Action: Oct. 2, 2017

TMA Action Oct. 2, 2017   News and Insights from Texas Medical Association

TMA Already Pushing Lawmakers on 2019 Issues
Judge Tosses Suit Over End-of-Life Care Law
Have Your Say in Building Workers’ Comp Audit Process
Do You Have a Medicare Bonus – or Penalty – Coming Next Year?
MIPS Milestone: Last 90-Day Performance Period Starts Oct. 2
Update: UnitedHealthcare Reverses Plan to Stop Paying For Consultation Codes

Get Practice-Wide HIPAA-Compliant Messaging Today
TMA Dues Statements Coming
What Should You Do When a Colleague's Behavior is Disruptive?
Learn, Network at Texas Immunization Conference
This Month in Texas Medicine

TMA Already Pushing Lawmakers on 2019 Issues  

Remember the 85th Texas Legislature? It wrapped up in May only to reconvene again for a special session in July.

You remember. That's the one where hundreds of physicians helped create important laws that allow greater access to telemedicine, reduce maintenance of certification requirements, and empower physicians to override health plans' step therapy protocols, among many other legislative wins.

Still don't remember? Perhaps the fact that the Texas Medical Board was almost eliminated will jog your memory.

Now that we're all on the same page, let's start talking about the next legislative session — the one that starts Jan. 8, 2019.

Sure, that's a little far off considering it's still 2017, but don't think that means TMA isn't already working hard to improve the health of all Texans.

You see, TMA sent letters to Charles Schwertner, MD, chair of the Senate Health and Human Services Committee; and Jane Nelson, chair of the Senate Finance Committee, that outline several areas those committees should study in depth before the 2019 session.

TMA's recommendations include:

  • Continuing efforts to improve care for women and infants, including the availability of prenatal and postpartum care;
  • Expanding options for behavioral health services, particularly treatment for mothers and newborns who have addictive disorders;
  • Working with TMA to simplify Medicaid's vendor drug program, to increase physician input into clinical decisionmaking, and to align Medicaid fee-for-service and managed-care rate-setting schedules to avoid unnecessary retroactive adjustments;
  • Identifying and designing a process to determine standards of care during natural disasters such as Hurricane Harvey;
  • Making the process of receiving adult vaccinations more efficient;
  • Studying increased funding for graduate medical education; and 
  • Better promoting the state's organ donation program.

Of course, we've got more letters in the works that we'll send to House leaders, but we're still working on those.

As always, we'll keep you updated.

Close to $1 Million Raised to Help Harvey-Affected Physicians Rebuild

When physicians lost homes and practices because of the devastation caused by Harvey, their colleagues across Texas and throughout the United States stepped up to offer their support.

Thanks to that generosity, TMA’s Disaster Relief Program has received almost $1 million in donations to help physicians whose practices sustained physical Harvey-related damage not covered by insurance or other sources of assistance.  

TMA’s philanthropic arm, the TMA Foundation, is raising funds, and a special committee of The Physicians Benevolent Fund is administering the TMA Disaster Relief Program. 

Donations have been received from more than 20 states and the District of Columbia as well as state medical societies in California, Colorado, Massachusetts, and Rhode Island. In addition, representatives from the American Medical Association and The Physicians Foundation presented checks for contributions in the amount of $150,000 and $500,000, respectively, at the 2017 TMA Fall Conference.

Physicians in a Harvey federally declared disaster area needing financial assistance to rebuild their practice can apply at, or email questions to disaster[at]texmed[dot]org.  

Apply Now Button

You can make a tax-deductible donation to the Disaster Relief Fund at

 Donate Now button  

Judge Tosses Suit Over End-of-Life Care Law

A Harris County district judge rejected a constitutional challenge to part of the Texas Advance Directives Act, siding with TMA and several other organizations that filed a brief in support of the law.

Judge Bill Burke on Sept. 12 threw out the lawsuit filed by Evelyn Kelly of Pasadena against Houston Methodist Hospital. Ms. Kelly had sued Methodist over the care her late son, Chris Dunn, received under the Advance Directives Act.

If a physician believes life-sustaining treatment would exacerbate or extend a patient's suffering, the law allows that physician to present the case to an ethics committee to evaluate the appropriateness of continuing that treatment. If the ethics committee affirms the attending physician's decision that the treatment would be medically inappropriate, the law provides a qualified immunity from liability for causing the treatment to be withheld or withdrawn. The attending physician has to make a reasonable effort to transfer the patient to another physician. 

Ms. Kelly's suit claimed part of the law gives doctors and hospitals "absolute authority" to stop life-sustaining care and violates a patient's right to due process. 

According to the Houston Chronicle, Judge Burke said repealing the 1999 law would be "a case of throwing the baby out with the bath water." He said any needed fix to the statute would be a task for the legislature, echoing an argument that TMA, the Texas Alliance for Patient Access (TAPA), the Texas Catholic Conference of Bishops, and other organizations had made in a friend-of-the-court brief filed in late July. Unsuccessful attempts to gut this law have been introduced in every legislative session since 2005.

"It would be a big mistake to throw out a statute in place for nearly 20 years that seems to be working pretty well," Judge Burke said, according to the Chronicle. "If you think the law doesn't provide sufficient protection for patients, go to the legislature to remedy it."

About a month after Mr. Dunn was admitted to the hospital in 2015, his attending physicians and patient care team decided life-sustaining treatment was medically inappropriate, and the hospital's ethics committee agreed. But attorneys for Mr. Dunn began a court battle to continue the life-sustaining treatment. Methodist continued that treatment until Mr. Dunn died on Dec. 23, 2015. Ms. Kelly filed suit claiming that Methodist "prematurely applied the procedures" in the law and that her son's constitutional rights were violated.

TMA and the other organizations, which included some pro-life groups, had argued in their brief that the law section at issue was constitutional and is "designed to resolve otherwise-intractable end-of-life disputes. In almost every case — including this one — it does so without violating patient wishes. If reform is necessary, it should take place in a legislative venue."

TAPA General Counsel Brian Jackson said in a statement that with Mr. Dunn's unfortunate passing, "there is no case or controversy. We were not surprised that the judge dismissed the case." He said the law "implements a public policy that was thoroughly vetted and unanimously adopted by the right-to-life community, health care providers, and the Texas legislature."

Ms. Kelly told the Chronicle that she was planning to appeal the ruling, but her attorney had told the paper earlier that no appeal decision had been made.

Have Your Say in Building Workers’ Comp Audit Process

It’s generally pretty nice when somebody asks you for advice. It means they trust your opinion and believe you’ll have offer some much-needed insight.

To that end, the Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) wants your help in developing a Designated Doctor Plan-Based Audit to review the quality of reports created by physicians designated to individual workers’ comp cases. The audits also will review whether additional testing and/or referrals ordered by that physician are necessary.

The document sets the scope, methodology, selection criteria, and roles and responsibilities of a plan-based audit, which is part of TDI-DWC's 2017 Medical Quality Review Annual Audit Plan.

If you participate in the workers' comp program and have ideas on how such an audit should be carried out, check out the proposed audit on the TDI's website.

But time is running out. You've only got until 5 pm CT Oct. 4 to email your suggestions.

 TMAIT Action Ad 6.15

Do You Have a Medicare Bonus – or Penalty – Coming Next Year?

Well, the moment you've been waiting for has finally arrived.

No, you didn't win the lottery.

But if you participated in the 2016 Physician Quality Reporting System (PQRS) or the Value-Based Payment Modifier programs, you can now find out whether you'll receive bonus payments in 2018. Heyo! (You also can find out if you'll get hit with a payment cut, which is actually nothing like winning the lottery.)

Anyway, the Centers for Medicare & Medicaid Services (CMS) recently released two separate reports from the 2016 PQRS and Value Modifier programs that include information about your (yes, your) quality and cost performance. Both reports are accessible online only.

Under the PQRS program, CMS will soon send letters to physicians who will receive a 2-percent per-claim cut (say that five times quickly) to Medicare payments. 

Under the Value Modifier program – which uses a quality-tiering approach – the annual Quality and Resource Use Report (QRUR) will let you know your quality-tier designation: high, average, or low quality and cost. That means your Medicare payments will be adjusted up (bonus!) or down (penalty) on a per-claim basis as well.

You're going to want to read these reports as soon as possible to ensure that your data are correct and that you won’t receive a cut by mistake. 

Now, let's say you believe your data are incorrect; here's what you do: Submit an "informal review request" by Dec. 1. But. This is the only appeals process CMS has for these programs. 

  • To submit an informal review request for a PQRS feedback report, refer to the PQRS Informal Review Made Simple guide. 
  • To submit an informal review request for a QRUR, refer to the “Value Modifier Informal Review Request Quick Reference Guides” and FAQs on the Value Modifier website

In case you forgot, PQRS and Value Modifier payment adjustments, which are based on 2016 quality and cost performance, end in 2018. Both programs, along with the meaningful use program, were consolidated into the Merit-Based Incentive Payment System (MIPS) this year under the new Quality Payment Program. Medicare payment adjustments in 2019 will be based on your 2017 MIPS performance. Analyzing the data in your reports now will help you evaluate your performance on quality and cost measures so you can identify areas for improvement and take action to improve your overall score under the new MIPS program. 

For questions about your PQRS feedback report, contact the CMS QualityNet help desk. For questions about your QRUR, contact the CMS Physician Value help desk

And for more information on all of these programs, you can always check out the Practice Help section of the TMA website.

MIPS Milestone: Last 90-Day Performance Period Starts Oct. 2

Well, October is upon us, which means Halloween is right around the corner and the baseball playoffs are about to start.

It also means that the final 90-day performance period of the new Merit-Based Incentive Payment System (MIPS) under the Quality Payment Program framework has already begun — that happened Oct. 2, to be exact.

If you plan to participate in MIPS this year and haven't determined how you will participate, you better review your options now and create an action plan to avoid the 2019 MIPS penalty. 

According to the Centers for Medicare & Medicaid Services (CMS), you will avoid a 4-percent pay cut to your Medicare Part B payments in 2019 if you successfully submit data to MIPS under one of the following “pick your pace” options this year:

  • Submit data covering a full year from Jan. 1 to Dec. 31, 2017, or
  • Submit data covering at least a consecutive 90-day period in 2017, or
  • Submit a minimum amount of data covering 90 days or less in 2017.

So what does all that mean?

Well, in general, you'll submit 2017 MIPS performance data between Jan. 2 and March 31, 2018. But you have to figure out this year which measures to choose, which improvement activities to take part in, and which time frame to collect data (that's those three options above).

Here's some information based on data submission mechanisms that might help:

  • Medicare Part B Claims (individuals): If reporting for at least 90 consecutive days, start the process on Oct. 2 or as soon as possible. If reporting only one measure/one patient/no penalty, see guide.
  • Qualified Registry (individuals or groups of two or more): Check with your registry vendor of choice for details and specific deadline.
  • Qualified Clinical Data Registry (individuals or groups of two or more): Check with your QCDR vendor of choice for details and specific deadline.
  • Electronic Health Record (individuals or groups of two or more): Check with your EHR vendor for details and specific deadline.
  • Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey (groups of two or more): Review the CMS guide and check with your CAHPS survey vendor of choice for details and specific deadline.
  • CMS Web Interface (groups of 25 or more): Review CMS guide for details and specific deadline.

If you need more help on how to master requirements for each MIPS performance category, check out this TMA article. For questions, contact the CMS Quality Payment Program Service Center at (866) 288-8292 or email at QPP[at]cms[dot]hhs[dot]gov

As always, visit the TMA MACRA Resource Center to stay up-to-date on the new Quality Payment Program. 

Update: UnitedHealthcare Reverses Plan to Stop Paying For Consultation Codes

Thanks to TMA advocacy, UnitedHealthcare (UHC) will continue to pay for consultation codes, the company announced in September.

UHC had planned to stop paying for the codes starting Oct. 1. In response, TMA worked on a letter with the Medical Society of New Jersey urging UHC to reconsider the policy. The letter was cosigned by multiple state and specialty societies.

UHC said it will announce the delay in the October edition of its monthly newsletter.

TMA had reported UHC’s original announcement to stop paying for the codes in August.

 Action TMLT Ad 10.15

Get Practice-Wide HIPAA-Compliant Messaging Today

Chances are pretty good you use the DocbookMD app.

How do I know? Because about a quarter of TMA's 50,000 members have downloaded the service, which allows them to search TMA's physician directory and send HIPAA-secure messages, including images, directly from their mobile devices.

But, understandably, TMA members recently have wanted more out of the app than just a way to communicate with each other. They want a custom-designed service for the entire practice — a way for all physicians, practice managers, physician assistants, and other staff to communicate and collaborate.

Who wouldn't want that?

Well, DocbookMD not only listened (most people can do that) but also got to work creating upgraded team and enterprise plans that include additional features such as: 

  • A dedicated practice directory;
  • A deeper level of data control with a stats dashboard, message auditing, the ability to add or remove users, password reset, remote wipe, and access to edit physician and staff profiles; and
  • The ability to instantly get lab reports, discharge paperwork, answering service pages, and more. 

And check this out: If your practice has 100-percent membership in TMA, you will get 50 percent off these upgraded services for a full year.

If all this sounds good, visit for all of the details on plan options and which one is right for your practice. If you want that 50-percent discount, use coupon code 50TMA100 before Nov. 30.

And to move your practice to 100-percent membership, email Mari Hosek in TMA's Membership Development Department or call (800) 880-1300, ext. 1402, or (512) 370-1402. 

TMA Dues Statements Coming

It's membership renewal time again. I wrote a poem about it. It goes like this:

Let's talk about TMA dues;
Did you know that it's time to renew?
Go online to make payment;
Or check your mail for a statement;
So TMA can keep working for you.

Not bad.

Why renew? Because membership in the nation's largest and best state medical association gets you access to TMA's top-notch services, including: 

  • Practice consulting;
  • Useful, up-to-date news and information;
  • Professional education and continuing medical education; 
  • Exclusive vendor services; and 
  • Ways to give back to your community.

And of course, TMA's advocacy efforts give physicians a powerful voice in legislative and policy decisions that affect Texas and the rest of the nation.

If you have any other questions about renewing your membership, contact the TMA Knowledge Center by phone at (800) 880-7955 or by email.

What Should You Do When a Colleague's Behavior is Disruptive?

Do you know the difference between "disruptive behavior" and "unprofessional behavior" when talking about how physicians might affect workplace culture?

Could you recognize inappropriate or intimidating behavior, and do you know what you should do if you see it in your practice?

Are you familiar with the many ways that negative actions could cause medical errors, increase the cost of care, and lead employees and patients to seek new practices?

If you'd like to learn more about these questions or negative physician behavior in general, check out TMA's new white paper, "Disruptive Behavior and Behavior That Undermines a Culture of Safety."

The purpose of the paper, which was written by the TMA Office of the General Counsel, "is to discuss specifically the 'disruptive behavior' standard — and how that standard has evolved — and to provide examples of behavior that may and may not be classified as undermining a culture of safety."

The white paper is among the many tools and information you can find in TMA's Employed Physician page.

If you want more information on almost any medical or practice topic you can think of, contact the TMA Knowledge Center via email or at (800) 880-7955.

   PC Action Ad Oct 13

Learn, Network at Texas Immunization Conference

You know the importance of immunizations. So do many of your peers and colleagues.

But, unfortunately, a lot of people are either misinformed or simply don't know about the benefits of immunizations.

That's why the Texas Department of State Health Services (DSHS) is holding the 2017 Texas Immunization Conference in late November.

The conference will provide a way for public health experts, physicians, health care providers, and advocates to share information, discuss current issues, and recommend strategies to improve immunization rates across Texas.

Topics to be discussed include:  

  • Texas immunization law and the future of Texas immunizations,
  • HPV data and trends and cancer prevention promotion,
  • Updates on adult immunizations,
  • Communicating with parents confidentially,
  • Federal policy updates, and
  • Storage and handling.    

There will also be continuing education credits for multiple disciplines.

The conference will be held Nov. 28–30 at the San Antonio Hyatt Regency on the Riverwalk.

If all of this sounds like a good way to spend a couple of days after Thanksgiving, register for the conference on the DSHS website.

TMA's immunizations webpage also has a host of information, including the latest news, schedules, information, and requirements as well as how you can host your own vaccination event through our Be Wise — ImmunizeSM program.

Be Wise — Immunize is a service mark of the Texas Medical Association.

This Month in Texas Medicine

The October issue of Texas Medicine looks at the effects of TMA-supported legislation to loosen maintenance of certification requirements. Thanks to that law, Texas is now a national leader in reducing the onerousness of MOC on physicians, but what will the new law do once it takes effect at the beginning of 2018, and what could it do to keep more physicians in practice? The magazine also goes in depth on Environmental Protection Agency requirements regarding medical hazardous waste, as well as the importance and feasibility of paid parental leave for small practices. Other articles discuss how physicians can further understand the MACRA Quality Payment Program, and a new book on how physicians can better market their practice.

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 on the TMA website (may not work with all browsers). Or, download an RSS reader, such as Feedreader, Sharpreader, Sage, or NetNewsWire Lite, to have the feed delivered to your desktop or mobile device. You also can subscribe to the RSS feeds for TMA news releases and for Blogged Arteries, the feed for Action

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, also is available as an RSS feed. This is a valuable resource for your office staff, as well.

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 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.  

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

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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

October 12, 2017