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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.