Action: July 5, 2017

TMA Action July 5, 2017   News and Insights from Texas Medical Association

Have Your Say on 2018 MACRA Proposed Rule
Citing Telemedicine Law, FTC Drops TMB Antitrust Probe
TMA, THA Leaders Push Senator Cornyn on Proposed Medicaid Changes
Houston Hospital Physicians Unanimous on Removing MOC
Website Provides Help for Palliative Care-Givers, Patients
Texas Physicians Helping Draft Maternal Patient Care Rules
Have a Critical Practice Question? Short on Time?

Get Tech Help Online From TMA
Need Ethics CME? PHW Is Your No. 1 Stop!
Medicine Is Also a Business, TMA Can Help You Learn It
Register for TMA’s Fall Conference
TMA Annual Gala Photos Are Out of This World
This Month in Texas Medicine

Houston Hospital Physicians Unanimous on Removing MOC

Physicians at Houston’s Memorial Hermann Hospital Southeast have sent a clear and unified message on Maintenance of Certification (MOC) requirements: Not at our hospital.

During a General Medical staff meeting June 27, attending physicians voted unanimously to recommend that MOC requirements be removed systemwide. Memorial Hermann Health System bylaws require that any changes be approved by the active medical staff at all 16 of its hospitals.

“The message here is that every Memorial doctor needs to wake up and vote it out because that’s what the law says,” urologist Ori Hampel, MD, said, referring to Senate Bill 1148, a new law aimed at cracking down on what many Texas physicians see as “MOC abuse.” 

The bill, written by Sen. Dawn Buckingham, MD (R-Lakeway) and co-sponsored by Rep. Greg Bonnen, MD (R-Friendswood), will prevent the Texas Medical Board from using MOC as a requirement for doctors to obtain or renew a medical license. It also bars hospitals and health plans from requiring physicians to obtain MOC for credentialing or contracts. A hospital may require MOC only with an affirmative vote from its medical staff. It was signed by Gov. Greg Abbott in June and will take effect Jan. 1.

“The legislature did their job, Doctors Buckingham and Bonnen did their jobs, now all of us need to take back the autonomy we gave up when we allowed MOC,” Dr. Hampel said. “We need to vote it out of every bylaws in the state.”

Speaking to the Texas Medical Association, Senator Buckingham encouraged all doctors “to push to remove these outdated and unnecessary requirements from hospital bylaws. It is time for doctors to take back their profession and fight for quality care that best serves their patients.”

TMA strongly supported SB 1148, which TMA President Carlos J. Cardenas, MD, said prevents physicians from dealing with an "unnecessary — and very costly — distraction.”

“The MOC and all of its requirements have been taking physicians away from caring for their patients as they’ve performed tasks and studied for trivial exams that do not reflect their scope of practice,” Dr. Hampel said. “Additionally, the most qualified and experienced physicians time their retirements based on their MOC cycle, which removes physicians who would be happy to continue caring for Texans out of the physician workforce.”

During the legislative session, nearly 1,400 TMA members sent lawmakers 2,300 emails in support of the bill using the TMA Grassroots Action Center.

TMA, THA Leaders Push Senator Cornyn on Proposed Medicaid Changes

Leaders of TMA and the Texas Hospital Association met with U.S. Sen. John Cornyn on July 3 to work out a better solution for the Medicaid provisions in the Better Care Reconciliation Act (BCRA), the Senate’s bill to repeal and replace the Affordable Care Act.

Senator Cornyn, the Senate Majority Whip, didn’t return to Texas for the July 4 recess. He stayed in Washington to work on the bill after a planned June 27 vote was cancelled. He met with the physician and hospital leaders via teleconference.

San Antonio pediatrician Ryan Van Ramshorst, MD, chair of TMA’s Select Committee on Medicaid, CHIP, and the Uninsured, and other members of the committee, participated in the meeting along with TMA Board of Trustees member David Fleeger, MD, of Austin. They explained to the senator how the BCRA’s Medicaid provisions would affect their practices and their patients.

In a joint letter signed June 28, both organizations offered their help in rewriting the bill.

“If enacted as drafted, the Medicaid provisions of the BCRA will have significant negative consequences for Texas, for Texans, and for the Texas state budget,” the joint letter said. “We welcome the opportunity to work with you to devise improvements that keep Medicaid costs low, reduce Medicaid’s administrative challenges, and preserve Medicaid’s important role in the health care delivery for all Texans.”

Compared to other states, the letter said, the proposed changes would punish Texas’ lean, efficient Medicaid system, which already underpays physicians and hospitals by as much as 60 percent and requires that enrollees must join a managed care organization. TMA and THA pointed out that: 

  • Medicaid funding is the financial lifeline for rural, border, and urban safety-net hospitals and physician practices upon with all Texans rely;
  • Four million, or 15 percent, of Texans benefit from Medicaid directly;
  • Texas Medicaid is the cord that binds the state’s health care safety net, covering 40 percent of low-income children and 50 percent of births; and
  • If the federal government shifts costs to the states, Texas will be forced to shift costs to counties, which in turn will increase property taxes and/or services to compensate. 

“Undoubtedly, Medicaid is imperfect. We agree reforms are necessary,” the letter said. “However, in lieu of the BCRA’s Medicaid proposals, we strongly encourage you to examine other sensible and fiscally sound options. Texas hospitals and physicians stand ready to help you develop pragmatic reforms that will preserve a high-functioning, efficient, and fair Medicaid program that supports quality health care for Texans.”

TMA also signed on to a separate letter on the same issue, sent to Senate leaders from the Coalition of State Medical Societies. That letter offers the assistance of the Coalition’s 10 member societies to “craft a better bill that will engender broader support from your colleagues and the American public.”

“We are concerned that the Medicaid per-capita cap and block grant growth index will not keep pace with rising costs beyond our control,” the Coalition’s letter said. “The proposal places an untenable burden on state budgets and an uncompensated care burden on physicians who are on the front lines caring for these patients every day. We need Congress’ help to better care for our patients.”

Per policy the TMA House of Delegates adopted earlier this year, TMA is committed to preserve guaranteed, uncapped federal Medicaid funding for at least all Texas Medicaid populations covered by the program as of Jan. 1, 2017.

Have Your Say on 2018 MACRA Proposed Rule

More physicians will be exempt from MIPS participation next year, and what you have to do to avoid penalties will increase only slightly under the MACRA Proposed Rule for 2018, according to initial TMA staff analysis.

The draft rule outlines compliance and reporting measures for the 2018 Quality Performance Program (QPP), which includes both the Merit-Based Incentive Payment System (MIPS) fee-for-service payments and the Alternative Payment Model (APM) programs affecting Medicare payment in 2020. 

TMA staff has been analyzing the rule in detail to offer written comments by the deadline Monday, Aug. 21. Physicians may offer their own comments through the website, or by emailing TMA at macra[at]texmed[dot]org by Aug. 1.

The Centers for Medicare & Medicaid Services (CMS) won’t publish the final rule until fall.

TMA’s initial analysis of the draft rule found:  

  • More physicians will be exempt. CMS proposes a considerable increase to the low-volume threshold, exempting more physicians from MIPS participation in 2018 than in 2017. The proposed threshold would exclude physicians and other eligible clinicians with $90,000 or less in Medicare Part B allowed charges, or 200 or fewer Medicare Part B beneficiaries during a low-volume threshold determination period. (Up from $30,000 or 100 in 2017.) Since last year, TMA has urged CMS to set the low-volume threshold at $250,000. That would exempt physicians who have no possibility of a positive return on their investment in the cost of reporting.
  • The performance score necessary to avoid penalties is only slightly increased. CMS proposes to increase the composite performance threshold to 15, up from 3 in 2017. Practices that score 15 of the possible 100 points will avoid a MIPS payment penalty. The additional performance threshold to earn an exceptional performance bonus will remain at 70. 
  • Physicians can earn up to the minimum required 15 points by reporting only MIPS Improvement Activities. CMS proposes changing some activities and adding more to the list of 92 activities. The number of required activities will remain the same. 
  • The quality reporting period is increased, but others are not. The quality category will have a 12-month performance period, but incomplete reporting will earn a minimum of one to three points per measure. The advancing care information and improvement activities categories will continue to require a minimum of a continuous 90-day performance period. 
  • Cost measures will be calculated and reported, but still will not affect performance score. CMS proposes keeping the weight for the cost category at 0 percent. This means that cost performance in 2018 would not affect payment in 2020. 
  • Quality scoring will not change much: CMS proposes keeping the weight for the quality category at 60 percent. Data submission mechanisms and most of the quality reporting requirements will remain same. 
  • EHR requirements are slightly eased. CMS proposes offering physicians the option to use the 2014 or 2015 electronic health record (EHR) edition or a combination of the two to meet compliance and reporting requirements for the Advancing Care Information Category.
  • There are new ways to earn bonus points: CMS proposes new bonus-point policies and methodologies for MIPS categories, such as for physicians who care for medically complex patients and for those in small and rural practices.'
  • Physicians may form “virtual groups” for reporting and scoring. CMS will allow physicians to form virtual groups in 2018. This would provide solo physicians and small group practices (with 10 or fewer eligible clinicians), regardless of location or specialty, with the option to band together to form a virtual group for the purposes of MIPS participation.  

Note that any of these provisions may change when the final rule is published in the fall. 

TMA offers many resources to help you navigate the MIPS and APM pathways. Visit the TMA MACRA Resource Center to learn more. 

Citing Telemedicine Law, FTC Drops TMB Antitrust Probe

Following the passage of TMA-supported legislation governing telemedicine in Texas, the Federal Trade Commission (FTC) has closed an investigation into whether the Texas Medical Board (TMB) violated antitrust law, FTC said in a release.

In announcing it had voted June 21 to close its investigation, the FTC cited the state's new telemedicine law, which it says "fosters the growth of competitive and innovative healthcare services for Texas consumers, overriding the TMB's restrictive rules." 

Senate Bill 1107 by Sen. Charles Schwertner, MD (R-Georgetown), which TMA helped craft, provides a clear framework for proper telemedicine services in Texas and clarifies that the standard of care for a telemedicine visit is the same as one done in-person. Gov. Greg Abbott signed SB 1107 on May 27.

The FTC had been investigating TMB after it adopted rules in April 2015 restricting telehealth and telemedicine in Texas, a continuation of years-long wrangling with telemedicine provider Teladoc. Teladoc sued that same month over the rules, which prohibited prescription of dangerous drugs or controlled substances without a face-to-face or in-person examination of the patient. 

Teladoc's suit claimed TMB had violated antitrust law, but TMB argued that it was immune from antitrust liability because it is an agency with active supervision by the state. The lawsuit is on hold until Sept. 1. Attempts to reach Teladoc chief legal officer Adam Vandervoort were unsuccessful.

"As the Commission first noted in a 2004 report, when properly used, telemedicine has considerable promise to broaden access, lower costs, and improve health quality," FTC said in its statement. "The Commission hopes that by expanding the availability of telemedicine and telehealth alternatives, the new law will lead to many benefits for Texans, including increased competition among providers, more innovation in the delivery of care, increased access to health care services, reduced travel costs, and greater convenience."

TMAIT Action Ad 6.15

Website Provides Help for Palliative Care-Givers, Patients

The state of Texas has a new online resource that might help you the next time you have one of those most-difficult conversations with a patient.

The Texas Health and Human Services Commission (HHS) has launched a comprehensive online resource for palliative care patients and the people who care for them.

“In instances where a serious illness may alter your life, access to reliable information and resources can make all the difference,” HHS said in announcing the website, which “includes information on the benefits of palliative care and toolkits for patients and families seeking an additional layer support.”

The resource, which can be found on the HHS website, also explains the difference between the two types of palliative care — supportive and hospice — and includes information on how to pay for care, and ways to plan for serious illness.

Texas Physicians Helping Draft Maternal Patient Care Rules

Physicians from several state pediatric, maternal, and general medical societies sounded off recently on draft proposed rules regarding the levels of care hospitals must provide maternity patients.

The Texas Department of State Health Services (DSHS) and the Perinatal Advisory Council (PAC) sought the input, which will be reviewed and incorporated, as appropriate, before being opened to 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 the state 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.  

In a letter dated June 20, leaders from the TMA, the American Congress of Obstetricians and Gynecologists (ACOG)-Texas Chapter, the Texas Academy of Family Physicians, and more presented a series of proposed rule changes based on physician feedback.

“On balance, the physicians who submitted comments to our organizations strongly favored the rules, though not surprisingly, some provisions will require greater clarification and wordsmithing,” the letter said.

Most of the letter recommended technical changes, but the letter expressed concern that the draft proposed rules did not sufficiently distinguish between Level III and Level IV facilities.  Clearer distinctions will make it easier for hospital medical staffs and administrators to determine the services most appropriate for their facilities as well as reduce duplication of services. TMA and specialty societies recommended that DSHS revise the draft Level IV rules to reflect the Level IV ACOG standards. 

Formal rules will be published in the Texas Register later this year, at which time TMA, specialty societies, and other interested physicians will have 30 days to submit formal comments.  

Have a Critical Practice Question? Short on Time?

You know a lot of things. You went through years of college and medical school, you’ve kept up with CME, and you’ve got wisdom and institutional knowledge that can only come from just being alive.

But there’s a lot of stuff you don’t know. It’s OK to admit that. You can’t know everything. It’s impossible, and frankly there are a lot of things you don’t want to know.

But sometimes, what you don’t know can hurt you. And we know that you know that you don’t want to get in trouble.

You want to know more about HIPAA compliance rules. You have urgent questions about selling your practice. You need to know the guidelines for medical records disclosure — now. Don’t panic. 

Here at TMA, we have a lot of answers (Your keys are under the center sofa cushion – you’re welcome).

If you want help with something to do with your practice, simply email or call the TMA Knowledge Center at (800) 880-7955. TMA’s expert staff can answer your questions about health law, practice management, medical economics, and health care in general. 

Looking for answers at 12:30 a.m.? Search the Knowledge Center FAQs or submit a question, and a TMA information specialist will reply by email within two business days.

And I know you’re always looking for that CME. Complete this form for each question you research on the e-Resources webpage, and earn 0.5 AMA PRA Category 1 Credits™ per completed activity. It’s that easy.

If we haven’t given you enough information on all the ways TMA Knowledge Center works to support members like you, we’ve got even more information on the Knowledge Center's webpage.

  Action TMLT Ad 10.15

Get Tech Help Online From TMA

Technology. It’s changed our lives in so many ways: You can now program your television with your phone, turn on the porch light when you’re at dinner, you can even have your refrigerator tell you when it’s running low on food.

But, let’s face it, technology can present plenty of challenges, especially when it comes to medical billing, coding, and other processes your practice needs.

Thankfully, the Texas Medical Association works diligently to give you the tools tackle these challenges. Need help selecting an electronic health record (EHR) or understanding the Medicare Access and CHIP Reauthorization Act (MACRA) program? I know I do. Can’t figure out the EHR incentive program? Need information on e-prescribing? TMA has you covered. 

You can find links to all of these tools on the Technology page of the TMA website. (This, of course, requires having enough tech savvy to use the internet, but I think you’re doing fine.)

Here’s some of the many resources TMA has to offer: 

  • EHR Product Evaluation Tool: This tool, for members only, compares the most-used EHRs in Texas by functionality and pricing.
  • MACRA Resource Center: Whether you’re just trying to meet the minimum requirements to avoid the penalty, or you’re looking to maximize your incentive payment, here’s where you’ll find the latest MACRA program information, resources, CME, and consulting options.
  • Advancing Care Information (ACI) Resource Center: Learn what you need to do to meet the ACI objectives and measures for the Merit-Based Incentive Payment System (MIPS). You can also find out about ACI scoring, reporting options, and what you need to have in case of an audit. 
  • EHR Buyer Beware: Issues to Consider When Contracting with EHR Vendors: You’re ready to buy an EHR, but do you know what you need to know before locking down the contract? This paper discusses eight important EHR contract terms you should consider before signing an EHR contract.
  • EHR Incentive Program Resource Center: The Medicaid EHR Incentive Program continues until 2021. Stay in-the-know about program updates so you don’t miss out on the incentive payments.
  • E-Prescribing Resource Center: Benefits of e-prescribing include medication reconciliation, medication history, eligibility, and formulary information. Visit the resource center for help with e-prescribing. 
  • Ransomware and Cyber Security Resource Center: Ransomware has reached Texas, and its teaches us all why it’s so important to keep our security systems up-to-date. Use this resource center to access articles and education on cyber security and ways to protect your practice. 

You can even check out this handy print-out, which lists the online TMA Technology tools and the web links. 

If you have questions about these health information technology (HIT) tools and resources or if you need additional help, contact the TMA HIT Helpline at (800) 880-5720 or by email.

Need Ethics CME? PHW Is Your No. 1 Stop!


Have we got a great offer for you. One-stop shopping for something that can improve your own health, bolster your education, and give you the CME you need to renew your medical license.

The TMA Committee on Physician Health and Wellness (PHW) offers live presentations — as well as online and home-study courses — all accredited for AMA PRA Category 1 Credit™. They are also designated for ethics and/or professional responsibility education.  

  1. Live Presentation: Choose from 29 courses presented by a PHW education team member at your county medical society, hospital, or other meeting.
  2. Online: Take PHW courses online via the TMA Education Center. Courses are all PDFs, so one click takes you to the primary document. Once you complete the test and evaluation, you can snag your CME transcript online. Choose from 23 courses, in one-hour and two-hour formats.
  3. Home Study: All the online courses are available for home study. Read the PDF course and then complete the TMA Identification page, test, and evaluation. Send the completed documents to TMA with your administration fee, and we’ll send a CME transcript right back. 

Sound good? Check out course descriptions, summaries, and prerequisites in this online brochure.

Contact TMA PHW Committee staff at (800) 880-1300 to request a live presentation or home-study course.

Medicine Is Also a Business, TMA Can Help You Learn It

We know you’re becoming an excellent physician. (We’re not just saying that because we might need you to care for us one day.) But are you ready to tackle the business side of medical practice? If you’re like most resident physicians, you probably haven’t had much time to think about that.

Whether you’re starting your own practice, joining a group, or becoming employed, it’s important to know what to consider when making early career decisions. Because those decisions will affect you for years. 

Now at TMA, we don’t just offer flattery. We also offer education sessions that will give you a better understanding of your options when it comes to the business of medicine. And, just like the flattery, the information sessions are free!

Here are some examples of what you can learn:

Professional Development  

  • CV Writing and Interview Preparation*
  • Starting in Medical Practice
  • Timeline for Transitioning Into Practice*
  • You Get What You Negotiate* 

Legal and Financial Considerations  

  • Finding the Right Practice and Signing the Right Contract*
  • Physician Contracts: A Comprehensive Analysis*
  • Noncompete Covenants
  • Disability and Life Insurance: Why Are They Important?
  • Health Care Data — Managing Cyber Threats – NEW for 2017
  • What Every Physician Needs to Know: Medical Malpractice 101 – NEW for 2017 

*These courses include a complimentary catered breakfast or lunch (because we remember what it’s like to be starting out on your own).

You can request any of these free seminars for your residency program by contacting TMA Practice Consulting at (800) 523-8776 or[at]texmed[dot]org.

  PC Action Ad Aug 13 

Register for TMA’s Fall Conference

Registration is now open for the 2017 TMA Fall Conference, which is scheduled for Sept. 15-16 at Hyatt Regency Lost Pines Resort and Spa. This free member benefit lets you reconnect with colleagues and learn more about what’s new in Texas health care.

This year’s programming will feature a recap of the 85th Legislative session. It also will include a discussion of the long- and short-term effects of abuse and neglect and other adverse childhood experiences. 

Register today and make your room reservation at the Hyatt Regency Lost Pines. For more information about the conference, please visit the TMA Fall Conference website

Questions? Email the TMA Knowledge Center or call (800) 880-7955 Monday through Friday, 8:15 a.m. to 5:15 p.m. central time.

TMA Annual Gala Photos Are Out of This World

Were you one of the nearly 475 guests who attended the 24th annual TMA Foundation (TMAF) Gala on May 5 in Houston? Were you there bidding on space-related experiences, political memorabilia, jewelry (and more), and dancing until closing to Matchmaker Band? Do you remember how absolutely fabulous you looked?

Relive the fun and check out the gala photos of your friends and colleagues (and maybe you) TMAF’s Flickr page.

If you missed the chance to take part, don’t miss the chance to check out the Flickr page to prime the pump for you to be there at next year’s gala in San Antonio.

This sold out event raised nearly $310,000, and it’s not done yet. The Star Campaign has just kicked off thanks to a generous $10,000 “challenge” grant opportunity from the John P. McGovern Foundation, Houston. It is not too late to double the impact of your gift and help the gala to be among the most successful ever. Donate today!

The annual gala enables the foundation to support TMA’s annual award-winning programs such as Hard Hats for Little Heads, Walk With a Doc Texas, Science Teacher Awards, and more. Additionally, grants to TMA county medical societies, and TMA Alliance and medical student chapters are made possible through funds raised at the gala. 

Top sponsors were H-E-B, Pfizer Inc., Texas Medical Liability Trust, TMA Insurance Trust, UnitedHealthcare, and UTMB Health. Thirty other institutional and individual sponsors helped round out the gala’s success.

This Month in Texas Medicine


The July issue of Texas Medicine continues to dig into medical disparities in Texas, with a focus on getting more black and Hispanic students into the state’s medical schools. One 2015 JAMA study found that African-Americans made up just under 4 percent of practicing physicians, 6 percent of trainees in graduate medical education, and 7 percent of medical school graduates. Meanwhile, U.S. Census data show that 15 percent of the total population was black. Statistics for Hispanics are similar. The July issue also includes stories about how the Physician-Focused Payment Model Technical Advisory Committee has been accepting proposals for alternative payment models from physicians participating in MACRA; primary care physicians who opt to open “urgent care” facilities or add urgent care services to their practices; and the potential impact in Texas if interstate health plan sales were to become more of a reality, including potential pitfalls and benefits..

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  

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

Last 90-Day Period for the 2017 MIPS Performance Year

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.  


Modern Marketing for Five Star Reviews
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

July 14, 2017