The Weekly Dose           Bexar County Medical Society

Week of Sept. 1, 2013 

Vol. 2, No. 51



Things you need 

to know NOW!


Physicians expected

to take another unfair financial risk


Through the Affordable Care Act (ACA), health insurance exchanges are being developed for those patients who need health insurance at an "affordable" rate. Those patients participating in the exchange program starting Jan. 1, 2014, have been given a 90-day grace period to pay their premiums by the Centers for Medicare and Medicaid Services (CMS). According to CMS, health plans will take the first 30-day financial risk, but physicians are to bear the remaining 60-day financial risk. 


The controversy arose when regulations written to implement the major sections of the ACA in 2014 created a 90-day grace period before insurers can drop patients who fall behind on premiums. Insurers were unwilling to accept full financial burden so the Obama administration changed the rules so that the financial burden for the first 30 days fell on insurers, while physicians and other providers would carry the financial default risk for care provided in the remaining 60 days.


The ACA does mandate that the health plan inform a physician of the unpaid premium; therefore, if a physician decides to sign these contracts he/she should ask that question when verifying eligibility.


Other informational items about insurance exchanges:

  • Insurance exchange products in Texas will not be regulated by the TexasDepartment of Insurance;
  • As with any contract, physicians should review all insurance exchange contract language, including the fee schedule, and make a business decision regarding sustained financial stability; and 
  • No identification is mandated by law to inform physicians that the patient is with an insurance exchange health plan.




The Bexar County Medical Society encourages its members to contact their U.S. Congress representatives and U.S. Senators to request a change in the law language to move the 90-day financial burden completely over to the health plans. This is an issue between the health plan, the patient and the FEDERAL GOVERNMENT. 






Border Health Conference participants attending the Welcome Reception in Laredo (standing from left); 

Manuel Acosta, MD, Border Health Caucus Chairman; Mary Nava, BCMS Chief Governmental and Community Relations Officer; Congressman Henry Cuellar (Texas Congressional District 28); John Wisniewski, BCMS CEO/Executive Director; Luis Benavides, MD, Border Health Caucus Vice-Chairman; Hilda Davila, General Director of International Relations, Mexico Health Secretariat, Mexico, D.F.; and Jake Fuller, Border Health Caucus Coordinator.


Border Health Conference

a success in Laredo


BCMS physician and staff representatives attend in support


By Mary E. Nava, MBA

BCMS Chief Governmental and

Community Relations Officer


A little over a week ago, the eighth annual Border Health Conference took place in Laredo at the historic La Posada Hotel.  This was the first time the annual conference took place along the border in our state. Until now, this conference occurred in Washington, DC.  Moving forward, the plans are to alternate the location of the conference between DC (during even-numbered years) and Texas (during odd-numbered years). More than 150 attendees participated, including physicians and government and staff officials representing all levels of government from the city and county levels to state and U.S. House of Representatives and U.S. Senate; in addition to officials from the Mexican Consulate and Mexico's Health Secretariat.


The conference was led by Congressman Henry Cuellar, U.S. Representative for the 28th District in Texas and Border Health Conference Congressional Chair; along with co-chairs, Manuel Acosta, MD, and Luis Benavides, MD, chairman and vice-chairman, respectively, of the Border Health Caucus.  Congressman Cuellar provided opening remarks during a Welcome Reception on Aug. 22 to set the tone for the conference as one of collaboration between representatives from both sides of the border. The following morning, conference attendees boarded buses for a tour of the area colonias.  To say the least, these impoverished areas, or colonias, were quite an eye-opening experience for those witnessing such poverty first-hand.  In addition, we visited two community health centers: Gateway Community Center, a FQHC that serves people from area colonias and the Larga Vista Health Center in the town of El Cenizo, where at the time of our visit, the town was in a serious health crisis in the face of contaminated water.


Physicians and executive staff representing BCMS included: John Nava, MD; John Holcomb, MD; Raymond Osbourn, MD; BCMS CEO/Executive Director John Wisniewski, and Mary Nava, BCMS Chief Governmental and Community Relations Officer.  Dr. John Nava also participated as a member of a panel discussion entitled "Public Health Collaboration Between the U.S. and Mexico."  Other topics presented in panel discussions included:  Graduate Medical Education:  The Importance of Recruiting, Training and Retaining Physicians on the Border; SGR (Adequate Provider Reimbursement) Fraud, Myths and Reality; Immigration, Border Security and the Impact on Healthcare; and the Affordable Care Act - Implementation and Impact on Healthcare.


For local discussion on this and other advocacy topics, consider joining the BCMS Legislative and Socioeconomics Committee by contacting Mary Nava at







The Future of Latino Healthcare


9 a.m.-11 a.m. Thursday, Sept. 5

UTSA Downtown Campus

501 W. Cesar E. Chavez Blvd., San Antonio 78207


Sponsored by the Texas Tribune and

 Blue Cross Blue Shield of Texas


Reservations required by 3 p.m. Wednesday, Sept. 4

at or call 512-716-8641










Achieving ICD-10 Implementation Success


Monday, Sept. 9

Southwestern General Hospital

Classroom A

7400 Barlite Blvd.

San Antonio, 78224


Sponsored by TMA


Click here for information and registration




Odds and ends


By John K. Wisniewski

BCMS CEO/Executive Director


Richard Perez, President/CEO of the Greater San Antonio Chamber of Commerce is working on direct flights to New York, JFK, and Boston, Logan International. If are a frequent traveler to one of these destinations, please call him directly with details at 210-229-2130.


Tom Tidwell, SAMGMA leader and practice management consultant, wanted you to be reminded of property damage clauses in your equipment leases.  Often, these clauses result in automatic surcharges if you fail to provide proof of general liability coverage ... so check your equipment lease bills to avoid unnecessary costs.


BCMS President Dr. Gabriel Ortiz will be making "rounds" at some of the area hospital physician lounges and hopes to visit with as many of you as possible.  Be on the lookout for announcements of specific dates from your hospital medical staff offices.


Best wishes for a safe and joyful Labor Day! 









Are you ready for NIIT?


By Joe Davis. CPA, 

David J. Bailey & Co., PC


In 2010, when the Affordable Care Act was being considered, Congress realized that they were going to need a way to pay for the cost of this healthcare bill. One of the ways that Congress devised to raise revenue and offset the costs of the ACA was the creation of a new tax: the Net Investment Income Tax (NIIT).


Generally speaking, beginning with the 2013 tax year, if your adjusted gross income is more than $250,000 and you file a joint federal income tax return, or more than $200,000 in most other filing situations (i.e., single, head of household) and you have what is defined as "net investment income" (NII), some or all of that NII will incur an additional tax, at the rate of 3.8 percent, on top of the regular income tax.


Net investment income has been defined to include, among other items, income in the form of interest, dividends, annuities, royalties, rents and net capital gain.


If you feel that you may be subject to this new tax, contact your tax advisor for more information.


Contact Joe Davis, CPA, at David J. Bailey & Co., PC, at 210-344-5000;



Circle of Friends web logo  


This information is sent on behalf of a valued BCMS Circle of Friends sponsor at the Bronze level, but it is not an endorsement. Donations from Circle of Friends sponsors help keep down the cost of dues and allow BCMS to continue to provide quality service to its members. The society continues its pledge to you and only will involve itself in services and programs that benefit you, the member, and your patients.




 About The Weekly Dose 

  The Weekly Dose is a service of the Bexar County Medical Society.

Some of the suggestions conveyed may not be applicable to your practice today,
 but the goal is to offer information over time that returns value in excess

of the cost of your membership.

If you would like to recommend future topics to share with your colleagues,

please submit them to the BCMS executive director at

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Copyright 2013
 Bexar County Medical Society, San Antonio, Texas.



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