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ACOs, Texas-Style - 07/17/2023

Burdensome federal regulations and antitrust rules and hefty overhead costs are oft-cited stumbling blocks to physician involvement in accountable care organizations (ACOs). So perhaps it came as little surprise when the Texas Legislature, less than enamored with the federal health reform legislation that authorized the coordinated care models, came up with its own rendition. In 2011, state lawmakers passed Senate Bill 7, which created a Texas-style ACO, known as a health care collaborative, to encourage physicians, hospitals, and payers to collaborate on more coordinated, cost-effective health care delivery. Now that the Texas Department of Insurance has adopted rules laying out a path to licensure as a collaborative, Texas physicians have a more flexible option that overcomes many of the barriers preventing them from stepping into integrated care models.

Mastering Quality Reporting: Ease the Challenge of Quality Reporting - 07/10/2023

Understanding the maze of quality reporting pathways may help ease the challenge.

Surprise Billing Rules Garner More Legal Action - 02/10/2023

Pressure is mounting on federal authorities with several legal actions now aiming to stop what physicians and hospitals say is an unfair arbitration process outlined in rules implementing the No Surprises Act, legislation passed in 2020 to address surprise medical bills.

Medicare Bundled-Payment Model Could Expand Access to Value-Based Specialty Care - 01/26/2023

Medicare’s recent extension of a bundled payment model marks a rare opportunity for more specialists to participate in value-based care and could pave the way for better coordination with primary care.

New TMA Task Force on Alternative Payment Models Charts a Path Toward Value-Based Care - 01/26/2023

The shift from fee-for-service to value-based care is underway, with public and private payers introducing myriad new payment models in recent years. But many physicians find the variety of plans overwhelming, and the investments necessary to support them challenging.

Medicare Fee Schedule a Mixed Bag for 2023 - 01/26/2023

The Centers for Medicare & Medicaid Services (CMS) recently posted the 2023 Medicare Physician Fee Schedule, which takes effect Jan. 1 and brings with it a mixed bag of consequences for physicians.

Beware of Phony TMB, DEA Agents and Other Scams - 11/15/2022

The Texas Medical Board (TMB) is warning physicians and pharmacies of a scam involving criminals who sometimes pose as TMB officials. TMB passed along a report from the U.S. Drug Enforcement Administration (DEA) that says physicians registered with the DEA are receiving calls and emails from criminals who identify themselves as DEA personnel or other law enforcement agents.

Holding Their Own: Texas ACOs Contribute to Billions in Savings in Medicare Program - 11/01/2022

For the fifth straight year, the Medicare Shared Savings Program (MSSP), through its work with accountable care organizations (ACOs), generated significant savings and high-quality results, with Texas entities once again contributing to that success.

Stark Self-Referral Laws and Regulations - 10/07/2022

Stark generally prohibits a physician (or an immediate family member of such physician) who has a direct or indirect financial relationship with an entity that provides a designated health service from making a referral for that service for which Medicare or Medicaid would otherwise pay. This very broad prohibition is mitigated by a large number of exceptions. These exceptions must be met exactly. Failure to meet a Stark exception will result in a violation.

What's New in Value-Based Care - 09/23/2022

Once dubbed unicorns, value-based care (VBC) models that eschew fee-for-service payment in favor of rewarding quality have materialized; the Texas Medical Association aims to be on the crest of this wave with the formation of its new Task Force on Alternative Payment Models.

Texas ACOs Contribute to $1.6 Billion in Savings in Medicare Shared Savings Program - 09/09/2022

For the fifth straight year, the Medicare Shared Savings Program (MSSP), through its work with accountable care organizations, generated significant savings and high-quality results, with Texas entities once again contributing to that success.

Medicare ACOs Face Key Changes in Proposed Fee Schedule - 08/10/2022

In an effort to boost participation in accountable care organizations, Medicare has significant changes to its shared savings program on tap in the proposed 2023 physician fee schedule.

Value-Based Care for All: Practices of All Sizes Can Make the Switch - 07/29/2022

Moving away from fee-for-service requires taking on risk as well as hiring staff, launching new programs, and investing in data analysis, but practices of all stripes have made the switch successfully.

Beware Third Party Scams - 12/21/2021

As technological capabilities have evolved, some individuals and organizations are using these capabilities to try to scam others out of their private personal or payment information.

Data Driven: Medicaid’s Inspector General Focuses on Fraud Prevention, Not Just Prosecution - 09/06/2021

Since her appointment in 2018, Texas Health and Human Services Inspector General Sylvia Hernandez Kauffman has homed in on using data analytics not only to prosecute fraud, waste, and abuse within the Medicaid program, but also to prevent it from happening in the first place. Texas Medicine spoke to Ms. Kauffman about what appears to be a shift in tone from this department as it also focuses on using the data it collects to educate physicians and other health care professionals on common billing mistakes.

What Triggers a Coding Audit? - 08/20/2021

What Triggers a Coding Audit?

Rewarding Results: Texas Medicare ACOs Perform Promisingly - 11/30/2020

For the Medicare Shared Savings Program (MSSP) and many of the accountable care organizations (ACOs) that participated in it, 2019 was billed as a transition year. But data released by the Centers for Medicare & Medicaid Services (CMS) in September show Texas ACOs fared quite well last year – and a number of Texas physicians and ACO officials say the savings generated are worth the gruntwork that MSSP requires.

Watch Out For COVID-19 Cyber Scams - 03/20/2020

Internet scammers are trying to cash in on the widespread anxiety over COVID-19, and awareness is the best defense, according to the U.S. Cybersecurity and Infrastructure Security Agency. Likewise, the Texas Attorney General's Office has issued a warning about outbreak-related scams.

Microsoft Windows, Server Systems Vulnerable to Hackers, Feds Warn - 01/17/2020

Texas physicians should look out for a security weakness in Microsoft Windows 10, Server 2016, and Server 2019, the Department of Homeland Security (DHS) said this week.

Far-Reaching Implications: The Ripple Effects of Texas' Uninsured Rate - 12/04/2019

Data compiled by the Texas Medical Association and other organizations, as well as physicians’ own anecdotal experiences, show how 5 million uninsured patients in Texas become 5 million dominoes. As they fall, so do countless others representing the health of Texas: The economy and well-being of entire communities. The classmates and friends of uninsured children. And yes, the physicians who deal with the burdens of treating uninsured patients in emergency rooms and providing uncompensated care.

The Uninsured in Texas Quick Links - 11/13/2019

The Uninsured in Texas Quick Links

Big Noises Big Issues: Health Care Takes Center Stage One Year Out From 2020 Election - 11/11/2019

One year from now, Texas voters will hit the polls. They’ll be voting for president, for Congress, and for seats in the Texas Legislature. At the state and national levels, health coverage, Medicaid access, and prescription drug costs have gotten plenty of attention already, and they’ll get plenty more between now and the closing of the polls on Nov. 3, 2020. Here’s a look at some of the major health care debates taking center stage during the 2020 election cycle, what voters are and will be hearing about, and what Texas Medical Association policy says on those particular issues.

Ousting the ‘F-Word’ From Your Practice - 10/29/2019

You do everything you can to keep your patients safe and healthy. But are you sure your practice is safe from fraud and abuse? Don’t wait for a costly government audit – or a criminal charge – to come knocking. Check out the Texas Medical Association’s e-book, Fraud and Abuse Prevention Simplified, which can help you learn to protect both your practice and patients.

Medical Devices Could Be Vulnerable to Hackers, FDA Warns - 10/02/2019

Certain medical devices and hospital communications networks could contain cybersecurity vulnerabilities that could allow a remote attacker to take control of the device and change its function, the Food and Drug Administration (FDA) warned on Tuesday.

Beware of Scam Email Sent to TMA Members - 08/21/2019

An unauthorized email that claimed to be from the Texas Medical Association recently was sent to some TMA members stating that the individual member’s dues statement and insurance policy update was included. If you received this email, please know that it did not originate from nor was it authorized by TMA or the TMA Insurance Trust, and you should discard it.