the final weekend of the session, Senate Bill 1148 by Sen. Dawn Buckingham, MD (R-Lakeway), finally passed. As originally written, SB 1148 would have prohibited health plans and hospitals from using maintenance of certification (MOC) to differentiate among physicians for payment, contracting, or credentialing. It also would have required TMB to certify alternative MOC programs. In the final compromise version, the bill still prohibits the state from using MOC as a requirement for state licensure or renewal, or insurance participation — but permits health facilities to use MOC if hospital medical staffs vote it is appropriate for their own hospital. Rep. Greg Bonnen, MD (R-Friendswood), was the House sponsor.

House Bill 10 by Representative Price will establish a state mental health parity work group, designate an ombudsman as an advocacy resource, and clarify benefit terms and coverage for mental health and substance use. TMA hopes the legislation also will improve Texas Department of Insurance mental health parity oversight; increase physician, health care provider, and patient engagement toward achieving true mental health parity; and identify areas to improve historic parity challenges.

House Bill 62 by Rep. Tom Craddick (R-Midland) to ban texting while driving statewide is on Gov. Greg Abbott’s desk. After a 10-year journey and a nearly unanimous vote, hopefully the governor will sign it into law. Sen. Judith Zaffirini (D-Laredo) was the bill’s Senate sponsor. The measure was a TMA and Texas Public Health Coalition (TPHC) priority. Please use the TMA Grassroots Action Center to send Governor Abbott a message urging him to sign this bill.

House Bill 1917 by Rep. Richard Raymond (D-Laredo) will keep the Medicaid Preferred Drug List (PDL) under Texas Health and Human Commission (HHSC) oversight. The bill places the PDL under HHSC auspices until 2023, after which managed care organizations would manage the formulary and the PDL. The bill's Senate sponsor was Senator Schwertner. 

House Bill 2561 by Rep. Senfronia Thompson (D-Houston) finally passed, amended by lawmakers to include Physician Drug Monitoring Program (PDMP) initiatives to identify potentially harmful prescribing or dispensing patterns or practices that might suggest drug diversion or “doctor shopping.” The idea is to address people’s misuse of, and addiction to, opioid pain medicines. The prescribing amendment calls for physicians and all other prescribers and dispensers to check the PDMP before prescribing any of the listed classes of medications after Sept. 1, 2019. The implementation date provides TMA with the opportunity to request possible revisions during the 2019 Texas Legislature.

House Bill 3576 by Rep. Bobby Guerra (D-McAllen) will shore up the state’s testing and screening capabilities for infectious diseases, such as the Zika virus. TMA told lawmakers physicians support the bill because it upholds a core function of public health. Disease surveillance allows for the implementation of prevention and treatment activities, TMA said.

Senate Bill 570 by Sen. Jose Rodriguez (D-El Paso) “relating to the regulation of the retention, storage, transportation, and disposal of used or scrap tires” was successfully reconsidered after initially failing on a tight vote, thanks in part to Representative Davis’ floor explanation that the bill could help mitigate the spread of infectious diseases such as the Zika and West Nile viruses by reducing the standing rainwater in old tires (thereby keeping disease-carrying mosquitoes from breeding in the stagnant water). She drew from points provided by TPHC, of which TMA is a member. Boom — the bill was saved and passed and is on Governor Abbott’s desk.

Senate Bill 674 by Senator Schwertner created an expedited licensing process for psychiatrists who are licensed to practice medicine in another state and board certified.

Senate Bill 894 by Senator Buckingham relates to HHSC’s strategy for managing audit resources, including procedures for auditing and collecting payments from Medicaid managed care organizations (MCOs). The bill requires HHSC to adopt risk-based audit procedures for MCOs, making the process transparent.

Senate Bill 922 by Senator Buckingham will allow Medicaid to reimburse school districts and open-enrollment charter schools for telehealth services provided to students.

Senate Bill 1066 by Senator Schwertner requires new medical schools to offer new GME positions to keep pace with their medical graduates. TMA testified in February in support of the bill.

House Bill 435 by Rep. Ken King (R-Canadian) became the host vehicle for House Bill 14 by Andrew Murr (R-Junction), which will allow the Texas Department of State Health Services (DSHS) to post signs prohibiting handguns at Texas’ 10 state mental health hospitals.

House Bill 1600 by Representative Thompson will allow Medicaid to pay physicians to conduct mental health screenings during each annual well-child exam, under the Texas Health Steps program. TMA explained in committee testimony that this bill improves the current scenario in which designated Medicaid procedure codes for this screening may be used only once in a young patient’s lifetime (between ages 12 and 18).

House Bill 2466 by Representative Davis will require children’s Medicaid and the Children’s Health Insurance Program (CHIP) to cover maternal depression screening for an enrolled child’s mother during a covered well-baby visit or other office visit to a pediatrician or pediatric provider. Sen. Joan Huffman (R-Houston), the Senate sponsor, added an amendment allowing pregnant women enrolling in Medicaid to sign up for texts, emails, or phone calls from their Medicaid HMO to receive appointment reminders, as well as health information to maintain a healthy pregnancy.

The governor has 21 days to sign bills, veto them, or let them become law without his signature. TMA will be reporting what happens.

Bills TMA Opposed That Died

House Bill 1415 by Rep. Stephanie Klick (R-Fort Worth) and its companion, Senate Bill 681 by Senator Hancock, would have granted advanced practice registered nurses full, independent practice and prescribing authority without physician supervision.

Senate Bill 728 by Sen. Van Taylor (R-Plano) and its companion, House Bill 2118 by Representative Klick, would have allowed patients 30 days of direct access to treatment by physical therapists without being seen first by a physician.

House Bill 719 by Rep. Gene Wu (D-Houston) would have indexed the caps established in the 2003 tort reform law according to changes in the Consumer Price Index.

House Bill 593 by Rep. Dustin Burrows (R–Lubbock) and its companion, Senate Bill 1240 by Senator Rodriguez, would have allowed psychologists prescribing authority, a practice reserved for medical school-trained physicians.

House Bill 4011 by Representative Burrows would have amounted to unnecessary overregulation of the business of medicine by requiring physicians to receive from patients a signed disclosure form with an itemized statement of the amounts to be billed for nonemergency medical services before those services were even provided. Thanks to hundreds of calls and emails from TMA member physicians to the Capitol, HB 4011 was voted down on the House floor, 97 to 34.

Senate Bill 2127 by Sen. Larry Taylor (R-Galveston) would have prohibited a credit reporting agency from including on a credit report a collection account for certain health care services provided by out-of-network physicians. Narrow insurance networks cause this problem by creating balance-billing circumstances, which was addressed in other legislation.

House Bill 1675 by Rep. Dan Flynn (R-Van) would have allowed health plans to require physicians to accept virtual credit cards for payment for services rendered.

House Bill 1070 by Rep. Jeff Leach (R-Plano) would have prohibited physicians from refusing to care for a patient based on his or her immunization status.

House Bill 1124 by Rep. Matt Krause (R-Fort Worth) and its companion, Senate Bill 2008 by Sen. Van Taylor, would have made it easier to parents to opt out of vaccinating their children.

Senate Bill 95 by Sen. Bob Hall (R-Edgewood) would have expanded the lawful sale of raw, unpasteurized milk and cheese at farmers markets.

House Bill 2962 by Rep. Giovanni Capriglione (R-Southlake) would have required physicians and health facilities to file a form to report any medical complications following an abortion. TMA noted earlier in opposing the measure that it would require a physician who diagnoses a complication following an abortion and/or initiates treatment of a woman following an abortion to report that information to the state — and imposes a penalty for not doing so. This requirement would include an emergency physician with no prior history about the patient. (TMA’s concerns have nothing to do with the issue of abortion, but instead the bill’s intrusion into the patient-physician relationship.)

House Bill 3476 by Rep. Dan Huberty (R-Houston) would have required preparticipation electrocardiograms for all school student athletes, a test that not every student athlete needs and one that could result in false positives, which could ultimately harm students and their parents.

The Budget Compromise

The final compromise state budget for the 2018-19 biennium totals $216.7 billion in all funds and $106.8 billion in state general revenue dollars. It also draws $1 billion from the rainy day fund, an idea embraced by the House Appropriations Committee. The final budget also uses some of the Senate’s accounting idea of delaying payment of transportation dollars until the start of the next biennium, to credit this budget that amount.

A breakdown of what the conference committee did follows.

Medicaid  

  • It approved $427 million general revenue in Medicaid cost containment (technically the rider applies to all HHSC agencies, but most of the savings will come from Medicaid); $77 million is anticipated to come from reducing the risk margins to Medicaid and CHIP plans. It eliminated a separate rider asking HHSC to achieve $1 billion in savings by pursuing federal Medicaid flexibility. 

Maternal and Child Health  

  • It adopted a Senate rider directing HHSC to pursue a Medicaid 1115 women's health waiver, which if approved will provide a 90/10 federal funding match for the Healthy Texas Women’s program, effective 2019.
  • It also adopted riders to decrease Medicaid neonatal intensive care unit costs, prevent maternal mortality, screen and treat women for perinatal depression, report postpartum depression screening and treatment, and collaborate with the Maternal Mortality and Morbidity Task Force to study maternal mortality to reduce the incidence. 

Mental Health  

  • It adopted $300 million for replacement or repair of state hospitals or other inpatient mental health facilities, and added $160 million for state hospital deferred maintenance.
  • It also approved $67 million for community-based crisis service provisions, $30 million to reduce homelessness and recidivism, and $67.6 million to eliminate adult and child mental health waiting lists. 

GME  

  • Lawmakers added $44 million for graduate medical education (GME) expansion grants, and increased GME formula funding by $4.3 million.
  • The Family Medicine Residency Program was cut by $6 million, and the Physician Education Loan Repayment Program was reduced by $8.4 million. 

Department of State Health Services  

  • Conferees approved Senate funding levels, $131 million, and directed $219,000 in federal funds to local health departments. The bill imposes a roughly $30 million cut in public health preparedness. It also reduces funding for immunizations, HIV/AIDS, infectious diseases, chronic disease prevention, and the Children with Special Health Care Needs program.
  • On the bright side, the compromise plan requires HHSC and the comptroller to study how increasing the legal age for buying tobacco products from 18 to 21 could result in Medicaid savings by reducing the rates of preterm and low-birth-weight births. TMA and TPHC strongly supported a bill to raise the tobacco-use age from 18 to 21, but that bill was one of many that died this session. 

Supplemental Budget Passes: The Senate unanimously passed the supplemental budget bill for the current two-year cycle on Tuesday. House Bill 2 totals $2.6 billion and adds about $800 million in state funds plus $1.6 billion in federal funds to cover the current budget's Medicaid shortfall. Another $158 million in combined state/federal funds pays for Texas Department of Family and Protective Services needs, largely for hiring new Child Protective Services caseworkers. HB 2 also covers repairs at state mental hospitals as well as gaps in public education and the state teachers' pension program. The House concurred in the Senate’s changes later in the week and sent the bill to Governor Abbott.

Bills TMA Supported That Did Not Pass

Senate Bill 80 by Sen. Jane Nelson (R-Flower Mound) was one of several versions of the Texas Medical Board sunset bill. TMA is hopeful a version of this bill will be revisited should the governor call a special session, as TMB needs to be continued by Sept. 1, 2017, or its authority to license and credential physicians in Texas expires.

Senate Bill 833 by Sen. Bryan Hughes (R-Mineola) and its companion, House Bill 752 by Rep. Morgan Meyer (R-Dallas), would protect employed physicians who act as whistleblowers against corporate employers over patient health care quality issues. The bill would have required TMB to investigate complaints against the entities it certifies (like nonprofit health corporations [NPHCs]), just as it must do for licensees. The bill changes nothing about NPHCs that are operating properly, but it will address the NPHCs that retaliate against whistleblowing physicians.

Senate Bill 1929 by Sen. Lois Kolkhorst (R-Brenham) would continue the Maternal Mortality and Morbidity Task Force at DSHS, which is helping the state identify the causes of Texas’ high and growing rates of maternal mortality and morbidity. TMA urged support of the bill to combat maternal deaths and their root causes, which include mental health issues and opioid abuse.

House Bill 477 by Rep. Nicole Collier (D-Fort Worth) would have required health coverage providers to educate consumers purchasing individual health benefit coverage.

House Bill 1908 by Rep. John Zerwas, MD (R-Richmond), would have raised the age to purchase tobacco products from 18 to 21. A compromise in the budget will require HHSC and the comptroller to study how increasing the legal age for purchasing and using tobacco could result in Medicaid savings due to fewer preterm and low-birth-weight births.

House Bill 2249 by Rep. J.D. Sheffield, DO (R-Gatesville), the “Parents’ Right to Know” bill, would have required the state to report vaccination exemption-rate data at the more-precise school level rather than at the school district level.

House Bill 2760 by Representative Bonnen and its companion, Senate Bill 2210 by Senator Hancock, would have required daily updates of health plan network directories.

House Bill 3124 by Rep. Lance Gooden (R-Terrell) would have allowed doctors in physician-led accountable care organizations to receive and share physician-specific comparison data and information.

New Leaders Take the Helm at TMA

Just minutes before Edinburg gastroenterologist Carlos J. Cardenas, MD, was installed as TMA’s 152nd president, the association’s House of Delegates elected numerous new officers, trustees, and representatives to the American Medical Association House of Delegates.

“No community can exist without a strong healthy environment and a leader to stand up and cry ‘foul’ when necessary,” Dr. Cardenas told the TMA house after his predecessor — Don Read, MD, of Dallas — administered the oath of office. “It is up to us, the physician-leaders, to chart the course for the health of our communities and when called upon to be the voice for the voiceless. It is who we are!”

Taking Dr. Cardenas’ spot as TMA president-elect is Athens family physician Doug Curran, MD. “The opportunity to serve as president-elect and ultimately president of this great organization will allow me to speak from the heart about the profession I love and the commitment to improve the health care of all Texans,” Dr. Curran said.

Delegates reelected TMA Board of Trustees members Gary Floyd, MD, of Fort Worth, and Linda Villarreal, MD, of Edinburg. They also voted Dallas internist Sue Bornstein, MD, and Ray Callas, MD, an anesthesiologist from Beaumont, to the board. The TMA Resident and Fellow Section chose Justin Bishop, MD, a resident in physical medicine and rehabilitation at Baylor College of Medicine in Dallas, to be its representative on the board. The Medical Student Section elected Patrick Crowley, a third-year student at the University of North Texas Health Science Center at Fort Worth Texas College of Osteopathic Medicine.

TMA Secretary/Treasurer Michelle Berger, MD, of Austin; Speaker of the House Susan Strate, MD, of Wichita Falls; and Vice Speaker Arlo Weltge, MD, of Houston all won reelection without opposition.

The board chose San Antonio pathologist David Henkes, MD, to be its new chair, Austin colon and rectal surgeon David Fleeger, MD, to be vice chair, and Dr. Floyd to be board secretary.

In other elections, the house voted for four new alternate delegates to the AMA House of Delegates: Robert Emmick Jr. MD, an Austin emergency medicine physician; Steven R. Hays, MD, a nephrologist from Dallas; Jennifer Rushton, MD, a pathologist from San Antonio; and Sherif Zaafran, MD, an anesthesiologist from Houston. Habeeb Salameh, MD, an internal medicine resident in Galveston, is the new resident alternate delegate. Jessie Ho, a student at the Texas A&M Health Science Center, is the new student alternate delegate. The house also reelected nine physicians to two-year terms on the Texas Delegation to the AMA.

More about TexMed 2017, including news on the House of Delegates, videos, and audio can be found here

TMA Foundation Also Chooses Leadership

The TMA Foundation (TMAF) Board of Trustees elected officers at its annual meeting in Houston. 

Officers serve a two-year term. They include: 

  • President Leslie H. Secrest, MD, a Dallas psychiatrist; 
  • Vice President Susan M. Pike, MD, a Round Rock board-certified plastic surgeon;
  • Secretary Rajam S. Ramamurthy, MD, a San Antonio neonatologist; and
  • Treasurer Michael E. Speer, MD, a Houston neonatologist.  

Kate Rogers, of San Antonio, was elected Executive Committee member-at-large and will serve a one-year term. She is executive vice president of the Holdsworth Center, a nonprofit organization focused on excellence in education leadership created by Charles Butt, H-E-B chair and chief executive officer. Before joining the Holdsworth team, Ms. Rogers spent 18 years as an executive with H-E-B.  

Read more about the new officers on the TMAF website.

Just Like Summer, West Nile Virus Season Heating Up

So summer doesn’t officially begin for another 19 days, but Texas already has had two reported cases of West Nile virus.

The first case, a woman from Montgomery County just north of Houston, was reported to the Department of State Health Services (DSHS) in late April. The second case, a man in his 40s, was reported by the City of El Paso Department of Health in late May, according to the El Paso Herald-Post newspaper. The man, who has underlying medical conditions, had not reported travel outside of the city, the newspaper reported.

But wait, there’s more.

Mosquito pools positive for West Nile virus have been reported in Dallas, Harris, Johnson, Nueces, and Tarrant counties.  

So, what should you do as a physician?

Good question. One of the best things you can do is educate your patients on how to prevent getting mosquito-borne diseases like West Nile and Zika (you’ve heard that old saying about an ounce of prevention).

Here’s what to tell your patients: 

  • Use EPA-approved insect repellent every time you go outside.
  • Cover exposed skin with long pants and long-sleeved shirts whenever possible.
  • Use air conditioning or window and door screens that are in good repair to keep mosquitoes out.
  • Limit outdoor activities during peak mosquito times.
  • Remove standing water in and around homes, including in trash cans, toys, tires, flower pots, and other containers so mosquitoes can’t lay their eggs.
  • Use a larvicide in water that can’t be drained to keep mosquitoes from developing. 

Everybody got that?

In 2016, Texas reported 370 human cases of West Nile illness, including 18 deaths. Most people who get infected don’t get sick, but about 20 percent will experience symptoms like headache, fever, muscle and joint aches, nausea, and fatigue.

I can tell you have more questions infectious diseases. That’s good. You can find plenty of answers by visiting TMA's Infectious Diseases Resource Center

If you want more information (and I’m so glad you do), you can also stay up to date with DSHS recommendations at the Health Care Professionals page of TexasZika.org or get more info at the DSHS West Nile virus page.

Action TMLT Ad 10.15

Boost Your Community’s Immunity: Apply for a TMA Vaccination Grant

You’re smart. You spent all those years in medical school. If you want to pass that wisdom on to others, and help protect your community from all of those pesky diseases that could be prevented with a vaccine, host a TMA Be Wise — Immunize® event.

What’s a TMA Be Wise — Immunize event, you ask? Well, let me tell you. Basically, it’s a shot clinic. But it’s put on by you with a ton of help from TMA. All you have to do is apply for a TMA grant of up to $2,500 that can be used for events to vaccinate children, adolescents, and adults. It’s all part of the many ways TMA helps members, county medical societies, TMA Alliance chapters, and medical student chapters.

It couldn’t be that simple, you say. But it is. Just ask Nandini Kohli, MD, and Austin Primary Care Physicians; they’ll tell you. Earlier this year, they turned to TMA for help with a project to prevent bacterial pneumonia in elderly Medicare patients who couldn’t afford the copay for the vaccination.

All told, TMA awarded six Local Impact Grants in March for events that provided back-to-school, bacterial pneumonia, and flu vaccinations. We’ve been doing it since 2012, awarding more than $130,000 during that time.

If you’re interested — and by now I’m sure you are — apply by July 1 on the TMA website. Grant applications should be submitted at least four months before an event, and grantees have up to 12 months to use the funds (That’s a whole year, but you knew that). If you miss that deadline, or you just want to continue keeping your community safe, you can apply again by Nov. 1 for events in 2018.

To plan your free or low-cost vaccination event, check out the Be Wise — Immunize Quick Start Manual: A Step-by-Step Vaccination Outreach Guide. If you still have questions, contact Tammy Wishard, TMA’s outreach coordinator, at (512) 370-1470 or (800) 880-1300, ext. 1470.

Be Wise — Immunize is a joint initiative led by TMA physicians and the TMA Alliance. Funding for Be Wise — Immunize is provided by the TMA Foundation 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.

Medicare Further Delays New Bundled Payment Models

Well, you saw this coming: The Centers for Medicare & Medicaid Services (CMS) has further delayed the start of some Medicare bundled payment programs until Jan. 1, 2018.

The programs, an expansion of the Comprehensive Care for Joint Replacement (CCJR) program and two new cardiac care programs, were initially set to begin July 1. 

If you’ve been paying attention, you remember that CMS in March proposed the Jan. 1 delay to give participants time to understand the rules and to adjust to any potential changes.

As part of that proposal, CMS opened up a 30-day window for comments. During that time, they received 47 comments (more than one a day!), most of which supported the Jan. 1 start date. The decision to delay was made in mid-May.

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 to include surgical hip and femur fracture treatment and recovery in those same 67 metropolitan areas, including Austin-Round Rock, Beaumont-Port Arthur, Corpus Christi, Killeen-Temple, Lubbock, and Tyler.

The Acute Myocardial Infarction Model and the Coronary Artery Bypass Graft Model were set to begin July 1 in 98 metropolitan areas, including Abilene, Austin-Round Rock, Dallas-Fort Worth-Arlington, and Sherman-Denison. 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, including Abilene, Corpus Christi, Dallas-FortWorth-Arlington, and Waco. 

Medicine Fights Proposed Medicaid Specialty Care Cuts

Can we talk about CPT codes for a minute?

If you’re still reading, then you obviously care about CPT codes. If you don’t care about them, feel free to move on. 

As it does every two years, the Texas Health and Human Services Commission’s (HHSC's) Rate Analysis Department is reviewing CPT codes and making adjustments to the payments for those services. Sometimes, the payments go up, sometimes they go down, and sometimes they stay the same. Sunrise, sunset.

Well, this time, HHSC is proposing cuts in Medicaid payments for cardiovascular, gastroenterology, and robotic prostate surgery services. The problem is, practice costs are expected to increase in the coming years. That could be a problem for the ol’ financial department.

In response, TMA sent a letter to HHSC regarding proposed cuts to cardiology services. But that’s not all. TMA has also cosigned two more letters from the Texas Society for Gastroenterology and Endoscopy (TSGE) and the Texas Urological Society (TUS), who also are fighting the reductions.

TSGE opposes rate cuts of 1 percent to 4 percent for gastroenterology services, and TUS is pushing back against a proposed 16-percent reduction in robotic prostate reimbursement.

“These cuts add to the cumulative erosion of Medicaid payments and their failure to keep pace with the costs of running a practice,” the letters say.

The proposed changes could go into effect July 1 after HHSC reviews the comments. Stay tuned.

Get Dual Incentives through MACRA, Meaningful Use

Hey, you. In the white coat. No, not you. You — the one who participates in Medicaid’s meaningful use program.

Did you know that you’re also eligible to receive incentives through the Medicare Access and CHIP Reauthorization Act (MACRA)? It’s true!

If you knew that, then you probably submitted data reports to get credit for 2016. If you didn’t submit those reports by May 15, you should have. That was the submission deadline to get credit for 2016 — the final year physicians could have begun participating in the meaningful use program, which runs through 2021.

The dual incentives are available only to participants in the Medicaid meaningful use program who also meet the Merit-Based Incentive Payment System requirements. Both programs have different requirements and reporting methods, but many areas overlap. It is necessary to report separately for each program to receive credit and incentives for both.

Penalties for eligible participants who submit nothing for MACRA for 2017 would begin in 2019. The last year of Medicare meaningful use penalties is 2018. The penalties for each program don’t overlap.

More information can be found via the links above or by emailing the TMA HIT Helpline or calling (800) 880-5720.

TMAIT Action Ad 6.15

Venous Blood Lead Test Not on the Level

Raise your hand if you’ve performed venous blood lead tests using Magellan Diagnostics’ LeadCare analyzer recently.

If your hand is up, it’s possible that those tests may have returned underestimated blood lead levels, according to a national health advisory the Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) issued last month.

Now, most Texas physicians won’t have to worry about this. The Department of State Health Services (DSHS) manages the Texas Childhood Lead Poisoning Prevention Program (CLPPP) and doesn’t use the Magellan Diagnostics analyzer.

Furthermore, the advisory does not apply to capillary blood tests, which — as you know — are collected by finger stick or heel stick.

But if you are concerned that you might have administered an underestimated blood lead test, there are a couple of things to do, according to FDA, CDC, and DSHS:

First of all, stop using Magellan Diagnostics’ LeadCare analyzers for venous blood samples.

After that, retest the following patients whose initial venous blood tests — that’s venous, remember — were analyzed using Magellan Diagnostics’ LeadCare: 

  • Children younger than 6 years at the time of the alert, May 17, 2017, who had a lead test result of less than 10 micrograms per deciliter; and
  • Pregnant or lactating women.    

All other adults who are concerned should talk to you about whether to be retested. 

If you still have questions, contact CLPPP at (512) 776-7268.

TMA Joins Large Coalition Backing Physician-Owned Hospitals

It looks like a controversial moratorium on expanding and building physician-owned hospitals — aka POHs — could be repealed.

That’s the good news. The better news is that a bill moving its way through Congress to put that repeal in motion has the support of more than 50 medical organizations, including TMA. We’re also talking about the American Association of Orthopaedic Surgeons, the American Medical Association, and multiple state medical societies.

In a letter to federal lawmakers, the organizations encourage lawmakers to pass the “Patient Access to Higher Quality Health Care Act of 2017.” That very letter also lays out the benefits of POHs and dispels any nagging concerns.

Consumer Reports magazine reported that hospitals run by physicians have been shown to run more efficiently and have higher quality patient outcomes than those run by non-physicians or appointed boards,” the letter said. “And these hospitals are not just providing high-quality care and contributing to local economies — they are saving the government money. An analysis by Avalon Health Economics found POHs are saving Medicare $3.2 billion over 10 years.”

As always, stay tuned. We’ll let you know how this one comes out.

Focus on Member Services: HR Help

Now here’s something you might not know: More than 80 percent of medical clinics fall victim to employee theft — that’s employees stealing stuff from your practice, not somebody stealing your employees.

Now, there’s not much TMA can do if somebody’s stealing your employees (you really should lock them down), but we do offer a whole bunch of benefits to mitigate staffing issues such as embezzlement — that’s theft of funds, y’all — or high employee turnover (that’s employees leaving, not necessarily being stolen). 

And here’s the good news: As a TMA member, you can turn to us for help if you need it. For example, you can use your benefits to foster and retain existing support staff. And if you do have a problem, TMA Practice Consulting experts can help you recruit reliable staff and even provide an on-site interim practice manager (what don’t we do?).

Here’s a few more details on what we provide, and how you can access it:

  • TMA Knowledge Center: Members can contact TMA at (800) 880-7955 or by email with human resources (HR) questions, like specific requirements for overtime pay.
  • FAQs & Education: TMA offers a wealth of HR information in our TMA Practice E-Tips, the free white paper "Delegation of Duties," and continuing medical education.
  • HR Consulting: TMA’s experts can work with you on everything from defining staff roles and efficient staffing levels to onsite training, and TMA will even "mystery shop" your practice.
  • Insurance: Provide your staff with medical, life, income, and ancillary insurance via the members-only TMA Insurance Trust.  

More information on all the ways TMA provides you with HR help can be found on the TMA website.

Have Your Say on Hospital Levels of Care for Maternity Patients

The Texas Department of State Health Services (DSHS) and the Perinatal Advisory Council (PAC) are seeking physician input as they create rules on the levels of care hospitals must provide maternity patients.

Comments will be reviewed by DSHS and PAC and, as appropriate, incorporated into revised draft rules before being approved for publication in the Texas Register for formal public comment.

A state law that went into effect in 2013 directed DSHS and PAC to develop the hospital care levels for neonatal and maternity services. The neonatal rules took effect in June 2016. Hospitals must obtain designation by Sept. 1, 2018, in order to receive Medicaid reimbursement for neonatal services.

For maternal levels of care, the law requires HHSC to complete hospital designations by March 1, 2019. The draft rules propose four levels: 

 

  • Level 1 — basic/well nursery;
  • Level 2 — specialty care;
  • Level 3 — subspecialty care;
  • Level 4 — comprehensive care. 

 

DSHS also will hold two question-and-answer sessions on draft rules at dates to be determined. TMA will also host a conference call to discuss the draft rules and comments, though a date has not been announced.

TMA members can also email comments to Helen Kent Davis, director of governmental affairs at TMA.


  PC Action Ad July 13 

Double Your Impact on the Health of Texans

Want to make a donation to the TMA Foundation (TMAF) go twice as far? Of course you do!

For the 11th year, the John P. McGovern Foundation of Houston has challenged TMAF with a grant for its Star Campaign for all matching donations up to $10,000. 

All you have to do is make a gift to the Star Campaign, and it will be combined with donations from dozens of TMA and TMA Alliance members who also want to improve the health of all Texans through the TMA initiatives that the foundation makes possible.  

The Star Campaign is an important way that the foundation raises unrestricted funds that the board can apply to the greatest need. This year, unrestricted funds are helping to support the significant expansion of the TMA Excellence in Science Teaching Awards program and Walk With a Doc Texas.

Your gift and this match will enable TMAF to fully support TMA’s outstanding health improvement programs, as well as local county society and alliance and medical student chapter outreach that will impact Texans in 2017 and beyond. 

Join the effort and make your gift today!

Get Awarded for Quality Improvements

Has your practice made a successful shift to quality reporting? Are you using health information technology (HIT) to enhance patient engagement and preventative care? If so, get the recognition your practice deserves.

Applications are now open for the 2016–17 Physician Practice Quality Improvement Award. The application is straightforward, and awards will be presented to physician practices that use effective care management methods and HIT to achieve strong clinical outcomes. 

TMA, the Texas Osteopathic Medical Association, and the TMF Health Quality Institute have partnered (again) on the Physician Practice Quality Improvement Award program. Applications are due by June 10, 2017. Award-winning practices will receive commemorative items to display and will be recognized through a media campaign. 

Download the program overview and criteria for complete details. Apply today. You deserve it.

This Month in Texas Medicine

The June issue of Texas Medicine recaps a Houston cardiothoracic surgeon's years-long battle over Memorial Hermann Memorial City's alleged smear campaign against him. A jury awarded Miguel Gomez, MD, $6.4 million in a civil case that started after the Texas Supreme Court compelled the release of peer review documents Dr. Gomez said would prove his case. The June issue also includes stories about how the TMF Health Quality Institute can help smaller practices navigate MACRA's Quality Payment Program; a study on health disparities across Texas; and the Galveston National Lab at The University of Texas Medical Branch, the only facility on a college campus rated to handle the most deadly and exotic pathogens, such as Ebola, bubonic plague, and Zika.

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. 

CMS Quality Payment Program Deadlines

6/30
Last Day to Register for the CAHPS for MIPS Survey Reporting Option for the 2017 MIPS Performance Year

Last Day to Register or Cancel Registration for the CMS Web Interface Reporting Option for the 2017 MIPS Performance Year

8/31
Last Day of the Final Determination Period for 2017 Advanced Alternative Payment Models

10/2
Last 90-Day Period for the 2017 MIPS Performance Year

12/31
Last Day of the 2017 MIPS Performance Year

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.  

Seminars

Take Back the Power: Payer Contract Negotiations
Live webcast: June 20

Modern Marketing for Five Star Reviews
Austin
July 28

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

About Action       

 Action, the TMA newsletter, is emailed twice a month to bring you timely news and information that affects your practice

To change the email address where you receive Action, go to Member Log-In on the TMA website, then click on "Update Your TMA Demographic Information (including newsletter subscriptions and preferences)."

To unsubscribe from Action, email TMA's Communication Division at tmainfo[at]texmed[dot]org.

If you have any technical difficulties in reading or receiving this message, please notify our managing editor, Shari Henson. Please send any other comments or suggestions you may have about the newsletter to the Action editor

Last Updated On

June 02, 2017