Physician Payment Reform

July 31st – US House of Representatives Energy and Commerce Committee approved in a 51-0 vote a Medicare physician payment overhaul bill, (to replace the SGR) and institute an enhanced fee-for-service system as well as alternative payment models which link payments to value, quality of care payment schedules to be developed.


One provision calls for the Patient Centered Medical Home to be able to be set-up by physicians, nurse practitioners or physician assistants in order to address the needs of increased access to care.


Under current law, when payment-related codes are reviewed and found to have resulted in payments that are too high for a particular type of doctor care, the excess amount goes back into the overall pool of payments so that it does not shrink. However, the Energy and Commerce bill directs the Centers for Medicare and Medicaid Services (CMS) in 2016, 2017, and 2018 to make net payment reductions of up to 1 percent for misvalued services in the Medicare physician fee schedule. The reductions would represent a cut in Medicare spending.


The Senate Finance Committee is working on their version of payment reform. If the Congress doesn’t have a law passed this year, in Jan. physicians payments under the current SGR will be cut by 25% . Another major hurdle is to find the offsets from other healthcare funding to pay for the new program. Senator Rockefeller, a champion for health reforms that improve delivery to vulnerable communities (he represents West Virginia), has suggested having drug rebates for those patients who are dual eligible that would provide funds to go back to CMS for this program. Other ideas will be occurring in the Fall when this bill will be debated in the Senate.


The Affordable Care Act Open Enrollment Starts October 1st --- For all individuals ---go to healthcare.gov and start your ACCOUNT ---the website is now LIVE so you can input your contact and income information, and on Oct. 1st you will be able to select an insurance plan in the Marketplace offered to you –either by your State or CMS for those States who decided not to start their own.


For the Small Businessmen and women in our membership -

The Small Business Health Options Program (SHOP) is a new program that simplifies the process of buying health insurance for your small business. For 2014, the SHOP Marketplace is open to employers with 50 or fewer FTEs. In 2016, it will be open to employers with fewer than 100 FTEs. In many states, at least 70% of your full-time employees must enroll in your SHOP plan


The advantages of using SHOP include:

  • You control the coverage you offer and how much you pay toward employee premiums.
  • You can compare health plans online on an apples-to-apples basis, which helps you make a decision that's right for your business.
  • You may qualify for a small business tax credit worth up to 50% of your premium costs. You can still deduct from your taxes the rest of your premium costs not covered by the tax credit. To be eligible, you must cover at least 50% of the cost of single (not family) health care coverage for each of your employees. You must also have fewer than 25 FTEs. Those employees must have average wages of less than $50,000 a year.

You must use Form 8941, Credit for Small Employer Health Insurance Premiums, to calculate the credit. To apply for SHOP Insurance you will need your EIN, Tax ID, Employee names, DOB, and social security numbers.


If you are a tax-exempt organization, include the amount on line 44f of the Form 990-T, Exempt Organization Business Income Tax Return. You must file the Form 990-T in order to claim the credit.


With one online application, you can compare price, coverage, and quality of plans in a way that's easy to understand.


You can enroll starting October 1, 2013 for coverage starting as soon as January 1, 2014.


Have questions about the SHOP Marketplace for businesses with 50 or fewer employees? Call 1-800-706-7893 Monday through Friday, 9 a.m. to 5 p.m. EST.


Other ACA Provisions Impacting Small Businesses:

Summary of Benefits and Coverage Disclosure Rules

  • Medical Loss Ratio rebates (commonly referred to as the “80/20” rule)
  • W-2 Reporting of Annual Health care costs (unless required to file fewer than 250 W-2s in year prior)
  • Annual tax deductible cap for employee contributions to Flexible Spending Accounts is $2,500
  • Starting in 2014, plans can’t impose waiting periods of more than 90 days for otherwise eligible new hires to begin coverage.
  • Starting in 2014, employers may use additional incentives/rewards under workplace wellness programs (e.g. max reward increases to as much as 50% for smoking cessation programs).


NHMA announces its Covered Hispanics Campaignto increase awareness about the ACA Enrollment in the Hispanic community – for those eligible, for the uninsured and for the insured –to learn about options for more affordable health care insurance through the Marketplace (Medicaid, CHIP, Private Insurance, Medicare).  NHMA has coordinated a list of Spokespersons - physicians, nurses, dentists and public health professionals who will work with our media partners who met at the NHMA Conference and others to support the Enrollment into Health Insurance this Fall under the ACA.

UNIVISION invited NHMA physicians to participate in their Townhalls airing this month in partnership with Anthem (Blue Cross). ImpreMedia, CNN en Espanol, Telemundo, NBC Universal, NBC Latino, MundoFox, Hispanic Link, Latina Magazine, Impacto Latino, CNN Latino, and the National Association of Hispanic Publications are all on board to work with Latino health professionals.  NHMA plans to write articles and talking points for the health experts and provide media resource lists to TV, radio, newspapers,  magazines and social media.  If you are interested in supporting this Campaign or in participating– please call Dr. Elena Rios at 202-628-5895.


NHMA Health Advocacy efforts with federal government on health issues that impact our Hispanic populations:

Meeting with the Chairman, Commerce Committee Staff about Latino health priorities. They ask we consider issues that are cross cutting and not linked to diseases. For example, a bill being considered for treatment and management for acute care – allergic reactions. We suggested settings in our communities –such as schools to have better care for students who are sick; experiential speakers; more health focus . Other items discussed were the concepts of health care workforce issues and diversity. Staff were educated on what is Title VII and VIII and diversity programs for health professions.


NHMA planning a new effort with the Environmental Protection Agency on Asthma education in our communities…Rios met with new Administrator of EPA McCarthy and a team of EPA leaders - all interested in educating the Hispanic population.

NHMA meeting with the Hispanic Educational Excellence Initiative and the White House on the efforts to build the President’s STEM Initiative – and planning a Invitational Summit with the Josiah Macy, Jr. Foundation and Federal lead agencies – the Department of Education, National Science Foundation , the National Institutes of Health, the Smithsonian, the National Academies of Sciences/Institute of Medicine and the White House for the Fall to produce recommendations needed about STEM Expansion to Healthcare Professions Workforce and Diversity. If you have best practices for underserved students ---please send in to Elena Rios, MD for the Summit notebook.

NHMA continues to nominate our members to Hispanic health care employees and advisory board members – working with the National Hispanic Leadership Agenda, White House, and OPM to further this effort – we need health professionals interested in public service to be nominated to advisory boards. Join NHMA today.


New Program:

GE – NHMA Healthcare Professional Student Leadership and Mentoring Program – for 50 outstanding medical and public health students who will be selected to learn skills to be successful in serving underserved Hispanic patients and families on prevention, ACA and be traveled to the NHMA Annual Conference in Washington, DC next March for further training. Application on www.nhmamd.org. Deadline: September 6th.


NHMA Leadership Fellowship Class of 2013 comes to Washington, DC next month to meet with Federal leaders and learn leadership skills to prepare them for high level decision-making careers in national health care positions.  We look forward to the Fellows week of activities.


OMH – NHMA Council of Resident Mentoring Program –for Residents interested in having mentors from NHMA members who are Academic Researcher; Academic Clinician; Community Clinician; or Public Health/Industry Administrator.  NHMA Council of Residents very interested in gaining mentoring to advance their careers –

NHMA Regional ACA Forums – with the US Department of Health and Human Services Regional Directors and Marketplaces speakers to provide ACA Updates with Networking Receptions to follow. LA – Sept 21; NYC – Sept. 26; San Antonio – Sept. 28; DC – Oct. 3; Atlanta with CDC – Oct. 11; and Chicago – Oct. 12.  RSVP at This email address is being protected from spambots. You need JavaScript enabled to view it. and please place the name of the City in the subject line.


OMH – NHMA – AAMC – Medical School Recruitment for Hispanic High School and College Pre-Medical Students or those interested in applying to medical school. You are invited to attend the NHMA Conferences – at Charles R. Drew University of Medicine and Science in Los Angeles, CA on Sept. 21st and at the University of Texas Health Science Center at San Antonio on Sept. 28th. Speakers from admissions committees, medical students and physicians will address How to Apply to Medical School, Overview of the MCAT Test, Interviews for Medical School , and Financial Aid. We will be inviting the area medical school recruiters to attend so students can learn about different medical schools in California and Texas.  Please inform children of your colleagues to join us. RSVP to John Aguilar at This email address is being protected from spambots. You need JavaScript enabled to view it. by September 15th.


NHMA 2014 CONFERENCE – ACA and the Hispanic Community –CALL FOR ABSTRACTS now online at www.nhmamd.org for Hispanic health research, clinical updates, medical education and ACA impacts for private practice. Deadline: Sept. 30th.


NHMA Foundation’s Hispanic Health Professional Student Scholarship – application are online at www.nhmafoundation.org. Scholarships will be awarded to 20 medical, nursing, dental, public health and policy students.  Eleven will receive $5000 award /year x 2; 9 will receive $2000 once. All will receive mentoring with the program.



We encourage all who read this Newsletter to consider joining the NHMA and to contribute to our Covered Hispanics Campaign to assist our efforts over the next few years with ACA rollout.


Rios Speeches to educate about NHMA and the ACA at Impacto Latino Newspaper Latino Health Awareness Luncheon at NYU on Aug. 8th– with an audience of media, NHMA doctors, National Association of Hispanic Nurses NY Chapter and NJ Health Officer, NYS Office of Minority Health and Health Disparities, and many other health leaders


Rios Speeches on mentoring for students to consider health care career advancement:


  • To the Margaret E. Mahoney Fellowship of NYAM, July 31st.
  • To the Summer High School Program, Dr. Judy Flores, Woodhull Medical Center on Aug. 8th.

Flavia Mercado, MD – is appointed as Medical Director for Inovalon, Inc - A Leading Healthcare Data Analytics Solutions Provider in Bowie, MD.

Alfredo Lopez, MD and Javier Sevilla, MD, contributes to the NHMA Hispanic Covered Campaign and Verizon and Aetna Foundation  supporting the planning of the NHMA Steering Committees and 6 Regional ACA Forums on the New Marketplace Roll outs to happen on October 1st


Over 30 NHMA Members have signed up to be media spokespersons for the NHMA  “Covered Hispanics Campaign” ---let Sharon Martins, This email address is being protected from spambots. You need JavaScript enabled to view it. know if you are interested in the effort to educate our community on the ACA.




Public Comment Requests:


HHS Office for Civil Rights: Issues a request for information. Civil Rights Provision of the Affordable Care Act (Section 1557). Deadline is September 30, 2013.


USDA: Issued a request for public comment. The Nutrition Standards for All Foods Sold in School. Deadline is October 28, 2013


Association of American Medical Colleges (AAMC) 2013 Minority Faculty Career Development Seminar: A 3-day professional development seminar to support the career development of junior faculty (senior clinical and research fellows, instructors, and assistant professors) and post docs who aspire to leadership positions in academic medicine.  This year’s seminar is September 20-23, 2013 in New Orleans, LA. The Early Bird fee is available through August 15.  If you areintersted please contact: Lily May Johnson at  This email address is being protected from spambots. You need JavaScript enabled to view it.


Association of American Medical Colleges (AAMC) K-Writers Coaching Group, a program that includes a one day seminar and online sessions for up to 3 months, is designed for junior faculty who are actively working on an NIH Career Development (K) proposal, and interested in obtaining additional support with developing the proposal.   A separate application and registration are required and there are a limited number of slots.  Information is available here. The application deadline for the K-Writers Workshop is August 9, 2013.  Contact: Lily May Johnson at This email address is being protected from spambots. You need JavaScript enabled to view it.


19th Annual Latino Behavioral Health Institute Conference,   September 10 -13,  2013, Sheraton Downtown Los Angeles, CA , For more information, call 818-713-9595


National Latin@ Policy Summit on Domestic Violence, to develop national policy agenda aimed at preventing and ending domestic violence and sexual assault among Latinas, Violence against Women Act and Immigration Reform.  Washington Marriott Hotel, September 19 -20, For information, This email address is being protected from spambots. You need JavaScript enabled to view it..



1920 L St., NW, Suite 725
Washington, DC 20036
Phone: 202-628-5895
Fax: 202-628-5898
Email: nhma@nhmamd.org