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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.