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Wednesday, July 15, 2015

Board Builds Stronger TMA

The TMA Board of Trustees met for a day-long look forward and back at the state of the association. The board focused on our three core functions: membership, member advocacy, and member education. Board Chair Doug Curran, MD, led board members and senior TMA staff through discussions of challenges and opportunities, and helped draft a work plan for the coming year. In the advocacy arena, for example, we see six areas where TMA will have to develop new strategies for success:
  • Medicaid,
  • Physician-directed delivery systems and the Medicaid 1115 waiver,
  • End-of-life issues,
  • Scope of practice,
  • Balance billing and fee transparency,
  • Protecting the prohibition on the corporate practice of medicine and stopping abuses by 5.01(a) organizations, and
  • Building stronger coalitions with county medical societies and state specialty societies.

Feds Heed Medicine's Call for ICD-10 Flexibility

It wasn’t all that we asked for. But it was a good bit more than I expected from a federal agency that hasn’t exactly embraced the idea that the ICD-10 coding system is a hugely expensive waste of time for physicians and patients. First off, the Centers for Medicare & Medicaid Services’ (CMS’) decision is not a delay. To get paid by Medicare — and other payers — physicians still must begin using ICD-10 on Oct. 1. Most importantly, the grace period essentially means that for one year Medicare claims will not be denied solely on the specificity of the ICD-10 diagnosis codes physicians provide, as long as you submit an ICD-10 code from an appropriate family of codes. TMA President Tom Garcia, MD, expressed some serious skepticism over whether this will be enough to prevent a coding disaster. “I'm worried that the software vendors, government, and other links in this complex chain will not be ready, and if so, physicians and their patients will suffer the consequences,” Dr. Garcia told the news media. “I hope CMS will extend the one-year penalty-free and audit-free grace period if we need more time.”

TMA, meanwhile, is ramping up our ICD-10 educational materials for physicians and your staff:

TMA PracticeEdge Working With a New Primary Care ACO

The TMA PracticeEdge team was in Kerrville this week visiting with members and recruits for the new Hill Country ACO, LLC. This primary care group plans to participate in the 2016 Medicare Shared Savings Program. Contact Kim Harmon, TMA PracticeEdge’s director of administration and membership, at kim@tmapracticeedge.com or (888) 900-0334 if you are interested in joining this group or would like more information about physician-led ACOs in your area.

EVPGram Takes Summer Break

This will be your last regular issue of the EVPGram for the summer. We’ll be back in your in-box after Labor Day. Of course, we’ll keep you up to date through our Action newsletter and through Texas Medicine, and I’ll send out special editions of the ’Gram when necessary.

Monday, June 29, 2015

Supreme Court Ruling in ACA Case Leaves TMA in Familiar Spot

For the second time in three years, the U.S. Supreme Court has upheld a key piece of the Affordable Care Act (ACA). This time, the decision leaves in place the government subsidies for people who buy ACA health plans in states — like Texas — that have not established state-run ACA exchanges. In the wake of that ruling, TMA remains committed to our “find it, fix it, keep it” ACA strategy: find what’s missing from the law, fix what’s broken, and keep what’s working. Congress took care of our top “find it” priorities earlier this year when it repealed Medicare’s Sustainable Growth Rate formula and guaranteed that the ACA won’t topple Texas tort reforms. We’re still pushing for antitrust protections for physicians as well as a law to give physicians and senior citizens the ability to directly contract for any Medicare services. We’re also seeing some progress in the “fix it” category, as the House last week passed a bill to repeal the Independent Payment Advisory Board. We continue to push to eliminate restrictions on physician ownership of hospitals and facilities, and to delete the multitudinous, onerous regulations that force physicians to spend time filling out forms instead of seeing patients.

Counties and TMA Search for Members, Value

Growing membership and enhancing value for members — which, in turn, builds membership — were the hot topics at the annual meeting of Texas’ county medical society executives at the TMA building. We reviewed the digital tools TMA has built to help us recruit new members and renew lapsed members, and shared best practices from around the state. Darren Whitehurst, TMA’s chief lobbyist, discussed the highs and lows from the 2015 session of the Texas Legislature. Dave Spalding, the chief operating officer for TMA PracticeEdge, shared the new company’s growth plans and how it helps physicians who want to maintain their independence. I discussed the Washington, D.C., lobbying we’re undertaking as part of the 10-state Coalition of State Medical Societies and our joint federal advocacy efforts with the three other largest state societies.

Four Largest States to Congress: Stop ICD-10 or Require a Grace Period

TMA joined with the medical societies from California, Florida, and New York in a letter asking the leaders of the U.S. Congress to stop the Oct. 1 implementation of the ICD-10 coding system or require the Centers for Medicare & Medicaid Services (CMS) to establish a two-year, penalty-free grace period for physicians. “We remain steadfast in our belief that the ICD-10 coding system offers no real advantages to physicians and our patients — and certainly no advantages to justify the time and expense the entire health care system has invested in this transition,” we wrote, pushing them to pass HR 2126, the Cutting Costly Codes Act of 2015, by U.S. Rep. Ted Poe (R-Houston). “If these requests are not achievable, we strongly encourage you to pass legislation such as HR 2652, the Protecting Patients and Physicians Against Coding Act, by Congressman Gary Palmer (R-Alabama) and others, or simply join our call for CMS to implement a two-year ICD-10 grace period.” That request of CMS, expressed in an earlier joint letter to Acting Administrator Andy Slavitt, appears to be gaining traction at the agency. CMS leaders last week arranged a conference call for physicians and staff from the four states to further explain what we want to happen. TMA President Tom Garcia, MD, and Asa Lockhart, MD, vice chair of the Texas Delegation to the American Medical Association House of Delegates, represented Texas on the call.