the company’s vice president and chief medical officer and a member of the TMA Board of Trustees. That effort is critical here in Texas,
where roughly one-quarter of the popu- lation remains uninsured, he said. To reach those patients, the Blues plan also is partnering with community and advocacy groups, schools, churches, physicians, and hospitals. Dr. McCoy said physician partnerships will be criti- cal to ensuring patients have “a consis- tent source of care as they transition from uninsured to their newly insured status.”
The company will rely on its commu- nity partners to distribute educational materials and host neighborhood events to help uninsured patients enroll in and navigate the insurance exchange. A text- messaging campaign will inform patients about approaching deadlines for access- ing insurance coverage.
TMA also has materials to help your patients understand changes in the health care marketplace caused by PPA- CA. “Because Your Doctor Cares” is an easy-to-understand TMA brochure that addresses the questions asked by un- insured patients and those covered by Medicare, Medicaid, and private insur- ance. Call the TMA Knowledge Center at (800) 880-7955 to order free copies.
move toward a system that pays doctors based on physician-endorsed quality measures and later on efficiency. The latest draft replaces the SGR with set payment updates over a certain period in the first phase of the shift to an alternative system, according to an American Medical Association analy- sis. During that time, physicians would work on developing quality measures that could be incorporated into phase two of the process. During the second phase, a portion of fee-for-service payments would be based on quality measures through an incentive-based payment program. In the third phase, fee-for-service payment rates also could be enhanced through additional incentives based on efficient use of health care resources. The new performance-based fee sys- tem would mostly impact physicians who remain in a Medicare fee-for-service plan. Those who choose to participate
in an alternative payment model would be exempt.
The legislation reflects core principles that medicine, including TMA, has ad- vocated to Congress for transitioning from the SGR to a new, high-performing Medicare system. Read the principles at
http://bit.ly/SGRtransition. Medicine’s leaders remain optimis- tic about the progress on these reforms, given the congressional interest in the issue. In addition, an overview of the Obama administration’s proposed 2014 budget states its support for “immedi- ate reforms to improve the accuracy of Medicare’s current physician payment system” and “a period of payment stabil- ity lasting several years to allow time for the continued development of scalable accountable payment models.” n
Amy Lynn Sorrel is an associate editor of Texas Medicine. You can reach her by telephone at (800) 880-1300, ext. 1392, or (512) 370-1392; by fax at (512) 370-1629; or by email at
amy.sorrel@
texmed.org.
Proposals to repeal SGR take shape
In April, congressional leaders issued a more detailed draft of their framework for repealing and replacing the Medicare physician payment system, a top priority on the Texas Medical Association’s fed- eral legislative agenda. Republican leaders of the House En-
ergy and Commerce Committee and the House Ways and Means Committee un- veiled plans earlier this year for a three- phase bill. It would start with eliminat- ing the Sustainable Growth Rate (SGR) formula that physicians say does not keep up with the cost of care and then
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