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Monday, December 14, 2015

PAI Takes on Insurance Mega-Mergers

The pending mergers of Aetna with Humana and Anthem with Cigna were the hot topic at last week’s meeting of the Physicians Advocacy Institute (PAI). We agreed that physicians need a coordinated effort and strategy to oppose the mergers nationally, and to provide support to state medical associations seeking to fight the mergers in the states. (TMA already submitted a formal letter opposing the Aetna-Humana merger.) PAI will coordinate efforts by TMA and eight other state societies to develop additional legal documents opposing the mergers to send to the Department of Justice. These mergers would create two “too big to fail” insurers whose combined market power would be bad for physicians and for patients. Read more in the cover story of this month’s Texas Medicine. In other action, PAI reviewed the status of a congressional measure we support to rein in the Recovery Audit Program bounty-hunter contractors (RACs). The bill is HR 2568, the Fair Medical Audits Act of 2015, by Rep. George Holding (R-N.C.).

Medicare Bonuses for Primary Care Expire Dec. 31

Primary care physicians need to brace for another New Year’s pay cut. Last year, it was the expiration of the Medicare-parity payments for primary care services provided to Medicaid patients. (TMA fought to preserve those payments in the 2015 Texas Legislature, but lawmakers decided not to fund it in the final days of the session.) Now, it’s a provision in the Affordable Care Act that provided Medicare bonus payments to primary care physicians that is expiring on Dec. 31. The Primary Care Incentive Payment Program bonuses were equal to 10 percent of the Medicare-paid amount for primary care services. One family physician told TMA his 13-physician practice expects to lose $100,000 in Medicare payments next year. Read more in tomorrow’s Action newsletter.

TMA: Chiro Board Oversteps Authority, Again

TMA told the Third District Court of Appeals that the Texas Board of Chiropractic Examiners went too far, once again, in allowing chiropractors to perform acupuncture. TMA filed an amicus curiae brief asking the court to reverse a lower court’s judgment in Texas Association of Acupuncture and Oriental Medicine v. Texas Board of Chiropractic Examiners and Yvette Yarbrough. Our brief points out that the Chiropractic Act doesn’t authorize any procedures on the nervous system nor does it authorize chiropractors to perform acupuncture. The hearing in the case was Dec. 2. A decision is expected next year.

Garcia: “Stop This Ongoing Government Mistreatment of America’s Physicians”

In what one media outlet described as a “trenchant letter to Congress,” TMA President Tom Garcia, MD, asked for relief from yet another “ridiculous edict from the Centers for Medicare & Medicaid Services (CMS).” Our target this time was the CMS blunder on data physicians submitted for the Physician Quality Reporting System (PQRS) and value-based payment modifier (VBM) programs. Unless they file an appeal by Wednesday, Dec. 16, thousands of U.S. physicians will see Medicare payment cuts of 2 to 4 percent next year. “Our experience of just the past few months has proven that CMS is much better at generating mass confusion than it is at helping physicians care for Medicare and Medicaid patients,” Dr. Garcia wrote. “The agency’s incompetence only multiplies the burden of numerous, overly complex regulations it forces onto physicians. … We sincerely ask your assistance in stopping this ongoing government mistreatment of America’s physicians.”

Auto-Renew Your Membership Today; Get a Free TMA Publication

You can take one step today that will triply benefit your practice. Renew your TMA membership, and don’t forget to select the “Automatic Dues Renewal” option. The three benefits:
  1. You join TMA for 2016, helping to keep us strong to fight for you and your patients, and give you the practice management tools you need.
  2. You ensure that your membership won’t lapse.
  3. You get a free copy of our 130-page Business Basics for Physicians publication.

Happy Holidays From EVPGram

All of us here at TMA wish you, your families, your staff, and your patients a very enjoyable and safe and relaxing holiday season. Happy Hanukkah, Merry Christmas, Joyous Kwanza, Fantastic Festivus, and Excellent Diwali from us to you. Here’s to all the best in 2016 — we’ll be back in your in box on Monday, Jan. 11.

Monday, December 7, 2015

Send Us Your Out-of-Network Problems

Are insurance companies not offering you in-network contracts? Have you been removed from an insurance company’s network after being in-network for a long time? Are you or your patients experiencing out-of-network or balance billing issues? TMA is determined to demonstrate the cause-and-effect link between insurance company practices and these serious problems for physicians of all specialties. Help us document the specifics by sending the details to TMA’s Hassle Factor Log program. Our Balance Billing Task Force, appointed by the TMA Board of Trustees, met again Saturday at the TMA 2015 Advocacy Retreat. The group heard results of public opinion research we commissioned, discussed physicians’ opinions, and continued to plot out possible legislative responses. The task force is asking that all specialty societies be sure to attend the Interspecialty Society Committee meeting at 2016 TMA Winter Conference (Jan. 29-30 in Austin) to discuss the issue. The Balance Billing Task Force will hold an open forum at the conference to present its white paper on the issue and receive member comments as TMA prepares for the 2017 legislative session.

Representative Davis Picks Up Year’s First TMA Patient Protection Award

When you look at the voting record of State Rep. Sarah Davis (R-West University Place), it’s obvious she listens to what her physician-constituents have to tell her. When you realize that more physicians live in her district than in any other in Texas, you have an even better understanding of her 100-percent voting record with medicine — everything from the budget to public health to insurance and scope of practice issues in the 2015 Texas Legislature. Arlo Weltge, MD, vice speaker of the TMA House of Delegates and one of the many physicians whom Representative Davis represents, presented her with the first 2015 TMA Patient Protection Award, which we issue to thank and call attention to those lawmakers who do best by physicians and patients. Others who will receive 2015 awards in the future at upcoming TMA and other physician-led events — contact TEXPAC Director Clayton Stewart if you want to help — are State Reps. Four Price (R-Amarillo), Drew Darby (R-San Angelo), Carol Alvarado (D-Houston), Ken Sheets (R-Dallas), Todd Hunter (R-Corpus Christi), and Senfronia Thompson (D-Houston); and State Sens. Juan Hinojosa (D-McAllen), Brandon Creighton (R-Conroe), Jane Nelson (R-Flower Mound), and Judith Zaffirini (D-Laredo). Congratulations and thank you.

Appeal Medicare Penalties by Dec. 16 to Avoid Pay Cut

What a mess at the Centers for Medicare & Medicaid Services (CMS). What? You’re not surprised? You might be if you end up getting your Medicare payments cut by 2 percent next year. What’s worse is this could happen to those very physicians who’ve actually been trying to understand and comply with Medicare’s Physician Quality Reporting System and Value-Based Payment Modifier programs. The mess stems from “issues” with data submitted to CMS for those two programs and “issues” with how CMS used that data to calculate bonuses or penalties. “CMS’ failure to provide transparent, clear, and timely information on the various data problems and the system glitches that have impeded accurate calculation of 2016 adjustments has led to mass confusion,” American Medical Association CEO James Madara, MD, wrote in a letter asking CMS to grant a waiver for all physicians or at least extend the appeal deadline. TMA President Tom Garcia is following up today with a strongly worded letter to the Texas congressional delegation. The key to remember is if you’re confused or concerned that you might get a penalty, file an appeal with CMS by Dec. 16. Look for a special issue of TMA’s Action newsletter tomorrow with all the details.

Texas Ranks Near the Top in U.S. Physician Recruitment

Thanks to our strong economy, good practice environment, and 2003 medical liability reforms, Texas continues to be a national leader in attracting new physicians to the state. The just-released 2015 Association of American Medical Colleges (AAMC) Data Book shows Texas ranked second only to California in growth in the number of new patient care physicians in 2012-14 and fifth in the nation in percentage growth. That continues a trend AAMC has documented since 2008. During that period, Texas ranked second nationally both in percentage growth and in attracting the most physicians who treat patients. Texas attracted nearly as many active patient care physicians as Florida and New York combined. “Texas has effective medical lawsuit reforms,” said Howard Marcus, MD, chair of the Texas Alliance for Patient Access. “Florida and New York do not.”

Medicine Backs Bill to Help Physician-Owned Hospitals

Two Texas congressmen — U.S. Reps. Sam Johnson (R-Plano) and Ruben Hinojosa (D-Mercedes) — have filed legislation that would partially lift the ban on new physician-owned hospitals and also address restrictions on the growth of existing facilities. TMA has long opposed the ban, which was an ill-advised provision of the Affordable Care Act. We are joining with AMA and 40 other state medical associations and national specialty societies in a letter urging Congress to pass HR 2513, the Protecting Access, Competition, and Equity Act. “Physician-owned hospitals have injected much-needed competition into the hospital market, forcing traditional hospitals to improve and innovate,” the letter states. “This is a win-win for patients and for the entire health care system as we work to improve care.”

Nominate the Best Health Care News of the Year

Every year since 1956, TMA’s Anson Jones, MD, Awards have recognized the most outstanding health care stories written by Texas news media. We need your help to find the best of 2015. Maybe you’ve seen, heard, or read a story this year about Medicaid cuts, a new medical treatment, ICD-10, or obesity or another public health concern that caught your attention. Or maybe you have been on the reporting side as a physician or medical-student journalist and believe your work deserves recognition. Last year, four winners were nominated by TMA family members. If you’ve seen a great story by a local journalist or a colleague, nominate it by Jan. 10.

Monday, November 23, 2015

TMA Says Future Medicare Requirements Are Wasteful, Costly

TMA is “very concerned that many of the compliance, documentation, and reporting requirements that will be implemented in the future Medicare system are wasteful, costly, and do little or nothing to improve care quality or increase efficiency,” TMA President Tom Garcia, MD, told the Centers for Medicare & Medicaid Services (CMS). The strong comments came in response to a CMS request for information regarding implementation of the Merit-Based Incentive Payment System (MIPS), promotion of alternative payment models, and incentive payments for participation in alternative payment models. “The requirements and incentives may even have the counterproductive effect of reducing access to good ambulatory care for some or all Medicare beneficiaries,” Dr. Garcia’s letter said. “If the goal is to reduce total medical cost, it is counterproductive to try to achieve that by increasing the total cost of medical practice. If the goal is better use of ambulatory care by patients, it is counterproductive to penalize the physicians who provide it.”

Lawsuit Threatens Texas Docs Who Care for New Mexico Patients

When it comes to health care, eastern New Mexico is really part of Texas. That’s the message physicians and advocacy groups in both states are sending to the New Mexico Supreme Court. Pending there is a malpractice lawsuit — MontaƱo v. Frezza — in which a lower court has ruled that New Mexico law governs, and our Texas’ medical liability reforms don’t. The case involves a patient from New Mexico who was treated in Texas. In court filings and news stories, TMA, the Texas Alliance for Patient Access (TAPA), the New Mexico Medical Society, and others argue that upholding the lower court ruling “will likely diminish access to care for thousands of Eastern New Mexicans, at a time when the area is already medically underserved.” For example:
  • More than 27 percent of New Mexico residents live in the 13 counties that border Texas. However, those counties account for only 14 percent of the state’s specialty physicians.

  • Two of the 13 counties have among the greatest shortage of primary care physicians in New Mexico. Nine of the 13 counties need general surgeons, and four have a shortage of obstetrician-gynecologists.

  • Sambaiah Kankanala, MD, an internist in Hobbs, N.M., told the TAPA annual meeting that his town has just four primary care physicians for a population of more than 30,000.

  • New Mexico’s only Level 1 trauma center is in Albuquerque. More than one-third of New Mexico’s critically injured trauma patients are treated in Texas.

Feds to Set Network Adequacy Standards for ACA Exchange Plans

CMS says it plans to set minimum network adequacy standards for Affordable Care Act plans sold on insurance exchanges. There’s more good news in this than that CMS will adopt some of Texas’ consumer protections for out-of-network services. According to news reports, the CMS proposal is a departure from model legislation drafted by the National Association of Insurance Commissioners (NAIC), which was to be ratified last weekend, and which prohibits physicians from billing patients in certain circumstances. As we wrote NAIC in our most recent comment letter in what has become a long and frustrating process, “Now is the time for [CMS] and the Center for Consumer Information and Insurance Oversight to move forward and impose time and distance requirements upon insurers, as they had proposed, while leaving more stringent state standards in place.”

San Antonio Group Signs ACO Pact With TMA PracticeEdge

UPSA ACO, LLC, a group of 48 San Antonio physicians, is TMA PracticeEdge’s newest client for accountable care services. The contract comes in conjunction with a Blue Cross and Blue Shield of Texas (BCBSTX) value-based agreement beginning Jan. 1, 2016. The two agreements will provide UPSA with shared savings opportunities while managing the population health of 5,400 BCBSTX members. The deal includes the TMA PracticeEdge turnkey solution for ACO services, such as population health management tools, local care coordination resources, and a state-of-the-art IT solution. “High-quality patient care and population health management, delivered by independent primary care physicians, is the future of health care in this country,” said Lloyd Van Winkle, MD, president of UPSA. TMA PracticeEdge is a physician services organization TMA created to strengthen the independent private practice of medicine in Texas. Its programs bring physicians the technology, expertise, and resources needed to take advantage of emerging health care payment models. For information, visit www.TMAPracticeEdge.com, email info@tmapracticeedge.com, or call (888) 900-0334.

Bill Would Grant Meaningful Use Exemptions for 2015

Sometimes the bureaucrats at CMS really outdo themselves. Like when they finally passed a new rule for the meaningful use program too late for physicians to have 90 days left in the year to comply with the rule. TMA is backing HR 3940 by U.S. Rep. Tom Price, MD (R-Ga.), which authorizes a meaningful use significant hardship exception for the 2015 reporting period due to the delay publishing the rule. “Physician practices and the health care industry cannot be expected to turn on a dime, especially when regulatory changes are rolled out during a required reporting period,” Dr. Garcia wrote in a letter to Congressman Price and the Texas delegation in Congress.

EVPGram Takes Turkey Break

Despite the troubles in our world, we all have so much to be thankful for. All of us at TMA wish you and yours a very Happy Thanksgiving. EVPGram will take a short break. We’ll be back Dec. 7.

Tuesday, November 17, 2015

Young Texans Win AMA Posts

Congratulations to the Texas medical students and residents who continued the tradition of strong Texas leadership in the American Medical Association. Winning elections during this week’s meeting of the AMA House of Delegates were:
  • John Corker, MD, a resident at The University of Texas (UT) Southwestern, Dallas; and Laura Faye Gephart, MD, at Baylor Scott & White, Temple, were elected sectional delegates for the AMA Resident and Fellow Section (RFS). The RFS also voted to endorse Dr. Gephart as one of two candidates for the resident position on the AMA Council on Medical Service. The election will be in June.

  • Jared Bell, from the Paul L. Foster School of Medicine in El Paso, is the new Region 3 delegate for the AMA Medical Student Section (MSS). Jerome Jeervarajan of UT-Southwestern Medical School is the alternate delegate.

  • Megan Swonke from The University of Texas Medical Branch at Galveston and Milan Raythatha, from Texas A&M Medical School, Round Rock, are the very first MSS Region 3 liaisons to the AMA Foundation. They will be responsible for all region communication and increasing students’ participation in the foundation’s fundraising and community service activities.

Dr. Bailey Takes the Gavel

Sue Bailey, MD, of Fort Worth, the former TMA president, is presiding over her first meeting as speaker of the AMA House of Delegates. She calmly handled a complicated parliamentary quandary Sunday morning. The dust-up ended with the house giving Dr. Bailey a strong vote of confidence. TMA members serving key roles at the 2015 interim meeting of the house are these:
  • Larry Reaves, MD, of Fort Worth is chairing a special reference committee on modernizing the AMA Code of Medical Ethics.

  • Gary Floyd, MD, of Fort Worth is serving on the Reference Committee on AMA Governance and Finance.

  • Susan Strate, MD, of Wichita Falls, the speaker of the TMA House of Delegates, is serving on the Reference Committee on Amendments to the AMA Constitution and Bylaws.

  • John Flores, MD, of Little Elm is serving on the Reference Committee on Medical Service, Medical Practice, and Insurance.

Texas Resolutions Making Little Headway in AMA House

The Texas Delegation to the AMA brought three new policy resolutions for the house to consider. Two addressed problems with out-of-network billing and the third called for simplification in how physicians submit and retrieve data for Medicare’s quality reporting programs. So far it appears that the house sees nothing new in our proposals and will likely reaffirm existing AMA policy that covers these issues. I’ll bring you a final report next week.

Tell the Feds What You Think of Your EHR

Apparently Washington is getting the message that too many physicians are seeing too little return on the massive investment they made in electronic health records (EHR) systems. The Office of the National Coordinator for Health Information Technology (ONC), which oversees the certification of EHR products, is asking for your health information technology-related concerns or complaints. Use the Health IT Complaint Form website so ONC can hear your concerns.

So You Want to Be in Our Next ACO Leadership Development Class?

Last week’s EVPGram story about the graduation of the inaugural class in our Accountable Care Leadership Development Program drew plenty of interest — especially from physicians who want to enroll. The program is recruiting for the 2016 class now. If you’re interested in participating, email Christina Shepherd of the TMA staff. The next class should begin in the first quarter of 2016.

Tomorrow: TMA Webinar on Practice Financial Policies

Register now for our Nov. 17 live webinar, Financial Policies Do’s and Don’ts. Are you smart about collecting patient copays and deductibles? Are your uncollected accounts receivables climbing? Do your practice’s financial policies comply with state law? Tune in tomorrow at noon (CT).

Monday, November 9, 2015

Brady Wins Key House Leadership Spot

With strong support from his predecessor — who just happens to be new U.S. House Speaker Paul Ryan — U.S. Rep. Kevin Brady (R-The Woodlands) won election as new chair of the powerful House Ways and Means Committee. The panel’s jurisdiction not only covers all tax laws but also plays a huge role in overseeing Medicare and Social Security. After his election, Representative Brady said one of his priorities will be replacing the Affordable Care Act with a new “patient centered” system. Medicine has a strong working relationship with the 10-term congressman, who was a key player in the repeal of Medicare’s Sustainable Growth Rate (SGR) formula earlier this year. Texans now chair seven permanent committees in the House, more than any other state.

14 Earn ACO Leadership Diplomas

Congratulations to the first class of graduates from TMA’s ACO Leadership Development Program. With a grant from United Healthcare, TMA launched the program under the oversight of The University of Texas at Dallas to help physicians learn about and use accountable care organizations. Our first class graduated this weekend after completing nearly 90 hours of study:
  • Saba Asad, MD, of Fort Worth;
  • Luis M. Benavides, MD, of Laredo;
  • Gregory M Fuller, MD, of Keller;
  • Oscar Garza, MD, or Pearsall;
  • Brenna Gerdelman, MD, of Austin;
  • Sander Gothard, MD, of Plano;
  • C. Shane Hall, MD, of McKinney;
  • Jeffrey B. Kahn, MD, of Austin;
  • Lianne Marks, MD, PhD, FACP, of Round Rock;
  • Phuong-Khanh Jessica Nguyen-Trong, MD, of Dallas;
  • Garth Vaz, MD, of Gonzales;
  • John F. Villacis, MD, of Austin;
  • Brenda Vozza-Zeid, MD, FACP, of Henderson; and
  • Kevin Winfield, MD, MBA, of Houston.

Lawmakers Get Head Start on 2017 Health Care Issues

The 140 days the Texas Constitution allocates every other year for a state legislative session is never enough time for lawmakers to study and grasp all they need to do with the most complex issues. House and Senate committees use the time between sessions — the interim — to conduct research, hold hearings, and draft bills. Lt. Gov. Dan Patrick and House Speaker Joe Straus have laid out their interim charges to the committees; health care issues will get a share of legislators’ attention. Medicaid — including the 1115 waiver — trauma systems, workers’ compensation, out-of-network billing, public health preparedness, chronic diseases, telemedicine, prompt pay, and behavioral health are all on the committees’ lists. TMA leaders and lobbyists will monitor the work closely, providing background and perspective to lawmakers and their staff, arranging witnesses for hearings, and suggesting language for the draft bills that emerge. Stay tuned.

Tort Law Doesn’t Apply to Rape Allegation

The stunning headline might have caught your eye; it certainly caught mine. A big piece of it, though, is flat out wrong. “Doctor accused in rape unlikely to be held liable in civil court,” the Houston Chronicle headline read. “The Texas Supreme Court has ruled that rape in some circumstances is covered by medical malpractice laws,” the author wrote further down in the story. Wrong. Texas Alliance for Patient Access Chair Howard Marcus, MD, set her straight. Here’s his statement in full: “Rape is a reprehensible act. Neither the legislature not the courts gave medical liability protections to this criminal offense. Most recently, in Ross v. St. Luke’s Episcopal Hospital, the Texas Supreme Court set forth a seven-factor test to determine whether an injury was or wasn’t a health care claim. The Ross decision makes clear that rape is not related to the provision of health care, and is not a protected act simply because it occurred in a health care setting. The court has left no room for confusion.”

Dr. John Hellerstedt Named New Texas Health Commissioner

Congratulations to Austin pediatrician John Hellerstedt, MD, who is returning to state government as our new Texas health commissioner. Dr. Hellerstedt, a TMA member, is the former state Medicaid director. Prior to that, he spent 18 years with Austin Regional Clinic. He is currently vice president of medical affairs for Dell Children’s Medical Center. The Department of State Health Services has been without a commissioner since David Leakey, MD, left in January. We wish Dr. Hellerstedt the best of luck in a difficult job and look forward to working closely with him.

Are You Ready for Medicare Next Year? We Are

The bill that did away with the SGR also has some big changes in store for Medicare and you, including alternative payment models and revisions to fee-for-service payments. Plus, there’s a new Medicare fee schedule, the chronic care management program, and end-of-life counseling. TMA can help you prepare for and make the most of these changes. Live seminars are coming up in San Antonio, Houston, Austin, and McAllen. Registration is open. Can’t make it in person? Register for our live webcast on Tuesday, Dec. 1, from 9 am to 12:30 pm (CT).

Monday, November 2, 2015

TMA to Congress: End “Meaningless Abuse”

In a strongly worded letter to the Texas delegation in Congress, TMA President Tom Garcia, MD, urged lawmakers to lift the “convoluted and tedious” federal meaningful use regulations. “No federal program ever bore a more inaccurate name than ‘Meaningful Use.’ It’s no surprise that physicians around the country have begun calling it ‘Meaningless Abuse,’” Dr. Garcia wrote. “Neither the electronic health records nor the Meaningful Use regulations were designed with the realities of medical practice in mind. Together, they leave us clicking more but achieving less.” The letter asks the Texans to support and cosponsor two bills that could bring relief from the meaningful use regulations. Dr. Garcia urges TMA leaders to send your own message to Sens. John Cornyn and Ted Cruz and your representative using the TMA Grassroots Action Center.

First Class to Graduate From TMA ACO Leadership Development Program

More than a dozen physicians from across Texas graduate this week during the first capstone event of TMA’s ACO Leadership Development Program. TMA launched the program under the oversight of The University of Texas (UT) at Dallas to help physicians learn about accountable care organizations and how their practices might interact with — or help launch — an ACO. UT Dallas’ Clinical Professor of Health Care Leadership and Innovation Michael Deegan, MD, leads the course. It incorporates 10 study units, each averaging 10-15 hours to complete. Students receive 85 hours of continuing medical education credit upon completion. The initial class includes students of various ages, specialties, practice sizes, and geographic locations across Texas. A few have already formed their own ACO, including one rural physician group who did so under the guidance of TMA PracticeEdge. The program operates under a grant from United Healthcare. Richard Migliori, MD, United’s chief medical officer, will attend the graduation event.

Texans to Bring Three Resolutions to AMA House Meeting

The American Medical Association House of Delegates convenes for its 2015 interim meeting in Atlanta on Nov. 14. The Texas Delegation to the AMA is bringing three new policy resolutions for the house to consider:
  • Resolution 808 is the first of two items we are taking regarding balance billing. It asks AMA to seek changes in federal law to require health insurers to disclose their median in-network payment rates and the amount they pay for out-of-network emergency services. It also asks for a federal law to allow people who buy their insurance from the Affordable Care Act (ACA) marketplace to be able to buy additional coverage that would pay in-network benefits for out-of-network claims for labor and delivery, emergency care, and any subsequent in-hospital care.

  • Resolution 215 is a reaction to the National Association of Insurance Commissioners’ (NAIC’s) move to inappropriately regulate physicians by prohibiting out-of-network billing in certain circumstances. Our resolution calls on AMA to push the Centers for Medicare & Medicaid Services (CMS) — not NAIC — to develop and adopt strong network adequacy standards for health plans offered on the ACA exchange.

  • Resolution 216 would direct AMA to advocate that CMS develop a one-portal system with a single username and password for all physician data reporting and retrieval in Medicare quality programs.

Earl Grant, MD, a Quiet Leader, Passes

The TMA family mourns the passage of a devoted physician, a strong leader, and a fine gentleman. Earl Grant, MD, of Austin, first a general practitioner and then an anesthesiologist, left us at age 86 after more than 50 years in medicine. Dr. Grant’s long tenure of service to the profession includes stints as president of the Texas Society of Anesthesiologists and Travis County Medical Society, and chair of the TMA Board of Trustees and of the Board of Councilors. “Earl was most proud of [TMA’s] beautiful new building on 15th Street, which was built during his tenure on the Board,” his obituary stated. In lieu of flowers, the family requests that donations be made to the Episcopal Church of the Good Shepherd in Austin, the Texas School for the Deaf Foundation, the TMA Foundation, or a charity of your choice.

New Texas Medicaid Director Appointed

Long-time state employee Gary Jessee, who has served three years as the No. 2 person in the Texas Medicaid program, will be the state’s new Medicaid director. He will oversee the $31 billion-a-year program, taking over from Kay Ghahremani, who is retiring.

Monday, October 26, 2015

Physicians Tell Congress: Get Government Off of Our Backs

Leaders from TMA and the medical associations from California, Florida, and New York stormed Capitol Hill last week with our plan to take the regulatory burden off physicians’ practices. Former TMA Board of Trustees Chair Carlos Cardenas, MD, joined TMA lobbyist Dan Finch and me in D.C. The group visited with 25 lawmakers or their offices, including Texas Reps. Michael Burgess, MD (R-Lewisville), and Gene Green (D-Houston), and House Budget Committee Chair Tom Price, MD, of Georgia. The Coalition of State Medical Societies’ priorities included calls for Congress to:
  • Eliminate federal mandates, like the poorly named “meaningful use” program, that compel physicians to do unnecessary make-work and wade through convoluted reporting systems;

  • Stop the bounty-hunting Medicare Recovery Audit Program contractors (RACs);

  • Maintain the state-based system of licensing physicians;

  • Be prepared to act quickly to protect physicians’ practices from financial problems caused by the new ICD-10 coding system;

  • Clarify that maintenance of certification is not and never will be a nationwide condition for physicians to receive or keep a state license or to participate in Medicare or Medicaid;

  • Allow physicians and patients on Medicare to contract for services directly; and

  • Bolster funding for graduate medical education.

TMA Submits 16 Recommendations to Improve Texas Medicaid

As last week’s Texas Medicaid Congress illustrated, Medicaid’s cumbersome regulations make it that much more unlikely that physicians will participate in a program that pays so poorly. Boosting physicians’ Medicaid pay remains one of TMA’s top priorities, but that requires action by the legislature, which doesn’t meet again until 2017. Meanwhile, TMA and the Texas Pediatric Society submitted a list of 16 recommendations to Health and Human Services Commissioner Chris Traylor to make Medicaid and Medicaid HMOs work better for physicians. Among our ideas:
  • Require Medicaid HMOs to process physician credentialing applications at the same time the state is processing Medicaid enrollment. Physicians tell us it can take six months or more to enroll in Medicaid, become credentialed by the HMOs, and begin seeing HMO patients.

  • Simplify and streamline the Medicaid Vendor Drug program. The drug benefit is too complicated, frustrating, and time-consuming for physicians. No other payer has such a byzantine pharmacy benefit, thus fueling physicians’ reluctance to participate in Medicaid.

  • Make the various insurance companies and HMOs handle coordination of benefits. Stop recouping payments from physicians and forcing them to find the right insurer to bill.

  • Promote adoption of innovative Medicaid delivery models, such as physician-led accountable care organizations or patient-centered medical homes.

Wanted: New State Health Commissioner

Texas needs an outstanding physician to head the state health department. We’ve had a caretaker commissioner in place since David Lakey, MD, left the Department of State Health Services (DSHS) in January. This week, the Texas Health and Human Services Commission posted the position. In addition to running DSHS, the commissioner is frequently the face of public health policy in Texas. I encourage physicians who want to make a real difference in the health of our state to apply.

Dr. Garcia Leads Exclusive Briefing for 100-Percent Groups

One benefit of 100-percent membership in TMA for large groups is an annual give-and-take session with TMA leaders. The groups share problems they want TMA to address, and senior TMA staff provide exclusive briefings on hot issues. TMA President Tom Garcia, MD, moderated our meeting last week with groups from Travis County. Participating were Austin Area OB/GYN and Fertility, Austin Diagnostic Clinic, Austin Gastroenterology, Austin Regional Clinic, Capital Medical Clinic, Capitol Anesthesiology, Premier Family Practice, and The University of Texas at Austin Dell Medical School Residency Program.

Dr. Secrest Honored for Mental Health Work

Congratulations to Dallas psychiatrist and former TMA Council on Legislation Chair Les Secrest, MD, who received a Prism Award from Mental Health America of Greater Dallas. Dr. Secrest received the Ruth Sharp Altshuler Award, which recognizes “outstanding community service meeting the needs of persons with mental illness.” The award is named for, and was presented by, long-time Dallas volunteer and philanthropist Ruth Sharp Altshuler.

Physicians Foundation Aims for a Better Future for U.S. Physicians

The board of the Physicians Foundation met in Austin and formulated plans to continue our extensive work in support of physicians and your practices. In addition to renewing our biennial, nationwide physician and patient surveys, the foundation agreed to conduct a new study of telemedicine. In recognition of the nine years I served as president of the foundation, the board awarded an annual grant in my name to support the Association of American Medical Society Executives’ Leadership Academy. I am humbly grateful and hope the grant will help raise a new generation of executives to serve America’s physicians.

Monday, October 19, 2015

Medicaid Congress Tackles Physicians’ Ire

Capturing the frustration of all the physicians in the room, San Antonio radiologist Adam Ratner, MD, asked a simple question with a very complicated answer at Friday’s Texas Medicaid Congress meeting. “Why can’t we just make this all simpler?” Dr. Ratner asked Texas Health and Human Services Executive Commissioner Chris Traylor. “It’s like unraveling a bowl of spaghetti,” responded Traylor, whose administration of the $30 billion-a-year program is bound by federal and state laws and dozens of contracts with Medicaid HMOs. Despite the glutinous nature of the problems, members of the congress vowed to find ways to cut through the payment hassles, enrollment and credentialing morass, vexing drug formularies, and other obstructions that dissuade Texas physicians from participating in Medicaid. TMA Board of Trustees Chair Doug Curran, MD, and John Holcomb, MD, chair of TMA’s Select Committee on Medicaid, CHIP, and the Uninsured, led the meeting. The group will explore potential solutions in January at the 2016 TMA Winter Conference meeting of the Select Committee on Medicaid, CHIP, and the Uninsured.

Primary Care Preceptorship Program Is Back

Attention physicians in family practice, internal medicine, and pediatrics: Love what you do and want to show medical students why your primary care specialty is so, well, special? Thanks to medicine’s hard work during this year’s legislative session, lawmakers reinstated funding for Texas’ Statewide Primary Care Preceptorship program since all appropriations for the program were eliminated in 2011. The $3 million, two-year appropriation brings back a program that introduces students to real-life primary care — and hopefully encourages them to choose those specialties. Students typically participate during the summer between their first and second year of medical school. By working in practicing physicians' offices, they experience the daily life and work of primary care physicians. Watch for word from your specialty society on how you can participate.

UTHealth Med School’s First Female Dean Begins Work

Barbara Stoll, MD, is the new dean of UTHealth Medical School in Houston and the first woman to hold that post. The Yale-educated pediatrician comes to Texas from Emory University School of Medicine in Atlanta, where she chaired the Department of Pediatrics and served as CEO of Emory-Children’s Center. “One of the reasons I took this job is because I think women need to step forward when offered senior leadership roles,” Dr. Stoll told the Houston Chronicle. “I love the Chinese expression, ‘Women hold up half the sky.’

Confused About Value-Based Modifier? Look to TMF

Hot on the heels of PQRS and meaningful use comes yet another federal program that will bring bonuses or cuts to your Medicare payments. The value-based modifier combines your PQRS quality scores and cost measures to come up with a “payment adjustment.” Free help is available for Texas physicians from TMF Health Quality Institute. “TMF now works with physicians and physician practices to provide free assistance to help them meet the requirements of the value modifier program,” said Cliff Moy, MD, TMF’s medical director for behavioral health. “Part of that assistance is to help physicians and physician offices understand how the value modifier is calculated.” See TMF’s Value-Based Improvement and Outcomes Network for details. TMF also has launched educational networks to help physicians meet Medicare patients’ behavioral health needs and boost adult immunization rates to help prevent influenza, pneumonia, and shingles.

Make Waves in DC on Twitter — Learn How for Free from TMA

A headline on the website of KIAH-TV in Houston caught our eye: “Want something done in Washington? Report says ‘Tweet it!’ ” The report in question is the Congressional Management Foundation’s annual study of how best to capture the attention of our senators and representatives and their staffers. Social media, like Twitter, it says, are particularly effective because they are public. Considering medicine’s need for some serious action from Congress — on issues like PQRS, meaningful use, RAC audits, graduate medical education, and public health funding — I’m inviting TMA leaders like you to get tweeting. Don’t know how? Check out our free TMA Twitter Academy. Four easy video lessons will help you set up your account, earn some followers, and grab politicians’ attention. For starters, here’s a list of the Twitter handles for all 36 U.S. House members from Texas. Our senators? They’re @JohnCornyn and @SenTedCruz.

Monday, October 12, 2015

New Mexico Court Urged to Heed Texas Tort Reforms

A medical liability case involving a Texas physician who provided care to a New Mexico resident in Texas should not be governed by New Mexico’s far weaker tort laws, TMA, the Texas Alliance for Patient Access (TAPA), the New Mexico Medical Society, and dozens of other physician groups in both states wrote in a brief to the New Mexico Supreme Court. Access to health care is already challenging enough for New Mexico patients seeking care. New Mexico doctors and hospitals have long relied on referring or transferring sick and injured patients to Texas for specialized care. The willingness of Texas physicians and hospitals to receive those patients may be shaken if the New Mexico Supreme Court upholds a recent state appellate court ruling. That ruling is causing a significant liability risk for Texas doctors, forcing physicians here to consider what patients they will see and under what circumstances they will see them. Unless overturned, this decision will diminish access to care for thousands of Eastern New Mexicans.

TMA Calls Out Insurance Companies Over Balance Billing

The national health insurance lobby and their cronies in the Texas Association of Health Plans released their annual “report” citing physicians for what they called “exorbitant” bills for out-of-network services. We challenged the allegations publicly and earned some positive news media coverage. “This so-called report is nothing more than a desperate smoke screen to divert attention from the real problem,” said TMA President Tom Garcia, MD. He not only pointed out the absurdity of using Medicare payments as a benchmark for “reasonable” charges. He also directed reporters to a recent University of Pennsylvania study that found Texas home to some of the narrowest physician networks in the country. “The health insurance industry games the system to keep more of patients’ premium dollars by forcing patients to seek care out of network,” Dr. Garcia said. “Then they have the gall to criticize what some doctors’ bill for that care.”

Medicine Fights Federal Mandates on Physicians

Since our last visit to Capitol Hill, Congress has repealed the Medicare Sustainable Growth Rate (SGR) formula, and House Speaker John Boehner’s announced retirement has created a free-for-all battle for House leadership positions. But TMA and the Coalition of State Medical Societies are still fighting to pry some of the regulatory burdens off of physicians’ backs. When we return to Washington in a few weeks, our agenda will sound familiar to senators and representatives:
  • Eliminate federal mandates, like the poorly named “meaningful use” program, that compel physicians to engage in unnecessary activities and reporting;
  • Stop the bounty-hunting Medicare Recovery Audit Program contractors (RACs);
  • Maintain the state-based system of licensing physicians;
  • Be prepared to act quickly to protect physicians’ practices decimated by the new ICD-10 coding system; and
  • Clarify that there are not now and never will be a requirement for Maintenance of Certification (MOC) to be a condition for state licensure or for participation in Medicare or Medicaid.

Dr. Garcia’s Travels Heat Up As Weather Cools

Fall finds Dr. Garcia spending more time on the road, spreading the word about TMA’s legislative successes, and helping to recruit new members. He recently spoke to the Wichita County Medical Society and the Southwest Branch of Harris County Medical Society. Coming up is a visit to the Webb-Zapata-Jim Hogg County Medical Society in Laredo. Then Dr. Garcia will be a featured speaker at the National Association of Latino Elected and Appointed Officials on what health reform means to physician practices. Let us know if you want Dr. Garcia to speak to your county society or physician group.

TMA Raises Serious Concerns About Aetna-Humana Merger

If Aetna is allowed to complete its deal to buy Humana, our state’s already highly concentrated health insurance market would be even less competitive. And that would be bad for physicians and patients. That’s what TMA wrote in a formal comment letter to the Department of Justice. Texas’ many one- to three-physician groups “may have very little negotiating leverage to allow them to secure favorable pricing terms,” we wrote. “Health plans that can wield unchecked pricing power can force physician practices out of business.” That would create access problems for patients in addition to the problems associated with trying to buy insurance in noncompetitive markets. The letter cited data showing the purchase would give the new company “enhanced market power” in San Antonio, Houston, Austin, El Paso, Corpus Christi, and many other Texas markets.

High Court to Hear Tobacco Tax Case

The Texas Supreme Court has accepted an appeal of a lower court ruling that invalidated a tax the legislature applied to so-called “small tobacco.” Back in 1998, the nation’s five largest tobacco companies settled a case with Texas and 45 other states over the health care costs of cigarette smoking. They agreed to pay $10 billion a year indefinitely to the states. In 2013, state lawmakers enacted the “small tobacco” tax to “recover health care costs” from the tobacco companies that were not part of the settlement. TMA urged the high court to take the case. “Whether produced and sold by Small Tobacco or by Big Tobacco, tobacco products cause the same health problems and inflict the same physical and financial burdens upon Texas citizens and the State budget,” we wrote in our amicus brief to the court. “Both should, therefore, have to pay their fair share of tobacco-related health costs whether that be through a judgment, settlement, tax or otherwise.”

Monday, October 5, 2015

Submit ICD-10 Problems to TMA’s Hassle Factor Log

Thursday, Oct. 1, was the mandatory date to switch to the ICD-10 coding system in the United States. The government’s paltry “grace period” notwithstanding, all claims to Medicare, Medicaid, commercial insurers, and other payers with a date of service on or after Oct. 1 must use ICD-10. If you run into problems submitting claims, email PaymentAdvocacy@texmed.org or send a report to TMA’s Hassle Factor Log. TMA staff will monitor the reports and contact health plans, Medicare, or Medicaid. If your practice is behind in its ICD-10 preparation, or if you’re just looking for some tips and tools to make the new system work more smoothly, see TMA’s ICD-10 Resource Center.

TEXPAC Backs Supreme Court Challenger

The TEXPAC Board of Directors voted to endorse Justice Michael Massengale for Texas Supreme Court Place 3. Justice Massengale has served on the First Court of Appeals since 2009, when then-Gov. Rick Perry appointed him, and he won reelection in 2012. “After completion of a very thorough vetting process, Texas physicians believe the decision is clear: Justice Massengale will be the best choice to serve on the Texas Supreme Court,” said TEXPAC Chair Brad Holland, MD. “We further believe he will be an unwavering protector of tort reform, he will help both patients and physicians, and he will interpret the law in a fair and objective manner.” After interviewing both candidates in the race extensively, TEXPAC board members said Justice Massengale clearly articulated his belief that the law is the law and judges should not legislate from the bench.

Sign Up Now for Our Medicare 2016 Seminar

Once again, big changes are coming to Medicare. Although the Sustainable Growth Rate (SGR) formula is now history, the bill that repealed the SGR is likely to accelerate the movement towards value-based payment systems — for all physicians. Sooner rather than later, you will have to prepare to participate in a Merit-Based Incentive Payment System (MIPS) or an alternative payment model system. Doing nothing may cost you. TMA can help you do it and do it right. Our day-long Medicare Now and Tomorrow seminar will help you develop short-term and long-term strategies to adjust. Registration is open now for the seven-city tour.

Governor Abbott Appoints Falcon to University Research Initiative Advisory Board

Rio Grande City family physician Tony Falcon, MD, is among nine Texans whom Gov. Greg Abbott appointed to the University Research Initiative Advisory Board. The program will provide matching funds to help public colleges and universities recruit prestigious, nationally recognized researchers to their faculty. The advisory board will review grant applications and recommend approval or disapproval to the governor’s office. Dr. Falcon, a long-time, active TMA and TEXPAC member, joins a group of business and philanthropy leaders on the advisory board.

Don’t Miss TMA’s 2015 Advocacy Retreat

While Texas politics is a year-round sport, the season really heats up in odd-numbered years just about the time mall elves and holiday music are making their crescendos. That’s why we hold our biennial political retreat the first week of December. Register today for TMA’s 2015 Advocacy Retreat, Dec. 4-5 at the Omni Barton Creek Resort in Austin. Join other physician leaders from around the state as we gather to recap the 84th Texas Legislature and discuss what the 2016 elections will mean for Texas medicine.

Tuesday, September 29, 2015

Panel Begins Balance Billing Work

In every session for more than a decade, Texas lawmakers have tried to pass legislation that would prevent physicians from billing for services provided out of network. TMA has stopped or deflected those bills, including a slew of proposals in the 2015 session. Physicians in other states have had less success, and now face stringent new laws on how much — or even whether — they can bill patients for the difference between the doctor’s charge and what the insurance company decides to pay. To forestall Texas from becoming the next casualty in this nationwide trend, the TMA Board of Trustees appointed a special Task Force on Balance Billing to develop policy, advocacy, options, and communication strategies. The task force, led by Trustee Keith Bourgeois, MD, met for the first time over the weekend.

Reporters Offer Insight Into What Makes News

With social media forcing big change in how traditional news organizations operate and making “disseminating false information easier than ever,” complicated and dry issues like health care sometimes get left out of the news, three veteran members of the Texas Capitol Press Corps told the audience at TMA’s 2015 Fall Conference. The hour-long panel discussion pulled the curtain back a bit on how reporters decide what to cover and how different media approach the same story. One tip they offered for doctors being interviewed: Drop the medical nomenclature and use very plain English whenever possible. In other highlights of the General Session:
  • TMA President Tom Garcia, MD, reviewed medicine’s successes — and failures — in the 2015 Texas Legislature.

  • Louisiana surgeon Frank Opelka, MD, chair of the American Medical Association’s Physician Consortium for Performance Improvement, laid out a blueprint for health care and medical education redesign.

  • A panel of Texas experts provided a clinical update on hepatocellular carcinoma, a disease that afflicts and kills Texans more than people in any other state.

Texans to Ask AMA to Push for Better Insurance Regulation

The Texas Delegation to the AMA House of Delegates began planning for the house meeting next month in Atlanta. In addition to some concerns over the proposed plan to “consolidate, modernize, and clarify” AMA’s Code of Medical Ethics, delegates decided to bring several resolutions to the meeting. Among them are plans directing AMA to:
  • Seek a new federal law to require insurance companies to disclose how much they pay in network and out of network for emergency services, including active labor,

  • Push for strong federal network adequacy standards for health insurance plans offered on Affordable Care Act exchange, and

  • Work with the Center for Medicare & Medicaid Services to establish a single sign-in portal for all for physicians to report and review all Physician Quality Reporting System, value-based modifier, and meaningful use data.

Midland Physician Funds Minority Scholarships

A $50,000 thank-you to Patrick Y. Leung, MD, a family physician from Midland, for his huge donation to the TMA Foundation in support of the TMA Minority Scholarship Program. The new TMAF Patrick Y. Leung, MD, Minority Scholarship Endowment is the first endowment for this program, which provides cash grants to entering first-year students at each of the state’s medical schools. “It is a great feeling to know that you are helping to build the medical profession in Texas and leaving a legacy for years to come,” said Dr. Leung, who was honored along with his wife, Nancy, at a reception at 2015 TMA Fall Conference. Since 1999, TMA has awarded 101 scholarships totaling $505,000, thanks to generous gifts from donors to the TMA Foundation.

Counties, Practices Come Up Big for TEXPAC

Medicine can’t be the real force you need at the Texas Legislature and U.S. Congress until we can grow TEXPAC into a competitive force in politics. To keep our membership numbers headed upwards, TEXPAC has organized friendly competitions among our county medical societies and special awards for physician practices with 100-percent membership in the PAC. The winners were announced at the packed TEXPAC meeting at 2015 TMA Fall Conference:
  • Among the large counties, Harris County Medical Society brought in the most donations and the most members. Among mid-size counties, Denton County Medical Society raised the most, and Lubbock-Crosby-Garza County Medical Society signed up the most members. The Gregg-Upshur County Medical Society took the honors in both categories among the small counties.

  • The 100-percent membership practices honored were: Anesthesia Associates of Beaumont, Greater Houston Anesthesiology, Kelsey-Seybold Clinic (Houston), Radiology Associates of North Texas (Fort Worth), South Texas Radiology Group (San Antonio), Texas Colon & Rectal Surgeons (Dallas), and Victoria Women’s Clinic. Thank you!

Another Post-Tort Reform Record for New Texas Physicians

As it has for four of the past seven years, the Texas Medical Board licensed a record number of new physicians for the fiscal year that ended Aug. 31, surging past the 4,000 mark for the first time in history. The board licensed a record 4,295 new Texas doctors last year, up 301 (7.5 percent) from the previous year’s record of 3,994. The number of license applications received (5,377) also broke the record of 5,150 set in 2014. “Twelve years since the passage of our historic 2003 medical liability reforms, we continue to attract new physicians to Texas in record numbers,” said Austin internist Howard Marcus, MD, chair of Texas Alliance For Patient Access. “I don’t at all find that to be a coincidence.”

Tuesday, September 22, 2015

TMA Leaders Forecast the Future on Critical 2017 Legislative Issues

What steps can we take today that will help convince the 2017 Texas Legislature to raise physicians’ Medicaid payment rates? Which nonphysician practitioner group will be most creative in its 2017 push to expand its scope of practice? What tactics will serve us best in the 2017 battle to preserve balance billing? Those are the kinds of questions Texas medicine’s leaders will tackle at a special meeting this week at the start of the TMA 2015 Fall Conference. The group, convened by the TMA Board of Trustees, includes the chairs of all TMA councils and the presidents and CEOs of our largest county medical societies. The issues we’ll examine include scope of practice, the corporate practice of medicine, telemedicine, Medicaid, balance billing and transparency, and end-of-life care.

ICD-10 Coding Tool Available for Members

Are you and your staff ready to pluck the correct code from the thousands of possibilities when the nation’s health care payment systems switch to ICD-10 on Oct. 1? Even assuming that all the electronic systems from here to the payers work correctly, you won’t get paid correctly if you use the wrong code. And you might not get paid at all. To help you get it right the first time, TMA is offering members the e-MDs ICD-10 Code Search Tool. ”Using a combination of keyword filters, anatomical locations, gender, and age, the tool offers a highly intuitive way to build a narrow list of billable ICD-10 codes based on user preferences,” as our marketing team puts it. For practices still trying to get all their ICD-10 ducks in a row, we also are rebroadcasting our Essentials in ICD-10 Coding seminar on Friday, Sept. 25, from 12:30 to 3:30 pm CT.

Dr. Garcia Shares Legislative Box Score

With Major League Baseball’s playoffs just a few weeks away, TMA President Tom Garcia, MD, is using some familiar baseball analogies in his visits around the state. Last week, he made two stops in San Antonio, sharing TMA’s 2015 legislative box score with members of the Bexar County Medical Society and with the Baptist Health System’s Physician-Hospital Organization. He spoke of the home runs we hit: funding for graduate medical education, big reforms in Medicaid fraud and abuse investigations, e-cigarette regulation, tax relief, and elimination of the occupation tax and the state controlled-substance permit. He described the “perfect game” we pitched on scope of practice issues. But he also pointed out that we failed to score on Medicaid payment increases, and on some public health improvements and insurance reforms. Those losses, of course, illustrate why we need more members to join TEXPAC to help us elect more medicine-friendly legislators.

TMA PracticeEdge Bringing Purchasing Heft to Physicians’ Practices

Hospital organizations traditionally have generated the greatest amount of savings from Group Purchasing Organizations (GPOs) by leveraging their centralized financial management systems. However, independent medical practices that consistently apply a GPO purchasing strategy have been able to obtain annual savings of 10 to 15 percent. Later this fall, TMA PracticeEdge will roll out a purchasing program with the largest GPO in the country focused on the needs of independent physicians. The program can add value to all TMA members regardless of practice type or specialty. If you are interested in leveling the purchasing playing field with the hospitals, contact TMA PracticeEdge for more information via email or by calling (888) 900-0334.

The Early Bird Gets Employment Tips at 2015 TMA Fall Conference

If you’re planning to sign or renew a physician employment contract soon, you’d better not miss the Dawn Duster session at TMA’s 2015 Fall Conference on Saturday. The Philip R. Overton Annual Lectureship in Medicine and the Law presents a one-hour seminar on the topic, from 7:30 to 8:30 am, by Mike Kreager, president of the Kreager Mitchell law firm, and TMA General Counsel Rocky Wilcox. Fall Conference meetings start late on Thursday and run through Saturday afternoon. I’m excited about this event, and Texas physicians seem to be as well. Conference preregistration numbers are running about 25 percent ahead of last year. Online registration is now closed, but you can register for free on site at the Hyatt Lost Pines in Bastrop. Our room block at the Hyatt is sold out; see the TMA website for lodging options.

Monday, September 14, 2015

TMA PracticeEdge Moving Forward With Five ACOs, Chronic Care Management

After review last week from its Board of Managers, TMA PracticeEdge now has plans to help five groups of TMA physicians implement accountable care organizations (ACOs). In addition to two previously announced ACO projects in Houston and Central Texas, TMA PracticeEdge is poised to move ahead with three more. The five projects include more than 170 physicians and cover 26,000 patient lives. I’ll soon be sharing more details about the three new ACOs as well as about a plan to provide practices technology and tools to take part in Medicare’s Chronic Care Management (CCM) program. Read more about CCM in this month’s Texas Medicine. To find out more about how TMA PracticeEdge can help your practice, send an email or call (888) 900-0334.

ICD-10 Webcast Offers Last-Minute Training

Medicare’s half-hearted attempt at a reprieve notwithstanding, the deadline for switching to the ICD-10 code set is still Oct. 1. To put it bluntly, if you don’t use ICD-10 codes starting Oct. 1, you won’t get paid. A widely publicized TMA survey released last month found that nearly two-thirds of Texas physicians have little or no confidence that their practice is prepared to transition to ICD-10 by the deadline. And three-quarters said they either have not started or have made only some of the switch to the new system; solo practitioners are especially behind. To help you try to catch up, we are rebroadcasting our Essentials in ICD-10 Coding seminar on both Sept. 18 and Sept. 25, from 12:30-3:30 pm CT. This webcast dives into the ICD-10-CM code set and delivers a deeper understanding for staff who touch diagnosis data — managers, billers, coders, and front desk and clinical staff. Receive detailed answers to your ICD-10 questions and gain confidence in working with these codes. Registration is still open.

Two Former Health Commissioners Help Public Health Coalition Plan For the Future

The Texas Public Health Coalition — of which TMA is a charter member — has played a key role in educating state lawmakers and their staff on the state’s public health problems and in passing legislation to address those problems. This year’s victories included better funding for chronic disease prevention programs and cancer screening, passing the bill to regulate the sale of e-cigarettes, and passing the bill to strengthen Texas’ immunization registry. But coalition members are hungry for more. Former Texas health commissioners David Lakey, MD, and Eduardo Sanchez, MD, led a day-long strategic planning retreat to explore how the coalition can expand its influence. TMA Foundation President Deborah Fuller, MD, and TMA Council on Science and Public Health Chair Wesley Stafford, MD, provided additional insight.

2015 TMA Fall Conference Program Touches All the Bases

Our 2015 Fall Conference at the Hyatt Lost Pines in Bastrop is less than two weeks away. In addition to three days of TMA board, council, and committee meetings, the diverse conference General Session program on Saturday, Sept. 26, offers physicians up to 3.75 hours of free continuing medical education credit. Learn about physician employment contracting, our successes and failures in the 2015 Texas Legislature, what makes health care news at the state Capitol, medical education redesign, and hepatocellular carcinoma in Texas. The conference is free for TMA members, and registration is still open. Our room block at the Hyatt is sold out; see the TMA website for lodging options.

TMA to Feds: Pay Doctors for Medicare Hassles

The TMA Council on Socioeconomics has a strong message for the Centers for Medicare & Medicaid Service (CMS): Increase physicians’ Medicare pay to cover all the new federal mandates or see physician participation in the program continue to fall. “The growing Medicare administrative burden, added to the recent history of and future plans for inadequate fee updates, is making Medicare participation and compliance increasingly difficult and costly for practicing physicians, and will impair access to care for Medicare beneficiaries,” Council Chair Joe Valenti, MD, wrote in a formal comment letter to CMS. “When Medicare adds administrative burdens, those added burdens should be accompanied by RVU [relative value unit] or conversion factor increases to offset the added costs.” The letter is a response to CMS’ proposed 2016 Medicare physician fee schedule.

Make an August House Call on Your U.S. Senators and Representative

This month, members of Congress will be home for the August recess. The Texas Medical Association urges physicians to make appointments with your U.S. representatives in August to share medicine’s prescription for federal health care changes.

In meeting with U.S. Sens. John Cornyn and Ted Cruz and your U.S. representative (find contact information on the TMA Grassroots Action Center), TMA encourages you to discuss these critical issues pending in Washington:

 Maintenance of Certification
Language in the bill that repealed the Medicare Sustainable Growth Rate formula leaves many physicians worried that Maintenance of Certification will become a condition for participation in Medicare, Medicaid, and other government health care programs.

TMA is asking Congress to clarify that there is not and will not be such a requirement.

 ICD-10 Transition
The Centers for Medicare & Medicaid Services (CMS) announced a one-year “grace period” protecting physicians from the coding errors and technical glitches that likely will accompany the Oct. 1 mandatory transition to the ICD-10 coding system. This is a start, but just a start. The press release is long on words but short on action.

TMA is asking Congress to maintain strict oversight of the ICD-10 rollout, be prepared to act quickly in the event of a technical disaster, and to ensure that:
  • Claims will not be reduced or denied based on failure to fully comply with the new coding system,
  • Physicians will not be penalized or audited for errors or malfunctions of CMS’ systems, and
  • CMS makes advance payments available to help physicians experiencing serious payment delays.
 RAC Audits
Medicare pays recovery audit contractors, or “RACs,” like bounty hunters to find overpayments made to physicians and health care providers. This provides these contractors incentives to disrupt doctors’ practices as they comb through patient files looking for the tiniest of errors.

TMA is asking Congress to establish incentives for RACs to make more accurate audit findings, to reduce the period for which claims may be audited, to direct RACs to focus only on practices with demonstrated inappropriate billing patterns, and to provide due process and fair procedures for physicians who are subject to a RAC audit. Please ask your member of the Texas delegation to sign on as a cosponsor of HR 2568, the Fair Medical Audits Act of 2015, by Rep. George Holding (R-N.C.).

 Physician-Owned Facilities
Section 6001 of the Affordable Care Act (ACA) prohibits new doctors from investing in hospitals that take Medicare patients; no physician-owned hospitals may start nor may current ones expand. This significantly inhibits physicians’ legal right to own or invest in hospitals and other facilities that provide their patients high-quality care. TMA strongly supports responsible physician investment in technology, facilities, services, and equipment. Congress should focus not on who owns the medical facility but on the quality of the facility and appropriateness of patient care.

TMA is asking Congress to repeal Section 6001 of the ACA.

 Site-of-Service Differential
Medicare typically pays two to three times as much for a service or procedure provided in a hospital clinic or outpatient department as it does for the same service or procedure done in a physician’s office. The purported rationale is to help hospitals cover the costs of expensive operations such as laboratories and emergency rooms.

TMA is asking Congress to require Medicare to pay appropriately for services and procedures regardless of where they are performed instead of paying hospitals more in one area and then cost-shifting.

 Medical Education
Medicare payments to residency programs for graduate medical education (GME) have been frozen since 1997. This has placed increasing pressure on governments, medical schools, and hospitals in fast-growing states like Texas to find ways to establish enough residency slots to keep up with demand for new physicians. In addition, most of the Medicare funding for GME flows to hospitals even though a large portion of residency training now takes place in outpatient settings.
We need to make sure Congress continues to provide opportunities for graduate medical education to ensure we have appropriate numbers of health professionals to meet the needs of 21st-century America.

 Direct Contracting
The Medicare Patient Empowerment Act would allow seniors to use their current Medicare coverage to see a doctor who is not accepting Medicare. It would strengthen patient choice and access to physicians. It would ensure that seniors can see any doctor they choose and still use the Medicare benefits for which they have paid, without having to change their Medicare plan. The act would allow Medicare patients and their physicians to enter into private contracts without penalty.
TMA is asking Congress to pass the Medicare Patient Empowerment Act.

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.

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.

TMA Foundation Hits $5 Million Milestone

Since its inception in 1993, the TMA Foundation (TMAF) has awarded more than $5.1 million in health improvement grants to TMA, county medical societies and alliance chapters, medical student groups, and other organizations. A record-setting gala at TexMed 2015 is helping to refill the TMAF coffers. Under the leadership of co-chairs Drs. Michelle Berger, David Tobey, Susan Pike, and Harry Papaconstantinou, the May 1 event raised more than $386,000. You can help extend that record thanks to a new challenge grant from the John P. McGovern Foundation, which will match donations up to a total of $10,000. TMAF proceeds support such TMA programs as Hard Hats for Little Heads, the Minority Scholarship Program, and Walk With a Doc Texas.

EVPGram Takes July 4 Holiday

In honor of the 239th anniversary of the birth of our great nation, EVPGram won’t publish next week. We’ll be back in your inbox on July 13.

Tuesday, June 23, 2015

Governor Signs TMA “Home Runs” Into Law

Gov. Gregg Abbott completed his review of the 2015 Texas Legislature’s work, signing or allowing into law about 1,400 bills and resolutions, and issuing veto proclamations for 42 others. Over the past week, the governor put his signature on most of TMA’s major legislative successes, including:
  • Big increases in funding for new graduate medical education programs, mental health, and women’s health;
  • Significant reforms of how the state investigates and prosecutes suspected Medicaid fraud;
  • Elimination of the state Controlled Substances Registration program;
  • Elimination of the $200 annual occupation tax that all physicians pay;
  • ID card requirements for patients covered by Affordable Care Act (ACA) marketplace plans;
  • Retention of vaccination records in ImmTrac until age 26;
  • Tougher network accountability requirements for Medicaid HMOs; and
  • Enhanced liability protections for physicians using health information exchanges.

TMA Working Multiple Fronts on ICD-10

As the Oct. 1 deadline for transitioning to the ICD-10 coding system draws closer, TMA is working with other state medical societies to stop or delay the change or soften its blow. We continue to support HR 2126, the Cutting Costly Codes Act of 2015, by U.S. Rep. Ted Poe (R-Houston), to stop the implementation of ICD-10 outright. Last week, we joined with the California, Florida, and New York state medical associations in a letter asking the Centers for Medicare & Medicaid Services (CMS) to adopt a two-year, penalty-free, ICD-10 grace period. Writing on behalf of more than 120,000 physicians and medical students, we asked for:
  • A two-year period during which physicians will not be penalized for errors, mistakes, and/or malfunctions of the system;
  • A two-year period in which physicians will not be subject to special Medicare-payment audits due to ICD-10 coding mistakes;
  • A two-year period during which physician payments will not be reduced or withheld based on ICD-10 coding mistakes; and
  • Advance payments in the event that claims are delayed.
We are working with those same states and the larger Coalition of State Medical Societies on several other bills in Congress that would force CMS to mitigate the ICD-10 impact on physicians. We’re also putting the finishing touches on our August and September ICD-10 workshops for physicians and staff, and we offer several outstanding ICD-10 planning webinars, podcasts, and publications in the TMA Education Center.

Nation Braces for Supreme Court ACA Ruling

Unclear and uncertain. That’s the forecast for the U.S. Supreme Court’s expected ruling on the King v. Burwell case challenging subsidies for patients who sign up for ACA plans in insurance exchanges run by the federal government. Unclear, of course, is exactly how the court will decide the case and whether it will rule illegal the subsidies in the 34 exchanges that aren’t run by state governments. Texas is one of those 34. Also unclear is how much or how little of the rest of the ACA will be affected by the decision. Uncertain is the response by President Obama or the Republican-led Congress to a ruling that tosses the subsidies. Also uncertain is how such a decision would affect the 1 million or so Texans who have purchased subsidized plans, or the physicians who care for them. Over the years, TMA has proposed private-sector and public-private partnership solutions designed to provide marketplace incentives to increase coverage. We still believe that those proposals, along with needed improvements to Texas’ Medicaid program and other ACA changes we support, can provide better access to quality care for all Texans.

Let Our Doctors Own

Speaking of the ACA, we are once again working with the Coalition of State Medical Societies and Congress to reverse the ACA-imposed ban on physician-owned hospitals. The ACA makes future hospital ownership illegal for physicians who go to medical school, obtain a license to practice medicine, care for Medicare patients, and then want to refer their Medicare patients to a hospital in which they may have ownership. TMA promotes responsible ownership of all health care facilities, whether owned by a physician, hospital, or other provider.

TMA PracticeEdge Hits 100-Physician Mark

Thanks to some strong recruitment efforts, the three nascent accountable care organizations under contract with TMA PracticeEdge now have 100 physicians within their folds. TMA PracticeEdge services help physicians transform their practices so they can remain independent and compete in a pay-for-performance environment. Learn more on the website or call (888) 900-0334.

Brotherton Takes Helm at CEJA

Former TMA President Steve Brotherton, MD, of Fort Worth is the new chair of the AMA Council on Ethical and Judicial Affairs. He assumed his post earlier this month just as Cliff Moy, MD, of Frisco finished his term as chair of the Council on Long Range Planning and Development.

Monday, June 15, 2015

States, AMA Seek Two-Year ICD-10 Grace Period

We still want to stop the mandatory implementation of the ICD-10 coding system on Oct. 1. But the congressional tea leaves don’t look very promising right now. That’s why the Texas Delegation to the American Medical Association House of Delegates worked hard to pass a resolution that offers physicians a solid backup plan. Today, we are finalizing a letter — along with the three other largest state medical societies — calling on the acting administrator of the Centers for Medicare & Medicaid Services (CMS) to implement a two-year grace period during which:
  • Physicians will not be penalized for errors, mistakes, and/or malfunctions of the system; and
  • Physician payments will not be reduced or withheld based on ICD-10 coding mistakes.
Coming next will be a call for physicians to write Congress to ask our senators and representatives to push CMS on the grace period. “The bottom line is that ICD-10 will significantly overwhelm physician practices with a 400-percent increase in the number of codes physicians must use for diagnosis, which will take time away from the valuable one-on-one patient-physician interface that is the hallmark of taking the best care of patients,” said AMA Trustee Russ Kridel, MD, of Houston. “Coding and billing protocols should never get in the way of patients receiving high-quality care.”

Box Score: Home Runs and Solid Defense Mark Legislative Session for Medicine

We’re working on our wrap-up document from the 2015 Texas Legislature, using a baseball box score analogy to mark our wins and losses. Today I want to share a sneak peek on a few issues:
  • Home Run: Graduate medical education (GME) funding gets a big boost in the 2016-17 state budget. Our goal is to have 1.1 entry-level residency positions for each graduating medical student. That would ensure we have enough slots for the Texas students who want to stay here and to recruit from other states. To meet that goal, we need to add almost 600 GME positions by 2022. Lawmakers appropriated enough money for the next two-year budget to keep the new positions they added in 2013 and to create up to 125 new slots. The Legislature also passed a separate bill to create a permanent endowment of roughly $300 million to be used solely to help expand GME starting in fiscal year 2018. Thanks goes to Sen. Jane Nelson (R-Flower Mound), the Senate Finance Committee chair, for making this one of her priorities.

  • Home Run: TMA collaborated with associations representing a total of 600,000 Texas professionals to win passage of House Bill 7 by Rep. Drew Darby (R-San Angelo) and Senator Nelson, which eliminates the $200 occupation tax physicians pay each year. Gov. Greg Abbott signed the bill today.

  • Home Run: You won’t need a state controlled substance permit starting Sept. 1, 2016, because we passed Senate Bill 195 by Sen. Charles Schwertner, MD (R-Georgetown), and Rep. Myra Crownover (R-Denton). The bill also moves the Prescription Drug Monitoring Program from the Texas Department of Public Safety to the Texas State Board of Pharmacy.

  • Perfect Game: Once again, not a single bill passed that would expand midlevel practitioners’ scope of practice beyond what is safely within their education, skills, or training. Many lawmakers, Republican and Democrat, in the House and Senate, stood with us on these bills.

Texans in Congress Push for Smooth ICD-10 Transition

Led by Rep. Kevin Brady (R-The Woodlands), members of the House Ways and Means Committee are asking CMS to reassure physicians that the Oct. 1 ICD-10 implementation “will not cause widespread disruption.” In a letter to CMS Acting Administrator Andy Slavitt, Representative Brady, Rep. Sam Johnson (R-Richardson), and 12 other committee members outlined steps the agency can take to instill confidence and address concerns among physicians and the public. Tops on the list:
  • Make public any contingency plan for how Medicare will process claims if CMS cannot process ICD-10 diagnosis codes on Oct. 1, and
  • Indicate whether claims must include the ICD-10 diagnosis code with the highest level of specificity immediately upon the Oct. 1 effective date or whether a clinically accurate but less granular code will be accepted.

More Texans Win AMA Leadership Posts

Last week we reported that former TMA President Sue Bailey, MD, was elected speaker of the AMA House of Delegates. I want to congratulate these new and returning AMA leaders from Texas:
  • Dallas internist Lynne Kirk, MD, reelected to the AMA Council on Medical Education;
  • Theresa Phan of Texas Tech University Health Sciences Center in Lubbock, the new vice speaker of the AMA Medical Student Section (MSS);
  • Former Texas medical student Ben Karfunkle, MD, of Louisiana, chair of the AMA Resident and Fellow Section (RFS) Region 3;
  • Rie Sharky, MD, of Dallas, vice chair of AMA RFS Region 3;
  • San Antonio medical student Jennifer Nordhauser, chair of AMA MSS Region 3; and
  • Jerome Jeevarajan, a student at The University of Texas Southwestern Medical Center, elected legislative chair of AMA MSS Region 3.