Jun 8, 2015

AMA Calls for Two-Year ICD-10 Grace Period If It Can’t Stop the Train

(CHICAGO) – Following up on yesterday’s story (ICD-10: Stop This Freight Train ... Or At Least Install Seat Belts!), we can report that the American Medical Association House of Delegates today unanimously adopted the Texas-backed proposal to ask the federal government to adopt a two-year, penalty-free grace period following the expected Oct. 1 mandatory implementation of the new ICD-10 coding system.

As the Reference Committee on Legislation noted in its report, “Our AMA will continue to prioritize our existing AMA policy that first seeks to stop the implementation of the ICD-10 code set and, only if a delay is not feasible, seek mitigation strategies.”

The delegates voted without objection in support of the grace period plan, which the reference committee cobbled together based on suggestions from the Alabama and Texas delegations as well as other states. The adopted language reads:

If a delay of ICD-10 implementation is not feasible, that our American Medical Association ask the Centers for Medicare & Medicaid Services (CMS) and other payers to allow a two-year grace period for ICD-10 transition, during which physicians will not be penalized for errors, mistakes, and/or malfunctions of the system. Physician payments will also not be withheld based on ICD-10 coding mistakes, providing for a true transition where physicians and their offices can work with ICD-10 over a period of time and not be penalized.

That our AMA educate physicians of their contractual obligations under Medicare and insurance company contracts should they decide to not implement ICD-10 and opt to transition to cash-only practices which do not accept insurance.

That our AMA aggressively promote this new implementation compromise to Congress and CMS since it will allow implementation of ICD-10 as planned, and at the same time protect patients’ access to care and physicians’ practices.

That our AMA provide the needed resources to accomplish this new compromise ICD-10 implementation and make it a priority.

That our AMA seek data on how ICD-10 implementation has affected patients and changed physician practice patterns, such as physician retirement, leaving private practice for academic settings, and moving to all-cash practices and that, if appropriate, our AMA release this information to the public.

Jun 7, 2015

ICD-10: Stop This Freight Train ... Or At Least Install Seat Belts!

(CHICAGO) -- Staring down the muzzle of the Oct. 1 mandatory deadline to implement the ICD-10 coding system, the American Medical Association House of Delegates searched for multiple ways to help U.S. physicians dodge a dangerous bullet.

Thanks to strong lobbying from AMA, the Texas Medical Association, and other physician groups, the original Oct. 1, 2013, ICD-10 deadline has been pushed back twice.

Dr. Fuller testifies at AMA

Both TMA and AMA still formally oppose ICD-10. They've pointed out that many physicians, especially those in small practices, are still not ready to use the new coding language. Some cite the high cost of transition; others blame electronic health record vendors that have not yet made ICD-10-compliant software available. Those who aren't ready run the risk of having all or some of their Medicare, Medicaid, and commercial insurance claims going unpaid.

TMA supports H.R. 2126, the Cutting Costly Codes Act of 2015, by U.S. Rep. Ted Poe (R-Humble), which would prohibit the government from requiring physicians and health care providers to use ICD-10.

Texas physicians at the AMA meeting spoke out about the dangers they foresee, especially for primary care practices. Greg Fuller, MD, a family physician from Keller, said the wide array of medical problems primary care physicians treat is forcing them to try to learn thousands of new codes.

"We need to stop ICD-10," Dr. Fuller told the Reference Committee on Legislation. "Any delay in pay is going to kill these practices."

Dr. Villarreal at reference committee

E. Linda Villarreal, MD, an internist in the Rio Grande Valley, said she is concerned about the ramifications for access to care in South Texas, many parts of which already face a dire shortage of physicians. "I've taken three courses in ICD-10, and I still don't get it," Dr. Villarreal said.

But Washington watchers say Congress has no stomach for delaying the implementation date one more time. "The ICD-10 Coalition has done a better job than [medicine has] over the past four years," one delegate said.

That leaves organized medicine in a tough spot, said Fort Worth pediatrician Gary Floyd, MD, a member of the TMA Board of Trustees. Groups like AMA and TMA must continue to push for a last-minute reprieve and at the same time work to protect their members from the likely upheaval that will come with ICD-10, he explained.

"Our message is this," Dr. Floyd said, "don't give up the ship, but make sure the lifeboats are manned and at the ready."

Physicians line up to testify on ICD-10

One likely outcome of the House of Delegates meeting will be a directive for AMA to push the Centers for Medicare & Medicaid Services (CMS) for some leeway for physicians who can't master the intricacies of ICD-10 right away.

"We simply need to implement ICD-10 as planned and ask for a grace period where we are not held financially accountable for improper coding in order to protect our patients access to care and to protect physicians’ practices," said Alabama urologist Jeff Terry, MD, who has been an outspoken critic of ICD-10 for the past several years. He said a bill introduced last week in Congress by U.S. Rep. Gary Palmer (R-Alabama) would set up such a grace period.

In testimony before the reference committee today, Dr. Terry, Dr. Floyd, and others outlined a series of protections they want AMA request from CMS:

  • Two years with no penalties for incorrect coding;
  • Two years with no bounty-hunting auditors looking for coding errors;
  • A promise of no delay in payments to physicians; and
  • Acceptance of ICD-10 codes with less-than-optimal degrees of specificity.

Dr. Floyd describes the terms of

the ICD-10 grace period.

The reference committee's recommendations are expected early Monday, and the full House of Delegates will debate the issues before the meeting ends on Wednesday.


TMA offers extensive ICD-10 coding training materials, including specialty-specific online ICD-10 documentation training, on-demand webinars, and customized on-site ICD-10 training.

Sue Bailey, MD, Elected Speaker of AMA House of Delegates

(CHICAGO) -- With an uncontested race, the outcome was all but certain ... but the celebration was real.

After a four-year stint in the No. 2 spot, Fort Worth allergist Sue Bailey, MD, today won election as speaker of the American Medical Association House of Delegates. She moved up one notch after the current speaker -- Andy Gurman, MD, of Pennsylvania, was chosen AMA president-elect.

"I love this house, and I love this organization," Dr. Bailey said after the delegates elected her by acclamation. "I look forward to continuing our robust work to improve the health of our nation together."

Dr. Henkes nominating Dr. Bailey

David Henkes, MD, of San Antonio, chair of the Texas Delegation to the AMA, placed Dr. Bailey's name in nomination. "Sue Bailey is a good person, a nice person, a wise person, and a wonderful mentor," Dr. Henkes said. "I guarantee you, the physicians of Texas would follow wherever she leads – and this house would be well-advised to do the same."

Dr. Bailey has a long history of service to organized medicine, beginning with her stints as chair of the medical student sections of both the Texas Medical Association and the AMA. She chaired the TMA Council on Communication and served as speaker of the TMA House of Delegates before winning election as TMA's 145th president in 2010. She also was president of the Tarrant County Medical Society.

At the AMA, she has served as chair of the Texas Delegation, as a member and chair of the AMA Council on Medical Education, and as the AMA representative on the board of the Accreditation Council for Continuing Medical Education. She has served as vice speaker of the AMA House of Delegates since 2011.

Dr. Gurman (l) congratulates Dr. Bailey

Dr. Bailey is an allergist in private practice at Fort Worth Allergy and Asthma Associates. She previously served as an associate consultant at the Mayo Clinic's department of pediatrics in Rochester, Minn. She is board certified in allergy, and immunology, and pediatrics.

Dr. Bailey received her medical degree from Texas A&M Health Science Center College of Medicine and later served on the A&M Board of Regents. She completed her residency in general pediatrics and her fellowship in allergy/immunology at Minnesota's Mayo Graduate School of Medicine.

May 18, 2015

Failure to Address Physician ICD-10 Concerns, Misalignment of Federal Health IT Priorities are Strategic Blunders


This article was originally published in Digitized Medicine on May 18, 2015. Reprinted with permission.

Texas Representative Ted Poe has introduced H.R. 2126, the Cutting Costly Codes Act of 2015.   This legislation would prohibit the federal government from requiring physician offices to comply with the proposed transition to ICD-10 codes. “The new ICD-10 codes will not make one patient healthier," Representative Poe said. "What it will do is put an unnecessary strain on the medical community who should be focused on treating patients, not implementing a whole new bureaucratic language.” He has clearly listened to the Texas Medical Association (TMA) which has consistently advocated for postponement of ICD-10 on behalf of 48,000 physician members. 

I am one of those Texas physicians who is thankful that a congressman has listened to us. If this bill were passed it would postpone ICD-10 and call for the GAO to study the issue, but it does not propose any solutions. Although I am in favor of this bill, I agree with the cry of many healthcare stakeholders that we need a solution to move away from the antiquated ICD-9 codes. It seems likely that a bill that does not propose an alternative solution will have difficulty getting passed. 

I am hopeful, though, that debate about this bill might illuminate two major flaws in national health IT strategic planning. The current ICD-X strategy which includes no roadmap to ICD-11 will set up the U.S. healthcare industry for strife and conflict in the 2020s when we see the rest of the world leveraging integration between ICD-11 and SNOMED to improve quality of care and control costs while we struggle to gain value from what will then be an antiquated ICD-10 coding system. 

The first flaw is the lack of a strategic plan or roadmap at a national level for ICD-X conversions.  For example, there is no mention of ICD-10 or ICD-11 planning in ONC's federal health IT strategic plan 2015-2020. It is difficult to trust a strategic plan that fails to account for the tremendous burden that an ICD-10 and/or ICD-11 conversion brings to the healthcare industry. The ICD-10 tactical delays can be directly attributed to conflicting strategic national healthcare priorities which resulted in an overlap of  initiatives at the local level, such as the Meaningful Use Program and e-prescribing requirements, and created unreasonable, concurrent burdens on physicians. Tactical delays like this can be avoided through more effective strategic planning at the national level. 

It is particularly disconcerting that there is no national roadmap to ICD-11. As I previously wrote, the U.S. is planning to achieve a short-term tactical goal of replacing antiquated ICD-9 codes while the rest of the world is closing in on their long-term strategic goal of implementing ICD-11. Informatics experts are in agreement that ICD-11 is superior to ICD-10 and is much more integrated with SNOMED codes. Unless we develop a long-term ICD-11 strategy, we are destined to be in the same predicament in the 2020s when we will be struggling with a tactical goal to get off of last century’s ICD-10 with no roadmap in place to align that effort with other healthcare priorities. 

The second flaw is the lack of an effective process during ICD-X conversion planning to identify and address the concerns of grass root physicians who see patients every day. Failing to address physician concerns prior to developing the ICD-10 solution to the replacement of ICD-9 was a strategic blunder. Perhaps the most significant physician concern is the tremendous burden placed on physician practices by the ICD-10 conversion. Optimal planning on how to replace antiquated ICD-9 codes really should include discussions on how we might best reduce or avoid that burden. At the very least, we should discuss how best to reduce that burden in the future, because physicians see ICD-11 coming around the corner. 

For example, we should discuss the possibility of converting from use of ICD-9 or ICD-10 to use of SNOMED codes in physician practices. Physicians would not have to learn new ICD-X codes each time administrators decide a conversion is necessary. Use of SNOMED codes mapped to ICD-X codes would be less disruptive to physician work flow and be more cost effective for physician practices as compared to complying with future ICD-X conversion mandates. 

The analysis on how best to resolve the ICD-9 problem should address physician concerns and result in a strategic plan that is determined to have the highest potential to improve healthcare quality at the lowest cost.  So what are some attributes of the optimal strategic planning effort? It would be included in ONC's federal  health IT strategic plan. It would include a national roadmap to ICD-11. It would include a comparative analysis of the cost/benefits of completing a conversion of ICD-10 versus a direct conversion from ICD-9 to ICD-11. It would include an analysis of  the potential to replace ICD-9 or ICD-10 codes in physician practices with SNOMED codes. And it would include a process to identify and address the concerns of physician practices throughout the planning stages.

Mar 19, 2015

TMA Endorses Medicare Reform Bill



“On behalf of our 48,000-plus physician and medical student members — and the patients we serve — the Texas Medical Association strongly endorses HR 1470, the SGR Repeal and Medicare Provider Payment Modernization Act of 2015, to repeal and replace Medicare’s Sustainable Growth Rate (SGR) formula,” TMA President Austin I. King, MD, said today.

“The SGR has never worked to hold down Medicare costs,” Dr. King said. “It has only served to anger and frustrate physicians and scare our patients. That’s why doing away with the SGR has been at the top of our congressional agenda for more than a decade.”

“We applaud Reps. Michael Burgess, MD (R-Lewisville), Kevin Brady (R-The Woodlands), Gene Green (D-Houston), and their Republican and Democratic partners in both the House and the Senate for their hard work in crafting this bill over the past two years,” Dr. King added. “Today, we begin a massive grassroots campaign for Texas physicians to demand that Congress pass this bill — and that President Obama sign it — before the 22.4-percent Medicare cut kicks in on April 1.”

“Physicians are tired of the never-ending uncertainty; the never-ending threats to cut Medicare pay; the never-ending need to lobby Congress on the same, never-ending problem,” he said. “Our patients are tired of the never-ending fear of losing their doctor. Eighteen years and 17 patches is enough.”

Mar 17, 2015

5 Reasons True Conservatives Should be Cheering the Medicare Reform Plan

Texas physicians, of course, are applauding the news reports that a bipartisan plan to repeal Medicare’s Sustainable Growth Rate (SGR) formula is picking up steam.

Physicians are tired of the never-ending uncertainty, the never-ending threats to cut Medicare pay, the never-ending need to lobby Congress on the same, never-ending problem. Our patients are tired of the never-ending fear of losing their doctor. Eighteen years and 17 patches is enough.

If history is any guide, the current threatened Medicare pay cut – 22.4 percent scheduled to take effect April 1 – won’t take effect. Congress will either finally repeal the SGR, or they’ll put yet another last-minute patch on it, perhaps with some retroactive shenanigans that will wreak havoc with our cash flow and our bookkeeping.

Meanwhile, what the Wall Street Journal calls “faux fiscal hawks” are threatening to scuttle the deal brokered by U.S. House Speaker John Boehner and Minority Leader Nancy Pelosi because they don’t like the budget numbers behind it. That’s the Wall Street Journal, not The New York Times, we’re quoting. Recent editorials in the Journal and Forbes, and from Americans for Tax Reform, the American Action Forum, and the National Center for Policy Analysis give us five solid reasons real conservatives should be embracing this plan and lobbying hard for its passage:

1.      The SGR is a failed attempt at government price control.

The SGR has never held down the cost of providing health care to patients on Medicare and TRICARE. Government-imposed price controls don’t work. As conservatives know, price controls distort the free market; in this case they’ve simply forced physicians to find creative ways to bill Medicare for the services their patients need.

2.      The “cost” of repealing the SGR is fake.

As Americans for Tax Reform reminds us: “Congress has delayed the onset of SGR 17 times over more than a decade. It is blindingly obvious to everyone who pays attention to this in Washington that Congress will continue to not impose SGR cuts. To pretend that it will, and then demand spending cuts to ‘pay for’ repealing it, is cognitive dissonance of the highest order. … Getting rid of it is simply not a budgetary event.”

The Wall Street Journal calls it “a two-decade budget cheat” and explains that Congress has “paid for” the previous 17 patches through “the failed habit of fiddling with this or that price-control dial in Medicare.”

3.      The SGR hides the true cost of Medicare.

Pretending that the SGR will someday take effect and someday hold down Medicare spending, Americans for Tax Reform says, “makes the solvency and sustainability of Medicare look stronger than it actually was. That allowed for the Obama Administration and allies on Capitol Hill to justify the creation of Obamacare (paid for in large part by Medicare cuts, incidentally) because of this rosy long-term cost scenario for government in general.”

Or, as the Journal, puts it, “The practical result has been to disguise future spending from the federal budget and thus hide Medicare’s true cost.”

4.      The SGR repeal bill makes important and significant changes in Medicare financing.

The package does more than eliminate the SGR; it profoundly reforms how Medicare pays physicians for health care services. The Journal describes it as “a reform to reward doctors for providing more valuable care, rather than cutting the same fee-for-service check regardless of performance.” That will keep taxpayers healthier in more ways than one.

Secondly, the plan pays for some of the cost of repealing the SGR with changes in Medicare premiums and Medigap coverage for the wealthiest retirees. Long-term, those are some huge savings.

“Because these policies are phased in, they don’t affect Medicare much in the first 10 years,” said Douglas Holtz-Eakin, president of the American Action Forum and budget director under President George W. Bush. “But the savings will continue to rise, grow faster than physician reimbursements, and on balance lower projected Medicare spending indefinitely into the future. A rough projection is that the combination of the Medigap policies and the reduced premium subsidies will cut Medicare outlays by $230 billion over the second 10 years, 2026-2035.”

The American Action Forum research puts the 20-year savings at $295 billion.

5.      The SGR stands in the way of real health care reforms.

The constant patches and negotiations over the “doc fix” bills distract Congress from the significant structural reforms conservatives want.

“If you’re a conservative interested in repealing Obamacare, reforming Medicare, or block granting Medicaid to the states, removing the SGR kabuki theater from the congressional agenda is absolutely essential,” says Americans for Tax Reform. “Put bluntly, we will never, ever get to do all the cool entitlement reforms we want to do if ‘doc fix’ is on the congressional agenda ahead of them every year.”

As the Journal editorialized, “Congress is close to repealing a two-decade budget cheat and reforming the entitlement state for the first time in the Obama Presidency.”

Let’s not let fake government accounting get in the way.



Links:

Feb 8, 2015

The Faces of First Tuesdays


A snapshot of a few of the 300 physicians, medical students, and TMA Alliance members who came to be lobbyists for a day at the February 2015 First Tuesdays at the Capitol.

Register now for the March 3 First Tuesdays.

Feb 5, 2015

Announcing TMA PracticeEdge

Texas Physicians to Benefit from First-Of-Its Kind Organization Created by Texas Medical Association and Blue Cross and Blue Shield of Texas 

TMA PracticeEdge to Offer Physicians Options to Remain Independent


The Texas Medical Association (TMA) and Blue Cross and Blue Shield of Texas (BCBSTX) are launching TMA PracticeEdge to help empower a strong base of independent physicians to provide quality, cost-effective care to their patients. This first-of-its kind joint effort leverages the strengths of TMA’s statewide physician membership and BCBSTX’s resources to benefit the entire Texas health care community, including patients, hospitals, payers, and other physicians.

TMA’s membership includes more than 48,000 Texas physicians and medical students. BCBSTX serves more than 5 million members in all 254 Texas counties.

TMA PracticeEdge, LLC, will offer physicians access to enhanced patient care tools and resources so they can better provide cost-effective patient care. Physicians working with TMA PracticeEdge will be able to take advantage of the opportunities available in the rapidly changing health care marketplace.

TMA and BCBSTX share the goals of increased quality and cost-effective care found in existing physician-led accountable care organizations (ACOs). TMA PracticeEdge similarly will provide tools to reduce physicians’ growing data-entry burden to allow them to focus on taking care of their patients. The goal is to establish a system that pays physicians and providers based on the quality of patient outcomes and patient care.

While most ACOs are constrained by a specific hospital system, TMA PracticeEdge will help connect physicians centered on the needs of their specific patients. TMA PracticeEdge will offer participating physicians the means to provide coordinated collaborative care, including prevention and management of chronic disease.

According to the 2014 TMA Survey of Texas Physicians, approximately two-thirds of Texas physicians work for themselves or in practices that are wholly owned and controlled by other physicians. Most of these independent physicians traditionally have not had access to the tools and resources needed to participate in an ACO.

“BCBSTX will work with TMA to give physicians alternatives to today’s fee-for-service system,” said TMA President Austin I. King, MD. “With today’s announcement, BCBSTX becomes the first health insurer to stand by independent Texas physicians in support of 21st century patient care.”

“This represents a significant investment in our relationship with the TMA and Texas physicians, and will benefit our members, who value their relationships with their independent physicians,” said Bert Marshall, President of Blue Cross and Blue Shield of Texas.

TMA PracticeEdge will help physicians lead health care innovation in today’s evolving marketplace. PracticeEdge will offer participating physicians several services, including:

  • Consultations to help reduce administrative burdens so they can spend more time focusing on patient care.
  • Help for practices wishing to create care management teams to better serve patients with complex or chronic health problems.

Physicians and office managers who are interested in learning more about TMA PracticeEdge should contact TMAPracticeEdge@texmed.org by email.