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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.