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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 Congress took care of our top “find it” priorities earlier this year when it repealed Medicare’s Sustainable Growth Rate formula and guaranteed that the ACA won’t topple Texas tort reforms.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.

Monday, June 8, 2015

Dr. Bailey Elected Speaker of AMA House of Delegates

With an uncontested race, the outcome was all but certain ... but the celebration was real. After a four-year stint in the No. 2 spot, Fort Worth allergist and former TMA President Sue Bailey, MD, won election as speaker of the American Medical Association House of Delegates. She moved up one notch after the current speaker — Andy Gurman, MD, of Pennsylvania — was chosen AMA president-elect. “I love this house, and I love this organization,” Dr. Bailey said after the delegates elected her by acclamation. David Henkes, MD, of San Antonio, chair of the Texas Delegation to the AMA, placed Dr. Bailey’s name in nomination. “Sue Bailey is a good person, a nice person, a wise person, and a wonderful mentor,” Dr. Henkes said. “I guarantee you, the physicians of Texas would follow wherever she leads — and this house would be well-advised to do the same.” Elections in contested AMA races are tomorrow. Dallas internist Lynne Kirk, MD, is one of three incumbents — and six candidates total — running for four seats on the AMA Council on Medical Education.

Video Outlines Medicine's Wins and Losses in Texas Legislature

The 84th Texas Legislature adjourned for good June 1. Our latest Legislative News Hotline video features TMA chief lobbyist Darren Whitehurst summarizing the session’s outcome for organized medicine and patient care. Darren breaks it down into four segments: (1) bills TMA sought that did not pass, (2) bills TMA did not support that did pass, (3) bills TMA opposed that died during the course of the session, and (4) bills TMA supported that passed both chambers.


Governor Vetoes Two Mental Health Bills

The day after Texas lawmakers went home, Gov. Greg Abbott pulled out his veto pen and dispatched a pair of TMA-supported mental health bills. Senate Bill 359 would have allowed a four-hour emergency department hold for a mentally ill patient the physician believes is a danger to self or others. “TMA is extremely disappointed in Governor Abbott for vetoing a bill that would have saved lives, provided short-term help for people with mental illness, and actually would have kept some of them out of forced imprisonment,” TMA President Tom Garcia, MD, told the media. “The governor should have reached out to physicians and other medical personnel who provide care in the real world of our emergency rooms before vetoing this legislation.” The governor also vetoed House Bill 225, which would have protected from prosecution people who seek emergency care for someone suffering a drug overdose. It also would have allowed first responders to administer an opioid antagonist to save someone from a potentially fatal overdose. Senate Bill 1462, which is still awaiting the governor’s action, also contains the opioid antagonist language.

Dr. Janek Out, Chris Traylor In as HHS Executive Commissioner

Texas Health and Human Services Executive Commissioner Kyle Janek, MD, will step down from his post on July 1, Governor Abbott announced. Dr. Janek, an anesthesiologist, had served in the top spot since 2012. Chris Traylor, the commission’s No. 2 officer and a former state Medicaid director with whom TMA has worked for years, will take over as head of the $35 billion agency.

AMA House Looks to Stop ICD-10, Protect Physicians From It

Staring down the muzzle of the Oct. 1 mandatory deadline to implement the ICD-10 coding system, the AMA House of Delegates is searching for multiple ways to help U.S. physicians dodge a dangerous bullet. Greg Fuller, MD, a family physician from Keller, said the wide array of medical problems primary care physicians treat is forcing them to try to learn thousands of new codes. “We need to stop ICD-10,” Dr. Fuller told the Reference Committee on Legislation. “Any delay in pay is going to kill these practices.” While AMA and TMA continue to back legislation to stop the switch to ICD-10, Washington observers say Congress has no stomach for another delay. Groups like AMA and TMA must continue to push for a last-minute reprieve and at the same time work to protect their members from the likely upheaval that will come with ICD-10, said TMA Trustee Gary Floyd, MD. “Our message is this,” Dr. Floyd said. “Don't give up the ship, but make sure the lifeboats are manned and at the ready.” In testimony before an AMA reference committee, Dr. Floyd and others outlined a series of protections they want AMA to request from the Centers for Medicare & Medicaid Services: two years with no penalties for incorrect coding; two years with no bounty-hunting auditors looking for coding errors; a promise of no delay in payments to physicians; and acceptance of ICD-10 codes with less-than-optimal degrees of specificity.

TMA Members Get Discounted HIPAA Security Compliance Tool

The Online HIPAA Security Manager is now available to TMA members at a group member discount starting at $99 per month. The tool offers HIPAA risk analysis, access to HIPAA experts who identify deficiencies and make recommendations, a dashboard to see risks to security and compliance, automatic documentation of HIPAA activities, online training, and more. We’ve set up free, 30-minute training and overview webinars on the tool at noon (CT) on June 9, 18, and 23. Read more about the tool and the webinars on the TMA website.

Monday, June 1, 2015

Medicine Stands Tall as Legislature Adjourns

Medicine’s advocates walk away from the 84th Texas Legislature, which ends today, with heads held high. The physicians who contacted their representatives and senators; the dozens who testified before committees; the hundreds who took part in First Tuesdays at the Capitol; and the staff at TMA, county medical societies, and state specialty societies all played important roles. Physicians won relief from a major practice hassle, increases in graduate medical education (GME) funding, big changes in Medicaid operations, health insurance reforms, and victories in the public health and mental health arenas. Among the most important victories:
  • Funding to expand GME slots received a $40 million boost; 

  • Texas’ Controlled Substance Permit will be eliminated as of Sept. 1, 2016;

  • Absolutely none of the proposed dangerous expansions of mid-level practitioners’ scope of practice passed;

  • Two priorities of TMA’s Behavioral Health Task Force won approval;

  • TMA stopped several bills that would have banned balance billing for out-of-network services;

  • E-cigarette sales to minors were outlawed; and

  • Physicians’ annual $200 occupation tax was repealed. 
Unfortunately, efforts to boost Medicaid payment rates and some other pieces of TMA’s Health Vision 2020 plan came up short. We’ll have to keep working on those for next session. Also, the bill banning texting while driving died in the Texas Senate, our bill prohibiting health plans’ use of virtual credit cards to pay for health care services didn’t make it through the House, and a measure allowing the use of low-THC cannabinoid oil will get Gov. Greg Abbot’s signature.

For more details, look for a special issue of Action later this week, a video wrap-up in Friday’s TMA Legislative News Hotline, and a full review of the session in the August issue of Texas Medicine.

Three Bills Already Signed by Governor Abbott

Governor Abbott already has signed three of medicine’s bills into law, and he allowed a fourth to take effect without his signature. They are:
  • E-cigarettes: Senate Bill 97 by Senator Juan “Chuy” Hinojosa (D-McAllen) and Rep. Carol Alvarado (D-Houston) outlaws minors’ ability to buy e-cigarettes and similar vapor products. It prohibits students or others from using vapor products at school-related or school-sanctioned events, on or off campus. It takes effect Oct. 1.

  • EpiPens: Senate Bill 66 by Senator Hinojosa and Rep. Myra Crownover (R-Denton) allows schools to stock epinephrine auto-injectors for school personnel to use on any student who suffers an anaphylactic reaction at school. It includes liability protections for physicians and health care providers. It takes effect immediately.

  • Direct Primary Care: House Bill 1945 by Rep. Greg Bonnen, MD (R-Friendswood), and Sen. Kelly Hancock (R-North Richland Hills) applies to physicians and patients who contract for primary care outside of the structure, restrictions, and hassles of a health insurance plan. The bill clarifies the definition of “direct primary care” and provides important protections for physicians and patients who use this model of health care. It takes effect Sept. 1.

  • ID Badges: Senate Bill 1753 by Sen. Donna Campbell, MD (R-New Braunfels), and Rep. Sarah Davis (R-West University Place) requires hospitals to spell out, in plain English, whether a person wearing a hospital ID badge is a “physician,” a “dentist,” a “therapeutic optometrist,” a “clinical nurse specialist,” etc. This bill became law without the governor’s signature.

A Big Thank You to Our Physician Witnesses

In every week’s EVPGram, I’ve tried to make it a point to thank the physicians who take time — usually an entire day — away from their practices to testify before a House or Senate committee on behalf of TMA. Along with the doctors, students, and TMA Alliance members who visited legislators’ offices during First Tuesdays, these physician-witnesses speak eloquently on behalf of your patients and your profession. This is an invaluable key to our legislative success. I specifically want to thank San Antonio pediatrician Ryan van Ramshorst, MD, who testified eight times this session.

Talking TMA PracticeEdge at Western Healthcare Leadership Academy

Doug Curran, MD, chair of the TMA Board of Trustees, and I had the great privilege to participate in the Western Healthcare Leadership Academy in Hollywood, CA. We made a presentation on TMA PracticeEdge, our new health care services company designed to help physicians maintain their independence. The company continues to grow, and I look forward to announcing the acquisition of our latest group of physician clients very soon. To learn more about TMA PracticeEdge, visit www.TMAPracticeEdge.com, email info@TMAPracticeEdge.com, or call (888) 900-0334.

Judge Allows Teladoc Lawsuit to Continue

Late Friday, a federal district judge in Austin ruled that the Texas Medical Board’s (TMB’s) new rules on telemedicine will not take effect while a suit challenging those rules moves forward. The suit was filed by Dallas-based Teladoc. “TMA is sorely disappointed with the court’s decision allowing the writing of prescriptions for dangerous drugs without first establishing a patient-physician relationship,” TMA President Tom Garcia, MD, said after the decision was announced. “Protecting patient health and safety and improving the quality of patient care are the TMB’s responsibilities. TMA supports the challenged rules and believe they fulfill the board’s mission.”