EVPGram Logo 

Volume 18, No. 34                   

Oct. 17, 2016            

Final MACRA Rule Includes Real Improvements

In the wake of this summer’s withering criticism of the Centers for Medicare & Medicaid Services’ (CMS) draft rule to implement Medicare’s new quality payment programs, CMS Acting Administrator Andy Slavitt pledged that he and his staff would listen to physicians’ real concerns about the Medicare Access and CHIP Reauthorization Act (MACRA). It looks like that listening included TMA’s formal comments on the rule and the hundreds of letters Texas physicians sent. CMS published the final rule on Oct. 14, and, at first blush, the 2,398-page document appears to include some significant improvements for physicians and patients. TMA staff experts will continue to analyze the final rule in depth. Per their preliminary findings, the final rule includes: 

  • A small increase in the low-volume threshold, exempting any physician who sees fewer than 100 Medicare patients or submits Medicare charges of less than $30,000 a year. CMS estimates that the low-volume threshold alone will exempt 28 percent of family practitioners and 25 percent of general surgeons.
  • A one-time, first-year reduction in the composite performance threshold so that any physician who earns a score of 3 out of a possible 100 points will not receive any Medicare payment penalties. (Remember, data collected on 2017 performance will affect physicians’ 2019 payments.) Any physician who successfully reports one quality measure or one of the new improvement activities will earn 3 or more points, and thus be protected from the possibility of a 4-percent cut in 2019. This is how CMS met the unofficial promise Mr. Slavitt made last month that physicians who at least try to comply with the rule next year will see no penalty in their 2019 payments. CMS now estimates that about 95 percent of eligible physicians will get a positive or neutral payment adjustment in 2019. This low standard applies only to the 2017 reporting year; the performance requirements will increase in 2018 and beyond.
  • A system that allows physicians and groups the flexibility to determine the most meaningful quality measures and reporting mechanisms for their practice and their patients. TMA asked CMS to “keep it simple.” In the interests of simplicity, we will just report here that they did.
  • An option for physicians to report information on their use of health information technology for just 90 days in 2017. This is the old meaningful use program. The draft rule would have required a full calendar-year reporting period beginning in 2017. Physicians can choose to report full-year metrics, and that will increase their chances of obtaining a larger bonus.  

If you missed it last week, TMA has developed a host of tools, education, and services to help you prepare for the changes.

 State Bar Honors TMA General Counsel Rocky Wilcox

There aren’t many attorneys in Texas who’ve had a greater impact on health law in this state than TMA General Counsel Rocky Wilcox. The Health Law Section of the State Bar of Texas honored Rocky’s 37-year TMA career with its Distinguished Service Award. The award recognizes outstanding achievement in the practice of health law. In addition to a career devoted to the practice of health law, the award recognizes the promotion and advancement of health law through mentoring, education, and leadership. Congratulations, my friend. Well deserved.

Texas Physicians Get Mixed Reactions in Airline Emergencies

Two TMA members received decidedly mixed receptions recently when they tried to respond to medical emergencies on board commercial airliners. Austin cardiologist Stan Wang, MD, answered a call for help during a flight from New York City to Barcelona, Spain. He helped to resuscitate a woman who had collapsed without a pulse and monitored her vital signs for the rest of the flight. The woman’s grateful daughter gave Dr. Wang a big hug. The outrageous story of what happened to Tamika Cross, MD, an obstetrics-gynecology resident at The University of Texas Health Science Center at Houston, has received national media attention. Flying from Detroit to Minneapolis, Dr. Cross jumped up when a nearby passenger screamed for help for her unresponsive husband. A flight attendant dismissed Dr. Cross, saying, “Oh, no, sweetie put your hand down, we are looking for actual physicians.” The incident has elicited outrage against Delta Airlines and spawned viral Twitter memes.

Texas Can Do More to Prevent Disease OUtbreaks in Long-Term Care Facilities

A more comprehensive approach to providing flu shots and pneumococcal vaccines to residents and staff of long-term care facilities, and better methods of tracking infections from multidrug resistant organisms are just two ways Texas can prevent disease outbreaks in those facilities. That’s the message pediatric infectious disease specialist Jane Siegel, MD, gave to the Joint Legislative Committee on Aging. Thank you, Dr. Siegel, for coming to the Capitol to testify.

 TMA PracticeEdge Growing

More and more Texas physicians are seeing the benefit of forming physician-led accountable care organizations (ACOs) through TMA PracticeEdge. By year’s end, the company will have 11 networks across the state, comprising about 500 independent primary care physicians. ACOs in the works, and which we will announce soon, include networks in East Texas, El Paso, the Rio Grande Valley, Austin, Laredo, and greater Houston. To find out more and see if TMA PracticeEdge is right for your practice, email info@TMAPracticeEdge.com or call toll-free (888) 900-0334.

Direct Primary Care Conference Draws a Crowd

TMA President Don Read, MD, welcomed more than 250 physicians from around the state to a conference in Irving on the growing phenomenon of direct primary care. TMA sponsored the conference, which focused on the nuts and bolts of establishing a direct primary care practice, legal issues, and building networks. The Physicians Foundation supported the program with a grant.