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 TMA Action Aug. 1, 2016   News and Insights from Texas Medical Association


INSIDE: DOJ Sues to Block Health Insurer Mergers

DOJ Sues to Block Health Insurer Mergers
TMA Opposes Independent Nursing Practice in VA System
TeleTown Hall Meeting Answers Texas Physicians’ MACRA Questions
TMA, AMA: TMB Has Authority to Set Telemedicine Rules
Improve LARC Access With New Toolkit
Medicaid Reenrollment Application Deadline Passed; Reenroll Now
Get Started on Your HIPAA Security Risk Assessment
Texas Has First Reported PAM Case; DSHS Issues Advisory

Become a Preceptor; Help Address Texas' Physician Shortage
Five Gray Areas of HIPAA You Can't Ignore: New White Paper
Participate in TMF Improving Immunizations Forum Aug. 9
Save These Dates
Win $5,000 for Your Champion of Health!
Physicians Benevolent Fund Can Help
This Month in Texas Medicine

DOJ Sues to Block Health Insurer Mergers

Two potential health plan mergers have come under intense fire. Last month, the U.S. Department of Justice (DOJ), acting under the direction of the U.S. attorney general and the states of Delaware, Florida, Georgia, Illinois, Iowa, Pennsylvania, Virginia, and Ohio, as well as the District of Columbia, brought a civil antitrust action to prevent the Aetna-Humana merger from going through. The government also sued to enjoin Anthem from acquiring Cigna. TMA and organized medicine have been scrutinizing the proposed mergers, which physicians say would profit insurers while leaving doctors and patients with fewer choices and higher costs. Aetna seeks to acquire Humana Inc. in a $37 billion deal focused largely on buying up Humana's Medicare Advantage business, while Anthem Inc. looks to take over Cigna for $50 billion.

The DOJ Aetna-Humana complaint states the proposed merger "would lead to higher health insurance prices, reduced benefits, less innovation, and worse service for over a million Americans." A comprehensive American Medical Association analysis (login required) backs up that contention. AMA found the Aetna-Humana merger in particular would have a significant impact across Texas — and 13 other states — likely enhancing Aetna's market power to concerning levels per the federal government's own standards. 

Physicians worry that consolidation raises insurers' leverage over negotiated rates with physician practices, more than half of which in Texas and across the nation are small groups, according to TMA and AMA research. "Competition to attract consumers causes insurance companies to offer lower premiums, improved benefits, more attractive networks of doctors and hospitals, and more effective care management," the DOJ’s Aetna-Humana complaint says.

In TMA's October 2015 letter to DOJ opposing the Aetna-Humana deal, Joseph S. Valenti, MD, then-chair of TMA's Council on Socioeconomics, expressed concern that other dominant insurers don't benefit from the Aetna-Humana deal. In the past, medicine successfully advocated that DOJ, which oversees antitrust issues, force merging insurers to sell off some of their combined business to a third party to reduce their market power. If federal regulators follow that prescription, TMA strongly opposes any partial acquisition by large players with significant market control.

TMA's letter to DOJ cautions, too, against anticompetitive effects in Texas' Medicare Advantage market, pointing out the newly combined entity would control 36 percent of that business across the state. The government's complaint against Aetna and Humana delves into the impact the merger would have on seniors who rely on Medicare Advantage plans. "Aetna's attempt to buy Humana undermines the central role that competition is meant to play in Medicare Advantage and on the public exchanges in holding down health care costs and improving quality for seniors, families, and individuals," DOJ wrote. "If permitted to proceed, Aetna's purchase of Humana likely would lead to higher prices and reduced benefits for seniors, families, and individuals."

For more information, read "Bigger Isn't Always Better" in the December 2015 issue of Texas Medicine

Action, Aug. 1, 2016

TMA Opposes Independent Nursing Practice in VA System

TMA joined more than 75 national specialty societies and state medical associations in voicing their strong opposition to a proposed rule that would allow advanced practice registered nurses (APRNs) — nurse anesthetists, nurse practitioners, nurse midwives, and clinical nurse specialists — to practice independently within the Veterans Affairs (VA) health system. TMA and the organizations outlined their concerns in a letter to David J. Shulkin, MD, VA undersecretary. The letter urges the VA to consider policy alternatives that prioritize team-based care rather than independent nursing practice. 

While the proposed rule doesn't change state scope-of-practice laws for APRNs working outside the VA system, it overrides those laws for care being provided inside the VA. TMA has called on Texas physicians to join their colleagues around the country in taking action to protect veterans' health care.

The letter expresses TMA's support for team-based care while stressing the skill level and depth of training physicians possess. "Our nation's veterans deserve high quality health care that is overseen by physicians," the letter states.

The Coalition of State Medical Societies, of which TMA is a charter member, earlier submitted a letter to the VA strongly opposing the proposed rule.

Action, Aug. 1, 2016

TeleTown Hall Meeting Answers Texas Physicians’ MACRA Questions

Almost 2,500 TMA-member physicians participated in the association's July 27, 2016, TeleTown Hall meeting on the Medicare Access and CHIP Reauthorization Act (MACRA).

If you missed the call, listen to the recording below. If you have questions of your own, submit them via email to

Polls of participants during the call found:

  • 69 percent said they don't know anything about MACRA and have taken no steps to prepare for the transition to date;
  • Only about 1 in 3 said they've been able to get Medicare bonuses through the existing PQRS program; and
  • Near the conclusion of the event, 57 percent said they still need more info to get ready for the change.

Gregory M. Fuller, MD, chair of the TMA Council on Health Care Quality, and John T. Carlo, MD, chair of the Council on Socioeconomics, hosted the event with help from TMA staff experts.

Passed by Congress on April 15, 2015, MACRA repealed Medicare's Sustainable Growth Rate (SGR) formula. It requires participating Medicare physicians to choose between two payment paths:

  • Fee-for-service Merit-Based Incentive Payment System (MIPS), and
  • Eligible Alternative Payment Models (APMs).

During the TeleTown Hall meeting, Drs. Fuller and Carlo spelled out TMA's primary concerns to the draft rule the Centers for Medicare & Medicaid Services (CMS) has proposed to implement the new law, based on a comprehensive position statement TMA issued earlier this month:

  • Compliance and reporting are costly, prohibitively so for small practices.
  • Compliance costs may exceed physicians' return on investment.
  • Many processes/outcomes on which physicians will be scored are out of doctors' control.
  • Physicians may be penalized for serving certain patient groups.
  • The draft rule shifts Medicare payments from small, rural practices to large, urban, physician groups and health care systems.
  • There is no evidence most MIPS requirements or incentives offer any return on investment to Medicare.

Before taking questions from physicians on the line, Drs. Fuller and Carlo also reviewed TMA's Five-Step MACRA Readiness Checklist (Members Only):

  1. Learn about MACRA and decide if an APM is right for your practice. Otherwise, you will be in MIPS.
  2. Assess your performance under Medicare's current quality programs.
  3. Review MIPS quality measures and reporting mechanisms.
  4. Contact your EHR vendor.
  5. Explore the list of clinical practice improvement activities.

For additional information and to stay up to date on MACRA and TMA's advocacy activities, bookmark and visit TMA's online MACRA Resource Center.

TMA, AMA: TMB Has Authority to Set Telemedicine Rules

In a 42-page brief jointly filed with a federal appeals court, TMA and the American Medical Association argue that federal antitrust regulation does not prevent the Texas Medical Board (TMB) from establishing rules that regulate the practice of telemedicine in Texas. At issue is a TMB rule that establishes the requirement that, as described in the brief, "Dangerous drugs and controlled substances … may not be prescribed by a physician who has not either physically examined a patient or examined a patient electronically with the assistance of a qualified medical professional who is physically present with the patient." 

Teladoc, Inc., a Dallas-based telehealth provider, challenged the rule in part on the grounds that TMB's rule is anticompetitive and thus violates federal antitrust law. TMA and AMA loudly disagreed. "The State has left no doubt that the Board's challenged Rule is an exercise of State policy-making in the complex and rapidly evolving area of medical practice — not a self-interested act of market participants," TMA wrote in the brief. 

TMB, TMA argued, is acting under the articulated authority of the Medical Practice Act and is not engaged in "self-interested rulemaking by market participants" because the state has retained "ultimate control of the Board's actions" in three ways: the governor's power to appoint all TMB members, the oversight of the Texas Legislature, and the authority of the courts to review TMB actions. The case is currently pending before the Fifth U.S. Court of Appeals. 

For more information, read "Seeking Invalidation" in the April 2016 issue of Texas Medicine.

Action, Aug. 1, 2016

 Action TMLT Ad 10.15    

Improve LARC Access With New Toolkit

You can help make long-acting reversible contraceptives (LARCs) available to all Texas women with the help of a new toolkit developed by the Texas Health and Human Services Commission in conjunction with the Texas Department of State Health Services and the Texas district of the American Congress of Obstetricians and Gynecologist. LARCs provide a highly effective contraceptive option with high rates of patient satisfaction and continued use. Improving access to LARCs is a TMA priority. 

The new toolkit offers suggestions and resources to make LARCs available to women throughout the reproductive cycle, including prior to the first pregnancy, during the postpartum period (both during the hospital stay and at the postpartum visit), and at any time when women receive family planning services.

For more information, call (800) 925-9126. 

Action, Aug. 1, 2016

Medicaid Reenrollment Application Deadline Passed; Reenroll Now

The June 17 intermediate submission deadline for Medicaid reenrollment has passed. If you participate in the Medicaid program and haven't submitted your application, please do so immediately. The Texas Health and Human Services Commission will process applications submitted after June 17 but can't guarantee those applications will be finalized by the federal deadline of Sept. 24, which could result in those applicants' disenrollment from Texas Medicaid and denial of payment.

The reenrollment requirement applies to you if you participate in Medicaid managed care, traditional fee-for-service Medicaid (each active Texas Provider Identifier suffix), the Texas Vendor Drug Program, and long-term care services administered through the Texas Department of Aging and Disability Services.

More Information

For acute care physicians reenrolling through the Texas Medicaid and Healthcare Partnership (TMHP): 

If you need help, contact a TMHP provider enrollment representative at (800) 925-9126, option 3, or email

For ordering- and referring-only physicians: If your only relationship with Texas Medicaid involves ordering or referring services for Medicaid clients, you also must enroll with Texas Medicaid as a participating physician.  

Action, Aug. 1, 2016

Get Started on Your HIPAA Security Risk Assessment

If you lost a laptop or smartphone, got a computer virus, received a patient HIPAA complaint, or had a business associate breach, would you be prepared? Conducting a security risk assessment is a key requirement of the HIPAA Security Rule and a core requirement for physicians participating in the Medicare and Medicaid electronic health record (EHR) incentive programs

The U.S. Department of Health and Human Services has a free HIPAA compliance tool for small- to medium-sized practices. The Security Risk Assessment (SRA) tool helps those practices conduct and document a risk assessment to determine potential HIPAA security risks and address them. The SRA website has user tutorials and videos to help you get started. The SRA tool also allows practices to print a report to provide to auditors.

If you need more hands-on help, another affordable option is the LayerCompliance™ tool. It is available to TMA members at a discount, as a benefit of membership. Take the LayerCompliance free audit assessment to see where your practice stands in terms of HIPAA compliance. 

If you have questions about HIPAA or SRA requirements, e-mail the TMA HIT Helpline, or call (800) 880-5720.

Action, Aug. 1, 2016

Texas Has First Reported PAM Case; DSHS Issues Advisory

The Texas Department of State Health Services (DSHS) issued a health advisory last month following the diagnosis of primary amebic meningoencephalitis (PAM) in a Texas teenager, the first case reported in Texas this year. DSHS reminds you to be aware of the possibility of Naegleria fowleri infection in patients presenting with bacterial meningitis-like symptoms and recent freshwater exposure. If you suspect a patient has PAM, DSHS recommends contacting the U.S. Centers for Disease Control and Prevention at (770) 488-7100 for consultation and assistance obtaining miltefosine, an anti-leishmania drug used for treatment. Report PAM cases to your local health department by calling (800) 705-8868.

Nine PAM cases have been reported in Texas since 2005. According to DSHS, N. fowleri is the free-living ameba that causes PAM, a rare and devastating brain infection that is almost always fatal. Infection occurs when contaminated water enters the body through the nose and the ameba travels to the brain, where it destroys the brain tissue.

N. fowleri is found in warm freshwater (lakes, rivers, and ponds) and soil. Infection most often occurs when people engage in recreational activities like diving and swimming in warm freshwaters. In very rare cases, DSHS says the infection has occurred when water from other sources (contaminated tap water) enters the nose. Infection does not occur by drinking contaminated water. According to DSHS, most infections occur in July, August, and September. 

The DSHS health advisory says PAM's initial symptoms start one to nine days after exposure and may consist of severe frontal headache, fever, nausea, and vomiting. As the disease progresses, later symptoms may include stiff neck, seizures, altered mental status, hallucinations, and coma. The disease progresses rapidly and usually results in death one to 18 days after symptom onset, the health advisory states. 

DSHS says the only way to prevent N. fowleri infection due to swimming is to refrain from water-related activities in freshwater. The health advisory lists these actions people can take to limit water exposure through the nose, thereby reducing the risk of N. fowleri infection: 

  • Avoid water-related activities in freshwater during periods of high water temperatures and low water levels.
  • Hold your nose shut, use nose clips, or keep your head above water when taking part in water-related activities in bodies of warm freshwater, hot springs, or untreated water.
  • Avoid digging up or stirring up sediment while engaging in water-related activities in shallow, warm freshwater.
  • If you use a Neti Pot or syringe for nasal irrigation or rinsing, be sure to use only sterile, distilled, or lukewarm previously boiled water.

Action, Aug. 1, 2016

      TMAIT Action Ad 6.15       

Become a Preceptor; Help Address Texas' Physician Shortage

In 2016, 163 Texas medical students took a first step in shoring up the state's looming physician gap by participating in mentorship programs with internists as part of the General Internal Medicine Statewide Preceptorship Program (GIMSPP). 

The program is one of many strategies that aims to curtail the impending shortage of primary care physicians in Texas. Medical students receive training on the methodologies and daily routine of internal medicine physicians — a practice that is often anything but routine. 

The students, most of whom just completed their first or second year of medical school, spend up to four weeks receiving personal instruction and supervision from physicians to gain a tangible understating of the practice of internal medicine. Nearly 42 percent of students who complete the preceptorship program do so in a rural Texas community or an area with shortages in access to medical care.

Studies show medical students typically remain in or return to the community where they received training. By delivering personalized instruction to students early in their medical careers, and primarily in local office-based settings as opposed to hospital-based systems, GIMSPP seeks to encourage students to pursue practice as a primary care physician in the areas of Texas that need it most.

The 2017 GIMSPP application cycle will begin soon. All physicians certified in internal medicine should sign up to become a preceptor, helping shape the future of internal medicine in Texas.

Action, Aug. 1, 2016

Five Gray Areas of HIPAA You Can't Ignore: New White Paper

With the U.S. Office for Civil Rights' Phase 2 HIPAA audits now under way, there's no room for complacency when it comes to HIPAA compliance. A new white paper from Scrypt Inc. highlights five areas of HIPAA compliance that leave room for misinterpretation. Scrypt Inc. helps practices protect sensitive information with products like TMA's free member benefit DocbookMD, a HIPAA-secure messaging application. 

Take note of these five areas of HIPAA compliance: 

  1. HIPAA is not just a health care industry issue.
  2. Find out when business associates can invoke the conduit rule.
  3. Learn when some types of personal health information (PHI) are not considered PHI.
  4. Addressable HIPAA safeguards are not optional.
  5. Penalties for noncompliance can be both civil and criminal. Intent matters.

Are you using DocbookMD yet? Designed by physicians and for physicians using smartphones and tablets, it allows you to send HIPAA-compliant messages bundled with photos of x-rays, EKGs, wounds, and more, just as if you were sending a text.

Learn more about DocbookMD, and download it free in the Apple App Store or Google Play.

Need help using the DocbookMD app? The user manual and tutorial videos will walk you through everything you need to know from beginning to end.

Action, Aug. 1, 2016

Participate in TMF Improving Immunizations Forum Aug. 9

Discuss and share strategies for improving adult immunization rates in the TMF Quality Innovation Network Quality Improvement Organization's Immunizations Open Forum on Aug. 9 from noon to 1 pm CST. 

To register, visit the Event Center. You will receive a registration confirmation containing your unique registration ID and password to join the event. 

To participate in the forum, log on to, and click on the Forums tab in the top navigation menu to visit the Forums page.

On the day of the event, TMF recommends joining 10 minutes before the presentation to ensure proper setup. You can also call at (800) 394-5972.  

Action, Aug. 1, 2016

Save These Dates

Registration is open now for the 2016 TMA Fall Conference, Sept. 23–24 at the Hyatt Regency Lost Pines between Austin and Bastrop. That hotel always sells out, so make your reservations early. 

As long as you have your calendar open, mark these dates as well: 

PC Action Ad Nov 13 

Win $5,000 for Your Champion of Health!

Nominate a program in your town or city that promotes healthy lives and healthy communities by Oct. 31, and it may win a $5,000 grant. The 2017 TMA Foundation (TMAF) John P. McGovern Champion of Health Award focuses on exceptional projects that address urgent threats to the public's health and those that further TMAF's mission: to help physicians create a healthier future for all Texans.

Established in 1995, the award has recognized local and statewide programs for their innovative and effective ways of reaching Texans. It is named after John P. McGovern, MD, a philanthropist and humanitarian who founded the John P. McGovern Foundation in Houston. Dr. McGovern established a permanent endowment at TMAF that supports this award. 

Deadline for entries is Oct. 31, 2016. Winners will be notified in December, and presentation of the award is Jan. 28, 2017, at the TMA 2017 Winter Conference at the Hyatt Regency Austin. Visit the TMAF website to download the nomination form, or contact the foundation at (800) 880-1300, ext. 1664, or (512) 370-1664 for more information about the program and a list of past winners. 

Action, Aug. 1, 2016

Physicians Benevolent Fund Can Help

Since 1961, assistance payments totaling more than $3.8 million have been given to Texas physicians and their families when they experience personal financial shortfalls. That is what The Physicians Benevolent Fund (PBF) does. We are there when the Family of Medicine is in need. 


Dr. Roberto J. and Annie M. Bayardo have made a generous gift to PBF. "My wife and I recognized the work that PBF does and how they support the Family of Medicine during some of a physician's most trying times," Dr. Bayardo said. "We have been fortunate and want to help those who find themselves in need."

Receiving this sizeable donation enables PBF to continue providing valuable assistance to physicians and their families when they cannot afford their personal monthly necessities. Oftentimes, physicians need help but do not qualify for other social programs. Contact PBF during those times, and we will do our best to assist.

For eligibility details or to donate, visit the PBF webpage, or call Chris Johnson at (512) 370-1602, or (800) 880-1300, ext. 1602.

Action, Aug. 1, 2016

This Month in Texas Medicine

The August issue of Texas Medicine features a cover story on Zika virus and TMA's advocacy to urge lawmakers in Washington, D.C., to agree on a funding package to combat the spread of the disease. In the issue, you'll also find a profile of Stuart D. Flynn, MD, the inaugural dean of the new Fort Worth allopathic medical school. The August issue highlights information on TMA and AMA's call for a federal patient safety center that would collect reported data on electronic health record-related adverse events; graduate medical education expansion grant awards; TMA's fight to keep sleep apnea diagnosis and screening within the scope of practice for physicians; and steps physicians can take to prevent cyber attacks.

Click to launch the digital edition in a new window.

Texas Medicine RSS Feed

Don't want to wait for Texas Medicine to land in your mailbox? You can access it as an RSS feed, the same way you get the TMA Practice E-Tips RSS feed.

E-Tips RSS Feed

TMA Practice E-Tips, a valuable source of hands-on, use-it-now advice on coding, billing, payment, HIPAA compliance, office policies and procedures, and practice marketing, is available as an RSS feed on the TMA website. Once there, you can download an RSS reader, such as Feedreader, Sharpreader, Sage, or NetNewsWire Lite. You also can subscribe to the RSS feeds for TMA news releases and for Blogged Arteries, the feed for Action.

Action, Aug. 1, 2016


 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.   

Medicaid Reenrollment Deadline

 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.  


Medical Records: Most Wanted Answers  
Straight From a Lawyer's Mouth: Answers to Your Legal Questions
Human Resources Seminar
E&M Coding Made Easy

Conferences and Events

TMA Fall Conference 2016
Sept. 23-24
Hyatt Regency Lost Pines

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