Action: Nov. 1, 2017

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

TMA Helps Nine More Practices Affected by Harvey
You Want TMA to Do What? We’ve Made It Easier to Be Heard
Weigh In on Medicare Cost Measures by Nov. 15
Preview Your Quality Performance Scores Before They Become Public
Are Your Technology Contracts Favorable?
New MIPS Option Now Available
How Do You Use the 1500 Claim Form?

Fight the Resistance: Educate Yourself on Antibiotics
CDC Updates Guidance on Zika in Newborns
AMA Called On to Address Scope-of-Practice Threat
And the Award for Practice Quality Improvement Goes to …
Give Kudos to Local Health Reporting
This Month in Texas Medicine

TMA Helps Nine More Practices Affected by Harvey

TMA's Disaster Relief Fund has awarded another $83,000 to nine additional practices damaged by Hurricane Harvey.

These practices suffered extensive water damage that in most cases required remodeling, repairs, relocation to temporary facilities, and replacement of equipment.

In two rounds of application reviews, the Disaster Relief Fund has awarded a total of $424,590 to 37 practices throughout federally designated disaster areas, including Beaumont, Columbus, Houston, Orange, Aransas Pass, and Victoria. The practices employ 116 physicians and 967 nonphysician staff.

The TMA Disaster Relief Program has collected 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 physicians and other 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. You can still make a tax-deductible donation online

Assistance is available for practices in FEMA-declared counties that sustained uninsured, underinsured, or nonreimbursable property damage and that 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 while funds are available. 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 TMA Past President Don R. Read, MD, of Dallas, is reviewing the applications monthly to determine assistance amounts based on need.

Contact TMA by email with your questions regarding the program or if you need help completing the application.

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

You Want TMA to Do What? We’ve Made It Easier to Be Heard

As a busy physician and member of organized medicine in Texas, I’m sure there are policy issues you've encountered in your practice that you'd like TMA to address.

But you might not believe your ideas can drive TMA policy. Well, think again.

TMA maintains a robust system of grassroots policymaking, from county medical society resolutions to TMA council and committee activities to the 500-voting-member TMA House of Delegates

TMA's policy is extensive, covering issues regarding substance abuse, civil and human rights, emergency medical services, immunizations, physician fees, rural care, telemedicine, and everything in between, all created as a direct result of member input and action.

Resolutions can be submitted to the TMA house every spring, but wouldn't it be great if there were a central hub where you could submit your ideas on an issue anytime year-round?

TMA has created just such a portal on its website. (If you lose that link, remember you can always find it on the House of Delegates page.) By completing this brief, simple form, you can send us your burning issues and recommendations for TMA action at any time of the year. You will receive a response within 10 business days, with specific information on how to ensure your issue is addressed through TMA in partnership with your local county medical society. 

So, get your issue heard by filling out this simple form. And if you want to get even more involved in any way with TMA, check out the About TMA section of the website.

Weigh In on Medicare Cost Measures by Nov. 15

What are your thoughts on how Medicare attributes costs to you or your practice in its incentive and penalty programs?

Are they working out for you? Or do you agree with TMA that they are inaccurate and unfair?

Either way, the Centers for Medicare & Medicaid Services (CMS) is testing and developing new methods to identify and attribute relevant Medicare costs, and they want your feedback.

As required by the Medicare Access and CHIP Reauthorization Act (MACRA), CMS is developing new measures for future use in the cost performance category of the Merit-Based Incentive Payment System (MIPS) under the Quality Payment Program. Specifically, CMS wants to know what physicians think of eight episode-based cost measures: 

  1. Elective outpatient percutaneous coronary intervention (PCI),
  2. Knee arthroplasty,
  3. Revascularization for lower extremity chronic critical limb ischemia,
  4. Routine cataract removal with intraocular lens implantation,
  5. Screening/surveillance colonoscopy,
  6. Intracranial hemorrhage or cerebral infarction,
  7. Simple pneumonia with hospitalization, and 
  8. ST-elevation myocardial infarction with PCI.

If you or your practice performs or manages the care for one or more of the procedures or medical conditions, look for the field test reports for your practice on the CMS Enterprise Portal and give feedback to CMS through this online survey by Nov. 15.

For complete details, refer to the CMS fact sheet or FAQs. For questions about the cost measures or feedback process, email CMS

After you provide feedback, contact TMA by emailing Donna Kinney, and let us know what you told CMS.   

Preview Your Quality Performance Scores Before They Become Public

You or your group practice dutifully reported quality data to the 2016 Physician Quality Reporting System (PQRS). And pretty soon, the Centers for Medicare & Medicaid Services (CMS) is going to report your performance scores on the Physician Compare website for all the world to see.

Wouldn’t you like to know those scores before they become public?

Does a stethoscope taste like metal?

Well, CMS is giving you or your group practice the chance to preview your scores to ensure that what is being reported about you is correct. If your data are not correct, email Physician Compare.

You can review your scores here, but you don't have much time: The preview period ends Dec. 1.

Data available for preview include: 

  • 2016 PQRS measures; 
  • 2016 Consumer Assessment of Healthcare Providers and Systems (CAHPS) for PQRS measures;
  • 2016 non-PQRS Qualified Clinical Data Registries (QCDR) measures; and
  • 2015 clinician utilization data. 

For guidance on how to preview your profile and performance scores, check out this CMS five-step tip sheet. For complete details, visit the CMS website. For questions, email Physician Compare

TMAIT Action Ad 6.15

Are Your Technology Contracts Favorable?

Your practice has multiple contracts in place, including those for technology and other equipment.

And although you've made sure that those contracts serve your practice's best interests, there might be some aspects of each that are unfavorable.

But how would you know?

That's why you should turn to the Coker Group, the newest company to join TMA's prestigious list of group discount program vendors. The Georgia-based health care consulting firm is offering TMA members free technology contract reviews. 

Coker's contract evaluation will look for terms and conditions that may be unfavorable to TMA members. After the contract has been reviewed, Coker Group consultants will discuss it with you, including suggestions on how to address any unfavorable terms. 

If you would like help negotiating the contract on your behalf, as a TMA member, you are eligible for a 5-percent discount on Coker's fees, which will be capped. If the fees are still higher than the amount you saved, Coker will not charge for time spent on price negotiations (however, time spent on term negotiations is still applicable). 

To start the process, visit the TMA website, and complete and submit a brief questionnaire. A TMA consultant will contact you to walk through the next steps. 

If you have any questions about this service, email contractreview@texmed.org or call (800) 523-8776.

New MIPS Option Now Available

Every day, you are faced with options: Should I wear this outfit or that one? Should I go to the gym before work or after? Is another slice of pie really the best thing for me right now?

If you want even more options, you're in luck. The Centers for Medicare & Medicaid Services (CMS) has added another way to participate in the Merit-Based Incentive Payment System (MIPS) under the Quality Payment Program.

For the 2018 performance year, solo physicians and small group practices will be able to band together to join MIPS as a — get this — "virtual group." 

Wow.

The new "virtual" option is voluntary, and physicians still can choose to participate as an individual or as a group. 

Each virtual group will be a combination of two or more taxpayer identification numbers (TINs) made up of the following:  

  • A solo practitioner who’s eligible to participate in MIPS and bills under a TIN with no other National Provider Identifiers (NPIs) billing under the TIN; or
  • A group with 10 or fewer eligible clinicians (at least one must be eligible for MIPS) that joins with at least one other solo practitioner or group for a performance period of a year. 

According to the 2018 Quality Payment Program proposed rule, the MIPS data-reporting requirements for virtual groups will be similar to the "real" group-level requirements.

But this option won’t be available for long: If you want to participate, you must name an official representative who will submit the group's election to CMS by email by Dec. 1.

CMS will publish final policies and criteria surrounding virtual groups in the 2018 Quality Payment Program final rule this month.

You also can download the 2018 Virtual Groups Toolkit on the CMS website. If you still have questions, contact the CMS Quality Payment Program Service Center at (866) 288-8292 or by email

For no-cost technical assistance, contact the TMF Health Quality Institute or submit an online help request. As always, visit the TMA MACRA Resource Center to stay up to date on the latest information. 

How Do You Use the 1500 Claim Form?

Quick, do you know what the National Uniform Claim Committee (NUCC) is?

You might not, and that's perfectly understandable.

Whether you do or not, you are probably familiar with the NUCC's signature creation: the 1500 Health Insurance Claim Form (or simply the 1500 form, successor to the old "HCFA 1500"). You (or somebody on your practice staff) likely fills out one of these to submit claims to insurance companies, Medicare, and the like.

This ringing any bells yet?

Anyway, the NUCC is conducting a survey on how the ol' 1500 is being used, specifically as both a digital form and a print image. You should take the survey because it'll help the NUCC further understand how the form is being used.

It's a pretty simple survey, should take only 5 to 10 minutes to complete, and all answers are confidential.

The survey closes on Nov. 10, so you better act soon. Email any questions you might have to NUCC

Oh, the NUCC? It's an organization, hosted and chaired by the American Medical Association, that advocates and supports the health care industry's adoption of uniform data and nationally standardized transactions. And because we like to be involved, TMA is the alternate state medical association representative on the NUCC.

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Fight the Resistance: Educate Yourself on Antibiotics

Halloween has come and gone, but something frightening has been happening for quite a while: antimicrobial resistance.

Scared yet? 

You should be, and here's why: As more and more organisms stop responding to drugs and antibiotics, we could return to a time when simple infections were fatal.

But don't hide under the covers or lock yourself in a closet. That's not going to make anybody safe.

What will help is if you learn more about the health risks associated with antibiotic resistance as well as ways to improve how you prescribe antibiotics.

Luckily, the Centers for Disease Control and Prevention's (CDC's) annual U.S. Antibiotic Awareness Week — Nov. 13-19 — is a great opportunity to educate yourself and your patients.

For example, here are a few guidelines and continuing education courses from CDC on prescribing antibiotics: 

  • Prescribe correctly: Prescribe the right antibiotic at the right dose for the right duration and at the right time.
  • Educate: Talk to your patients about appropriate use.
  • Test and reassess: Use diagnostic tests to identify bacterial infections. If you start antibiotics before a patient's full laboratory results are known, stop and reassess the prescribed therapy when clinical results are available.
  • Embrace antibiotic stewardship: Improve antibiotic use in facilities through stewardship programs

If you want to help educate your patients on why antibiotics should only be used when necessary, download a sample letter that you can post in your office from the CDC website.

CDC Updates Guidance on Zika in Newborns

Although fewer Zika cases have been reported in the United States this year compared with 2016, the disease is still a pretty big problem around the world.

Because of that, the Centers for Disease Control and Prevention (CDC) last month updated its guidance for infants whose mothers might have been exposed to Zika virus during pregnancy.

Specifically, the new guidance updates information on interpreting laboratory test results for infants and infant follow-up care, including: 

  • Updated recommendations for vision and hearing screening, including some tests that are no longer recommended;
  • An expanded list of potential problems to monitor in infants with birth defects consistent with congenital Zika syndrome, such as difficulty breathing, difficulty swallowing, and hydrocephaly;
  • Eye examinations for infants without birth defects born to mothers with laboratory evidence of possible Zika virus infection during pregnancy; and
  • A review of new data and clarification of the guidance on prenatal diagnosis. 

You can find the full set of recommendations on the CDC website.

As always, check out TMA's Infectious Diseases webpage, which covers Zika from Z to A.

AMA Called On to Address Scope-of-Practice Threat

The American Medical Association should initiate a national strategy to address the Advanced Practice Registered Nurses (APRN) Compact, which would allow APRNs to "assume responsibility and accountability for patient care" without physician involvement, according to a resolution to go before the AMA House of Delegates this month.

The resolution, which was introduced by TMA and numerous other state medical and national specialty societies calls on AMA to "convene an in-person meeting of relevant stakeholders" to address the compact.

The compact, which the National Council of State Boards of Nursing approved in 2015, would allow APRNs to practice in other party states without going through state-by-state licensing. It also establishes an interstate commission that would take many licensing decisions, including rules on scope of practice, away from state legislatures and state boards of nursing.

TMA has worked to keep APRNs from being granted full, independent practice and prescribing authority without physician supervision in Texas, including opposition to a House bill introduced in the 2017 legislative session that would've granted such practice authority. 

"Our AMA continues to advocate that physicians are best qualified by their education and training to lead the health care team," according to the resolution, which is one of several that AMA delegates will take up during their interim meeting in Hawaii Nov. 11-14.

And the Award for Practice Quality Improvement Goes to …

You know what's a beautiful sound? One hand clapping against the other. It usually means somebody's done something good — something that's worthy of applause.

If you like that sound, get ready to do it over and over for almost 100 medical practices in Texas that earned a TMF Physician Practice Quality Improvement Award in 2017.

The practices, which are located throughout the state, demonstrated improvements in four key clinical areas during 2016: 

  • Exemplary performance on nationally recognized clinical outcome measures, such as hypertension control, diabetes management, tobacco-use screening and cessation, influenza immunization, and cancer screenings;
  • Regular use of population care management methods, such as patient education, preventative health services, early detection, and chronic disease management;
  • Participation in data-reporting quality initiatives; and
  • Use of tools and processes to engage patients and improve their overall experience. 

The TMF Health Quality Institute, TMA, and the Texas Osteopathic Medical Association established the award program in 2012. It has since expanded beyond Texas to include practices in Arkansas, Missouri, Oklahoma, and Puerto Rico.

More information on the award can be found on the TMF website. The TMA website also has plenty of information on clinical quality and payment.


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Give Kudos to Local Health Reporting

Hurricane Harvey. Medicine's victories during the 85th Texas Legislature. Threats to funding for the Children's Health Insurance Program. These are just a few of the health topics that have made headlines this year.

If you've read, watched, or heard a great health news story by a Texas journalist, nominate that person for the annual TMA Anson Jones, MD, Awards.

The awards — named after pioneer physician, statesman, and prolific writer Anson Jones, MD — recognize print, television, radio, and online media journalists in 12 categories, including the Texas Health Journalist of the Year.

Award winners receive $500. The journalist of the year receives $1,000.

TMA is accepting entries for the 2018 awards through December, with judging set in January. 

Email your nominations, and include the reporter's name, date of broadcast/publication, media outlet, story name, and URL. TMA will send a postcard to the reporter alerting him or her of your nomination. 

More information about the awards program, which celebrated its 60th anniversary this year, can be found on the TMA website

This Month in Texas Medicine

The November issue of Texas Medicine takes an in-depth look at Hurricane Harvey and the devastation the storm caused to the coast as well as countless medical facilities and practices. Although some short-term health concerns related to the storm might be easy to spot, the longer-term effects — those associated with stress and environmental issues — can be harder to spot. Other articles discuss adjustments insurers have made to prescription drug policies in the wake of the opioid epidemic; a UT Health Science Center data center's use of Medicare claims data; and what rural communities can do when hospitals and other practices close.

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  

12/1
Last Day to Elect to Participate in a Virtual Group for the 2018 MIPS Performance Period

Last Day to File an Informal Review Request to Appeal Errors in Your Medicare PQRS Feedback Report and/or QRUR

Last Day to Preview Your PQRS Performance Scores Before They Are Reported Publicly on Physician Compare

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.  

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

November 02, 2017