TMA EVPGram

PAI Takes on Insurance Mega-Mergers

2015-12-14T15:15:00.002-06:00

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

2015-12-14T15:13:00.003-06:00

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

2015-12-14T15:12:00.002-06:00

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”

2015-12-14T15:11:00.002-06:00

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

2015-12-14T15:09:00.005-06:00

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:

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.
You ensure that your membership won’t lapse.
You get a free copy of our 130-page Business Basics for Physicians publication.

Happy Holidays From EVPGram

2015-12-14T15:08:00.003-06:00

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.

Send Us Your Out-of-Network Problems

2015-12-07T14:53:00.003-06:00

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

2015-12-07T14:51:00.004-06:00

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

2015-12-07T14:50:00.005-06:00

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

2015-12-07T14:49:00.001-06:00

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

2015-12-07T14:47:00.003-06:00

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

2015-12-07T14:46:00.003-06:00

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.

TMA Says Future Medicare Requirements Are Wasteful, Costly

2015-11-23T11:20:00.002-06:00

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

2015-11-23T11:19:00.002-06:00

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 — Montaño 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

2015-11-23T11:17:00.004-06:00

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

2015-11-23T11:16:00.003-06:00

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

2015-11-23T11:14:00.001-06:00

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

2015-11-23T11:13:00.003-06:00

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.

Young Texans Win AMA Posts

2015-11-17T11:10:00.003-06:00

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

2015-11-17T11:07:00.003-06:00

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

2015-11-17T11:04:00.002-06:00

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

2015-11-17T11:03:00.002-06:00

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?

2015-11-17T11:02:00.002-06:00

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

2015-11-17T11:00:00.001-06:00

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).

Brady Wins Key House Leadership Spot

2015-11-09T14:32:00.001-06:00

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.