Action Current Issue - full text

 TMA Action Oct. 14, 2016   News and Insights from Texas Medical Association


INSIDE: ICD-10 Update Creates Quality Reporting Headaches

TMA Supports JUA's Ability to Write New Business
ICD-10 Update Creates Problems for PQRS Reporting, Value Modifier
Houston Judge Changes Course, Says DOs Can File Commitment Papers
Be in the Know When You Purchase an EHR
Half of All U.S. Physicians Say They Are Burned Out
TMF Launches Quality Payment Program Network
What Happened to 2017's Half-Percent Medicare Fee Hike?

DSHS Reminds Pregnant Women Who Travel to Mexico About Zika Testing
CDC Recommends Only Two HPV Shots for Younger Adolescents
Navigate Health Care's Rocky Future: Join TMA's Accountable Care Leadership Program
This Month in Texas Medicine
Tools Help Reduce Inappropriate Prescribing of Antipsychotic Medications
TMF Announces 2016–17 Physician Practice Quality Improvement Award

TMA Supports JUA's Ability to Write New Business

On Oct. 5, TMA sent a letter urging Texas Department of Insurance (TDI) Commissioner David Mattax to prevent the Texas Medical Liability Insurance Underwriting Association (JUA) from suspending the writing of new business. The JUA, established in 1975, is "critically important as a last stop gap to assure that licensed physicians and health care providers are able to continue to provide medical and dental care for their Texas patients," TMA wrote.

In the letter, TMA General Counsel Rocky Wilcox argues that the state's rapidly growing physician workforce, economic uncertainty, and regular cycles in the liability climate all demand that the JUA remain open as the insurer of last resort. "Physicians are not able to contract with a network or have privileges in a hospital without medical professional liability coverage," Mr. Wilcox wrote. "Therefore, they would not be able to effectively practice medicine." 

Commissioner Mattax conducted a hearing on the question Oct. 17. The issue arises due to a law passed last year, which TMA supported, that would use some of the JUA's reserves to finance a permanent trust fund for graduate medical education programs.

The 1975 legislation that created the JUA "enacted the right of associations such as TMA to sponsor self-insured trusts as another means of solving the insurance availability and affordability problems" of physicians at the time. Under the law, TMA sponsored the creation of Texas Medical Liability Trust, which provides coverage to qualified TMA members.  

The letter asserts TMA's strong belief that the JUA is "still necessary and its authority to write new business should not be suspended." TMA writes that uncertainty in the medical professional liability insurance market, the worldwide market, medical professional liability court decisions, the political and economic environment, and the tort legal environment could affect physicians and could "cause some insurers to be more restrictive in underwriting."   

TMA says few liability insurers offer occurrence or claims-made policies, which the JUA provides. "Occurrence policies are an attractive alternative to some physicians in some specialties where there is a 'long-tail' on claims, such as pediatricians, obstetricians, and other providers treating young children."

TMA's letter concludes by requesting TDI "find that a necessity still exists for the JUA to be able to continue to write new business."

Action, Oct. 14, 2016 

ICD-10 Update Creates Problems for PQRS Reporting, Value Modifier

As if physicians don't have enough headaches and hassles to deal with to keep their practice doors open, the latest news from the American Medical Association is not good. It turns out the Oct. 1 ICD-10 update will negatively affect some physicians who participate in quality reporting for the Centers for Medicare & Medicaid Services (CMS) Physician Quality Reporting System (PQRS) and Value-Based Payment Modifier (VM) programs. To determine whether the update affects your specialty, review the list of affected quality measures.

Despite the recent ICD-10 update, specifications for all quality measures remain the same. Due to the timing in finalizing codes for the update and the number of codes involved, CMS did not update the measure specifications to include the coding changes, thereby creating problems for the PQRS and VM programs. This issue may lead to confusion for many physicians and groups, resulting in incorrect coding and failed reporting for the 2016 PQRS program year and payment penalties under both programs in 2018.

AMA reports it is working with CMS to resolve the issue and reports "the agency has assured the AMA that every effort will be made to prevent physicians from being penalized for issues resulting from the ICD-10 coding update." TMA will actively track this issue and will keep members informed as the association learns more. 

For more information, read this AMA article. And for guidance on quality reporting for the 2016 program year, visit the TMA PQRS and VM Resource Center

Action, Oct. 14, 2016 

Houston Judge Changes Course, Says DOs Can File Commitment Papers

Physicians across Texas are breathing a sigh of relief — at least for now — thanks to Harris County Probate Judge Rory Olsen's decision to allow doctors of osteopathy (DOs) to file Certificates of Medical Examinations needed for mental health commitments. TMA and a host of other physician organizations have been fighting the judge's initial ruling, which prohibited DOs from signing the commitment papers.

Responding to a request from a leading Houston psychiatrist who is also a DO, TMA's legal staff initially contacted Judge Olsen via telephone. TMA, the Harris County Medical Society, Texas Osteopathic Medical Association, the Federation of Texas Psychiatry, and the American Osteopathic Association (AOA) then wrote a joint letter to Judge Olsen explaining the legal equivalence in Texas of allopathic and osteopathic physicians. "Eliminating DOs' authority in the most populous county in Texas could have disastrous consequences for the health and safety of persons who physicians have determined need protective psychiatric care," they wrote.

Lawyers for the AOA and the Texas Medical Board also sent Judge Olsen detailed legal briefs on the issue.

The judge's controversial decision prompted Senate Health and Human Services Committee Chairman Charles Schwertner, MD (R-Georgetown), to take action. "As a physician, I find Judge Olsen's attempt to singlehandedly redefine the practice of medicine both reckless and profoundly misguided," he said as he asked Attorney General Ken Paxton to issue a formal opinion to affirm that MDs and DOs enjoy the same legal rights. 

The next day, Judge Olsen announced he would accept commitment requests signed by DOs, pending a decision from General Paxton. "Judge Olsen made the correct decision," said TMA President Don Read, MD. "Physicians and the patients we serve appreciate the intervention of Senator Schwertner and are confident General Paxton also will reach the correct decision."

"The simple fact is, Judge Olsen doesn't have the authority to decide which physicians he does or does not want to listen to," Senator Schwertner said. "Regardless of this man's opinion, the law governing the practice of medicine is exceedingly clear: DOs — just like MDs — are fully-trained, licensed, and accredited physicians with all the rights and responsibilities that entails. Period."

Action, Oct. 14, 2016 

Action TMLT Ad 10.15 

Be in the Know When You Purchase an EHR

The recently updated TMA EHR Vendor Comparison Tool provides TMA member physicians access to an assessment of EHR products that have a solid Texas market base. It gives physicians a view of company information, product functionality, pricing, and interoperability capabilities when comparing EHR systems.

The revised tool reflects current information from some of the top vendors in Texas. The top nine vendors, which have at least a 3-percent market-share in Texas, were asked to participate. Not all of them chose to submit their information.

As physicians review demonstrations and hear about the latest and greatest from EHR salespeople, remember it is the contract that seals the deal and defines the future relationship. TMA cannot stress enough the importance of a good contract review. Seek the guidance of your attorney or one who is savvy with EHR contracts. 

Paying for a contract review may be worthwhile because:  

  • There may be hidden fees not disclosed during the negotiations but spelled out in the contract;
  • You need an exit strategy in case the relationship sours beyond repair; and
  • The contract should include terms defining how you obtain your data should you sever the relationship. 

With these issues in mind, TMA developed a helpful tool, EHR Buyer Beware: Issues to Consider When Contracting with EHR Vendors, an eight-page document featuring eight must-haves for physicians. The Office of the National Coordinator for Health Information Technology recently made available another source, EHR Contracts Untangled: Selecting Wisely, Negotiating Terms, and Understanding the Fine Print. The 53-page document is more inclusive and covers information such as details about data rights and switching EHRs.

You can direct questions related to EHRs and other office technologies to TMA's Health Information Technology Department by calling (800) 880-5720 or by emailing

Action, Oct. 14, 2016 

Half of All U.S. Physicians Say They Are Burned Out

U.S. physicians love their patients and hate paperwork. Unfortunately, a newly released survey by The Physicians Foundation finds that the paperwork is winning. Fifty-four percent of physicians surveyed say their morale is somewhat or very negative, and 49 percent say they either often or always feel burned out. 

As a result, 48 percent plan to cut back on hours, retire, take a nonclinical job, switch to concierge medicine, or take other steps that will further limit patients' access to care. These patterns are likely to reduce the physician workforce by tens of thousands at the time that a growing, aging, and more widely-insured population is increasing overall demand for physicians.

Regulatory/paperwork burdens and loss of clinical autonomy are the primary sources of physician dissatisfaction. More than two-thirds (72 percent) say these third-party intrusions detract from the quality of care they can provide. 

 — Check out these TMA courses to help you recognize and counteract burnout and stress —

According to the research, 80 percent of physicians report being overextended or at capacity, with no time to see additional patients. This remains steady with the findings reported in the 2014 survey from the Physicians Foundation. Not surprisingly, 54 percent of physicians surveyed rate their morale as somewhat or very negative.

"Many physicians are dissatisfied with the current state of medical practice and are starting to opt out of traditional patient care roles," said Walker Ray, MD, president of the Physicians Foundation and chair of its Research Committee. "By retiring, taking non-clinical roles, or cutting back in various other ways, physicians are essentially voting with their feet and leaving the clinical workforce. This trend is to the detriment of patient access. It is imperative that all health care stakeholders recognize and begin to address these issues more proactively, to support physicians and enhance the medical practice environment."

Action, Oct. 14, 2016 

TMF Launches Quality Payment Program Network

The TMF Quality Innovation Network Quality Improvement Organization (QIN-QIO) has created a new network to help physicians and clinicians make the transition under the Medicare Access and CHIP Reauthorization Act (MACRA) to participate in Medicare's new Quality Payment Program and its Merit-Based Incentive Payment System (MIPS). To learn more and create a free account, visit the TMF Quality Payment Program web page.

Additionally, the TMF QIN-QIO is hosting upcoming online events for the benefit of physicians, hospitals, and other health care professionals. Mark your calendars, and plan to attend. 

Oct. 25 Webinar: How to Prepare for MIPS

Register to attend this TMF Quality Innovation Network webinar to learn how to prepare for a paradigm shift in quality reporting and payment programs. The highly anticipated proposed rule implementing MACRA on Jan. 1, 2017, is fast approaching. Participate in a webinar to receive valuable information from Selena Hood, program manager of quality measures and reporting with McKesson, to help you and your practice prepare to make the successful transition to participate in MIPS. This event will take place Tuesday, Oct. 25, from noon to 1 pm (CT). Register today

Oct. 26 Open Forum: 2016 Meaningful Use and PQRS

Join this TMF Quality Innovation Network open forum event to learn about upcoming changes related to meaningful use and the Physician Quality Reporting System. You will have the opportunity to ask questions and interact with peers, as well as TMF Quality Innovation Network consultants. This open forum will take place Wednesday, Oct. 26, from noon to 1 pm (CT). Register today.

Save the date for the Nov. 16 Open Forum. Visit, and click on the Events tab for more information. 

Action, Oct. 14, 2016 

What Happened to 2017's Half-Percent Medicare Fee Hike?

Zero. That's how much physicians' overall Medicare fees will go up next year, according to the Centers for Medicare & Medicaid Services' (CMS') complex rule on the 2017 proposed Medicare Physician Fee Schedule.

What happened, the Harris County Medical Society's Board on Socioeconomics wants to know, to the 0.5-percent Medicare payment increase physicians were supposed to see thanks to the passage of the bill last year that eliminated Medicare's Sustainable Growth Rate (SGR) formula?

Well, as they say, "it's complicated."

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which erased the SGR, did indeed include what CMS calls a 0.5-percent "positive update" for physicians every year from 2016 through 2018. Physicians, however, didn't see a positive update this year for the same reason they probably won't get one in 2017, and may not get one in 2018, explains Donna Kinney, TMA's director of research and data analysis.

The disappearing updates all stem from another piece of federal legislation passed in 2014 that requires CMS to set an annual target for reduced Medicare spending on physicians' services "resulting from adjustments to relative values of misvalued codes." That target for 2017 is a 0.5-percent reduction. (Depending on the specific services they provide and which codes they use, individual physicians will see larger or smaller changes in their payments, Ms. Kinney emphasizes.) The bottom line is, however, the adjustment for the "misvalued codes" exactly counteracts the 0.5-percent increase coming from MACRA.

"The recent history of and future plans for inadequate fee updates, paired with the growing Medicare administrative burden, is making Medicare participation and compliance increasing difficult and costly for practicing physicians, and will impair access to care for Medicare beneficiaries," John Carlo, MD, of Dallas, chair of TMA's Council on Socioeconomics, wrote in the association's formal comment letter to CMS on the 2017 proposed Medicare Physician Fee Schedule. "Increases in administrative complexity are making Medicare participation an increasingly unattractive proposition to the smaller sized practices common in Texas."

By the way, that 2014 bill — the Protecting Access to Medicare Act of 2014 — wasn't all bad news for physicians, Ms. Kinney says. The most important provision of that bill canceled a 23.7-percent, across-the-board cut in physicians' Medicare payments that had been required due to the SGR.

Action, Oct. 14, 2016 

   TMAIT Action Ad 6.15

DSHS Reminds Pregnant Women Who Travel to Mexico About Zika Testing

The Texas Department of State Health Services (DSHS) has issued a health alert to remind pregnant women who cross the border into Mexico that Zika testing is available to them. DSHS encourages them to discuss testing with their physicians. Current U.S. Centers for Disease Control and Prevention (CDC) guidelines recommend Zika testing for any pregnant woman who has traveled to a country with ongoing Zika transmission, including those who regularly cross the U.S.-Mexico border.

DSHS also reminds health care professionals to assess their pregnant patients for possible Zika virus exposure at each prenatal care visit. CDC and DSHS recommend testing for Zika antibodies as a part of routine prenatal care during the first and second trimesters in pregnant women with an ongoing risk of Zika exposure.

This reminder is especially important for pregnant women with regular, frequent travel to any part of Mexico during the peak mosquito season of August through October or who have a sexual partner who crosses the border weekly or more often.

DSHS is interested in expanding the amount of Zika testing being done in Texas, particularly in communities along the border considered to be at a higher risk of local transmission because of their geography and history of outbreaks of dengue, a similar virus spread by the same types of mosquitoes. Pregnant women are a particular focus because of the risk of birth defects associated with Zika. They should avoid travel to countries with a CDC Zika travel notice and prevent sexual transmission by using condoms or not having sex with partners who have traveled to those areas. 

Additionally, everyone can help prevent the spread of Zika by mosquito bites by: 

  • Using Environmental Protection Agency-approved insect repellent. (Repellents are safe to use during pregnancy when applied according to the label instructions.)
  • Wearing long pants and long-sleeved shirts that cover exposed skin.
  • Using air conditioning or window and door screens that are in good repair to keep mosquitoes out of their homes. 
  • Removing standing water in and around homes, including water in trash cans, toys, tires, flower pots, and any other container that can hold water. 

DSHS says Texas has had 229 reported Zika cases, all related to travel, including two cases transmitted via sexual contact with someone infected overseas and two infants who were infected before birth. For more information on Zika, including the latest testing criteria for health care professionals, visit the DSHS website.  

CDC Recommends Only Two HPV Shots for Younger Adolescents

The U.S. Centers for Disease Control and Prevention (CDC) recommends 11- to 12-year-olds receive two doses of human papillomavirus (HPV) vaccine at least six months apart rather than the previously recommended three doses to protect against cancers caused by HPV infections. Teens and young adults who start the series later, at ages 15 through 26 years, will continue to need three doses, CDC says.

"Safe, effective, and long-lasting protection against HPV cancers with two visits instead of three means more Americans will be protected from cancer," said CDC Director Tom Frieden, MD. "This recommendation will make it simpler for parents to get their children protected in time."

Based on a review of the medical literature, the Advisory Committee on Immunization Practices (ACIP) voted to recommend a two-dose HPV vaccine schedule for young adolescents. CDC and ACIP reviewed data from clinical trials showing two doses of HPV vaccine in younger adolescents (aged 9 to 14 years) produced an immune response similar to or higher than the response in young adults (aged 16 to 26 years) who received three doses.

Generally, preteens receive HPV vaccine at the same time as whooping cough and meningitis vaccines, according to CDC. Two doses of HPV vaccine given at least six months apart at ages 11 and 12 will provide safe, effective, and long-lasting protection against HPV cancers, CDC says. Adolescents aged 13 to 14 are able to receive HPV vaccination on the new two-dose schedule, as well.

CDC will provide guidance to parents, health professionals, and insurers on the change in recommendation. The U.S. Food and Drug Administration (FDA) last month approved adding a two-dose schedule for 9-valent HPV vaccine (Gardasil 9) for adolescents aged 9 through 14 years. CDC encourages clinicians to begin implementing the two-dose schedule in their practices to protect their preteen patients from HPV cancers. 

Navigate Health Care's Rocky Future: Join TMA's Accountable Care Leadership Program

New Medicare Access and CHIP Reauthorization Act (MACRA) rules released last month demonstrate that value-based health care is officially here to stay. Regardless of whether the phrases "accountable care" and "value-based care" cause you heartburn or your heart to flutter, TMA's 2017 Accountable Care Leadership Program can help demystify the paradigm shift. Applications are now open, and participants will earn more than 95 hours of continuing medical education credit. 

The Accountable Care Leadership Program transforms physicians into leaders, proverbial lighthouses who guide their community through the changing waves of health care regulations. Over the course of 10 months and 11 modules, participants explore the framework for accountable care organizations (ACOs), risk-based payment initiatives, and the development of patient-centered medical homes. By focusing on a series of case studies, physicians will also determine whether (and how) team-based managed care can enhance their ability to improve clinical outcomes and patient satisfaction. 

Currently, more than 470 ACOs nationwide provide care for nearly 9 million seniors, achieving more than $1.2 billion in savings since 2012. This is your opportunity to join the future of health care and influence how value-based care will affect you, your practice, and your patients. 

Submit your application today to become a forward-thinking leader on effective, value-based care. Apply early, as the 2017 Accountable Care Leadership class will be limited to 30 participants. For complete coursework details, program requirements, and participation fees, visit the TMA website.   


PC Action Ad June 13 

This Month in Texas Medicine

The November issue of Texas Medicine features a cover story on the Texas Medical Board's (TMB's) informal settlement conferences (ISCs), which defense attorneys who represent physicians say have become similar to administrative hearings, without the guaranteed accompanying protections. In scathing written comments TMA submitted to TMB in response to the board's proposed ISC rules, TMA said ISCs have become "more and more formal, prescriptive, and regulated," without giving physicians a fair forum to defend themselves. In the issue, you'll also find coverage of HIV pre-exposure prophylaxis, which can prevent patients from getting the virus; complaints TMA has received from several physicians that three of the state's biggest health plans are taking up to eight months to credential them; and a Houston palliative care and hospice physician's account of her family's experience caring for her terminally ill father.

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, 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, Nov. 1, 2016

Tools Help Reduce Inappropriate Prescribing of Antipsychotic Medications

Antipsychotic prescribing for patients with dementia has received intense scrutiny lately. Data suggest that in some Texas facilities physicians add new diagnoses, such as schizophrenia, to residents' clinical records to justify antipsychotic use, even in residents without a history of mental illness. According to the Texas Health and Human Services Commission (HHSC), inappropriate use of antipsychotic medications can harm people with dementia, as noted in the Food and Drug Administration's black box warning, which appears on a prescription drug's label and is designed to call attention to serious or life-threatening risks. 

Yet in spite of increased mortality risk, HHSC notes that antipsychotics continue to be used as a chemical restraint in nursing home residents with dementia but no underlying mental health issues.

The U.S. Centers for Medicare & Medicaid Services (CMS) is aware of this issue. CMS conducts focused dementia care surveys targeting nursing homes with high antipsychotic use for people with dementia. HHSC says these surveys help ensure facilities provide high-quality, person-centered care and use more non-pharmacological approaches to dementia care.

Physicians play a key role in reducing the inappropriate use of antipsychotic medications. HHSC has created tools to help provide education and resources for prescribers as part of an initiative to reduce inappropriate prescribing of antipsychotic medications. The Texas Department of Aging and Disability Services also has initiatives that help prescribers improve dementia care. Visit the HHSC Appropriate Use of Antipsychotic Medications webpage to access these tools.

TMF Announces 2016–17 Physician Practice Quality Improvement Award

Physician practices continue to make great strides in providing reliable preventive services by using health information technology and effective care management methods. TMF Health Quality Institute wants to recognize practices for their hard work. TMF is once again sponsoring the Physician Practice Quality Improvement Award program

The application process is simple. Review the criteria, identify any gaps that exist in your practice, work to fix those gaps and monitor your quality data, and complete an online application between April 1, 2017, and June 10, 2017.

Any practice in Texas, Arkansas, Oklahoma, or Puerto Rico with one or more licensed physicians providing care for Medicare fee-for-service patients is eligible to participate in the award program. All practicing providers must not have been disciplined or excluded by any federal or state regulatory agency, licensing board, or health care facility in the past five years.

Practices must meet established thresholds in all four categories, which include: 

  1. Exemplary performance on nationally recognized clinical outcome measures,
  2. Regular use of population care management methods,
  3. Participation in data reporting quality initiatives, and
  4. Implementation of tools and processes to promote patient engagement and improve the patient's experience. 

All practices meeting or exceeding the criteria will receive an award. Award recipients will receive a commemorative plaque to display in their practice and recognition through a media campaign. For more information, email

Upcoming Events

The TMF Quality Innovation Network hosts regular events for physicians, hospitals and other health care professionals. Mark your calendars and plan to attend. You can learn more by visiting and clicking on the Events tab.

Join the TMF Quality Innovation Network open forum event to learn about upcoming changes related to meaningful use and the Physician Quality Reporting System. You will have the opportunity to ask questions and interact with peers, as well as TMF Quality Innovation Network consultants. This open forum will take place Wednesday, Nov. 16, from noon to 1 pm CT. Register today.


 This Just In ...

Want the latest and hottest news from TMA in a hurry? Then log on to Blogged Arteries.  

 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.  


Medicare and MACRA: Get Clarity and Direction!
Medical Records: Most Wanted Answers  
Straight From a Lawyer's Mouth: Answers to Your Legal Questions  

Conferences and Events

2016 TMA Advocacy Retreat
Dec. 2-3
Omni Barton Creek Resort

About Action       

 Action, the TMA newsletter, is emailed twice a month to bring you timely news and information that affects your practice

To change the email address where you receive Action, go to Member Log-In on the TMA website, then click on "Update Your TMA Demographic Information (including newsletter subscriptions and preferences)."

To unsubscribe from Action, email TMA's Communication Division at

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 Crystal Zuzek, Action editor.

TMA: 401 West 15th Street, Austin TX 78701   Ph: (800) 880-1300, (512) 370-1300 
Copyright 1999-2016 Texas Medical Association
 TMA Web site Privacy Statement    TMA Contacts    How to Find It   RSS Feeds