Action: Dec. 15, 2017

TMA Action Dec. 15, 2017   News and Insights from Texas Medical Association

TMA Wins MIPS Exemption for Many Harvey-Affected Practices
Be Certain Your Behavior Around Colleagues, Patients Stays Professional
Telemedicine Benefits to Change for Texas Medicaid in 2018
Insurers’ Practices Drive Surprise Bills, TMA Leader Tells Lawmakers
Lawmakers, Consultants: Physicians Can Help Shape Medicine-Friendly Legislation in 2018
Need Help Becoming a Health Care Philanthropist?
Support What You Love and Get a Tax Break

Winter Is Coming: TMA’s Winter Conference 2018, That Is
New Tools Available to Submit MIPS Data Successfully
New Daily TMA Newsletter Coming in 2018
Physician, Med Student Journalists: Enter TMA Contest
18 Privacy Pitfalls. One Easy (and Free) Mobile Solution
This Month in Texas Medicine

TMA Wins MIPS Exemption for Many Harvey-Affected Practices

Many physicians whose practices are located in areas affected by Hurricane Harvey will not be required to participate in the 2017 Merit-Based Incentive Payment System (MIPS) and will not face a 4-percent Medicare payment penalty in 2019, officials announced in December.

TMA pushed for the exemption after Harvey came ashore, causing widespread flooding that damaged thousands of homes, hospitals and practices.

“We believe the hardship due to the extreme and uncontrollable circumstances from this natural disaster will prevent many of our physician members from spending the time necessary to learn about program requirements,” TMA wrote in a September letter to David D. Teuscher, MD, the director of the U.S. Department of Health and Human Services (HHS) region that includes Texas. “Many physicians will be challenged and no longer in a position to submit data successfully on quality measures and activities in 2017.”

The exemption applies only to MIPS-eligible physicians who practice in affected areas designated by the Federal Emergency Management Agency and are outlined in the 2018 QPP Final Rule:

Aransas, Austin, Bastrop, Bee, Bexar, Brazoria, Burleson, Caldwell, Calhoun, Chambers, Colorado, Comal, Dallas, Dewitt, Fayette, Fort Bend, Galveston, Goliad, Gonzales, Grimes, Guadalupe, Hardin, Harris, Jackson, Jasper, Jefferson, Jim Wells, Karnes, Kleberg, Lavaca, Lee, Liberty, Madison, Matagorda, Milam, Montgomery, Newton, Nueces, Orange, Polk, Refugio, Sabine, San Augustine, San Jacinto, San Patricio, Tarrant, Travis, Tyler, Victoria, Walker, Waller, Washington, and Wharton.. It does not apply to clinicians who are participating in an Alternative Payment Model (APM), the other Medicare Quality Payment Program (QPP) pathway that was implemented last year under the Medicare Access and CHIP Reauthorization Act (MACRA).

The rule does not specify that practices had to have been physically damaged by Harvey to be exempt, only located in an affected area.

The exemption does not apply to clinicians who are participating in an Alternative Payment Model (APM), the other Medicare Quality Payment Program (QPP) pathway that was implemented last year under the Medicare Access and CHIP Reauthorization Act (MACRA).

The Centers for Medicare & Medicaid Services (CMS) will identify exempt physicians based on the practice location address listed in the Provider Enrollment, Chain and Ownership System (PECOS) and automatically adjust their 2019 MIPS payment to neutral, meaning no bonus payment or penalty. Exempt physicians who choose to submit data for any of the 2017 MIPS performance categories will be scored based on the data they submitted, officials said.

More information can be found on the CMS Fact Sheet. For questions, contact the CMS QPP Service Center at (866) 288-8292 or by email at QPP[at]cms[dot]hhs[dot]gov. As always, visit the TMA MACRA Resource Center for the latest information. 

Be Certain Your Behavior Around Colleagues, Patients Stays Professional

By Joey Berlin

Harvey Weinstein, Kevin Spacey, Sen. Al Franken — and the list just keeps growing. They might be more famous than most physicians, but their appearances in recent headlines have shined new light on professional conduct — something doctors may do well to reexamine.

No matter how well you know a patient or how at ease you might feel around a colleague, be careful. With sexual harassment and assault allegations dominating the news lately, it's a good time to make sure you’re always conducting yourself in an unquestionably professional and appropriate manner.

Federation of State Medical Boards (FSMB) policy defines physician sexual misconduct as "behavior that exploits the physician-patient relationship in a sexual way." 

Among FSMB's listed examples of sexual impropriety:

  • Not employing disrobing or draping practices that respect the patient's privacy, or deliberately watching a patient dress or undress;
  • Examination or touching of genital mucosal areas without using gloves;
  • Inappropriate comments about or to the patient, which can include making sexual comments about a patient's body or underclothing, sexualized or sexually demeaning comments, and making comments about a potential sexual encounter during an examination; and
  • The physician initiating a conversation regarding the physician's sexual problems, preferences, or fantasies.

A TMA Board of Councilors opinion states that sexual contact occurring "concurrent with the patient-physician relationship constitutes sexual misconduct and is unethical."

The Board of Councilors recommends giving patients the option of having a chaperone present. In its opinion on the use of chaperones, the board also mentions several ways to ensure patients are in a "comfortable and considerate atmosphere," including:

  • Providing appropriate gowns;
  • Having private facilities for undressing;
  • Sensitive use of draping; and 
  • Clear explanations about different facets of the exam.

TMA offers several resources on professional conduct. The TMA course Challenges: Professional Boundaries and Patient Encounters teaches doctors to recognize how boundary problems occur, and how to ethically and professionally manage challenging patient encounters. TMA’s Policies and Procedures: A Guide for Medical Practices includes a harassment and discrimination policy that lists examples of prohibited conduct and the process of handling complaints. 

You can also review and refine your office policies using TMA's Employee Handbook for Medical Practices

Telemedicine Benefits to Change for Texas Medicaid in 2018

Just as throwing a stone creates waves throughout a pond, Texas' new law on telemedicine services is causing ripples among the state’s health plans, including Medicaid managed care organizations (MCOs).

At its core, Senate Bill 1107 defines a telemedicine visit as requiring the same standard of care as a patient/physician in-person visit. It also requires health plans to cover telemedicine services performed by a contracted physician. 

In response, the Texas Health and Human Services Commission (HHSC) recently announced that it will update several Medicaid related rules and benefits, including:

  • Patient and distant site guidelines;
  • Patient site presenter requirements;
  • Guidelines for valid prescriptions generated from telemedicine visit; and
  • Guidelines concerning the practitioner-patient relationship required for a telemedicine visit.

The changes are expected to go into effect in late summer of 2018, and other changes might be required, HHSC said.

SB 1107 was written by Sen. Charles Schwertner, MD (R-Georgetown), chair of the Senate Health and Human Services Committee, with substantial input from TMA and testimony from TMA members. The House sponsor was Rep. Four Price (R-Amarillo), chair of the House Public Health Committee.

Insurers’ Practices Drive Surprise Bills, TMA Leader Tells Lawmakers

By Jennifer Perkins

Despite years of legislative work on the issue — including Senate Bill 507 from earlier this year — patients will continue to struggle with surprise bills until lawmakers clean up health insurance companies’ business plans, Houston-area emergency physician Arlo Weltge, MD, told the House Insurance Committee last week.

“Patients and employers are purchasing their insurance with an expectation of having adequate coverage for unforeseen, as well as planned, life events. However, consumers’ expectations are not always consistent with their plan’s design,” Dr. Weltge told the panel. 

“To reduce the likelihood of an unanticipated balance bill, it is crucial that health plans provide adequate networks,” he added. “This is true because if a plan provides an adequate network, patients are less likely to receive services out of network. Balance billing occurs only when services are received out of network.”

With the opening of the 86th legislative session still thirteen months away, the Insurance Committee convened a mid-December hearing and launched into the interim studies assigned by House Speaker Joe Straus (R-San Antonio). One of the most contentious issues revolves around surprise medical bills that a patient may receive from a physician once their health plan has paid its portion of the bill. Beyond agreeing that unsuspecting patients do in fact receive balance bills, there was zero consensus among the multitude of parties present about the reason or the solution.

Testifying on behalf of TMA, Dr. Weltge – who is vice speaker of the TMA House of Delegates – reminded legislators of physicians’ concerns that all patients receive necessary care regardless of ability to pay and the importance of compensating physicians for the work they perform and care they provide.

While TMA is grateful for the progress made in the 2017 legislative session – expanding mediation for certain out-of-network claims – considerable work remains, he said. That includes:

  • Patient literacy and education on insurance plans;
  • Expanded network adequacy and opportunities for physicians to join networks; 
  • Price transparency so patients can make informed decisions; 
  • Provider network accuracy; and 
  • Proactivity on behalf on insurers regarding prior authorizations for elective procedures and maximum allowable out-of-pocket amounts for procedures and office visits.

Several speakers at the hearing noted that the Texas Department of Insurance (TDI) should be given authority not only to review the adequacy of PPO networks periodically, but also to ensure that third party administrators adhere to transparency standards — both of which would likely result in far fewer surprise bills.

The discussion was vigorous with all parties holding someone other than themselves responsible for surprise medical bills. After more than two and a half hours of questions, storytelling, debate, and finger pointing, the only clear conclusion to reach is that finding equitable and palatable resolution will be a marathon indeed. TMA will keep you apprised of developments.

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Lawmakers, Consultants: Physicians Can Help Shape Medicine-Friendly Legislation in 2018

By Joey Berlin and Sean Price

TMA physicians, students, and Alliance members heard from state lawmakers and political consultants at TMA’s Advocacy Retreat in early December in Austin.

The retreat, organized by TEXPAC, focused on how lawmakers will be preparing for the 2019 session and what physicians can do in 2018, including running for office or advocating on issues important to medicine. 

Perhaps the most important question Texas Democratic and Republican party officials had to answer was: Does bipartisanship exist anymore?

 “We have very much gotten away from bipartisanship in Texas,” Crystal Kay Perkins, executive director of the Texas Democratic Party, told physicians. “Unfortunately, this [2017 Texas legislative] session was hijacked by making sure that they appeased a very small number of people – making sure that Republican primary voters were fired up and making sure that they were talking about things like abortions and bathrooms and fearmongering instead of talking about jobs and schools and health care and things that everyday Texans need.”

But James Dickey, chairman of the Republican Party of Texas, said working across the aisle isn’t dead.

“The good news is the Republican Party of Texas is a large enough organization and a tactical enough one that we are a big tent,” he said. “We have representatives who represent a wide variety, a wide spectrum politically. And yeah, we have a history of working together when we can.” 

Meanwhile, four top political consultants – three Republicans and one Democrat – discussed how physicians can improve their clout with lawmakers. 

Republican Eric Bearse of Bearse and Co. said the most important way to influence lawmakers is to build relationships with them, and the easiest and most effective way to do that is to volunteer for their campaigns. 

“The best thing you can to is to call a campaign and say, ‘Hey, we have three or four docs that want to walk for you this Saturday. We can do a block walk and get a chance to meet the state rep or the candidate, spend a little time with him,’ “ Mr. Bearse said. 

The panel also featured Republican consultants Matt Brownfield of Murphy Nasica and Associates, and Jerod Patterson of Patterson and Co. as well as Democratic adviser James Aldrete of Message Audience Presentation Inc. Brad Patt, MD, the TEXPAC membership chair, served as moderator.

“I think health care is going to be a huge conversation [in future races], especially in the suburban [legislative] districts,” Mr. Aldrete said. “I think it would be good to have house parties to open that [dialogue] up and educate people and help shape this agenda so it’s not on such a superficial level.” 

At a later panel at the retreat, State Rep. Sarah Davis (R-West University Place), whose Texas Medical Center district includes more physician constituents than any of the state’s other 149 House districts, offered a simple way physicians can make a difference politically – just vote.

"Just vote,” she said. “Doctors are low voters. I harp on that all the time."

Need Help Becoming a Health Care Philanthropist?

Do you have an idea for a health improvement program or a medical student scholarship, but need help getting it off the ground?

Turn to the TMA Foundation, which has recently established a “Family of Friends” initiative to support TMA and TMA Alliance members’ charitable goals.

The first fund established under this new umbrella is the TMAF Hispanic Nursing Scholarship Trust Fund of Dr. Roberto J. and Agniela (Annie) M. Bayardo.

The Bayardo Trust Fund will provide scholarships annually for Hispanic nursing students in Harris and Travis counties and will be administered by the Harris County Medical Society Alliance Philanthropic Fund and the Travis County Medical Society Alliance Foundation. The first four scholarships, in the amount of $4,500 each, were awarded in November.

Future funds and endowments must be approved by the TMA Foundation Board of Trustees. For more information, contact Lisa Stark Walsh, TMAF executive director, at lisa.walsh[at]texmed[dot]org or (800) 880-1300, ext 1666.

Support What You Love and Get a Tax Break

Get a jump on your 2017 deductions before the busy holiday season is here.

A year-end gift of cash or appreciated stock can create a healthier future for all Texans and offers tax advantages. TMA Foundation has several options, including donation’s made in somebody else’s honor, if you act before Dec. 31.

More information about year-end giving options can be found on TMA’s website

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Winter Is Coming: TMA’s Winter Conference 2018, That Is

Do you have a special interest in maternal health and safety? Want to be a part of the discussion on the future of Medicaid? Is learning about cyber security the kind of thing that will get you out of bed early on a Saturday morning?

If you answered “yes” to any or all of these questions, it’s probably a good thing you became a physician. But, it also means you should join your fellow Texas physician leaders Jan. 26-27 at the 2018 TMA Winter Conference at the Hyatt Regency in downtown Austin.

Those topics, along with other issues that affect Texas medicine, will be discussed during the conference. Check out the conference agenda for more details.

All Saturday meetings will take place at the Hyatt Regency Austin, while some meetings Friday will be held at the TMA building at 401 W. 15th St. in downtown Austin. Shuttles will be available between the two locations.

The hotel group rate is $209 plus tax. TMA expects rooms to sell out, so make your reservation online today, or call (888) 421-1442. The last day to make your reservation at the discounted TMA rate is Jan. 5, or when the room block sells out.

You also can register for the conference anytime online or at the TMA building from 7:30 am to 7 pm Friday, Jan. 26. Registration will also be open at the Hyatt from 8 am – 7:30 pm Friday and from 6 am to 12:30 pm Saturday, Jan. 27.

New Tools Available to Submit MIPS Data Successfully

By David Doolittle

A lot of things happen on Jan. 1. The new year begins, thoroughbred horses turn another year older, gym memberships skyrocket.

Well, here’s another milestone you can add to the mix: Clinicians eligible for the Merit-based Incentive Payment System (commonly known as MIPS) can begin submitting data for the 2017 performance year on Jan. 1, 2018. (Cue party popper here)

Now, if you’re looking for a simple way to submit your data to the Centers for Medicare & Medicaid Services (CMS), keep reading because I’m going to tell you about TMF Health Quality Institute’s “MIPS Toolbox.”

Now don’t expect this toolbox to help you fix any physical problems you might have with MIPS. It doesn’t contain wrenches and screwdrivers.

Nope, this toolbox is actually an online app that you can use to select and track MIPS measures, calculate a projected final score, and submit data directly to CMS. Handy.

The best part is that all of it is at no or low cost.

But don’t take my word for it. Read more about it on TMF Health Quality Institute’s website, which also contains a link to sign up, plus phone numbers and email addresses where you can get answers to whatever questions you might have.

And be sure to check out TMA’s MACRA Resource Center, where you’ll get so plugged in to MACRA, MIPS, and APMs, you’ll start to glow.

New Daily TMA Newsletter Coming in 2018

By David Doolittle

As I told you about earlier this month, beginning Jan. 2, TMA will replace this newsletter with a daily email called Texas Medicine Today, which you can tailor to fit your specific interests.

This email will feature stories that cover a variety of topics, including community and public health, advocacy, and practice help. All medical students will automatically receive MSS information and news of interest to students.

As a member, you automatically will receive the emails. To customize the types of stories you receive, log on to your TMA profile and update your interests.

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Physician, Med Student Journalists: Enter TMA Contest

Do you moonlight as a medical reporter? Maybe you write a medical column or articles for your local newspaper or magazine. Or perhaps you host a health-focused segment on a local TV or radio station. If so, get recognized for your work in the TMA Anson Jones, MD, Awards contest.

“Physicians have a unique ability to explain difficult concepts and give insight into complex issues, and local media outlets are perfect forums for this,” said  2017 physician winner Sidney C. Roberts, MD, of Lufkin. “I can think of no better way to educate a wide local audience.”

The Physician Excellence in Reporting category is designed for physicians and medical-student reporters who regularly contribute to general-interest media aimed at a Texas public audience. (Eleven other award categories honor professional journalists in print, television, radio, and online media.)

Dr. Roberts said receiving the Anson Jones award validated the importance he places on his role beyond the clinic. “I am first and foremost a physician, but I believe one of my duties is to educate the community about health care issues in a way that positively impacts their health.” (Read Dr. Roberts’ winning article.)

Enter your work today. Any news story published or broadcast in 2017 is eligible. TMA will accept entries until noon on Jan. 10, 2018. You also can nominate a colleague who is an outstanding medical journalist — or a local professional journalist (nonphysician). 

TMA has honored Texas journalists for excellent medical news reporting for more than 60 years. Visit the Anson Jones webpage for complete contest details. 

If you have questions, call Tammy Wishard, TMA outreach coordinator, at (800) 880-1300, ext. 1470, or (512) 370-1470, or email ansonjones[at]texmed[dot]org

18 Privacy Pitfalls. One Easy (and Free) Mobile Solution

Think about it, can everybody on your staff instantly name all 18 protected health information identifiers (PHI)?

That’s important information to know, particularly if your practice is increasingly using mobile phones and the like to communicate about patient information.

If you want to make sure all of your practice’s mobile communications stay complaint with HIPAA regulations, you should check out DocbookMD.

DocbookMD is a HIPAA-complaint messaging app that allows entire care teams to communicate securely with one another, even across practices. The app is free for TMA members (seriously!): All you have to do is claim your free DocbookMD profile. 

With the app, physicians and practice staff have access to real-time lab reports, pager service responses, and discharge paperwork.

For access to enhanced app features – like a dedicated practice directory, message auditing, and remote wipe capability – DocbookMD is offering a 50-percent discount on team service plans to TMA members. Use coupon code: 50TMA100 on or before Dec. 31 to receive the discount (for one full year). 

So join more than a quarter of your TMA colleagues who are currently using DocbookMD in their practice, and be sure to take advantage of the TMA-exclusive discounts on team pricing options.

This Month in Texas Medicine

The December issue of Texas Medicine focuses on Senate Bill 507, by Sen. Kelly Hancock, which expands balance billing mediation to all physicians and other practitioners who provide out-of-network services at certain in-network facilities, and also expands mediation to out-of-network emergency care. Other articles look into a constitutional challenge to the state's Advance Directives Act; reference pricing, which has emerged as a potential strategy for health plans to keep premiums low and address the problems that managed care plans are facing; and steps physicians can take to prepare for natural disasters and other sudden calamities.

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.

Deadline 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

About Action       

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Last Updated On

December 18, 2017