Action: Oct. 17, 2017

TMA Action Oct. 17, 2017   News and Insights from Texas Medical Association

Trump Signs Executive Order on Association Health Plans: “All Any of Us Can Do Now Is Wait”
TMA Awards Nearly $350,000 to Harvey-Affected Physicians
Harvey Death Toll Reaches 93
TMA to Congress: Renew Health Coverage Funding for 400,000 Texas Children
TMA: Federal Legislation Needed to Continue Successful MIPS Rollout

Are You Eligible for a 5-Percent Medicare Bonus Payment?
Texas Hits Peak in Newly Licensed Physicians
Help Prevent Opioid Abuse During Drug Take Back Day
Want $2,500 to Improve the Health of Your Community?
Five New Members Take Their Place on the TMAF Board
This Month in Texas Medicine

Trump Signs Executive Order on Association Health Plans: “All Any of Us Can Do Now Is Wait”

Texas physicians could see a flood of new insurance plans — including some to cover themselves and their employees — under President Donald Trump's executive order that directs federal agencies to design lower-cost plans outside the Affordable Care Act.

The order, signed Thursday, would allow for so-called association health plans in which individuals or small businesses can band together to buy health insurance. TMA staff have begun an in-depth review of the order as well as another presidential directive issued on Friday that would eliminate federal subsidies to insurance companies that offer plans through the ACA exchange.

TMA currently offers a health plan to its members through the Texas Medical Association Insurance Trust (TMAIT); however, it was closed to new entrants in 2013 because of limiting language in ACA. Trump's order could reverse that.

"This could be a big deal," said James Prescott, administrator of TMAIT. "We have the infrastructure in place, the staff in place. If this goes forward, for us it would be a return to a segment of the insurance business we offered to TMA members for over 40 years. We anticipate that eligible TMA members would have access to an individual PPO plan, which they don't have now."

President Trump's executive order gives three cabinet departments 60 days to rewrite federal rules for association health plans. ACA requires that such plans be from the same state and meet certain protections, such as coverage of essential health benefits. The administration is likely to exempt associations from those rules. 

Any regulations are expected to be debated and challenged, and several state insurance commissioners have said they'd go to court to stop the order.

"All any of us can do now is wait," Mr. Prescott said.

If and when new plans appear, Mr. Prescott says, physicians should pay close attention to how they are regulated. "Years ago, similar insurance arrangements had no clear regulatory oversight, and numerous bankruptcies occurred, leaving individuals responsible for payments to physicians, hospitals, and other medical providers."

Physicians also should consider whether any plan abides by a state's consumer protection laws. If not, consumers would have little recourse if a plan can't pay a claim, nor would there be any appeals process for denied services, Mr. Prescott says.

He also says it is crucial to see how a plan keeps costs low. "Generally, premiums can only be reduced by some type of restrictions, such has higher copays, higher deductibles, smaller physician networks, or the removal of previously covered items."

TMAIT was created and is exclusively endorsed by TMA to provide insurance products to TMA members, their dependents, and staff. TMAIT offers group insurance contracts underwritten by Prudential and Blue Cross and Blue Shield. TMAIT's wholly owned insurance agency represents many different insurance carriers offering a variety of individual insurance products to TMA members. More information about TMAIT can be found on its website.

TMA Awards Nearly $350,000 to Harvey-Affected Physicians

The TMA Disaster Relief Program has awarded a total of $341,600 to 28 practices that were damaged by Hurricane Harvey during the first round of application reviews.

The practices, which employ 107 physicians and 936 staff members, are located throughout federally designated disaster areas, including Beaumont, Columbus, Houston, Orange, Aransas Pass, and Victoria. Most had extensive water damage due to flooding, which has required remodeling, relocating to a temporary location, and replacing equipment.

The TMA 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. 

Funds have come from generous donors throughout Texas and the United States as well as The Physicians Foundation; the American Medical Association; the medical societies of California, Massachusetts, Louisiana, Rhode Island, and Harris County; and New York's Henry Schein Cares Foundation. To make a donation, please visit the TMA Foundation webpage

"Although the damage caused by Hurricane Harvey was substantial, the generosity physicians showed their affected colleagues was even more powerful," said TMA President Carlos J. Cardenas, MD. "This assistance will help these practices return to doing what they do best: protecting the health and well-being of their patients and their communities."

Assistance is available for practices in FEMA-declared counties that sustained uninsured, underinsured, or nonreimbursable property damage and do not have adequate funding to cover the damage. This includes relocating or rehabilitating their medical office, replacing equipment, rebuilding patient records, and paying temporary operating expenses, including rent for temporary offices and other working capital requirements.

To be eligible, applicants: 

  • Must be licensed physicians practicing in Texas,
  • May apply only once per disaster, and 
  • May amend previously submitted applications if additional information becomes available.  

Apply for disaster relief assistance online. Applications and proof of insurance claim (if applicable) must be remitted and are limited to one application per practice. 

A special committee of the TMA Physicians Benevolent Fund, chaired by Immediate Past President Don R. Read, MD, of Dallas, is reviewing the applications and deciding on aid awards.

Contact Gail Schatte at (512) 370-1600 or by email if you have questions about the program or need help completing the application.

View TMA's Disaster Preparedness & Response Resource Center for additional resources regarding recovery from Hurricane Ike.

Harvey Death Toll Reaches 93

An estimated 93 Texans have died as a result of Hurricane Harvey, according to the Texas Department of State Health Services (DSHS).

Wind, rain, and floods were responsible for 62 deaths, DSHS said, while 26 were caused by "unsafe or unhealthy conditions," including electrocution, traffic crashes, infections, fires, and burns. Another five deaths possibly related to Harvey still are being investigated, officials say.

A final death toll is not expected to be released until next year, DSHS says.

Meanwhile, the Texas Health and Human Services Commission (HHSC) announced that copayments for the Children's Health Insurance Program (CHIP) will be waived for services provided Aug. 25 through Nov. 30 for CHIP members living in or displaced from a Hurricane Harvey FEMA-declared disaster county.

Managed care organizations (MCOs) will compensate physicians and other health care providers for waived CHIP copays, according to HHSC. 

Details and more announcements are on HHSC's updated Harvey FAQ page. Those updates include an emergency proclamation that requires MCOs to provide coverage for prescription drug supplies of up to 90 days, including early refills, which is set to expire Oct. 31.

HHSC has created an emergency procedure that allows pharmacists to override a "refill too soon" error code for people enrolled in Medicaid or CHIP affected by Harvey. 

The order also includes patients enrolled in the Children with Special Health Care Needs (CHSCN) and Healthy Texas Women programs who receive limited prescription drug benefits for those programs, HHSC officials said.

"Pharmacy staff should use their professional judgment when filling prescriptions to ensure adherence to state and federal law," officials said.

More information on Hurricane Harvey, including a video of a panel discussion on the relief response to Harvey, can be found on TMA's website.

The panel, which was held during TMA's 2017 Fall Conference in September, featured David Teuscher, MD, Dallas regional director of the U.S. Department of Health and Human Services, and Kirk Cole, senior adviser to the DSHS commissioner. It was moderated by TMA President Carlos J. Cardenas, MD. The panelists recounted how federal, state, and local authorities worked together to battle the storm's impact. 

Action TMLT Ad 10.15

TMA to Congress: Renew Health Coverage Funding for 400,000 Texas Children

Although Texas officials are optimistic that federal funding for the Children's Health Insurance Program (CHIP) will be renewed, TMA is leading the Coalition of State Medical Societies' efforts in urging federal lawmakers to support the program through 2019 and beyond.

Federal funding for CHIP, which provides health coverage for almost 400,000 Texas children, expired Sept. 30. 

Texas is expected to have sufficient funds for the program until February, according to a letter from a Health and Human Services Commission (HHSC) official to members of the Children's Health Coverage Coalition. However, the state would lose more than $1 billion annually if Congress doesn't reauthorize funds, HHSC Chief Deputy Executive Commissioner Cecile Erwin Young said in the letter.

About a dozen states will exhaust their federal CHIP allotments before the end of the year, and several have notified the Centers for Medicare & Medicaid Services (CMS) that they will need to suspend or end enrollment soon without swift congressional action. 

TMA and other state medical societies in October sent letters to the majority and minority leaders of the U.S. Senate and House of Representatives exhorting them to support legislation that would extend funding for CHIP.

"We respectfully urge Congress to continue federal funding of CHIP at the enhanced matching rate in effect for each state as of Sept. 30, 2017," the coalition's letter states. "Loss of CHIP coverage would mean almost 9 million vulnerable children would be forced into the expensive, unstable individual marketplace, likely resulting in no access to health care. After the natural disasters that recently ravaged Texas, Louisiana, and Florida, disrupting or eliminating coverage for children could be disastrous to their health."

The Children's Health Coverage Coalition, of which TMA is a leading member, sent letters in early September to Gov. Greg Abbott and to Texas members of Congress, urging them to continue to fund the program at the enhanced matching rate, which for Texas had been about 93 cents for every CHIP dollar in 2018.

CHIP provides health care coverage for children in families who are financially ineligible for Medicaid but who can't afford private coverage or don't have coverage through an employer. As of April 2017, about 36,000 Texas women also received prenatal care and post-delivery checkups with CHIP funds.

The Coalition of State Medical Societies — a group of 10 state medical associations representing more than 180,000 physician and medical student members — includes TMA and the medical societies of Arizona, California, Florida, Louisiana, New Jersey, New York, North Carolina, Oklahoma, and South Carolina.

TMA: Federal Legislation Needed to Continue Successful MIPS Rollout

Two provisions of the Medicare Access and CHIP Reauthorization Act (MACRA) that will expire in the spring should be extended for another three years to ensure a smoother rollout of the Merit-Based Incentive Payment Program (MIPS) under the new Quality Payment Program, TMA and other medical societies have told federal lawmakers.

Specifically, the societies are asking that the cost category under MIPS continue to be weighted at zero percent, as was done in 2017 and has been proposed for 2018, instead of the full 30 percent that would be required in 2019 when the provision expires next year. 

Because the program is still under development, the zero weight accurately reflects the complexities of cost measurement and does not discourage clinicians from caring for high-risk and medically complex patients, as was the case under the value-based modifier that MIPS replaced, the associations said.

The associations also are requesting that the Centers for Medicare & Medicaid Services continue to be flexible in selecting a target performance threshold. 

Gradually increasing the performance threshold gives physicians a chance to implement practice changes as they gain experience, the associations said. It also ensures that the performance threshold is not set too high, which could discourage participation or negatively impact practices with fewer resources.

In addition, the societies asked that changes be made to other MACRA provisions, including: 

  • Clarifying that Medicare Part B drugs and other items and services outside the physician fee schedule are not included in the application of MIPS payment adjustments and MIPS eligibility;
  • Rationalizing what is considered a "small practice"; and
  • Explicitly authorizing the Physician-Focused Payment Model Technical Advisory Committee to provide technical assistance to developers of advanced payment models.

 TMAIT Action Ad 6.15

Are You Eligible for a 5-Percent Medicare Bonus Payment?

If you participate in MACRA's Advanced Alternative Payment Model (APM) program, you've been waiting all year for this.


Yes, but that's not what I was talking about specifically.

It's time to find out whether you're one of the coveted qualifying APM participants (QP) and therefore eligible for that sweet, sweet 5-percent lump-sum Medicare bonus payment in 2019.

The Centers for Medicare & Medicaid Services (CMS) has studied claims you submitted from Jan. 1 to March 31 and determined whether you have indeed achieved QP status for a year.

You want to know your status, don't you?

Good news. CMS has rolled out an interactive look-up tool that will let you know just where you stand. How about that? 

That Jan. 1 to March 31 time frame is one of three "snapshots" that CMS will use to determine QP eligibility. The others are Jan. 1 to June 30, and Jan. 1 to Aug. 31.

Information on the other two "snapshot" periods will be available soon, so check that tool periodically to see your status. You also should check with your advanced APM administrator for the next steps.

If you want to learn more about any of this, CMS offers a methodology fact sheet as well as a supplemental service payments fact sheet that will help get you up to speed.

You also can check out the QPP Resource Center provided by the Physicians Advocacy Institute (PAI) and Washington, D.C.-based consulting firm Healthsperien.

If you want TMA's help, and we've got a lot of great information from some of the state's leading experts, check out our MACRA Resource Center

Texas Hits Peak in Newly Licensed Physicians

 Almost 5,000 new physicians received medical licenses in the state's 2017 fiscal year, a record that underscores the benefits of tort reform laws passed in 2003 and other positive factors that make Texas a good place to practice medicine.

In the year that ended Aug. 31, the Texas Medical Board issued 4,719 licenses, a gain of 700 (or 17.5 percent) over the previous year and 424 (9.9 percent) more than the old record set in 2015.

Texas has licensed more than 49,000 physicians, or an average of 3,500 every year, since 2003. In the 14 years before then, the board issued about 32,000 licenses, or an average of 2,300 annually. 

Help Prevent Opioid Abuse During Drug Take Back Day

Here's an interesting fact for you: Almost 132,000 pounds of unused prescription drugs have been collected in Texas during the past two National Prescription Drug Take Back Day events.

That's almost 66 tons of medications that had been sitting in medicine cabinets, kitchen drawers, and bedside tables throughout the state.

That's a lot of drugs that could end up in the hands of children or people battling opioid addictions.

The U.S. Drug Enforcement Administration (DEA) twice a year puts on the take back day events to provide a safe, convenient, and anonymous way for people to dispose of prescription drugs. The next one is scheduled for Oct. 28 at locations throughout the state.

TMA supports community programs such as take back days as part of its policy on addressing prescription drug abuse and overdose.

If you want to be part of the effort, you can find more information, posters, and other handouts on DEA's website.

   PC Action Ad Nov 13

Want $2,500 to Improve the Health of Your Community?

You know what everybody loves? Good stuff.

You know what everybody loves even more? More good stuff.

Sure, sometimes people say you can have too much of a good thing, but I prefer Mae West’s take on that: “Too much of a good thing can be wonderful.”

Lekshmi Nair, MD, of Pearland, knows about offering more good stuff. The family medicine physician has hosted a successful health fair in Brazoria County for several years, but she recently added vaccinations to the fall events with help from TMA’s Be Wise — ImmunizeSM program.

Be Wise works with physicians, medical students, and TMA Alliance members to improve vaccination rates in Texas through education and hands-on immunization clinics.

"Introducing vaccinations has added great value to the entire event," said Dr. Nair, who also has given away free bicycle helmets through TMA's Hard Hats for Little Heads program. "People call in advance to make sure they will receive the vaccine, showing the demand for vaccinations in the community.

"I also have noticed when vaccines are offered free, the barriers to immunize that physicians usually face in an office setting are overcome," she said. "Community members feel empowered and are more receptive to screenings, education, and vaccination."

Want to offer more of a good thing to your community?

TMA physicians/clinics, medical students, county medical societies, and TMA Alliance chapters can apply for a local impact grant of up to $2,500. Grantees have up to 12 months to use the funds. 

TMA will receive grant applications until Nov. 1 for vaccination events in early 2018 (applicants should apply four to six months in advance). Another round of applications will be accepted March 1. 

If you have questions, contact Tammy Wishard, TMA's outreach coordinator, at (512) 370-1470.

TMA actively works to improve vaccination rates in Texas through the Be Wise — Immunize program. More than 320,000 shots have been given to Texas children, adolescents, and adults since the program began in 2004. 

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.  

Five New Members Take Their Place on the TMAF Board

Three new members — including one resident, a PhD, and one medical student — were named to the TMA Foundation (TMAF) Board of Trustees during the TMA Fall Conference in September.

The new members who began their first three-year terms are: 

  • Raymond Moss Hampton, MD, a Midland board-certified obstetrician-gynecologist in practice for 33 years. Dr. Hampton also is a professor in the Department of Obstetrics and Gynecology at Texas Tech University Health Sciences Center of the Permian Basin;
  • Carla F. Ortique, MD, a Houston obstetrician-gynecologist, who cares for patients at Women's Specialists of Houston at Texas Children's Hospital. She also is a clinical instructor in the Department of Obstetrics-Gynecology at Baylor College of Medicine; and
  • Steven H. Kelder, PhD, of Austin, a professor in the Division of Epidemiology, Human Genetics, at The University of Texas School of Public Health and associate dean of the Austin campus.

Meanwhile, two special representatives began one-year terms: 

  • Arindam Sarkar, MD, Houston, a physician in residency at Baylor College of Medicine, is the Resident and Fellow Section representative; and 
  • Sinan Ali Bana, Sugar Land, a third-year medical student at Texas A&M Health Science Center College of Medicine, will represent the Medical Student Section. 

TMAF, the philanthropic arm of TMA, raises funds to support the population health, science, and quality-of-care priority initiatives of the association and the Family of Medicine. TMAF connects medicine, business, and community groups that carry out these programs at the local and state levels.

 Learn more about these leaders and how to support programs made possible by TMAF.

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 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

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Last Updated On

October 18, 2017