Jul 30, 2013

When Will I Have to Use an EHR?

We get asked this question all the time: "When, by law, do I have to switch from paper records to an electronic health record (EHR)?"

The answer is delightfully simple and maddeningly complex. No law says you have to switch to an EHR. But Medicare will hit you with a nasty payment hammer if you don't.

Read all the details.

Jul 29, 2013

Help on the Way

From health care problem, to TMA solution, here's the story behind the birth of TMA's Physician Services Organization for Patient Care. It's designed to deliver doctors the survival tools they need to provide demonstrably better and more efficient patient care and compete in today's health care marketplace.


“I am confident the Physician Services Organization for Patient Care will save local practices,” said TMA President Stephen L. Brotherton, MD. “Texas doctors are determined to make health care better and more affordable for Texans.

“To do that, we need to shift the balance of power away from the government, the health insurance companies, and the large hospital systems and back to the patients and their physicians.”

TMA’s Physician Services Organization for Patient Care is a physician-led organization that will offer services to bolster physicians’ clinical and financial autonomy. In addition to TMA, the Dallas County Medical Society (DCMS) and Harris County Medical Society (HCMS) are key members of the organization. The center will bring in new and existing physician groups, health plans, and technology vendors as needed to test and develop effective new care models.

Read more at www.texmed.org/tmapso.

Will the ICD-10 Switch Cost Me Money?

Moving from ICD-9 to ICD-10 will result in lost revenue. It is unavoidable. Practices can expect a 20-percent to 40-percent loss of productivity in the first three to six months after ICD-10 takes effect on Oct. 1, 2014, says Denny Flint of Complete Practice Resources in this video interview with TMA Practice Management Consultant Heather Bettridge.

Practices that prepare well in advance for the change will fare best, Mr. Flint noted. TMA can help you prepare. Visit our ICD-10 Video Vault for more quick Q&As covering a variety of ICD-10 topics. Be sure to bookmark TMA’s ICD-10 resource page for news, tools, education, and updates.

Jul 27, 2013

Stuck in the Medicare-Won't-Pay-for-an-Incarcerated-Patient Runaround? It Just Got Worse

Did you get a payment demand letter from Medicare because it paid a claim for a patient who was incarcerated on the date of service? Please note: Your instructions have changed!

Find out what this is all about and how tangled up it has become. We just don't know why it's gotten this bad, yet. But, as always, TMA is on it.

Jul 17, 2013

ICD-10: 442 Days and Counting

The remaining time before the ICD-10 transition date is short, especially given the amount of preparation that must be completed. This transition to a new coding system is primed to be the most challenging initiative since the inception of medical coding.

Find out how TMA can help.

Jul 15, 2013

Working With Vendors Toward ICD-10

Vendors are key partners who can help you prepare for ICD-10. Assess a vendor’s capabilities by answering these questions:

Well, where are the questions? Check it out here.

Jul 13, 2013

What Employer Mandate Delay Means for Your Practice

Physicians who have 50 or more employees have another year to comply with the "employer mandate" of the Patient Protection and Affordable Care Act (PPACA). The law requires employers with 50 or more employees to offer health insurance coverage or pay a penalty.

Read more.

Jul 12, 2013

Three Newly Common Medicare Claims Errors You Can Avoid

Novitas identified the top Medicare claim submission errors for Texas the first quarter of 2013. These three on the list are new compared with those reported in December 2012.

  1. Patient/insured health identification number and name do not match.
  2. Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement.
  3. The benefit for this service is included in the payment/allowance for another service or procedure that has already been adjudicated.

Learn more about these errors and pick up some tips on how to avoid them.

Jul 11, 2013

Texas Medical Records Law Provisions Eased

The 2013 regular session of the Texas Legislature brought relief from some burdensome provisions of Texas’ medical record privacy law. Senate bills 1609 and 1610 alter the privacy training requirements and breach notification requirements, respectively. TMA supported these changes to reduce red tape hassles for physician practices. The new provisions of the law are now in effect.

Find out more.

Jul 9, 2013

TMA PSO Seeks Health Care Service, Software Providers

Texas Medical Association’s Physician Services Organization for Patient Care today issued a Request for Information (RFI) for service and software vendors that wish to help the new organization develop and deliver to doctors the survival tools they need to compete in today’s health care marketplace.

“We are looking for the very best vendors, the ones who can help us build the support organization Texas physicians need,” said TMA President Stephen L. Brotherton, MD. “We are looking for firms whose skills and expertise can complement TMA’s outstanding brand image and credibility among Texas doctors.”

Find out more.

Jul 3, 2013

Go Team! Help Grandma!



From the people who brought you "Grandma and the Big, Bad SGR."

Our landmark scope bill that sets up a more collaborative, delegated practice among physicians and advanced practice nurses or physician assistants is now law. Texas Gov. Rick Perry has signed Senate Bill 406 by Sen. Jane Nelson (R-Flower Mound) and Representative Lois Kolkhorst (R-Brenham). The law firmly establishes the physician-led medical team, allows all involved to practice at their level of education and training, and places more authority and responsibility on the physician to supervise. TMA never deviated from the core principle that diagnosing and prescribing remain the practice of medicine. Now we have a process and a model for future scope-of-practice discussions.

This amusing little video demonstrates how Texas physicians and allied health practitioners turned a non-stop legislative battle into a joint bid for common goals.

And in case you forgot how much fun it was, here's the link to the original "Grandma" video.

Jul 2, 2013

4 complaints of physician employees and 1 solution to fix them

by Dike Drummond, MD

Originally published KevinMD.com, June 30, 2013. Reprinted with permission of publisher and author.

Medscape published an article titled, 4 Top Complaints of Employed Doctors, and it was a very interesting read. Turns out the things employed physicians complain about are basically that they are employees.

Let me lay out these employed physicians gripes for you with a little detail so you will see what I mean. I will finish this article with a solid way to address all of them. These gripes are basically a cry for effective physician leadership.

Although the numbers are not exact, these days about half of doctors are employed physicians, either by a hospital, a medical group or a larger healthcare system. That number is rising pretty rapidly as the industry consolidates to grab the bonus pools soon available to groups large enough to qualify as ACOs.

This move to become employed physicians is so popular, I have even seen articles lamenting the death of private practice and killing Marcus Welby.

Here is what Medscape identified as the four things employed doctors dislike the most and my suggestion of the best way to avoid these in your organization.

1. Being bossed around by less educated administrators.  As an employee, you no longer have the final say in the decisions affecting the logistics of your practice. The person actually in charge is often not a physician. They work for the institution, not you. They report to the heads of the administration, not you. They can literally tell you what will and will not be done. You are treated just like any other employee.

The article uses the term “loss of autonomy” over and over again.

You do retain most of your autonomy over clinical decisions in the exam room (notice I said “most”) and lose the decision making power over the way the office/hospital is run.

2. Not being able to make decisions about staff and personnel. That is because you are no longer their boss. You are not the leader/manager/person responsible for any of these decisions in the org chart.  If you had an office manager in your private practice, you probably lost them in the transition. Your medical assistant and receptionists are hired and fired by a middle manager, sometimes without your input, consent or awareness.

3. Having less authority over billing and charge coding. In many cases your employer has a remote and centralized billing office that takes over billing on day one. They may not have much experience with your specialty or outpatient medicine in general. They will require documentation in enough detail to survive an audit. You may not have been as thorough in your private practice as you are required to be now. It can sometimes feel like you have to learn documentation and coding all over again.

4. Being forced to use new equipment and technology. Your employer has their own equipment, EMR, supply chains and procedures. You will now comply with their systems, just like any other employee – systems you did not choose, request or approve along the way.

If a copier breaks down in your office you will have to go through the bureaucracy and policies and procedures to get a new one. That is much more difficult than handing your office manager the credit card and sending them down to the local office supply store to pick up a new one.

In some cases there are reports of groups “telling employed surgeons which kinds of joint implants to use, and according to a New York Times article, even whether to implant defibrillators in Medicaid patients.”

What don’t employed doctors complain about?

Turns out Medscape’s answer is practice guidelines. The reason is simple. Most groups don’t enforce them, yet. Many organizations have established guidelines, they can even be built into the meat of the EMR, however few are strictly enforcing them at this time. As ACOs grow and shoot for quality bonuses, you can certainly expect that to change.

Physician leadership is the answer to these concerns

Leaders have influence and power, Employees do not. So how can physicians get these features of autonomy back as employees? The key is a strong physician leadership structure on the clinical side of the business.

Doctors must step up and play a leadership role within the organization. Don’t fight and object and resist. Dive in and lead. Without strong physician leadership in your organization, you have little or no influence on the administration and in the board room.

It is equally important that you allow your physician leaders to lead. You must allow them to represent you and provide solid input from our clinical side of the house to all the decision making committees in the organization.

Without physician leadership, the gripes will continue and the feeling of powerlessness will not change.

There is a famous quote, “Lead, follow or get out of the way.” My encouragement is that these gripes be addressed by a wave of effective physician leadership that accompanies your move to become an employee. Just because you are not in private practice, does not mean leadership stops. It is perhaps even more important when you are inside MegaHealthCorp than when  you were in private practice.

The two biggest challenges to employed physicians taking this leadership role are:

1. Bandwidth. Where do you find the time for the committee work to represent the doctor’s interests in your busy practice?  Does your organization respect these leadership activities enough to compensate you fairly for them?

2. Learning how to lead inside a large and established bureaucracy. The rules of influence here are very different than in your smaller, physician lead private practice.  It is a whole different ballgame.

The bottom line is some group of physicians in the organization must step powerfully into this new style of leadership. It is the only way the doctors as a group can hope to maintain any influence or autonomy as members of a large group of employed physicians in a much larger organization.

There is an alternative that might become viable in the near future. I will only mention it here. That option is for physicians to unionize.

Dike Drummond is a family physician and provides burnout prevention and treatment services for healthcare professionals at his site, The Happy MD.

Jul 1, 2013

TMA Questions Newest Cigna Red Tape Hassle

TMA believes a Cigna referral policy imposes a red tape hassle on physicians and patients and will ask the Texas Department of Insurance (TDI) to determine if the company has violated the agency's network adequacy rules.

Read more.